Pediatric Endocrinology Fellowship Program

INTRODUCTION 
 
 Paediatric endocrinology is a paediatric subspecialty which deals with the diagnosis, treatment and long-term follow up of children with endocrine gland disorders.  This is a rapidly evolving field which has witnessed a very fast scientific progress over the last few decades.  Endocrine gland disorder is described possibly due to the high rate of consanguinity.  The health care system in the kingdom has provided an optimal care level through various well established units in various tertiary care centers.  It is, therefore, necessary to have trained physicians in this filed to maintain this care. 
 
 
II. GENERAL OBJECTIVES 
 
The goals and objectives of this program are to train peadiatricians to: 
 
1. Become competent and maintain the optimal care provided to children suffering from endocrine disorders. 2. Acquire knowledge and ability to problem solve and interpret data originating from laboratory investigations. 3. Become self-disciplined, self-dependent learners and learn to serve as consultants to other services and be able to provide an educational environment that will provide and promote high standard of health care. 4. Perform research and emphasize the research-oriented approach to new problems. 5. Reach an international acceptable standard with appropriate attitude and medical ethics. 
 
 
III. SPECIFIC OBJECTIVES 
 
1. Trainees should become competent in the clinical field of paediatric endocrinology which include but not limited to: 
 
 General Concepts:  Hormonal regulation of gene expression  Neuroendocrine regulation  Mechanisms of secretion and action of hormones and growth factors 
 
 Endocrine Development of the Fetus and the Newborn:  Growth hormone and prolactin  Posterior pituitary hormones  Thyrotropin and thyroid hormones  Sexual differentiation  Gonadotropic and gonadal hormomes  Hypothalamopituitary axis and adrenal cortex: fetoplacental unit  Pancreatic hormones: insulin and glucagons 
 
 Growth:  Postnatal growth and its endocrine regulation  Fetal growth  Normal and abnormal including overweight problems 
 
 Disorders of Endocrine Glands: 
 
Part A. Growth Hormone and Prolactin  Growth hormone and prolactin: biochemistry and physiology  Disorders of growth hormone and prolactin secretion. 
 
Part B. Thyroid Hormones  Biochemistry and physiology  Hypothyroidism  Hyperthyroidism  Goiter and thyroiditis  Iodine deficiency and excess 
 
Part C. Corticosteroids  Adrenal steroids: biochemistry and physiology  Disorders of hormonosynthesis  Adrenal insufficiency  Adrenal hyperfunction 
 
Part D. Gonadal Hormones  Biochemistry and physiology of gonadotropic and gonadal hormones  Normal pubertal development  Precocious puberty  Delayed puberty and hypogonadism  Pathology of the ovary  Disorders of the testis  Disorders of sexual differentiation 
 
Part E. Adrenal Medulla  Adrenal medulla: biochemistry and physiology  Disorders of the adrenal medulla 
 
Part F. Physical Exercise  Physical exercise and hormones 
  
 Hormones and Metabolism: 
 
Part A. Calcium and Phosphate Metabolism  Parathyroid hormone, vitamin D, calcitonin  Disorders of calcium and phosphate metabolism 
 
Part B. Water Metabolism and Posterior Pituitary  Hormonal regulation of water metabolism  Disorders of water metabolism 
 
Part C. Sodium Metabolism  Hormonal regulation of sodium metabolism  Disorders of sodium metabolism 
 
Part D. Glucose Metabolism  Biochemistry and physiology  Hypogycemia  Diabetes mellitus in children and adolescents 
 
Part E. Lipid Metabolism 
 
 Endocrine Disorders:  Autoimmunity in endocrine disease  Malignant endocrine tumors 
 
 Methods of Investigation and Reference Data:  Assessment of endocrine functions  Growth references 
 
 Radiological Imaging and Endocrine Disorders: 
 
2. An appreciation of the endocrine disorders literature with the ability to critically evaluate it.

3. Research experience with both clinical and laboratory investigation.

4. Educational skills with flexibility to teach endocrine disorder to patients, trainee and colleagues. 
 
 
IV. ADMISSION CRITERIA 
 
To be admitted to Paediatric Endocrinology program, an individual must: 
 
1. Possess a certificate of the Saudi Board or an equivalent recognized degree. 2. Pass successfully the interview conducted by the selection committee. 
3. Provide two letters of recommendation from consultants with whom the candidate has recently worked with a minimum period of six months. 4. Provide a written permission from the sponsoring institution of the candidate allowing him to participate, on full time basis, for the entire period of the program. 
 
 
V. TRAINING PROGRAM OUTLINE 
 
1. The program consists of two ears of full-time structured supervised training program in Paediatric Endocrine Disorders. 2. To ensure an adequate clinical exposure and professional supervision, one fellow will be accepted every year at each level of training. 3. Structure of the program. 
 
A. First Year: During the first year, the Fellow is expected to: 1. Acquire a board overview of basic science of endocrine disorder. 2. Have adequate knowledge of common paediatric clinical endocrine disorders. 3. Acquire skills in teaching.  - In dynamic hormonal studies 4. Initiate research activity  - Show competence in literative review 5. Have the following supervised rotations  a. Paediatric Endocrinology Clinical Service:  this includes inpatients, consultation and clinics for 8 months during which the fellow spends two (2) afternoons in basic sciences department (physiology, biochemistry and pharmacology). b. Radiology for 1 month: emphasis on skills in assessment of bone age, skeletal surveys, ultrasound and nuclear medicine. c. Genetic laboratory for 1 month. d. Endocrine laboratory for 1 month. e. Vacation for 1 month. 
 
B. Second Year: During the second year, the fellow is expected to: 1. Acquire a board overview of basic science of endocrine disorder. 2. Have adequate knowledge of common paediatric clinical endocrine disorders. 3. Acquire skills in teaching.  - Show competence of independency. 4. Continue and complete the research project  - Show competence in hyper visory skills and team teaching 5. Have the following supervised rotations: a. Paediatric Endocrinology Clinical Service:  this includes inpatients, consultation and clinics for 7 months during which the fellow spend two (2) afternoons in basic sciences department, in physiology, biochemistry and pharmacology.  - Show competence in critiquing of interactive b. Adult Endocrine Service for 2 months. 
c. Elective for 2 months. d. Vacation is 1 month. 
 
4. Program Content 
 
A. Clinical 
 
 The program will offer a broad range of clinical experience.  In addition to consultations in the general and subspecialty pediatric services, the program offers consultations to the surgical subspecialties, the Paediatric and Neonatal Intensive Care Units, and the various programs.  Through rotations at the radiological imaging department and discussing individual cases, the trainees will be able to obtain adequate knowledge necessary for radiological diagnosis.  Exposure to adult endocrine disorders is undertaken through rotations in an adult endocrinology training program. 
 
 Trainees have the opportunity of assuming responsibility for patients care over a sufficiently long period to observe the natural history of the disease and the benefits and complications of therapy.    Organized outpatient clinics are available for the investigation and treatment of patients not requiring hospitalization, as well as for follow-up of inpatients after discharge from the hospital. 
 
B. Research 
 
 Trainees are expected to participate in the research activities of the Division of Paediatrics Endocrinology and by the end of his training, he/ she should:

1. Complete one research project.

2. Prepare and submit at least one manuscript to a referred journal.

3. Present a paper in a scientific meeting locally or internationally. 
 
C. Academic Activities 
 
These may take several forms including: 1. Daily inpatient round with the on-service consultant 2. Attend outpatient clinics with every consultant 3. Case presentations and discussion 4. Endocrine grand rounds 5. Intercity Endocrine Club 6. Didactic lectures in core topics and recent reviews 7. Morbidity and Mortality meeting/ rounds 8. National and International symposia/ conferences 
 
D. Patients care and teaching responsibilities 
 
 The trainee is responsible for the patient care of the admitted patients within the service or though consultations in collaboration with the consultant endocrinologist. 
 
 The trainee is also responsible for teaching the paediatric residents in the service of or seeking consultation. 
 
 The trainee should take all the daily in-house call for the service.  The trainee may be asked to take calls for endocrine service with a maximum three nights per week and two weekends per month.  A paediatric endocrinologist consultant “back-up” will always be available for consultation. 
 
E. Program administration 
 
 The program should have a director chosen 3 months before the start of the program.  He/ she should be: 1. A qualified consultant paediatric endocrinologist 2. Actively working in this field 3. Demonstrating commitment, interest and have the time to fulfill the objectives of the program. 4. Active in both clinical and research ion this field. 
 
 
VI. PERFORMANCE EVALUATION 
 
 Evaluations of knowledge and performance of trainees are done by an established committee using regular written detailing the progress of each trainee at least twice per year is required. 
 
1. Elements of competence to be evaluated should include: a. History taking in endocrine disorders and ability to perform a comprehensive and accurate physical examination. b. Ability to arrive at an appropriate differential diagnosis. c. Give a sound management plan. 
 
2. Knowledge of basic and clinical aspects of paediatric endocrine disorders. 
 
3. Methods of Evaluation a. Formal evaluation by each Paediatric Endocrine Consultant on each rotation. b. In-training evaluating examination done at the end of the first year. 
 
 
VII. PROMOTION 
 
 By the end of the first year, the trainee should pass the evaluation and the examination by the supervisory committee.  If failed, the trainee should repeat the first year.  Failing the second attempt the trainee will be dismissed from the program. 
 
 
VIII. FINAL SUBSPECIALTY EXAMINATION    

Upon the completion of two years of training in Paediatric Endocrinology, a final certifying examination will be conducted.  The components of the final examination will include: 
 
1. Written Examination

2. Clinical/ Oral Examination 
 
Maximum of four (4) attempts is allowed. 
 
 
IX. CERTIFICATION 
 
 Upon completion of the training and passing of the final examination, the trainee will be awarded “King Saud University Fellowship Certificate in the Subspecialty of Paediatric Endocrinology”.