APDEM Meeting May 27, 2016 AACE 25th Annual Scientific and Clinical - PDF document

6/7/2016 APDEM Meeting May 27, 2016 AACE 25th Annual Scientific and Clinical Congress Our Time Today  APDEM Business Report  APDEM Initiatives  Endocrinology and NRMP’s “All ‐ In” Policy  Tools to Support Fellowship Training  APDEM Fellowship curriculum  Fellow Training Series in partnership with Endocrine society  ACCE/APDEM committee  Open Discussion 1

6/7/2016 APDEM Business Report  Treasurer Report  Membership Report  Total membership = 92  Target membership = 136 ACGME programs  Potential change to APDEM Membership Bylaws Potential Change to APDEM Bylaws: Membership  Currently: membership restricted to division directors and training program directors  Proposed: program ‐ based membership to APDEM  Multiple contacts on record: program director, associate program directors and program coordinators  PD: primary contact and voting member for the program  Better tracking and support for training programs  Email your feedback to apdem@endocrine.org  Approval process – spring/summer 2016 2

6/7/2016 ENDOCRINOLOGY AND NRMP’S “ALL ‐ IN” POLICY Current NRMP policy vs. All In  Current  Match participation by at least 75% of eligible programs  At least 75% of all available positions secured through the Match  All In  Any program registering for the Match must attempt to fill all positions through the Match  Specific exemptions can be stipulated 3

6/7/2016 2015 FELLOW SURVEY: Were you offered a position before Match Day? 30% of this group said they felt pressure to Yes accept the out ‐ of ‐ No Match offer no answer 2015 FELLOW SURVEY: Would you prefer having 100% of endocrine programs participate in the Match? No Yes 78% of no answer respondents 4

6/7/2016 APDEM All ‐ In Match Working Group  Convened by Council November 2015  Explore potential desirability of an All ‐ In Match Policy for endocrinology  Members:  Christopher McCartney, MD (Chair)  Andrew Gianoukakis, MD  Geetha Gopalakrishnan, MD  Janet McGill, MD  Paris Roach, MD  Elias Said Siraj, MD  Mark True, MD Work of the group  Identify and explore available options (benefits and liabilities)  Goal 1. Identify goals/preferences of fellows  Goal 2. Identify goals/preferences of PDs/Programs  Goal 3. Identify challenges in current system and in an All In system  Goal 4. Identify potential solutions to identified challenges  Goal 5. Develop action plans for success  Summary of the Working Group’s deliberations to date (p. 62) 5

6/7/2016 Selected perspectives  Candidates  Out ‐ of ‐ Match offers may result in unwanted pressure to make early commitments  Out ‐ of ‐ Match agreements may be best in some situations, e.g.,:  Combined training programs, ABIM Research Pathway  Military personnel  Candidates with an exclusive preference for a given Program  Programs  Out ‐ of ‐ Match offers may be leveraged as a competitive advantage  Other Programs (and possibly candidates) may bear opportunity costs YOUR THOUGHTS? 6

6/7/2016 APDEM CURRICULUM UPDATE APDEM’s Fellowship Curriculum  Revision underway  Aligned with ABIM Exam Blueprint  Uniform organization and structure  All topical areas of endocrine training  Clinical topics  Other ACGME Competencies 7

6/7/2016 Overview of Topics and Editors  Adrenal Disorders ‐ Ann Danoff  Bone and Mineral Metabolism ‐ Pam Taxel  Gonadal Disorders ‐ Chris McCartney  Diabetes ‐ Sanjay N. Mediwala  Nutrition and Obesity ‐ Daniel Bessesen  Lipids ‐ Geetha Gopalakrishnan  Pituitary ‐ Elias Said Siraj  Thyroid ‐ Whitney Goldner T opic Fundamental Advanced GLUCOCORTICOIDS Cushing Syndrome Clinical Presentation Summarize the symptoms and signs of Cushing syndrome resulting from chronic exposure to excess glucocorticoid, including progressive obesity, dermatologic manifestations, menstrual irregularities, signs of adrenal androgen excess, proximal muscle wasting and weakness, bone loss, glucose intolerance, cardiovascular disease, thromboembolic events, neuropsychological changes and impaired cognition, and infection and impaired immune function. Differential Diagnosis (Adrenal vs Ectopic vs Pituitary vs Exogenous vs Physiologic) Perform the differential diagnosis of Cushing syndrome to determine the source of cortisol excess, which could be adrenal, ectopic, or pituitary. Diagnostic Tests Select and interpret results from appropriate case-detection (screening) tests, which may include measurement of 24-hour urinary cortisol excretion, late-night salivary or serum cortisol measurement, or 1-mg overnight dexamethasone suppression. Select and interpret results from appropriate diagnostic tests to determine the source of glucocorticoid excess, which may include measurement of corticotropin inferior petrosal sinus sampling diurnal serum cortisol 8

6/7/2016 GLUCOCORTICOIDS Cushing Syndrome: Diagnosis *Nieman LK, Biller BM, Findling JW, et al. The diagnosis of Cushing’s syndrome: an Clinical Endocrine Society clinical practice guideline. J Clin Endocrinol Metab . Practice 2008;93(5):1526-1540. Guideline *Lacroix A, Feelders RA, Stratakis CA, Nieman LK. Cushing's syndrome. Lancet . Article 2015:386(9996):913-927. Beuschlein F, Fassnacht M, Assié G, et al. Constitutive activation of PKA catalytic Article subunit in adrenal Cushing’s syndrome. N Engl J Med . 2014;370(11):1019-1028. Kirschner LS. Medicine. A unified cause for adrenal Cushing’s syndrome. Science . Article 2014;344(6186):804-805. Assié G, Libé R, Espiard S, et al . ARMC5 mutations in macronodular adrenal Article hyperplasia with Cushing’s syndrome. N Engl J Med . 2013;369(22):2105-2114. Lacroix A. Heredity and cortisol regulation in bilateral macronodular adrenal Article hyperplasia. N Engl J Med . 2013;369(22):2147-2149. Louiset E, Duparc C, Young J, et al. Intraadrenal corticotropin in bilateral Article macronodular adrenal hyperplasia. N Engl J Med . 2013;369(22):2115-2125. Anselmo J, Medeiros S, Carneiro V, et al. A large family with Carney complex caused Article by the S147G PRKAR1A mutation shows a unique spectrum of disease including adrenocortical cancer. J Clin Endocrinol Metab . 2012;97(2):351-359. Almeida MQ, Harran M, Bimpaki EI, et al. Integrated genomic analysis of nodular Article Foundational Utility of Curriculum  Topics to expand to include other ACGME Core Competencies (e.g., Professionalism)  Linking to NAS Milestones  Ability for community to organize efforts  Development of targeted education  Building out curriculum for medical school and residency 9

6/7/2016 FELLOWS TRAINING SERIES ENDOCRINE SOCIETY Procedural Assessment Tools • Collaboration between ADPEM and Endocrine Society • Online tools to aid in assessing competence: – Interpretation of thyroid ultrasonography – Management of insulin pumps and continuous glucose monitoring (CGM) – Interpretation of dual-energy X-ray absorptiometry (DXA) • Series of image-based cases • Ability to review fellows’ work and provide feedback 10

6/7/2016 Interpretation of thyroid ultrasonography Management of insulin pumps and continuous glucose monitoring (CGM) 11

6/7/2016 Interpretation of dual-energy X-ray absorptiometry (DXA) Overview of project • Overseen by ES Clinical Endocrine Education Committee (CEEC) • Subscription-based access for fellowship training programs (PDs, fellows) • Available summer 2016 on Endocrine Society Center for Learning (education.endocrine.org) 12

6/7/2016 AACE/APDEM JOINT LIAISON COMMITTEE Members  Ann Danoff, MD ‐ Philadelphia, PA  Kathleen Figaro, MD, MS ‐ Davenport, IA  Geetha Gopalakrishnan, MD – East Providence, RI  Ved Gossain, MD, FRCP, FACE ‐ East Lansing, MI  Jonathan Leffert, MD, FACP, FACE, ECNU ‐ Dallas, TX  David Lieb, MD, FACE ‐ Norfolk, VA  Sara Lubitz, MD ‐ Westfield, NJ  Janet McGill, MD, FACE ‐ Saint Louis, MO  Vin Tangpricha, MD, PhD, FACE ‐ Atlanta, GA  Dace Trence, MD, FACE ‐ Bellevue – WA 13

6/7/2016 Committee Charges Pursue ways in in which APDEM and AACE may 1. collaborate on enhancing the educational curriculum and experience for fellows ‐ in ‐ training that will best serve to prepare them for pursuing their chosen area of interest and practice environment upon completion of their training. Partner together in the development of teaching 2. materials for fellows and reviewing the curriculum to ensure that it meets the needs of the current and changing practice environment. Explore ways to encourage more interest in endocrine 3. fellowships to address the severe shortage of endocrinologist workforce. Potential Areas Business of Endocrinology (how to decide what type of 1. job you want, negotiation, contracts, budgets, etc.) Developing a series on common problems encountered 2. in an endocrine practice (the non ‐ zebras: normal TSH, convinced fatigue is related to thyroid diathiasis; adrenal fatigue; eating disorders; non ‐ endocrine hair loss; normal T, wanting T, etc.) Working on a team in the office 3. 4. Developing a mentoring system/pool 14

6/7/2016 YOUR THOUGHTS? 15