Endocrinology Training Research Articles

Motivational Interviewing in Health Care: Results of a Brief Training in Endocrinology

Despite the importance of lifestyle change in disease management and the growing evidence supporting motivational interviewing (MI) as an effective counseling method to promote behavioral change, to date there are few published reports about MI training in graduate medical education. The study aimed to pilot the feasibility and effectiveness of a brief MI training intervention for endocrinology fellows and other providers. We used a pretest/posttest design to evaluate a brief MI training for 5 endocrinology fellows and 9 other providers. All participants completed subjective assessments of perceived confidence and beliefs about behavioral counseling at pretest and posttest. Objective assessment of MI was conducted using fellows' audiotaped patient encounters, which were coded using a validated tool for adherence to MI before and after the training. Paired t tests examined changes in objective and subjective assessments. The training intervention was well received and feasible in the endocrinology setting. At posttest, participants reported increased endorsement of the MI spirit and improved confidence in MI skills. Objective assessment revealed relative improvements in MI skills across several domains. However, most domains, as assessed by a validated tool, did not reach competency level after the training intervention. Although more intensive training may be needed to develop MI competence, the results of our pilot study suggest that brief, targeted MI training has short-term efficacy and is well received by endocrinology fellows and other providers.

Editorial introductions

Current Opinion in Endocrinology and Diabetes was launched in 1994, with Obesity added to the title in 2007. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The fields of endocrinology and diabetes are divided into 12 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce one of the Journal's Section Editors for this issue. SECTION EDITORS Ellen SeelyEllen SeelyEllen W. Seely is Director of Clinical Research for the Endocrinology, Diabetes and Hypertension Division at Brigham and Women's Hospital, USA. She is also Professor of Medicine at Harvard Medical School, USA. Dr Seely received her MD from Columbia University College of Physicians and Surgeons, USA and her training in Internal Medicine and Endocrinology and Metabolism at Brigham and Women's Hospital. Dr Seely directs the Unique Cardiovascular Risk Factors in Women Research and Mentoring Program, at Brigham and Women's Hospital which is supported by a NIH K24 Award. She serves as Vice Chair of Faculty Development in the Department of Medicine at Brigham and Women's Hospital and as Past-President of the Association for Patient Oriented Research. David HandelsmanDavid HandelsmanDavid Handelsman is Professor of Reproductive Endocrinology and Andrology, at the University of Sydney, Australia, and inaugural Director of the ANZAC Research Institute and head of Andrology Department, Concord Hospital, Australia. His interests in Andrology (male reproductive health, medicine and biology) involve basic, clinical, translation and public health research centred on the physiology, pharmacology and toxicology of androgens. Recent research has focused on genetic mouse models of tissue-specific androgen action in testis, prostate, breast and ovary notably hormonal regulation of spermatogenesis, detection of androgen doping in sport, steroid mass spectrometry and clinical pharmacology and trials of androgens in androgen deficiency, hormonal male contraception, male ageing and prostate disease.

Patterns of admissions in an acute medical unit: priorities for service development and education

An Acute Medical Unit has recently been established at York Hospital. The present study sought to characterise the case mix of acutely unwell medical patients to allow identification of priorities for ongoing service development and to assess educational opportunities for trainees in the region. Data were collected for 16001 admission episodes between January 2010 and April 2011 inclusive. These allowed characterisation of the case mix, and identified key priorities where clinical pathway do not yet exist, namely heart failure, urinary tract infection, and acute diarrhoea. Good educational opportunities exist for most aspects of the Acute Medicine curriculum; several weaknesses were identified, and trainees might address these by undertaking a specific period of specialty training in endocrinology and neurology.

Editorial introductions

Editorial introductions

Taking training into your own hands

The Young Diabetologists' Forum (YDF) is a group designed and run by specialist trainees in endocrinology and diabetes that aims to provide high quality educational events. The YDF recognised that not all trainees in the specialty had equitable access to training opportunities and resolved to try and remedy the situation. This article describes the history and evolution of the YDF into an organisation representing over 400 trainees in endocrinology and diabetes, providing up to seven training events per year and with a budget of over pounds 200,000. As well as offering education and training another key purpose of the YDF is to give trainees from around the country the opportunity to meet up and exchange thoughts and ideas. The overall aim of the organisation is to improve the lives of people with diabetes by helping to ensure that future specialists are fully equipped for their role.

Attracting Internal Medicine Trainees to Rheumatology: Where and When Programs Should Focus Efforts

To determine where and when efforts should be focused to increase recruitment of rheumatology trainees from internal medicine (IM) programs. (1) We calculated the percentage of trainees at each of the 13 English-speaking Canadian IM-accredited programs who entered a rheumatology training program in Canada from 2005 to 2007. We then correlated this with the opportunity they would have had to do a rheumatology rotation in each of their 3 postgraduate years of IM training. (2) We calculated the overall percentage of residents who remained at the same training institution after their IM program, 2005-2007, comparing this to 4 similar-size subspecialty training programs. Among IM trainees, 3.5% began rheumatology training in Canada. There was a positive relationship at the postgraduate year 1 (PGY1) level between more rheumatology opportunities and chance of entering rheumatology (r(2) = 0.35, p < 0.05), but not at the PGY2 or PGY3 level. Among rheumatology trainees, 78% remained at the training institution where they completed IM training, more than the 70% of gastroenterology trainees, 68% of nephrology trainees, 67% of endocrinology trainees, and 76% of infectious diseases trainees. The opportunity for a rheumatology rotation in the first year of IM training increases the likelihood the trainee may choose rheumatology as a career. Further, most rheumatology trainees continue at the same institution as their IM training, more than other subspecialties. This information may assist recruitment efforts to increase numbers of rheumatology trainees and the overall rheumatology workforce. These data warrant reevaluation of IM programs of study in order to influence trainee career choices and plan better for future workforce requirements in all IM fields.

Karen Lam Siu-ling: tackling diabetes in Hong Kong

Karen Lam Siu-ling: tackling diabetes in Hong Kong

Assessment of ultrasonographic features of polycystic ovaries is associated with modest levels of inter-observer agreement

BackgroundThere is growing acceptance that polycystic ovaries are an important marker of polycystic ovary syndrome (PCOS) despite significant variability when making the ultrasound diagnosis. To better understand the nature of this variability, we proposed to evaluate the level of inter-observer agreement when identifying and quantifying individual ultrasonographic features of polycystic ovaries.MethodsDigital recordings of transvaginal ultrasound scans performed in thirty women with PCOS were assessed by four observers with training in Radiology or Reproductive Endocrinology. Observers evaluated the scans for: 1) number of follicles ≥ 2 mm per ovary, 2) largest follicle diameter, 3) ovarian volume, 4) follicle distribution pattern and 5) presence of a corpus luteum (CL). Lin's concordance correlation coefficients and kappa statistics for multiple raters were used to assess inter-observer agreement.ResultsAgreement between observers ranged from 0.08 to 0.63 for follicle counts, 0.27 to 0.88 for largest follicle diameter, 0.63 to 0.86 for ovarian volume, 0.51 to 0.76 for follicle distribution pattern and 0.76 to 0.90 for presence of a CL. Overall, reproductive endocrinologists demonstrated better agreement when evaluating ultrasonographic features of polycystic ovaries compared to radiologists (0.71 versus 0.53; p = 0.04).ConclusionInter-observer agreement for assessing ultrasonographic features of polycystic ovaries was moderate to poor. These findings support the need for standardized training modules to characterize polycystic ovarian morphology on ultrasonography.

The Endocrine Society Laureate Awards

The Endocrine Society Laureate Awards

The conflict between specialist diabetes services and acute-general internal medicine for consultant diabetologists in the UK in 2006

An online survey of consultant diabetologists in the UK examined the interface between specialist services and acute-general internal medicine (acute-GIM). Out of 592 consultants, 289 (49%) responded. Of these, 94% contributed to acute-GIM, devoting equivalent time to acute-GIM and specialist diabetes services. Of the respondents, 10% provided a single-handed specialist service and 78% provided endocrine services. The survey found the input to acute-GIM was increasing, partly because other specialties were opting out. The increased commitment to acute-GIM compromised specialist diabetes activity through reduced consultant and training-grade time for outpatient activity and service development. The shift to primary care of chronic disease led to further conflict between acute-GIM and delivery of a specialist service, given the current systems for provision of consultant-led care. The large number of specialist trainees in diabetes and endocrinology will require innovative commissioning mechanisms that reflect the need to sustain and develop specialist diabetes and endocrine care in the appropriate settings as well as the continued input in acute trusts for acute-GIM.

Intersex Mental Health and Social Support Options in Pediatric Endocrinology Training Programs

ABSTRACT The birth of a child with an intersex condition is often an emotionally stressful event for parents. Preparation and ongoing support systems could be beneficial to both parents and children and would alleviate some of the shame and isolation associated with intersex conditions. To assess the extent to which psychological support is available, a short e-mail survey on this topic was sent to the directors of 50 pediatric endocrinology fellowship training programs (PEFTPs), who are most likely to evaluate and treat intersex children and their parents. Of the 29 PEFTPs that responded, 69% offer psychological support and 58% have a mental health specialist on staff. However, only 19% of patients or families receive emotional support during diagnosis and only 15% receive support after diagnosis. We found two barriers that prevent patients and families from receiving psychological help from their intersex care team. First, there is a lack of training for mental health professionals regarding the needs of intersex patients and families. Second, some families refuse help even though it is offered. This study reveals that further research is needed to overcome these two barriers regarding mental health treatment of intersex patients and families.

Initial symptoms and anamnestic time in 517 patients with pituitary adenoma

To find out whether recent techniques of investigating hypophyseal adenoma (computed tomography, magnetic resonance imaging and hormonal measurements) have brought about earlier diagnosis. The time of onset of first symptoms and the duration from first symptoms to diagnosis (anamnestic time) were determined retrospectively from clinical, endocrinological, ophthalmological and localizing data on 517 patients (311 women, 206 men) with hypophyseal adenoma. The most common initial symptom was oligo- or amenorrhoea, in 57.9% of women, and disturbed libido or potency in 38.5% of men. Next most common were visual field deficits (women: 11.6%, men: 26.7%), signs of acromegaly (women: 11.3%, men 18.2%) and headaches (women: 11.3%, men 15.5%). The median anamnestic time in women, 3.0 years, was significantly longer than the 2.3 years in men (P < 0.001). In hormonally inactive adenoma the corresponding times were 2.0 years in women and 1.0 year in men; in prolactinoma 4.2 years and 2.0 years; in growth-hormone secreting adenoma 5.0 years and 5.5; and in ACTH-secreting adenoma 5.0 years and 1.0 year. Although diagnostic techniques have greatly improved, the anamnestic time for hypophyseal adenoma is not shorter than in earlier studies. This findings underlines the need for clearly directed history-taking and for good training in endocrinology.

Interview with a Quality Leader: Thomas L. Garthwaite on Healthcare Quality in Large Enterprises

Thomas L. Garthwaite, MD, is the executive vice president and chief medical officer at Catholic Health East (CHE), Newtown Square, PA. He leads clinical services with systemwide efforts that improve the quality of care, ensure patient safety, disseminate best practices, assess new technologies, enhance physician satisfaction, and maximize performance. He also defines the clinical uses, standards, and priorities for information technology at CHE. A graduate of Cornell University, Ithaca, NY, and the Temple University School of Medicine, Philadelphia, PA, Garthwaite received training in internal medicine and endocrinology at the Medical College of Wisconsin, Milwaukee, WI, where he went on to become associate professor of medicine and associate dean. He was chief of staff at the Milwaukee Veterans Affairs (VA) Medical Center for 8 years before becoming the deputy undersecretary for health in the Department of Veterans Affairs in 1995. During his tenure as deputy and then undersecretary for health, the VA underwent a profound transformation. The VA is now seen as a leader in quality of care and the clinical use of computers. From 2002 until 2006, Garthwaite served as the director and chief medical officer of the Los Angeles County Department of Health Services.

I am approaching my third year of specialist training in endocrinology and diabetes. I feel I've made the wrong choice and want to change to gastroenterology. How feasible is this? Would the year of high intensity medicine at specialist registrar level be counted for another number?

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Competence-based assessment for higher specialist training in endocrinology and diabetes mellitus.

Competence-based assessment for higher specialist training in endocrinology and diabetes mellitus.

A short history of pediatric endocrinology in North America.

Pediatric endocrinology evolved as a subspecialty from the era of biochemical and metabolic clinical investigation led by John Howland, Edwards Park, and James Gamble at Johns Hopkins; Allan Butler at Boston University and Harvard University; Daniel Darrow at Yale University; and Irving McQuarrie at the University of Rochester and the University of Minnesota during the early 20th century. The father of the new subspecialty was Lawson Wilkins, a private pediatric practitioner in Baltimore, Maryland, who was invited by Dr. Edwards Park to establish an endocrine clinic at the Harriet Lane Home at Johns Hopkins in 1935. Dr. Wilkins managed his practice and the clinic until 1946, when, at the age of 52, he accepted a full-time position at the University. Dr. Nathan Talbot was invited to develop a pediatric endocrine clinic at Massachusetts General Hospital by Allan Butler in 1942. These units and their associated subspecialty training programs during the 1950s and 1960s provided the large majority of the second-generation pediatric endocrinologists who went on to establish endocrine subspecialty programs in university medical centers in North America as well as Europe and South America. Diabetes as a clinical pediatric discipline evolved in parallel from the early clinics of Elliott Joslin and Priscilla White in Boston, M.C. Hardin and Robert Jackson at the University of Iowa, George Guest at the University of Cincinnati Children's Hospital, and Alex Hartman at the St. Louis Children's Hospital. The Lawson Wilkins Pediatric Endocrine Society was founded in 1971, and the Council on Diabetes and Youth was established within the American Diabetes Association in 1980. Medical and economic factors led to increasing integration of pediatric diabetes and general endocrine care and training, and diabetes care now is a major activity within the subspecialty of pediatric endocrinology. The growth of pediatric endocrinology in North America has paralleled the growth of academic medicine during the past half-century. In 2002, there were 72 training programs in North America: 65 in the United States and seven in Canada. The endocrinology sub-board of the American Board of Pediatrics was established in 1978 to certify training and competence in endocrinology, including diabetes. By 2002, the board had certified 927 pediatric endocrinologists. Pediatric endocrine subspecialists during the past half-century have contributed major advances in our understanding of the ontogeny of endocrine systems and the diagnosis and treatment of fetal-perinatal endocrine disorders; newborn screening for endocrine and metabolic disorders; the physiology and therapies for disorders of sexual differentiation and pubertal maturation; the development of anthropometric standards for childhood growth and development; the characterization and physiology of hormone systems, including receptors and hormone actions; the molecular genetics of a number of congenital endocrine disorders and heritable endocrine diseases; development of pediatric endocrine diagnostics and reference standards; the pathophysiology and management of autoimmune endocrine disease; and development of a growing armamentarium of therapeutic agents for treatment of endocrine and metabolic diseases.

A Survey on the Use of Thyroid Ultrasonography in Clinical Endocrinology Training Programs

Thyroid nodules present a common diagnostic challenge in endocrine practice. Thyroid ultrasonography yields the best anatomic information about the thyroid gland and thyroid nodules. During the past decade, thyroid ultrasound studies have been increasingly used for diagnostic purposes. High-resolution ultrasonography allows “real-time” visualization and identification of structures (nodules that are 2 to 3 mm in diameter) within the thyroid and parathyroid glands. Even though studies regarding cost-effectiveness of thyroid ultrasonography have not been performed, appropriate use of this technology has been advocated as a supplement to physical examination for further evaluation and management of nodular thyroid disease.

Genetics of diabetes mellitus.

American Journal of Medical GeneticsVolume 115, Issue 1 p. 1-3 Introduction Genetics of diabetes mellitus Christos S. Bartsocas, Corresponding Author Christos S. Bartsocas cbartsok@cc.uoa.gr PO Box 17177, GR-10024 Athens, Greece. Dr. Christos S. Bartsocas, M.D., completed pediatric training at the Yale-New Haven Hospital and training in pediatric endocrinology and clinical genetics at the Massachusetts General Hospital in Boston, Massachusetts. He is Professor of Pediatrics, at the University of Athens, Greece. Dr. Bartsocas' present research interests include the genetics of diabetes mellitus.PO Box 17177, GR-10024 Athens, Greece.Search for more papers by this authorR.D.G. Leslie, R.D.G. Leslie Guest Editors Dr. David Leslie, M.D., completed training in general medicine, diabetes and endocrinology at Kings College Hospital, London and University of Chicago. He is Professor of Diabetes and Autoimmunity, at the University of London, UK. Dr. Leslie's present research interests include the cause and prevention of type 1 diabetes.Search for more papers by this author Christos S. Bartsocas, Corresponding Author Christos S. Bartsocas cbartsok@cc.uoa.gr PO Box 17177, GR-10024 Athens, Greece. Dr. Christos S. Bartsocas, M.D., completed pediatric training at the Yale-New Haven Hospital and training in pediatric endocrinology and clinical genetics at the Massachusetts General Hospital in Boston, Massachusetts. He is Professor of Pediatrics, at the University of Athens, Greece. Dr. Bartsocas' present research interests include the genetics of diabetes mellitus.PO Box 17177, GR-10024 Athens, Greece.Search for more papers by this authorR.D.G. Leslie, R.D.G. Leslie Guest Editors Dr. David Leslie, M.D., completed training in general medicine, diabetes and endocrinology at Kings College Hospital, London and University of Chicago. He is Professor of Diabetes and Autoimmunity, at the University of London, UK. Dr. Leslie's present research interests include the cause and prevention of type 1 diabetes.Search for more papers by this author First published: 19 April 2002 https://doi.org/10.1002/ajmg.10337Citations: 5 Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume115, Issue1Special Issue: The Genetics of Diabetes Mellitus30 May 2002Pages 1-3 RelatedInformation

From Artisan To Architect: The Specialist And Systems Of Provision Of Diabetes Care In 2001

To discuss the future role of the diabetes specialist and the endocrinologist in the care of patients with diabetes. We reviewed the literature on health care systems, integrated approaches to provision of health care, health care in the primary-care setting for patients with chronic illness, and population-based health care for patients with diabetes. Specialists who care for patients with diabetes will assume a more significant role as caretakers of teams of health care professionals who are responsible for the primary care of patients with diabetes. The integration of specialist care at the primary-care level may lead to improved outcomes at the primary-care level, increased access to specialty care, and decreased costs for the health care system. Alternative systems, such as regulatory barriers to specialist care, are less likely to accomplish these outcomes. In the near future, specialists will be expected to care for those who provide primary care for patients with diabetes. Endocrinologists and endocrinology training programs should recognize this emerging role and prepare for it.

Pregnancy and murine thyroiditis: thyroglobulin immunization leads to fetal loss in specific allogeneic pregnancies.

Thyroid autoantibodies are risk factors in human pregnancy. To investigate the influence of autoimmune thyroiditis on pregnancy, we have studied the impact of murine experimental autoimmune thyroiditis (EAT) on pregnancy outcome by using thyroglobulin (Tg) immunized CBA/J (H2(k)) female mice. When Tg immunized mice were mated with BALB/c (H2(d)) males, only 57% (47/83) of pregnant mice maintained their conceptions compared with >85% of other strain combinations (P < 0.05). We also found that MHC class II antigens were expressed on placental cells from Tg immunized pregnant mice but not in control normal pregnancies. Furthermore, the frequency and severity of thyroiditis, assessed by histological analyses, was also increased in Tg immunized mice mated with the BALB/c strain compared with syngeneic pregnancies (P < 0.05). In these pregnant mice mated with BALB/c, interleukin-4 secretion by mitogen-stimulated spleen cells was significantly suppressed and interferon-gamma secretion by mixed lymphocyte reactions with BALB/c cells was significantly increased. These data demonstrated enhanced Th1 cell proliferation and fetal loss in CBA/J X BALB/c pregnancies. We concluded, therefore, that pregnancy loss was increased in experimental autoimmune thyroiditis in a manner that was dependent on paternal antigens. These observations have broad implications for understanding the immunology of pregnancy.