May 2012 APDEM Agenda

Friday, May 25, 2012
Welcome and Introduction
ACGME “Next Accreditation System” (NAS)
Update on the ESAP In Training Examination (ESAP-ITE)
APDEM Site Visit Tool Box
APDEM Procedural Requirements Task Force
ESAP Ite 2012
• Total training programs: 128
• Total fellows:
• Mean score:
55.1% [28.3% to 81.7%]
1st years
2nd years
Number of
Procedural Task Force Recommended
Curricula, 1st draft
• ABIM in discussions with different
subspecialties about documentation of
• APDEM leadership met with endocrine
representative to ABIM to discuss issues
• APDEM created Procedural Task Force to
discuss issue and develop list endocrine
Background (cont’d)
• List of the following procedures was developed
by task force:
– Continuous Glucose Monitoring System
– DXA Evaluation
– Thyroid Ultrasound/FNA
• After list was developed, representatives from
APDEM, AACE, ATA, The Endocrine Society were
asked to develop model curricula for review by
APDEM membership and eventual discussion
with ABIM representatives
Thyroid Ultrasound/FNA
• Understand indications for neck ultrasound in evaluation of thyroid
nodules and for post-operative thyroid cancer surveillance
• Interpret thyroid imaging, addressing:
Quality of imaging
Thyroid parenchyma echotexture and size of lobes
Location and size of nodule(s)
Sonographic features of nodule(s)
• Perform thyroid ultrasound (minimum of 5 studies to be complete and
competent with direct observation by Ultrasound proficient faculty
member) with both documentation of images and reporting to include:
– Measurement of each thyroid lobe in 3 dimensions with description of
parenchyma echotexture
– Measurement of isthmus in transverse view
– Measurement of each nodule of interest in 3 dimensions with description of
location and sonographic features (echogenicity, composition, presence of
calcifications, margins, vascularity)
• Perform ultrasound guided fine needle aspiration of thyroid nodules
(minimum of 5 studies with the fellow documented to be competent by
Ultrasound proficient faculty member) in the ability to place needle in
nodules of interest accurately with ultrasound guidance
Continuous Glucose Monitoring
Understand technology of continuous monitoring
Understand guidelines and consensus statements concerning CGM from AACE and The Endocrine
Professional CGM
Understand the evidence base and indications for Professional CGM
Analyze data
Provide a minimum of 5 interpretations and reports reviewed by CGM proficient faculty and competency
documented summarizing the following:
Current therapy for diabetes
Data adequacy
Findings of tracings and logbook
Suggested therapeutic changes based on findings and current therapy
Personal CGM
Understand the evidence base and indications for Personal CGM
Understand Personal CGM features:
Be proficient in setting alarms
Perform download of the data
Interpret and initiate appropriate therapeutic changes based on the CGM data on a minimum of 5 CGM
downloads reviewed by CGM proficient faulty, including:
Adequacy of the report (MAD, paired readings, etc)
Interpreting the data (integrating logbook with the CGM data)
The patient’s current therapy for diabetes
Findings on CGM
Suggested therapeutic changes
Pass a proficiency test – 50% questions and 50% interpreting reports with 2 Professional and 5
Personal CGM cases
• Understand indications for DXA as part of work-up for
osteoporosis/metabolic bone disease
– Know appropriate clinical and laboratory testing approaches for
– Apply the WHO classification for diagnosis of osteoporosis
– Assess and monitor the fracture risk of the patient
• Understand the basic science of Bone Densitometry and Operating
– Describe basic DXA anatomy
– Explain the basic principles of operation for
– Central skeletal DXA
– Peripheral DXA (pDXA)
• QCT and pQCT
• Quantitative Ultrasound (QUS)
• Understand Radiation Safety and Quality Issues
– List properties of x-rays and biological effects of radiation; radiation
– Define the units of expressing radiation dose; typical dose or DXA
DXA (cont’d)
Understand DXA Method, Diagnosis of Osteoporosis, and Assessment of Fracture Risk
Understand Longitudinal Monitoring by DXA
Patient positioning and scan analysis (PA spine, hip, forearm, total body); recognize common errors in DXA
Review skeletal anatomy relevant to DXA
Recognize common artifacts on DXA scan images
Define standardized scores used in bone densitometry (T-and Z-score)
Compare and contrast use of different skeletal sites and regions of interest for diagnosis
Discuss the diagnosis of osteoporosis in pre-menopausal women, children, men-of different ethnic groups
Understand the use of central DXA for predicting fracture risk
Define absolute vs relative risk
Explain fracture risk assessment combining BMD with other risk factors (WHO FRAX model)
Know how to calculate precision error and least significant change
Know which skeletal site to measure, and how often to test
Explain clinical relevance of changes in BMD
Perform DXA Reports (minimum of 5) after reviewing scans with an ISCD-certified expert, utilizing:
Standard nomenclature for use in bone densitometry reports
ISCD basic recommendations for reporting densitometry results, or as appropriate, ISCD optional
recommendations for reporting densitometry results
Review for common errors in DXA reporting
Apply the ISC recommendations using case examples
• Next meeting
APDEM Annual Meeting
Hilton Americas Houston
Room 335
June 24, 2012
5:30 p.m. EST

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