SAUDI DIABETES FELLOWSHIP CURRICULUM 2015

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4 Curriculum Scientific Group DR. SAAD AL ZAHRANI DR. YOUSEF AL SALEH Curriculum Specialists PROF. ZUBAIR AMIN DR. SAMI ALSHAMMARI Scientific Committee SAUDI DIABETES FELLOWSHIP CURRICULUM 2015 Preparation Supervision Reviewed and Approved DR. AUS AL ZAID DR. MOHAMMED AL HARBI DR. BASMAH AL WAHABI DR. AISHA EKZAIMI DR. ATALLAH AL RUHAILY DR. ABDULLAH AL KHENIZAN DR. ABDULRAOUF AL MAHFOUZ SAUDI DIABETES FELLOWSHIP CURRICULUM 1

5 COPYRIGHT AND AMENDMENTS All rights reserved Saudi Commission for Health Specialties. This material may not be reproduced, displayed, modified, or distributed without prior written permission of the copyright holder. No other use is permitted without prior written permission from the Saudi Commission for Health Specialties. For permission, contact the Saudi Commission for Health Specialties, Riyadh, Kingdom of Saudi Arabia. Any amendment to this document shall be approved by the Specialty Scientific Council and Executive Council of the Commission and considered effective from the date the electronic version of this curriculum published on the Commission website was updated, unless a different implementation date is mentioned. P.O. Box: Postal Code: Contact Center: Website: Designed and formatted: Salem Altamimi (SCFHS) Manoj Thomas Varghese, CMT (SCFHS) 2 SAUDI DIABETES FELLOWSHIP CURRICULUM

6 TABLE OF CONTENTS SAUDI BOARD 1 INTRODUCTION 5 SPECIFIC LEARNING OBJECTIVES: CanMEDS COMPETENCIES 7 Medical Expert 7 Communicator 10 Collaborator 12 Manager 14 Health Advocate 16 Scholar 18 Professional 21 GENERAL TRAINING REQUIREMENTS 24 Program Framework 25 Program Structure 27 Rotation Road Map 30 In-patient and Consultation Services: The Second Core Program Structure 30 Mandatory Rotations 33 General Diabetes Rotation 33 Diabetes Education Rotation 37 Diabetes Nutritional Management Rotation 40 Ophthalmology Rotation 41 Pediatric Diabetes and Endocrinology Rotation 43 Podiatry Rotation 48 Nephrology Rotation 49 Endocrinology And Metabolism Rotation 53 Bariatric Medicine And Surgery Rotation 56 Psychiatry rotation: 59 Family Medicine Rotation 61 TEACHING AND LEARNING ACTIVITIES 63 General Didactic-centralized Components of the Curriculum 64 Table 1: Emergency Diabetes-related Topics 68 Table 2: Non-Emergency Diabetes-related Topics 69 Table 3: Procedure List 71 Table 4: Approach Topics in Academic Half-day Activity 73 Table 5: Clinical Skills 74 Table 6: Communication Situations 76 Table 7: Ethical Issues in Medicine 77 Table 8: Evidence-based Medicine and Clinical Research 80 Rotational (Practice-based) Components of the Curriculum 81 Daily round-based learning 81 On-call duty-based learning 81 SAUDI DIABETES FELLOWSHIP CURRICULUM 3

7 Clinic-Based Learning (CBL) 82 Self-Directed Learning 83 UNIVERSAL TOPICS 85 Module 1: Introduction 86 Module 2: Diabetes and Metabolic Disorders 88 Module 3: Medical and Surgical Emergencies 89 Module 4: Acute Care 90 Module 5: Frail Elderly 91 Module 6: Ethics and Healthcare 92 ASSESSMENT 95 Annual Assessment: 96 Final In-training Evaluation Report (FITER)/Comprehensive Competency Report (CCR) 97 Final Diabetes Fellowship Examination (Final Saudi Diabetes Fellowship Examination) 98 Certification 98 SUGGESTED LEARNING RESOURCES 99 APPENDICES 101 Objectives Of The Log Book 102 Guidelines For Fellows 102 Appendix 2/Evaluation Forms 103 Direct Observation Of Procedural Skills Assessment Form 114 Fellow Presentation Evaluation by Staff Supervisor 116 Fellow Evaluation Of The Different Components Of The Core Curriculum SAUDI DIABETES FELLOWSHIP CURRICULUM

8 INTRODUCTION INTRODUCTION The prevalence of diabetes in The Kingdom of Saudi Arabia (KSA) is one of the highest globally. It is currently reaching epidemic proportions, affecting 23.7% of the population over 30 years of age. This imposes a substantial economic burden on the healthcare system. Worldwide, there is an unprecedented growth of new treatments for patients with diabetes. Most diabetologists and endocrinologists (i.e., physicians who have been formally trained in internal medicine or pediatrics and who have completed an additional one or two years of fellowship in either adult or pediatric endocrinology to develop an expertise in diabetes). Unfortunately, true diabetes specialists may be considered an endangered species with the dwindling ranks of endocrinologists in Saudi Arabia. Given this situation, it is not surprising that primary care physicians manage over 90% of patients with diabetes. We believe that there is an urgent need to overcome the current and future shortage of diabetes specialists. Delivering proper care to patients with diabetes is of utmost importance to avoid its devastating consequences. The modern management of diabetes should be provided by a diabetes multi-disciplinary team (MDT) composed of certified diabetes educators (CDE), dieticians, pharmacists, podiatrists, social workers/psychologists, and ophthalmologists. Members of the MDT are led by specialized diabetologists with experience, qualifications, and skills required to organize the work and ensure proper use of the available resources. To achieve this and other goals, the SCFHS is establishing a fellowship training program in diabetology. Our target candidates are physicians who have successfully completed their training in internal medicine or family medicine. The program structure, provided by a scientific committee, is rotation-based and candidates will rotate across the participating institutions. They will be trained in the fields of inpatient and outpatient diabetes management, nutrition, obesity, diabetic foot care, gestational diabetes, and insulin pumps, obesity, diabetes in the elderly, and research. Diabetologists/endocrinologists (and other active diabetes providers, such as trained family practice consultants) will provide state-of-the-art training in outpatient clinics and the inpatient setting as well as opportunities at sites within communities. Candidate selection will be a competitive process and based on prior academic performance, demonstrated commitment to provide diabetic care, and recommendations from the fellows supervising faculty/attending physicians. The main objective of this program is to provide candidates with the clinical experiences and educational opportunities necessary to build a solid foundation of medical knowledge and skills, critical thinking abilities, literature review skills, diagnostic acumen, and technical skills in order to develop competence in clinical judgment in the expanding field of diabetes medicine. The program will also provide candidates with skills in research training. SAUDI DIABETES FELLOWSHIP CURRICULUM 5

9 INTRODUCTION The framework of competencies is based on the Canadian Medical Education Directives for Specialists (CanMEDS) principles. The CanMEDS framework, which is applied in postgraduate training programs in many countries, offers a model of physician competencies that emphasizes not only medical expertise but also multiple additional nonmedical expert roles that aim to serve society s needs competently. Therefore, the Saudi Commission for Health Specialties (SCFHS) is adopting the CanMEDS framework to establish a core curriculum for all training programs, including the Saudi Fellowship Certification in Diabetology. As a fellow, you will function within the seven CanMEDS roles: medical expert, communicator, collaborator, manager, health advocate, scholar, and professional. The Saudi Board Program of Diabetology consists of two years of full-time supervised fellowship training in diabetes and its branches in addition to the emergency and areas. The curriculum was developed by a group of well-known physicians with wide experience in the field of diabetes and was reviewed by experts in medical education. Furthermore, the committee reviewed several similar programs around the world to came up with a program. 6 SAUDI DIABETES FELLOWSHIP CURRICULUM

10 SPECIFIC LEARNING OBJECTIVES SPECIFIC LEARNING OBJECTIVES: CanMEDS COMPETENCIES The learning objectives of these seven CanMEDS competencies and mastery of topics are incorporated within the different academic activities of the Diabetes Fellowship Training Program at the Saudi Commission for Health Specialties. Medical Expert Definition: As medical experts, physicians integrate all of the CanMEDS roles, applying medical knowledge, clinical skills, and professional attitudes to the provision of patientcentered care. The role of medical expert is the physician s central role in the CanMEDS framework. Description: Physicians possess a defined body of knowledge, clinical skills, procedural skills, and professional attitudes, which are directed toward effective patient-centered care. They apply these competencies to collect and interpret information, make appropriate clinical decisions, and conduct diagnostic and therapeutic interventions. This is done within the boundaries of their disciplines, personal expertise, healthcare settings, patients preferences, and the context of patients complaints. The care offered by the physician is characterized by up-to-date, ethical, and resource-efficient clinical practice, with effective communication in partnership with patients, other healthcare providers, and the community. The role of medical expert is central to the function of physicians and draws on the competencies included in the roles of communicator, collaborator, manager, health advocate, scholar, and professional. Elements: Integration and application of all CanMEDS roles for patient care Core medical knowledge Patient problem identification Diagnostic reasoning Clinical judgment Clinical decision making Application of appropriate therapies Procedural skill proficiency Humane care Application of ethical principles for patient care Functioning as a consultant Knowing the limits of one s expertise Maintenance of competence Principles of patient safety and avoiding adverse events SAUDI DIABETES FELLOWSHIP CURRICULUM 7

11 SPECIFIC LEARNING OBJECTIVES Key Competencies: Physicians are able to undertake the following: 1. Function effectively as consultants, integrating all CanMEDS roles to provide optimal, ethical, and patient-centered medical care. 2. Establish and maintain clinical knowledge, skills, and attitudes appropriate to practice. 3. Perform complete and appropriate assessment of patients. 4. Use preventive and therapeutic interventions effectively. 5. Demonstrate proficient and appropriate use of diagnostic and therapeutic procedural skills. 6. Seek appropriate consultation from other health professionals, recognizing the limits of their own expertise. Enabling Competencies: Physicians are able to undertake the following: 1. Function effectively as consultants, integrating all CanMEDS roles to provide optimal, ethical, and patient-centered medical care: 1.1. Perform effective consultations, including the presentation of welldocumented assessments and recommendations in written and/or verbal form in response to requests from other healthcare professionals Demonstrate effective use of all CanMEDS competencies relevant to practice Identify and respond appropriately to relevant ethical issues arising in patient care Prioritize professional duties effectively and appropriately when faced with multiple patients and problems Demonstrate compassionate patient-centered care Recognize and respond to the ethical dimensions of medical decision making Demonstrate medical expertise in situations other than patient care, such as those involving the provision of expert legal testimony or advice to governments, as required. 2. Establish and maintain clinical knowledge, skills, and attitudes appropriate to practice Apply knowledge of the clinical, socio-behavioral, and fundamental biomedical sciences relevant to physicians specialties Describe the RCPSC framework for competencies relevant to physicians specialties Apply lifelong learning skills relevant to the role of scholar, implementing a personal program to remain abreast of current issues and enhance areas of professional competence Contribute to the enhancement of quality care and patient safety in practice, integrating the best evidence and practices available. 8 SAUDI DIABETES FELLOWSHIP CURRICULUM

12 SPECIFIC LEARNING OBJECTIVES 3. Perform complete and appropriate assessments of patients Effectively identify and explore issues requiring attention, including the patient s preferences and the context of his or her complaint, during patient encounters Elicit a history that is relevant, concise, and accurate with respect to the context of the patient s complaint and his or her preferences, for the purposes of prevention, health promotion, diagnosis, and/or management Perform a focused physical examination that is relevant and accurate for the purposes of prevention, health promotion, diagnosis, and/or management Select medically appropriate investigative methods in a resourceeffective and ethical manner Demonstrate effective clinical problem solving and judgment, including the interpretation of available data and integration of information to generate differential diagnoses and management plans to address patient problems. 4. Use preventive and therapeutic interventions effectively Implement effective management plans in collaboration with patients and their families Demonstrate effective, appropriate, and timely application of preventive and therapeutic interventions relevant to physician practice Ensure that appropriate informed consent is obtained for therapy Ensure that patients receive appropriate end-of-life care. 5. Demonstrate proficient and appropriate use of diagnostic and therapeutic procedural skills Demonstrate effective, appropriate, and timely performance of diagnostic procedures relevant to practice Demonstrate effective, appropriate, and timely performance of therapeutic procedures relevant to practice Ensure that appropriate informed consent is obtained for procedures Demonstrate appropriate documentation and dissemination of information related to the procedures performed and their outcomes Ensure that adequate follow-up is arranged for the procedures performed. 6. Seek appropriate consultation from other health professionals, recognizing the limits of their own expertise Demonstrate insight into the limitations of their own expertise via self-assessment. SAUDI DIABETES FELLOWSHIP CURRICULUM 9

13 SPECIFIC LEARNING OBJECTIVES 6.2. Demonstrate effective, appropriate, and timely consultation of another health professional for optimal patient care, as required Arrange appropriate follow-up care services for patients and their families. Communicator Definition: As communicators, physicians effectively facilitate the doctor patient relationship and the dynamic exchanges that occur before, during, and after medical encounters. Description: Physicians enable patient-centered therapeutic communication via shared decision making and effective dynamic interactions with patients, families, caregivers, fellow professionals, and other stakeholders in healthcare. The competencies of this role are essential to the establishment of rapport and trust, the formulation of diagnoses, delivery of information, striving for mutual understanding, and the facilitation of shared care plans. Poor communication can lead to undesirable results, and effective communication is critical for optimal patient outcomes. The application of these communication competencies and the nature of the doctor patient relationship vary according to specialty and type of medical practice. Elements: Patient-centered approach to communication Rapport, trust, and ethics in the doctor-patient relationship Therapeutic relationships with patients, patients families, and caregivers Diverse doctor patient relationships for different types of medical practice Shared decision making Concordance Mutual understanding Empathy Capacity for compassion, trustworthiness, and integrity Flexibility in the application of skills Interactive processes Relational competence in interactions Eliciting and synthesizing information for patient care Efficiency Accuracy Conveying effective oral and written information for patient care Effective listening Use of expert verbal and nonverbal communication Respect for diversity Attention to the psychosocial aspects of illness Breaking bad news Addressing end-of-life issues Disclosure of errors or adverse events Informed consent Capacity assessment Appropriate documentation 10 SAUDI DIABETES FELLOWSHIP CURRICULUM

14 SPECIFIC LEARNING OBJECTIVES Public and media communication where appropriate Key Competencies: Physicians are able to undertake the following: 1. Develop rapport, trust, and ethical therapeutic relationships with patients and their families. 2. Elicit and synthesize relevant information and the perspectives of patients, patients families, colleagues, and other professionals accurately. 3. Convey relevant information and explanations to patients, patients families, colleagues, and other professionals accurately. 4. Develop a common understanding of issues, problems, and plans with patients, patients families, colleagues, and other professionals to develop shared care plans. 5. Convey effective oral and written information regarding medical encounters. Enabling Competencies: Physicians are able to undertake the following: 1. Develop rapport, trust, and ethical therapeutic relationships with patients and their families Recognize that being a good communicator is a core clinical skill for physicians, and effective physician-patient communication can foster patient satisfaction, physician satisfaction, adherence, and improved clinical outcomes Establish positive therapeutic relationships, characterized by understanding, trust, respect, honesty, and empathy, with patients and their families Respect patient confidentiality, privacy, and autonomy Listen effectively Be aware of and responsive to nonverbal cues Effectively facilitate structured clinical encounters. 2. Elicit and synthesize relevant information and the perspectives of patients, patients families, colleagues, and other professionals accurately Gather information regarding diseases but also consider patients beliefs, concerns, expectations, and experiences of illness Seek out and synthesize relevant information from other sources, such as patients families, caregivers, and other professionals. 3. Convey relevant information and explanations to patients, patients families, colleagues, and other professionals accurately Deliver information to patients, patients families, colleagues, and other professionals in a humane manner that is understandable and encourages discussion and participation in decision making. SAUDI DIABETES FELLOWSHIP CURRICULUM 11

15 SPECIFIC LEARNING OBJECTIVES 4. Develop a common understanding of issues, problems, and plans with patients, patients families, and other professionals to develop shared care plans Identify and explore problems that require attention, including the context of the patient s complaint and his or her responses, concerns, and preferences, effectively during patient encounters Respect diversity and differences, including but not limited to the impact of gender, religion, and cultural beliefs on decision making Encourage discussion, questions, and interaction during encounters Engage patients, patients families, and relevant healthcare professionals in shared decision making to develop care plans Effectively address challenging communication issues, such as obtaining informed consent; delivering bad news; and addressing anger, confusion, and misunderstanding. 5. Convey effective oral and written information regarding medical encounters Maintain clear, accurate, and appropriate records (e.g., written or electronic) of clinical encounters and plans Present verbal reports of clinical encounters and plans effectively When appropriate, present medical information regarding medical issues to the public or media effectively. Collaborator Definition: As collaborators, physicians work effectively within healthcare teams to achieve optimal patient care. Description: Physicians work in partnership with others who are appropriately involved in the care of individuals or specific groups of patients. This is increasingly important in modern multi-professional environments, where the goal of patient-centered care is widely shared. Modern healthcare teams not only include groups of professionals working closely together at one site, such as a ward team, but also extend to teams with a variety of perspectives and skills in multiple locations. It is therefore essential that physicians are able to collaborate effectively with patients, families, and inter-professional teams of expert healthcare professionals to provide optimal care, education, and scholarship. Elements: Collaborative care, culture, and environment Shared decision making Sharing knowledge and information Delegation Effective teams Respect for other physicians and members of healthcare teams 12 SAUDI DIABETES FELLOWSHIP CURRICULUM

16 SPECIFIC LEARNING OBJECTIVES Respect for diversity Team dynamics Leadership based on patient needs Constructive negotiation Conflict resolution, management, and prevention Organizational structures that facilitate collaboration Understanding roles and responsibilities Recognizing one s own roles and limits Effective consultation with respect to collaborative dynamics Effective collaboration between primary care providers and specialists Collaboration with community agencies Community in practice Inter-professional healthcare Multi-professional healthcare Learning together Gender issues Key Competencies: Physicians are able to undertake the following: 1. Participate effectively and appropriately in inter-professional healthcare teams. 2. Work effectively with other health professionals to prevent, negotiate, and resolve inter-professional conflict. Enabling Competencies: Physicians are able to undertake the following: 1. Participate effectively and appropriately in inter-professional healthcare teams Describe their roles and responsibilities to other professionals clearly Describe the roles and responsibilities of other professionals within the healthcare team Recognize and respect the diversity of the roles, responsibilities, and competences of other professionals in relation to their own. SAUDI DIABETES FELLOWSHIP CURRICULUM 13

17 SPECIFIC LEARNING OBJECTIVES 1.4. Work with others to assess, plan, provide, and integrate care for individual patients (or groups of patients) Where appropriate, work with others to assess, plan, provide, and review other tasks, such as research problems, educational work, program reviews, or administrative responsibilities Participate in inter-professional team meetings effectively Enter into interdependent relationships with other professionals to provide quality care Describe the principles of team dynamics Respect team ethics, including confidentiality, resource allocation, and professionalism Where appropriate, demonstrate leadership in healthcare teams. 2. Work effectively with other health professionals to prevent, negotiate, and resolve inter-professional conflict Demonstrate a respectful attitude toward other colleagues and members of inter-professional teams Work with other professionals to prevent conflict Employ collaborative negotiation to resolve conflict Respect differences, misunderstandings, and limitations in other professionals Recognize one s own differences, misunderstandings, and limitations, which may contribute to inter-professional tension Reflect on inter-professional team function. Manager Definition: As managers, physicians are integral participants in healthcare organizations, organizing sustainable practices, making decisions regarding the allocation of resources, and contributing to the effectiveness of the healthcare system. Description: Physicians interact with their work environments as individuals, members of teams or groups, and participants in the healthcare system at local, regional, or national levels. The balance of emphasis between these three levels varies depending on the nature of the specialty, but all specialties have explicitly identified management responsibilities as a core requirement of the practice of medicine in their disciplines. Physicians function as managers in everyday practice activities involving coworkers, resources, and organizational tasks, such as implementing care processes and policies, and balancing their personal lives. Therefore, physicians require the ability to prioritize, execute tasks in collaboration with colleagues effectively, and make systematic choices when allocating scarce healthcare resources. The CanMEDS management role describes the active engagement of all physicians as integral participants in decision making in the operation of the healthcare system. 14 SAUDI DIABETES FELLOWSHIP CURRICULUM

18 SPECIFIC LEARNING OBJECTIVES Elements: Physicians as active participants in the healthcare system Physicians roles and responsibilities in the healthcare system Collaborative decision making Quality assurance and improvement Organizing, structuring, and financing the healthcare system Managing change Leadership Supervising others Administration Consideration of justice, efficiency, and effectiveness in the allocation of finite healthcare resources for optimal patient care Budgeting and finance Priority setting Practice management to maintain sustainable practice and physician health Health human resources Time management Physician remuneration options Negotiation Career development Information technology for healthcare Effective meetings and committees Key Competencies: Physicians are able to undertake the following: 1. Participate in activities that contribute to the effectiveness of healthcare organizations and systems. 2. Manage their practice and careers effectively. 3. Allocate finite healthcare resources appropriately. 4. Serve in administration and leadership roles as appropriate. SAUDI DIABETES FELLOWSHIP CURRICULUM 15

19 SPECIFIC LEARNING OBJECTIVES Health Advocate Enabling Competencies: Physicians are able to undertake the following: 1. Participate in activities that contribute to the effectiveness of healthcare organizations and systems Work collaboratively with others in organizations Participate in systemic quality process evaluation and improvement, such as those involving patient safety initiatives Describe the structure and function of the healthcare system as it relates to specialties, including the roles of physicians Describe the principles of healthcare finance, including physician remuneration, budgeting, and organizational funding. 2. Manage their practice and careers effectively Establish priorities and manage time to balance patient care, practice requirements, outside activities, and personal life Manage practice finances and human resources Implement processes to ensure personal practice improvement Employ information technology appropriately in patient care. 3. Allocate finite healthcare resources appropriately Recognize the importance of the just allocation of healthcare resources, balancing effectiveness, efficiency, and access in optimal patient care Apply evidence and management processes to provide costappropriate care. 4. Serve in administration and leadership roles as appropriate Chair or participate in committees and meetings effectively Lead or implement changes in healthcare Plan the relevant elements of healthcare delivery (e.g., work schedules). Definition: As health advocates, physicians use their expertise and influence responsibly to advance the health and wellbeing of individual patients, communities, and populations. Description: Physicians recognize their duties and abilities in improving the overall health of their patients and the society they serve. Doctors identify advocacy activities as important to the individual patient, populations of patients, and communities. Individual patients need physicians to assist them in navigating the healthcare system and accessing appropriate healthcare resources in a timely manner. Communities and societies need physicians special expertise to identify and address broad health issues and the determinants of health collaboratively. At this level, health advocacy involves efforts to change specific practices and policies on behalf of those served. 16 SAUDI DIABETES FELLOWSHIP CURRICULUM

20 SPECIFIC LEARNING OBJECTIVES Framed in this multilevel manner, health advocacy is an essential and fundamental component of health promotion. Health advocacy is expressed appropriately by both the individual and collective actions of physicians to influence public health and policy. Elements: Advocacy for individual patients, populations, and communities Health promotion and disease prevention Determinants of health, including psychological, biological, social, cultural, and economic factors Fiduciary duty of care The medical profession s role in society Responsible use of authority and influence Mobilizing resources, as required Adapting practice, management, and education to the needs of individual patients Patient safety Principles and implications of health policy Interactions with other CanMEDS roles and competencies in advocacy Key Competencies: Physicians are able to undertake the following: 1. Respond to individual patients health needs and issues as part of patient care. 2. Respond to the health needs of the communities that they serve. 3. Identify the determinants of health in the populations that they serve. 4. Promote the health of individual patients, communities, and populations. Enabling Competencies: Physicians are able to undertake the following: 1. Respond to individual patient health needs and issues as part of patient care Identify the health needs of individual patients Identify opportunities for advocacy, health promotion, and disease prevention for individuals to whom care is provided. 2. Respond to the health needs of the communities that they serve Describe the practice communities that they serve. SAUDI DIABETES FELLOWSHIP CURRICULUM 17

21 SPECIFIC LEARNING OBJECTIVES 2.2. Identify opportunities for advocacy, health promotion, and disease prevention in the communities that they serve and respond appropriately Appreciate the possibility of competing interests between the communities served and other populations. 3. Identify the determinants of health for the populations that they serve Identify the determinants of health in the population, including barriers to accessing care and resources Identify vulnerable or marginalized populations within those served and respond appropriately. 4. Promote the health of individual patients, communities, and populations Describe approaches to the implementation of changes to the determinants of health in the populations served Describe how public policy affects the health of the populations served Identify points of influence in the healthcare system and its structure Describe the ethical and professional issues, including altruism, social justice, autonomy, integrity, and idealism, inherent in health advocacy Appreciate the possibility of conflict inherent in the role of health advocate for a patient or community with that of manager or gatekeeper Describe the role of the medical profession in collectively advocating health and patient safety. Scholar Definition: As scholars, physicians demonstrate lifelong commitment to reflective learning and the creation, dissemination, application, and translation of medical knowledge. Description: Physicians engage in the lifelong pursuit of mastery of their domains of expertise. As learners, they recognize the need to be learning continually and model this for others. Through their scholarly activities, they contribute to the creation, dissemination, application, and translation of medical knowledge. As teachers, they facilitate the education of students, patients, colleagues, and others. 18 SAUDI DIABETES FELLOWSHIP CURRICULUM

22 SPECIFIC LEARNING OBJECTIVES Elements: Lifelong learning Moral and professional obligation to maintain competence and stand accountable Reflection on all aspects of practice Self-assessment Identifying gaps in knowledge Asking questions regarding effective learning Accessing information for practice Critical appraisal of evidence Evidence-based medicine Translating knowledge (evidence) into practice Translating knowledge into professional competence Enhancing professional competence Using a variety of learning methodologies Principles of learning Role modeling Assessing learners Providing feedback Mentoring Teacher-student ethics, power issues, confidentiality, and boundaries Learning together Communities of practice Research and scientific inquiry Research ethics, disclosure, conflicts of interest, human subjects, and industry relations Key Competencies: Physicians are able to undertake the following: 1. Maintain and enhance professional activities via ongoing learning. SAUDI DIABETES FELLOWSHIP CURRICULUM 19

23 SPECIFIC LEARNING OBJECTIVES 2. Critically evaluate information and its sources, and apply this to practice decisions appropriately. 3. Facilitate learning in patients, patients families, students, fellows, other health professionals, the public, and others, as appropriate. 4. Contribute to the creation, dissemination, application, and translation of new medical knowledge and practices. Enabling Competencies: Physicians are able to undertake the following: 1. Maintain and enhance professional activities via ongoing learning Describe the principles of competence maintenance Describe the principles and strategies for implementing a personal knowledge management system Recognize and reflect on learning issues in practice Conduct personal practice audits Pose an appropriate learning question Access and interpret relevant evidence Integrate new learning into practice Evaluate the impact of changes to practice Document the learning process. 2. Critically evaluate medical information and its sources, and apply them to practice decisions appropriately Describe the principles of critical appraisal Critically appraise retrieved evidence in order to address clinical questions Integrate critical appraisal conclusions into clinical care. 3. Facilitate learning in patients, patients families, students, fellows, other health professionals, the public, and others, as appropriate Describe the principles of learning that are relevant to medical education Collaboratively identify the learning needs and desired learning outcomes of others Select effective teaching strategies and content to facilitate others learning Demonstrate effective lectures and presentations Assess and reflect on teaching encounters Provide effective feedback Describe the principles of ethics with respect to teaching. 4. Contribute to the development, dissemination, and translation of new knowledge and practices Describe the principles of research and scholarly inquiry Describe the principles of research ethics Pose scholarly questions. 20 SAUDI DIABETES FELLOWSHIP CURRICULUM

24 SPECIFIC LEARNING OBJECTIVES 4.4. Conduct systematic searches for evidence Select and apply appropriate methods for addressing questions Appropriately disseminate the findings of studies. Professional Definition: As professionals, physicians are committed to the health and wellbeing of individuals and society via ethical practice, profession-led regulation, and high personal standards of behavior. Description: Physicians have a unique societal role as professionals dedicated to the health and care of others. Their work requires the mastery of a complex body of knowledge, skills, and the art of medicine. As such, the role of a professional is guided by codes of ethics and commitment to clinical competence, embracing appropriate attitudes and behaviors, integrity, altruism, personal wellbeing, and the promotion of the public good within the domain. This commitment forms the basis of a social contract between the physician and society. In return, society grants physicians the privilege of profession-led regulation on the understanding that they are accountable to those served. Elements: Altruism Integrity and honesty Compassion and caring Morality and codes of behavior Responsibility to society Responsibility to the profession, which includes peer review obligations Responsibilities to oneself, which includes personal care, in order to serve others Commitment to excellence in clinical practice and mastery of the discipline Commitment to the promotion of the public good in healthcare Accountability to professional regulatory authorities Commitment to professional standards Bioethical principles and theories SAUDI DIABETES FELLOWSHIP CURRICULUM 21

25 SPECIFIC LEARNING OBJECTIVES Medico-legal frameworks that govern practice Self-awareness Sustainable practice and physician health Self-assessment Disclosure of errors and adverse events Key Competencies: Physicians are able to undertake the following: 1. Demonstrate commitment to patients, the profession, and society via ethical practice. 2. Demonstrate commitment to patients, the profession, and society via participation in profession-led regulation. 3. Demonstrate commitment to physician health and sustainable practice. Enabling Competencies: Physicians are able to undertake the following: 1. Demonstrate commitment to patients, the profession, and society via ethical practice Exhibit appropriate professional behaviors, including honesty, integrity, commitment, compassion, respect, and altruism, in practice Demonstrate commitment to delivering the highest quality of care and maintenance of competence Recognize and respond appropriately to ethical issues encountered in practice Manage conflicts of interest appropriately Recognize the principles and limits of patient confidentiality defined by professional practice standards and the law Maintain appropriate relationships with patients. 2. Demonstrate commitment to patients, the profession, and society via participation in profession-led regulation Appreciate professional, legal, and ethical codes of practice Fulfill the regulatory and legal obligations required in current practice Demonstrate accountability to professional regulatory bodies Recognize and respond to others unprofessional behaviors in practice Participate in peer review. 22 SAUDI DIABETES FELLOWSHIP CURRICULUM

26 SPECIFIC LEARNING OBJECTIVES 3. Demonstrate commitment to physician health and sustainable practice Balance personal and professional priorities to ensure personal health and sustainable practice Strive to heighten personal and professional awareness and insight Recognize other professionals in need and respond appropriately. Reference: The CanMEDS 2005 Physician Competency Framework, edited by Jason R. Frank. SAUDI DIABETES FELLOWSHIP CURRICULUM 23

27 GENERAL TRAINING REQUIREMENTS GENERAL TRAINING REQUIREMENTS 24 SAUDI DIABETES FELLOWSHIP CURRICULUM

28 GENERAL TRAINING REQUIREMENTS Program Framework Program Period: The program is for two years and starts on March 1 each year. The first batch is expected to join March 1, Vacations: Fellows are eligible for one of the Eid holidays (one week), one week of annual professional leave, and one month of annual holidays. Requirements for admission: Recognized Medical Degree Certificate in Medicine or Family Medicine from the Saudi Commission for Health Specialties or an equivalent Licensure to practice medicine in KSA Passing the admission examination held by the Commission/Fellowship scientific committee Letter of sponsorship from the primary employer for the whole period of training (training is full time) Three letters of recommendation from previous supervisors Curriculum vitae Valid identification Three recent photos Requirements in centers that will join the program: To achieve the abovementioned goals, participating hospitals should have the following basic facility and staffing requirements: 1. Each center should appoint a program director as per the rules and regulations of the SCFHS. He/she should follow these rules and regulations. 2. The program must have proper administrative and secretarial support to facilitate scheduling, arranging consultations, evaluations, preparing conference schedules, referrals, and other administrative requirements. 3. Fellow trainees must be provided an office space, which includes computer facilities that can be used for and Internet services, including literature searches. 4. The faculty regularly receives a number of journals and books, all of which are available to the fellow. SAUDI DIABETES FELLOWSHIP CURRICULUM 25

29 GENERAL TRAINING REQUIREMENTS The Centers should also have the following: 1. Appropriate number of staff (minimum of three (3) endocrine consultants or diabetologists/endocrinologists who conduct diabetes clinics); 2 3 certified Family Practitioners are desirable by SCFHS. 2. Clinics: - General DM clinics - Insulin pump clinic - Gestational diabetes clinic - Bariatric medicine clinic (preferable) - Pediatric diabetes clinics - Clinical dietician clinic - Diabetes education clinics - Podiatry/foot care clinics 3. Longitudinal Care Clinic - All trainees must run an independent longitudinal care clinic once per week in a primary center with defined core patients. - The required number of patients in the longitudinal care session should be patients per clinic; this should increase gradually as the fellow progresses. This is extremely important, as DM is a long-term problem. 4. Inpatient services: - The center should have the necessary disciplines to be able to treat acute and various chronic complications of diabetes. 5. Research: - The center should have the capacity to conduct clinical research. 26 SAUDI DIABETES FELLOWSHIP CURRICULUM

30 GENERAL TRAINING REQUIREMENTS Program Structure The Saudi Board Program in Diabetology consists of two years of full-time supervised fellowship training in diabetes medicine and its branches. The training institution must be accredited by the SCFHS to offer a Saudi Specialty Certificate in Diabetes Medicine. Training in each rotation must be comprehensive and include in-patients, ambulatory care, and the emergency department. As trainees gain experience and competence, their responsibilities will continue to increase, and they will be actively involved in teaching junior fellows and other colleagues in addition to providing patient care. The Saudi Board in Diabetes Fellowship Program is divided into two levels: Junior (F1) and Senior (F2), each consisting of one year of training. The roadmap for the rotations, depicted below, must be followed strictly. However, the sequence of rotations within each level can be manipulated according to need. First-Year Fellows (F1) Rotations - 5 months in general diabetes clinics, including adult diabetes, adolescent diabetes, insulin pump, and gestational diabetes clinics - 1 month of clinical nutrition - 1 month of diabetes education clinics - 1 month of ophthalmology, mainly retina clinics - 1 1/2 months of pediatric diabetes clinics - 1 1/2 months of podiatry service - 1 month of annual vacation (4 weeks per year) - 1 week of professional leave The out-patient rotations form the core structure of the program. In addition, fellows are expected to cover in-patient and consultation services during these rotations. Fellow 1 (F1) Job Description: The first year of fellowship is devoted to clinical training through time spent on the in-patient consultation service, in general and specialty diabetes and on rotations with other multidisciplinary sections and departments throughout the institution. 1. Elicit a comprehensive history and perform a complete physical examination on admission; record the patient s assessment, differential diagnosis, and medical problems clearly; and initiate a management plan. 2. Discuss the management plan, including investigations and a treatment plan, with the trainee s senior and communicate the plan to the nurse assigned to the patient s care. 3. Attend to all patient complaints and concerns, follow up results of investigations daily, record problem-oriented progress notes daily, and update the patient s problem list. SAUDI DIABETES FELLOWSHIP CURRICULUM 27

31 GENERAL TRAINING REQUIREMENTS 4. Attend to consultations, including those of the emergency department, within and outside the department. 5. Outpatient clinics entail a minimum of 5 clinics per week (maximum of 7). Fellows should participate in outpatient clinics in the specialties to which the fellow is assigned under the supervision of consultants. Fellows are not expected to cover clinics without consultant supervision. 6. An additional half-day per week is spent on rotations in multidisciplinary clinics. 7. Perform the basic procedures necessary for diagnosis and management. 8. Present patients on daily rounds and assign all sick patients to the on-call team. 9. Ensure that the following discharge orders are placed in the patient s chart in a timely manner: discharge medications, follow-up appointments, and investigations. 10. Write a timely and thorough discharge summary. 11. Participate in departmental and section activities and the presentation of cases in the morning report, grand rounds, and all educational activities. 12. Participate in on-call duties according to the rules and regulations of the SCFHS. 13. In addition, the fellow is expected to actively participate in various lectures and seminars in diabetology/internal medicine, and family medicine (during family clinics rotations). 14. Fellows follow their own patients throughout their fellowship through the longitudinal care clinic in the department under guidance of the faculty, and have the opportunity to work with the entire faculty in the inpatient and outpatient settings. Second-Year Fellows (F2) Rotations - 4 months in general diabetes clinics, including adult diabetes, adolescent diabetes, insulin pump, and gestational diabetes clinics - 2 months weeks in family medicine department - 2 months in endocrinology department - 1 month in nephrology and hypertension department - 1 month in obesity/bariatric medicine and surgery department/clinics - 1 month in psychiatry/clinical psychology department - 1 month of annual vacation (4 weeks per year) - 1 week of professional leave 28 SAUDI DIABETES FELLOWSHIP CURRICULUM

32 GENERAL TRAINING REQUIREMENTS The in-patient and consultation services form the core structure of the program. In addition, fellows are expected to cover in-patient and consultation services during these rotations. Fellow 2 (F2) Job Descriptions 1. Review junior residents and fellows admission notes and orders, discuss proposed management plans, and supervise their implementation. 2. Document the patient s history and clinical examination independently, supervise the progress notes of junior residents and fellows daily, and record progress notes in the chart at least three times per week. 3. Assist and supervise the junior residents and fellows in interpreting laboratory investigations and performing bedside diagnostic and therapeutic procedures during working hours and on-call duties. 4. Assist junior residents and fellows in acquiring computer skills to search the literature and follow evidence-based approaches to patient care. 5. Attend to consultations, including those of the emergency department, within and outside the department. 6. A minimum of 5 times per week, participate under the supervision of consultants in outpatient clinics in the specialties to which the fellow is assigned. Fellows are not expected to cover clinics without consultant supervision. 7. Participate in departmental and section activities. 8. Participate in the education and training of medical students, interns, and junior fellows actively. 9. Produce timely and thorough reports for morbidity and mortality departmental meetings and specialty club meetings. 10. Participate in on-call duties according to the rules and regulations of the SCFHS. 11. Complete a research project. A wide spectrum of topics is open for this, including basic research, animal investigation, or clinical research with affiliated staff. Research work must be publishable at the end of the program. Fellows should be able to present their data to the fellowship research steering committee. SAUDI DIABETES FELLOWSHIP CURRICULUM 29

33 GENERAL TRAINING REQUIREMENTS In the first year, fellows must identify the area of research they wish to pursue and the faculty member they wish to work with. They should work closely with the faculty member to plan the project and prepare a written outline. Fellows are closely supervised during their research years by their faculty mentor, but there is also ample opportunity for guidance and scientific interaction with the entire faculty through participation in lab meetings, divisional research conferences, and institutional seminars. Rotation Road Map First Year Second Year Service Period Service Period Adult diabetes Adult diabetes General Adolescent Adolescent 5months. Diabetes Insulin pump Insulin pump 4 months. Gestational Gestational diabetes diabetes In-patient Diabetes Nephrology/ 1 month. diabetes 1 month. education hypertension consultation Clinical Endocrinolog 1 month. & in-patient 1 month. nutrition y diabetes service Specialized Clinics Leave Ophthalmology / retina 1 month. Bariatric medicine & surgery 1 month. Pediatric 1½ months. Psychiatry 1 month. Podiatry 1½ Family months. medicine 2 months. Annual 1 month. Annual 1 month. Professional 1 week Professional 1 week In-patient diabetes consultation & in-patient diabetes service In-patient and Consultation Services: The Second Core Program Structure General Goals and Objectives: To teach individuals how to be an effective consultant in diabetes disorders (this includes understanding what question is being asked by the referring physician, providing prompt evaluation of patients when consulted, providing effective and timely communication with the referring physician/team). o o To develop competence in the diagnosis and management of a broad range of diabetes, endocrine, and metabolic disorders. This experience specifically stresses those aspects that are most commonly encountered in the inpatient setting, such as: Diabetes emergencies, including: Diabetic ketoacidosis 30 SAUDI DIABETES FELLOWSHIP CURRICULUM

34 GENERAL TRAINING REQUIREMENTS o o o o o o o o o o o o Hyperosmolar non-ketotic state Hyperglycemia Hypoglycemia Fluid, electrolyte, and acid-base metabolism disorders, including: Hypernatremia and hyponatremia Hyperkalemia and hypokalemia Metabolic acidosis Metabolic alkalosis Diabetes mellitus, including: Disorders of magnesium metabolism Diabetes insipidus, central, and nephrogenic o Acutely ill surgical and medical patients o Intravenous insulin protocols o Transition from intravenous to subcutaneous insulin o Post-discharge management and follow-up planning for newly diagnosed patient Lipid, carbohydrate and protein metabolism disorders, including principles of enteral and parenteral nutritional support Hormone-producing neoplasms Endocrine adaptations and mal-adaptations to systemic diseases The neurosurgical patient during and after transphenoidal pituitary surgery Differential diagnosis and management of disorders of primary and secondary hypertension Neuroendocrinology and endocrine aspects of psychiatric diseases The interpretation of laboratory tests; immunoassays; and radionuclide, ultrasound radiologic, and other imaging studies for the diagnosis and treatment of diabetes and related disorders and metabolic disease, including the effects of a variety of unrelated disorder. Specific Objectives: By the end of the fellowship program, each trainee is expected to have a broad knowledge in the following (but not restricted to) fields: 1. Basic knowledge a. Energy expenditure and basic metabolic needs b. Appetite control and satiety, and dietary requirements c. Exercise physiology d. Physiology of glucose absorption and metabolism, and insulin secretion and action e. Anatomy, embryology, and histology of the pancreas and other endocrine glands involved in the glucose metabolism, such as pituitary and adrenal glands SAUDI DIABETES FELLOWSHIP CURRICULUM 31

35 GENERAL TRAINING REQUIREMENTS f. Pathophysiology of diabetes and its complications g. Genetics, immunology, and molecular biology of diabetes h. Epidemiology of diabetes i. Statistics and basics of research This can be achieved through continuous educational activities conducted throughout the academic year via the self-learning process, lectures, grand rounds, and clinical activities. 2. Clinical knowledge a. History and physical examination skills related to diabetes b. Prevention of diabetes c. Classification and diagnosis of diabetes d. Management of diabetes - Dietary, exercise, and lifestyle management - Management in inpatient setting - Management in outpatient setting - Diabetes in pediatric age group - Diabetes in the elderly - Pre-diabetes conditions: prevention, management and follow up - Pharmacology of therapeutic agents used in the broad field of diabetology and related disciplines Trainees must demonstrate a multi-disciplinary approach to diabetes management in collaboration with the following disciplines in caring for patients with diabetes. 32 SAUDI DIABETES FELLOWSHIP CURRICULUM

36 GENERAL TRAINING REQUIREMENTS Mandatory Rotations General Diabetes Rotation DURATION: A minimum of 5 months at the junior level (F1) A minimum of 4 months at the senior level (F2) OVERVIEW: The general diabetes rotation is mandatory and is the core rotation for all fellows. It provides in-patient and consult services for the adult and pediatric patients admitted to general internal medicine, subspecialties of medicine (i.e., cardiology, cardiac intensive care unit, nephrology, transplant, etc.), general surgery, specialties of surgery (i.e., cardiothoracic, trauma, vascular, neurosurgery) and OB/GYN Fellows in rotation for general diabetes must develop all CanMEDS core competencies while learning the basic skills required for the diagnosis and management of a broad range of medical conditions affecting adolescents and adults. Fellows should focus on undifferentiated patient problems as well as those that emerge in previously diagnosed patients. They should practice progressive responsibility and self-directedness in dealing with patients and their families, and be able to act as primary care providers for patients with multiple comorbidities. The list of presenting problems and underlying conditions is to be used as a guide. Fellows are expected to attend to any patient assigned to him or her, regardless of whether the patient s problem is included in the list. Fellows should view the list as representative and use it as a guide to help further their learning. The duration of the general diabetes rotation is flexible and can be extended to 9 months, which can be distributed throughout the 2-year training period. The specific competencies of this rotation are as follows: Develop all seven CanMEDS core competencies while learning the basic skills required for the diagnosis and management of a broad range of general medical conditions affecting adolescents and adults with diabetes. Demonstrate a thorough understanding of relevant basic sciences, including pathophysiology, drug therapy, and the microbial basis of diseases involving the key presenting problems and conditions listed below: o Order appropriate and selective investigations, and interpret the findings in the context of patients complaints. o Perform a complete health assessment that includes a focused physical examination and assessment of the patient s mental state. Formulate appropriate provisional and alternative diagnoses for key presenting problems and underlying conditions. o Provide immediate management to patients in need of such care. Perform the procedures shown in Table 3 in a safe and competent manner, including the following where appropriate: SAUDI DIABETES FELLOWSHIP CURRICULUM 33

37 GENERAL TRAINING REQUIREMENTS Recognition of indications and contraindications. Obtaining informed consent. Ensuring patient comfort, privacy, and adequate pain control. Documentation. Post-procedure follow up and handover. Document patient findings in medical records in a legible and timely manner. Proactively communicate and liaise with patients and families regarding the patient s condition, management plan, and disposition. Respect the roles and responsibilities of other healthcare professionals, including nurses, pharmacists, and allied health professionals. Promote prevention and health maintenance, including dietary factors, lifestyle modification, and smoking cessation, during every consultation. Develop patient-centered care that values individual and family preferences and societal and religious norms. Presenting Problem Underlying Key Condition Primary Focus in Learning Venue Acute complications of DM - Diabetes ketoacidosis - Hyperglycemic hyperosmolar state - Hyperglycemia - Hypoglycemia - Pathophysiology - Etiology - Diagnosis - Prevention - Screening - Management - Prevention - AH D - CBL - OBL 34 SAUDI DIABETES FELLOWSHIP CURRICULUM

38 GENERAL TRAINING REQUIREMENTS Presenting Problem Underlying Key Condition Primary Focus in Learning Venue Chronic complications of DM (Macro-Vascular) - Ischemic heart disease - Cerebrovascular accidents - Peripheral vascular disease - Pathophysiology - Etiology - Diagnosis - Prevention - Screening - Management (including those presenting with IHD and CVA) - Prevention - RCC - AH D - CBL - OBL Chronic complications of DM (Micro-Vascular) - DM nephropathy - DM neuropathy - DM retinopathy - Pathophysiology - Etiology - Diagnosis - Prevention - Screening - Management - Prevention - RCC - AH D - CBL - OBL Autonomic complications of diabetes - DM gastropathy - DM enteropathy - DM erectile Dysfunction - Postural hypotension - Bradycardia - Pathophysiology - Etiology - Diagnosis - Prevention - Screening - Management - Prevention - RCC - AHD - CBL - OBL SAUDI DIABETES FELLOWSHIP CURRICULUM 35

39 GENERAL TRAINING REQUIREMENTS Presenting Problem Underlying Key Condition Primary Focus in Learning Venue Dyslipidemia - Primary (familial) hyperlipidemia - Secondary (acquired) hyperlipidemia - Hypertriglycerdemia - Etiology - Screening - Clinical manifestation - Evaluation - Management - RCC - AHD - CBL Hypertension - Primary hypertension - Secondary hypertension - Hypertensive crisis - Diagnosis - Classification - Evidence-based management - Complications - RCC - AHD - CBL - OBL Diabetes in special Population - Gestational DM - DM in adolescents - DM in children - PDM in elderly - Etiology - Diagnosis - Prevention - Screening - Management - Prevention - RCC - AHD - CBL - OBL Pre-diabetes - Patients with metabolic syndrome - Pre-diabetes - Pathophysiology - Etiology - Diagnosis - Prevention - Screening - Management - Prevention - AHD - CBL 36 SAUDI DIABETES FELLOWSHIP CURRICULUM

40 GENERAL TRAINING REQUIREMENTS Presenting Problem Underlying Key Condition Primary Focus in Learning Venue In-hospital management of DM - DM patients going to surgery - Uncontrolled DM in general wards - DM in pregnancy - DM in patients with ischemic heart disease - Diagnosis - Management - Prevention of complications - AHD - OBL Insulin pump - Indications - Contraindications - Management - Complications - Install and operate the pump effectively - Initiate pump therapy - Follow and adjust pump settings - Interpret CGMS - AHD - CBL - RCC AHD: academic half-day activities; CBL: clinic-based learning; CGMS: continuous glucose monitoring system; CVA: cerebrovascular accident; DCC: didactic centralized component; IHD: ischemic heart disease; OBL: on-call-based learning; RCC: rotational component of the curriculum Diabetes Education Rotation - Demonstrate ability to educate patients and families in the comprehensive prevention and management of diabetes, working closely with diabetic educators, dieticians, and psychologists. - Efficiently use the available educational materials and actively participate in producing more of such materials. SAUDI DIABETES FELLOWSHIP CURRICULUM 37

41 GENERAL TRAINING REQUIREMENTS DURATION: A minimum of one month of rotation at the junior level (F1) DESCRIPTION: Fellows on rotation in the health education (mainly diabetes) departments must develop all CanMEDS core competencies while learning the basic skills required for proper education for diabetes patients. Fellows should focus on undifferentiated patient problems as well as those that emerge in previously diagnosed diabetes patients. Fellows should practice progressive responsibility and self-directedness in dealing with patients and their families and be able to act as primary care providers for patients with multiple comorbidities. The list of presenting problems and underlying conditions is to be used as a guide. Fellows are expected to attend to any patient that is assigned to him or her, regardless of whether the patient s problem is included in the list. Each presenting problem could involve a number of underlying conditions; the list is created to provide junior fellows (F1) with a clearer focus during their training. Fellows should view the list as representative and use it as a guide in furthering their learning. OBJECTIVES: The specific competencies of this rotation are as follows: Develop all seven CanMEDS core competencies while learning the basic skills required for the diagnosis and management of a broad range of nephrology conditions affecting adolescents and adults. Demonstrate a thorough understanding of relevant basic sciences, including teaching techniques, communication skills involving the key presenting problems, and disease conditions shown in the table below. Order appropriate and selective investigations and interpret the findings in the context of the patient s problems. Perform a complete health assessment that includes a focused physical examination and an assessment of the patient s mental state. Formulate appropriate provisional and alternative diagnoses for key presenting problems and underlying conditions. Render immediate management to patients who are in need of such care. Document patient findings in medical records in a legible and timely manner. Proactively communicate and liaise with patients and families regarding the patient s condition, management plan, and disposition. Respect the roles and responsibilities of other healthcare professionals, including nurses, pharmacists, and allied health professionals. Promote prevention and health maintenance, including dietary factors, lifestyle modification, and smoking cessation, during every consultation. Develop patient-centered care that values individual and family preferences and societal and religious norms. 38 SAUDI DIABETES FELLOWSHIP CURRICULUM

42 GENERAL TRAINING REQUIREMENTS Presenting Problem Diabetes education Underlying Key Condition - Hyperglycemia - Hypoglycemia - Insulin injections - Oral hypoglycemic agents - Chronic diabetes complications - Basic dietary advice Primary Focus in Learning - Etiology - Manifestation - Diagnosis - Complications - Evidence-based management - Prevention - Effective delivery of information - Communication skills - Patient empowerment - Effective use of teaching materials Venue - AHD - CBL - DCC - RCC Glucose Monitoring - Home glucose monitoring - CGMS - Indications - Monitoring - Installation and follow up of CGMS - Communication skills - Patient empowerment - AHD - CBL - DCC - RCC Insulin pump therapy - Install and operate the pump effectively - Follow and adjust pump settings - Interpret CGMS in pump patients - Carbohydrates counting - AHD - CBL - DCC - RCC Diabetes education in special situations - Hajj - Ramadan - Sick days - Management - Complications - Monitoring - AHD - CBL AHD: academic half-day activities; CBL: clinic-based learning; CGMS: continuous glucose monitoring system; DCC: didactic centralized component; OBL: on-call-based learning; RCC: rotational component of the curriculum SAUDI DIABETES FELLOWSHIP CURRICULUM 39

43 GENERAL TRAINING REQUIREMENTS Diabetes Nutritional Management Rotation - Develop an extensive knowledge in different types of diets; calories required for diabetic patient per day; calorie count; diet related to specific condition associated with diabetes, such as diabetic nephropathy; diet during Ramadan; and so forth. DURATION: A minimum of one month of rotation at the junior level (F1) DESCRIPTION: Fellows on rotation in the medical nutrition departments (mainly diabetes) must develop all CanMEDS core competencies while learning the basic skills required for proper nutritional management for diabetes patients. Fellows should focus on undifferentiated patient problems as well as those that emerge in previously diagnosed diabetes patients. Fellows should practice progressive responsibility and self-directedness in dealing with patients and their families and be able to act as primary care providers for patients with multiple comorbidities. The list of presenting problems and underlying conditions is to be used as a guide. Fellows are expected to attend to any patient that is assigned to him or her, regardless of whether the patient s problem is included in the list. Each presenting problem could involve a number of underlying conditions; the list is created to provide junior fellows (F1) with a clearer focus during their training. Fellows should view the list as representative and use it as a guide in furthering their learning. OBJECTIVES: The specific competencies of this rotation are as follows: Develop all seven CanMEDS core competencies while learning the basic skills required for the diagnosis and management of a broad range of nutritional conditions affecting adolescents and adults with diabetes. Demonstrate a thorough understanding of relevant basic sciences, including teaching techniques, communication skills involving the key presenting problems, and disease conditions shown in the table below. Order appropriate and selective investigations, and interpret the findings in the context of the patient s problems. Perform a complete health assessment that includes a focused physical examination and an assessment of the patient s mental state. Formulate appropriate provisional and alternative diagnoses for key presenting problems and underlying conditions. Render immediate management to patients who are in need of such care. Document patient findings in medical records in a legible and timely manner. Proactively communicate and liaise with patients and families regarding the patient s condition, management plan, and disposition. Respect the roles and responsibilities of other healthcare professionals, including nurses, pharmacists, and allied health professionals. Promote prevention and health maintenance, including dietary factors, lifestyle modification, and smoking cessation, during every consultation. Develop patient-centered care that values individual and family preferences and societal and religious norms. 40 SAUDI DIABETES FELLOWSHIP CURRICULUM

44 GENERAL TRAINING REQUIREMENTS Presenting Problem Diabetes nutritional management Underlying Key Condition - Low fat and carbohydrates diet - Carbohydrate counting - Glycemic indices of different foods - Estimation of caloric needs Primary Focus in Learning - Indications - Contraindications - Evidence-based management - Effective delivery of information - Communication skills - Patient empowerment - Effective use of teaching materials Venue - CBL - DCC - RCC AHD: academic half-day activities; CBL: clinic-based; DCC: didactic-centralized component; OBL: on-call-based learning; RCC: rotational component of the curriculum Ophthalmology Rotation DURATION: A minimum of one month of rotation at the junior level (F1) DESCRIPTION: Fellows on rotation in the ophthalmology departments must develop all CanMEDS core competencies while learning the basic skills required for the diagnosis and management of a broad range of ophthalmology conditions that are developed secondary to diabetes mellitus. Fellows should focus on undifferentiated patient problems as well as those that emerge in previously diagnosed diabetes patients. Fellows should practice progressive responsibility and self-directedness in dealing with patients and their families, and be able to act as primary care providers for patients with multiple comorbidities. The list of presenting problems and underlying conditions is to be used as a guide. Fellows are expected to attend to any patient that is assigned to him or her, regardless of whether the patient s problem is included in the list. Each presenting problem could involve a number of underlying conditions; the list is created to provide junior fellows (F1) with a clearer focus during their training. Fellows should view the list as representative and use it as a guide in furthering their learning. OBJECTIVES: The specific competencies of this rotation are as follows: Develop all seven CanMEDS core competencies while learning the basic skills required for the diagnosis and management of a broad range of nephrology conditions affecting adolescents and adults. Demonstrate a thorough understanding of relevant basic sciences, including pathophysiology, drug therapy, and the microbial basis of diseases involving the key presenting problems and disease conditions shown in the table below. Order appropriate and selective investigations and interpret the findings in the context of the patient s problems. Perform a complete health assessment that includes a focused physical examination and an assessment of the patient s mental state. SAUDI DIABETES FELLOWSHIP CURRICULUM 41

45 GENERAL TRAINING REQUIREMENTS Formulate appropriate provisional and alternative diagnoses for key presenting problems and underlying conditions. Render immediate management to patients who are in need of such care. Perform the procedures shown in Table 3 in a safe and competent manner, including the following where appropriate: Recognition of indications and contraindications Obtaining informed consent Ensuring patient comfort, privacy, and adequate pain control Documentation Post-procedure follow up and handover Document patient findings in medical records in a legible and timely manner. Proactively communicate and liaise with patients and families regarding the patient s condition, management plan, and disposition. Respect the roles and responsibilities of other healthcare professionals, including nurses, pharmacists, and allied health professionals. Promote prevention and health maintenance, including dietary factors, lifestyle modification, and smoking cessation, during every consultation. Develop patient-centered care that values individual and family preferences and societal and religious norms. Presenting Problem Underlying Key Condition Primary Focus in Learning Venue Acute complications of diabetic eye disease - Retinal detachment - Retinal hemorrhage - Etiology - Classification - Manifestation - Diagnosis - Complications - Evidence-based management - CBL - DCC - OBL - RCC 42 SAUDI DIABETES FELLOWSHIP CURRICULUM

46 GENERAL TRAINING REQUIREMENTS Presenting Problem Underlying Key Condition Primary Focus in Learning Venue Chronic complications of diabetic eye disease - Proliferative diabetic retinopathy - Non-proliferative diabetic retinopathy - Macular edema - Cataract - Iris disease secondary to diabetes - Screening - Etiology - Manifestation - Diagnosis - Complications - Evidence-based management - Prevention - Perform and interpret visual acuity testing - Use indirect ophthalmoscope - Interpret retinal photographs - Give advice about driving vehicles - CBL - DCC - OBL - RCC AHD: academic half-day activities; CBL: clinic-based learning; DCC: didactic centralized component; OBL: on-call-based learning; RCC: rotational component of the curriculum Pediatric Diabetes and Endocrinology Rotation DURATION: A minimum of 6 weeks at the junior level (F1) Overview: The pediatric diabetes and endocrinology rotation provides in-patient and consult services for the pediatric in-patients admitted to general internal medicine as well as the attending clinics. Fellows on rotation in the pediatric departments must develop all CanMEDS core competencies while learning the basic skills required for the diagnosis and management of a broad range of medical conditions affecting adolescents and children with diabetes. Fellows should focus on undifferentiated patient problems as well as those that emerge in previously diagnosed patients. Fellows should practice progressive responsibility and selfdirectedness in dealing with patients and their families and be able to act as primary care providers for patients with multiple comorbidities. The list of presenting problems and underlying conditions is to be used as a guide. Fellows are expected to attend to any patient SAUDI DIABETES FELLOWSHIP CURRICULUM 43

47 GENERAL TRAINING REQUIREMENTS assigned to him or her, regardless of whether the patient s problem is included in the list. Fellows should view the list as representative and use it as a guide to help further their learning. The specific competencies of this rotation are as follows: Develop all seven CanMEDS core competencies while learning the basic skills required for the diagnosis and management of a broad range of general medical conditions affecting adolescents and adults. Demonstrate a thorough understanding of relevant basic sciences, including pathophysiology, drug therapy, and the microbial basis of diseases involving the key presenting problems and conditions listed below. Order appropriate and selective investigations and interpret the findings in the context of patients complaints. Perform a complete health assessment that includes a focused physical examination and assessment of the patient s mental state. Formulate appropriate provisional and alternative diagnoses for key presenting problems and underlying conditions. Provide immediate management to patients in need of such care. Document patient findings in medical records in a legible and timely manner. Proactively communicate and liaise with patients and families regarding the patient s condition, management plan, and disposition. Respect the roles and responsibilities of other healthcare professionals, including nurses, pharmacists, and allied health professionals. Promote prevention and health maintenance, including dietary factors, lifestyle modification, and smoking cessation, during every consultation. Develop patient-centered care that values individual and family preferences and societal and religious norms. Presenting Problem Acute complications of DM Underlying Key Condition - Diabetes ketoacidosis - Hyperglycemia - Hypoglycemia Primary Focus in Learning - Pathophysiology - Etiology - Diagnosis - Prevention - Screening - Management - Prevention - Involving families in management Venue - RCC - AHD - CBL - OBL 44 SAUDI DIABETES FELLOWSHIP CURRICULUM

48 GENERAL TRAINING REQUIREMENTS Presenting Problem Chronic complications of DM (Microvascular) Autonomic complications of diabetes Dyslipidemia in children Underlying Key Condition - DM nephropathy - DM neuropathy - DM retinopathy - DM gastropathy - DM enteropathy - Postural hypotension - Bradycardia - Primary (familial) Hyperlipidemia - Secondary (acquired) Hyperlipidemia - Hypertriglycerde mia Primary Focus in Learning - Pathophysiology - Etiology - Diagnosis - Prevention - Screening - Management - Prevention - Pathophysiology - Etiology - Diagnosis - Prevention - Screening - Management - Prevention - Involving families in management - Etiology - Screening - Clinical manifestation - Evaluation - Management Venue - RCC - AHD - CBL - OBL - RCC - AHD - CBL - OBL - RCC - AHD - CBL Hypertension in children - Primary hypertension - Hypertensive crisis - Diagnosis - Classification - Evidence-based management - Complications - RCC - AHD - CBL - OBL SAUDI DIABETES FELLOWSHIP CURRICULUM 45

49 GENERAL TRAINING REQUIREMENTS Presenting Problem Underlying Key Condition Primary Focus in Learning Venue In-hospital management of DM - DM patients going to surgery - Uncontrolled DM in general wards - Diagnosis - Management - Prevention of complications - AHD - OBL Insulin pump in children and adolescents - Indications - Contraindications - Management - Complications - Install and operate the pump effectively - Initiate pump therapy - Follow and adjust pump settings - Interpret CGMS - Involving families - AHD - CBL - RCC in management AHD: academic half-day activities; CBL: clinic-based learning; CGMS: continuous glucose monitoring system; CVA: cerebrovascular accident; DCC: didactic-centralized component; IHD: ischemic heart disease; OBL: on-call-based learning; RCC: rotational component of the curriculum At the end of the rotation, fellows are expected to be able to complete the following: - Demonstrate awareness of how diabetes affects children. - Provide care to young persons with diabetes in transition to the adult service. - Respond to the physiological, psychological, and social problems of glycemic control in adolescents. - Identify common risk-taking behavior in young persons and their effects on diabetes. - Attain knowledge on preventive studies for type 1 diabetes. 46 SAUDI DIABETES FELLOWSHIP CURRICULUM

50 GENERAL TRAINING REQUIREMENTS - Provide proper education on diet, exercise, hypoglycemia (symptoms and management) for children and adolescents with type 1 and type 2 diabetes. - Develop skills for the management of type 1 and 2 diabetes in children and adolescents using different types of insulin and insulin regimens. - Attain knowledge and skills on the selection, education, and initiation of the insulin pump in children and adolescents with type 1 diabetes. SAUDI DIABETES FELLOWSHIP CURRICULUM 47

51 GENERAL TRAINING REQUIREMENTS Podiatry Rotation DURATION: A minimum of one month of rotation at the junior level (F1) DESCRIPTION: Fellows on rotation in the podiatry departments (mainly diabetes) must develop all CanMEDS core competencies while learning the basic skills required for proper foot care management for diabetes patients. Fellows should focus on undifferentiated patient problems as well as those that emerge in previously diagnosed diabetes patients. Fellows should practice progressive responsibility and self-directedness in dealing with patients and their families, and be able to act as primary care providers for patients with multiple comorbidities. The list of presenting problems and underlying conditions is to be used as a guide. Fellows are expected to attend to any patient that is assigned to him or her, regardless of whether the patient s problem is included in the list. Each presenting problem could involve a number of underlying conditions; the list is created to provide junior fellows (F1) with a clearer focus during their training. Fellows should view the list as representative and use it as a guide in furthering their learning. OBJECTIVES: The specific competencies of this rotation are as follows: Develop all seven CanMEDS core competencies while learning the basic skills required for the diagnosis and management of a broad range of nutritional conditions affecting adolescents and adults with diabetes. Demonstrate a thorough understanding of relevant basic sciences, including teaching techniques, communication skills involving the key presenting problems and disease conditions shown in the table below. Order appropriate and selective investigations and interpret the findings in the context of the patient s problems. Perform a complete health assessment that includes a focused physical examination and an assessment of the patient s mental state. Formulate appropriate provisional and alternative diagnoses for key presenting problems and underlying conditions. Render immediate management to patients who are in need of such care. Document patient findings in medical records in a legible and timely manner. Perform the procedures shown in Table 3 in a safe and competent manner, including the following where appropriate: Recognition of indications and contraindications Obtaining informed consent Ensuring patient comfort, privacy, and adequate pain control Documentation Post-procedure follow up and handover Proactively communicate and liaise with patients and families regarding the patient s condition, management plan, and disposition. Respect the roles and responsibilities of other healthcare professionals, including nurses, pharmacists, and allied health professionals. Promote prevention and health maintenance, including dietary factors, lifestyle modification, and smoking cessation, during every consultation. 48 SAUDI DIABETES FELLOWSHIP CURRICULUM

52 GENERAL TRAINING REQUIREMENTS Develop patient-centered care that values individual and family preferences and societal and religious norms. Presenting Problem Underlying Key Condition Primary Focus in Learning Venue Acute diabeticrelated foot conditions - Gas gangrene - Acute Charcot joint - Acute ischemic leg - Acute foot ulcers - Osteomyelitis - Etiology - Classification - Manifestation - Diagnosis - Complications - Evidence-based management (including debridement) - Prevention - AHD - CBL - DCC - OBL - RCC Chronic diabeticrelated foot conditions - Other bacterial gangrene - Chronic Charcot joint - Chronic ischemic leg - Chronic foot ulcers - Etiology - Classification - Manifestation - Diagnosis - Complications - Evidence-based management - Prevention - AHD - CBL - DCC - OBL - RCC Foot care - Proper teaching - AHD - CBL - RCC AHD: academic half-day activities; CBL: clinic-based; DCC: didactic-centralized component; OBL: on-call-based learning; RCC: rotational component of the curriculum Nephrology Rotation DURATION: A minimum of one month of rotation at the senior level (F2) DESCRIPTION: Fellows on rotation in the nephrology departments must develop all CanMEDS core competencies while learning the basic skills required for the diagnosis and management of a broad range of nephrology conditions developed secondary to diabetes mellitus. Fellows should focus on undifferentiated patient problems as well as those that emerge in previously diagnosed diabetes patients. Fellows should practice progressive responsibility and selfdirectedness in dealing with patients and their families, and be able to act as primary care providers for patients with multiple comorbidities. The list of presenting problems and underlying conditions is to be used as a guide. Fellows are expected to attend to any patient that is assigned to him or her, regardless of whether the patient s problem is included in the SAUDI DIABETES FELLOWSHIP CURRICULUM 49

53 GENERAL TRAINING REQUIREMENTS list. Each presenting problem could involve a number of underlying conditions; the list is created to provide senior fellows (F2) with a clearer focus during their training. Fellows should view the list as representative and use it as a guide in furthering their learning. OBJECTIVES: The specific competencies of this rotation are as follows: Develop all seven CanMEDS core competencies while learning the basic skills required for the diagnosis and management of a broad range of nephrology conditions affecting adolescents and adults. Demonstrate a thorough understanding of relevant basic sciences, including pathophysiology, drug therapy, and the microbial basis of diseases involving the key presenting problems and disease conditions shown in the table below. Order appropriate and selective investigations, and interpret the findings in the context of the patient s problems. Perform a complete health assessment that includes a focused physical examination and an assessment of the patient s mental state. Formulate appropriate provisional and alternative diagnoses for key presenting problems and underlying conditions. Render immediate management to patients who are in need of such care. Perform the procedures shown in Table 3 in a safe and competent manner, including the following where appropriate: Recognition of indications and contra-indications Obtaining informed consent Ensuring patient comfort, privacy, and adequate pain control Documentation Post-procedure follow up and handover Document patient findings in medical records in a legible and timely manner. Proactively communicate and liaise with patients and families regarding the patient s condition, management plan, and disposition. Respect the roles and responsibilities of other healthcare professionals, including nurses, pharmacists, and allied health professionals. Promote prevention and health maintenance, including dietary factors, lifestyle modification, and smoking cessation, during every consultation. Develop patient-centered care that values individual and family preferences and societal and religious norms. 50 SAUDI DIABETES FELLOWSHIP CURRICULUM

54 GENERAL TRAINING REQUIREMENTS Presenting Problem Underlying Key Condition Primary Focus in Learning Venue Hypertension - Essential hypertension - Secondary hypertension - Etiology - Classification - Manifestation - Diagnosis - Complications - Evidence-based management - CBL - DCC - RCC Diabetesrelated albuminuria - Micro-albuminuria - Macro-albuminuria - Screening - Etiology - Manifestation - Diagnosis - Complications - Evidence-based management - CBL - DCC - RCC Acute kidney diseases - Acute tubular necrosis - Contrast-induced nephropathy - Etiology - Classifications - Pathophysiology - Manifestation - Complications - Diagnosis - Management - Prevention - AHD - RCC - DCC SAUDI DIABETES FELLOWSHIP CURRICULUM 51

55 GENERAL TRAINING REQUIREMENTS Presenting Problem Underlying Key Condition Primary Focus in Learning Venue Chronic kidney diseases - Diabetes nephropathy - Hypertensive nephropathy - Screening - Etiology - Classifications - Pathophysiology - Manifestation - Complications - Diagnosis - Management - Prevention - Management of diabetes in chronic renal disease - RCC - DCC Dialysis Renal transplantation - Hemodialysis - Peritoneal dialysis - Indications - Contraindications - Management of diabetes in dialysis patients - Types - Indications for referral - Indications - Contraindications - Complications - Posttransplantation management - Management of rejection - Management of diabetes in transplanted patients - RCC - AHD - AHD - RCC - DCC AHD: academic half-day activities; CBL: clinic-based learning; DCC: didactic-centralized component; OBL: on call-based learning; RCC: rotational component of the curriculum 52 SAUDI DIABETES FELLOWSHIP CURRICULUM

56 GENERAL TRAINING REQUIREMENTS Endocrinology And Metabolism Rotation DURATION: A minimum of one month of rotation at the senior level (F2) DESCRIPTION: Fellows on rotation in the endocrinology and metabolism departments must develop all CanMEDS core competencies while learning the basic skills required for the diagnosis and management of a broad range of endocrinology and metabolic conditions affecting adolescents and adults with diabetes mellitus or affecting glucose metabolism. Fellows should focus on undifferentiated patient problems as well as those that emerge in previously diagnosed patients. Fellows should practice progressive responsibility and selfdirectedness in dealing with patients and their families and be able to act as primary care providers for patients with multiple comorbidities. The list of presenting problems and underlying conditions is to be used as a guide. Fellows are expected to attend to any patient that is assigned to him or her, regardless of whether the patient s problem is included in the list. Each presenting problem could involve a number of underlying conditions; the list is created to provide senior fellows (F2) with a clearer focus during their training. Fellows should view the list as representative and use it as a guide in furthering their learning. OBJECTIVES: The specific competencies of this rotation are as follows: Develop all seven CanMEDS core competencies while learning the basic skills required for the diagnosis and management of a broad range of endocrinology and metabolic conditions affecting adolescents and adults. Demonstrate a thorough understanding of relevant basic sciences, including pathophysiology, drug therapy, and the microbial basis of diseases involving the key presenting problems and disease conditions shown in the table below. Order appropriate and selective investigations, and interpret the findings in the context of the patient s problems. Perform a complete health assessment that includes a focused physical examination and an assessment of the patient s mental state. Formulate appropriate provisional and alternative diagnoses for key presenting problems and underlying conditions. Render immediate management to patients who are in need of such care. Perform the procedures shown in Table 3 in a safe and competent manner, including the following where appropriate: Recognition of indications and contraindications Obtaining informed consent Ensuring patient comfort, privacy, and adequate pain control Documentation Post-procedure follow up and handover SAUDI DIABETES FELLOWSHIP CURRICULUM 53

57 GENERAL TRAINING REQUIREMENTS Document patient findings in medical records in a legible and timely manner. Pro-actively communicate and liaise with patients and families regarding the patient s condition, management plan, and disposition. Respect the roles and responsibilities of other healthcare professionals, including nurses, pharmacists, and allied health professionals. Promote prevention and health maintenance, including dietary factors, lifestyle modification, and smoking cessation, during every consultation. Develop patient-centered care that values individual and family preferences and societal and religious norms. 54 SAUDI DIABETES FELLOWSHIP CURRICULUM

58 GENERAL TRAINING REQUIREMENTS Presenting Problem Underlying Key Condition Primary Focus in Learning Venue Thyroid gland disorders Dyslipidemia Calcium metabolism disorders Adrenal gland disorders Hirsutism Pituitary disorders - Hyperthyroidism and thyroid storm - Hypothyroidism and myxedema coma - Goiters - Thyroid cancers - Familial - Secondary - Hypo and Hyper parathyroidism - Vitamin D deficiency - Osteoporosis - Adrenal insufficiency - Cushing s syndrome - Hyperaldosteronism - Polycystic ovary syndrome - Cushing s syndrome - Acromegaly - Cushing's syndrome - Etiology - Pathophysiology - Classification - Manifestation - Diagnosis - Complications - Management - Etiology - Pathophysiology - Classification - Manifestation - Diagnosis - Complications - Management - Etiology - Classification - Diagnosis - Complications - Management - Etiology - Manifestation - Diagnosis - Screening - Management - Drugs - Etiology - Pathophysiology - Manifestation - Diagnosis - Management - Prevention - Etiology - Manifestation - Diagnosis - Screening - Management - AHD - CBL - DCC - OBL - RCC - AHD - CBL - DCC - OBL - RCC - AHD - CBL - DCC - RCC - RCC - DCC - AHD - RCC - DCC - AHD - RCC AHD: academic half-day activities; CBL: clinic-based learning; DCC: didactic-centralized component; OBL: on-call-based learning; RCC: rotational component of the curriculum SAUDI DIABETES FELLOWSHIP CURRICULUM 55

59 GENERAL TRAINING REQUIREMENTS Bariatric Medicine And Surgery Rotation DURATION: A minimum of one month of rotation at the senior level (F2) DESCRIPTION: Fellows on rotation in the bariatric medicine and surgery departments must develop all CanMEDS core competencies while learning the basic skills required for the diagnosis and management of a broad range of bariatric medicine and surgery conditions affecting adolescents and adults with diabetes mellitus. Fellows should focus on undifferentiated patient problems as well as those that emerge in previously diagnosed patients. Fellows should practice progressive responsibility and self-directedness in dealing with patients and their families, and be able to act as primary care providers for patients with multiple comorbidities. The list of presenting problems and underlying conditions is to be used as a guide. Fellows are expected to attend to any patient who is assigned to him or her, regardless of whether the patient s problem is included in the list. Each presenting problem could involve a number of underlying conditions; the list is created to provide senior fellows (F2) with a clearer focus during their training. Fellows should view the list as representative and use it as a guide in furthering their learning. OBJECTIVES: The specific competencies of this rotation are as follows: Develop all seven CanMEDS core competencies while learning the basic skills required for the diagnosis and management of a broad range of bariatric medicine and surgery conditions affecting adolescents and adults. Demonstrate a thorough understanding of relevant basic sciences, including pathophysiology, drug therapy, and the microbial basis of diseases involving the key presenting problems and disease conditions shown in the table below. Order appropriate and selective investigations and interpret the findings in the context of the patient s problems. Perform a complete health assessment that includes a focused physical examination and an assessment of the patient s mental state. Formulate appropriate provisional and alternative diagnoses for key presenting problems and underlying conditions. Render immediate management to patients who are in need of such care. Perform the procedures shown in Table 3 in a safe and competent manner, including the following where appropriate: Recognition of indications and contraindications Obtaining informed consent Ensuring patient comfort, privacy, and adequate pain control Documentation Post-procedure follow up and handover 56 SAUDI DIABETES FELLOWSHIP CURRICULUM

60 GENERAL TRAINING REQUIREMENTS Document patient findings in medical records in a legible and timely manner. Proactively communicate and liaise with patients and families regarding the patient s condition, management plan, and disposition. Respect the roles and responsibilities of other healthcare professionals, including nurses, pharmacists, and allied health professionals. Promote prevention and health maintenance, including dietary factors, lifestyle modification, and smoking cessation, during every consultation. Develop patient-centered care that values individual and family preferences and societal and religious norms. SAUDI DIABETES FELLOWSHIP CURRICULUM 57

61 GENERAL TRAINING REQUIREMENTS Presenting Problem Underlying Key Condition Primary Focus in Learning Venue Bariatric medicine - Obesity - Overweight - Metabolic syndrome - Etiology - Classification - Manifestation - Diagnosis - Complications - Evidence-based management - Prevention - Nutritional therapy - AHD - CBL - DCC - OBL - RCC Bariatric surgery - Gastric bypass surgery (Rouxen-Y) - Adjustable gastric banding (lap band surgery) - Gastric sleeve surgery (vertical sleeve gastrectomy) - Bilio-pancreatic diversion with duodenal switch - Indications - Contraindications - Complications - Post-operative evidence-based management - Nutritional management postsurgery - AHD - CBL - DCC - OBL - RCC AHD: academic half-day activities; CBL: clinic-based learning; DCC: didactic-centralized component; OBL: on-call-based learning; RCC: rotational component of the curriculum 58 SAUDI DIABETES FELLOWSHIP CURRICULUM

62 GENERAL TRAINING REQUIREMENTS Psychiatry rotation: DURATION: A minimum of one month of rotation at the senior level (F2) DESCRIPTION: Fellows on rotation in the psychiatry departments must develop all CanMEDS core competencies while learning the basic skills required for the diagnosis and management of a broad range of psychiatric conditions developed secondary to diabetes mellitus. Fellows should focus on undifferentiated patient problems as well as on those that emerge in those previously diagnosed with diabetes. Fellows should practice progressive responsibility and self-directedness in dealing with patients and their families, and be able to act as primary care providers for patients with multiple comorbidities. The list of presenting problems and underlying conditions is to be used as a guide. Fellows are expected to attend to any patient who is assigned to him or her, regardless of whether the patient s problem is included in the list. Each presenting problem could involve a number of underlying conditions; the list is created to provide senior fellows (F2) with a clearer focus during their training. Fellows should view the list as representative and use it as a guide in furthering their learning. Competencies: The specific competencies of this rotation are as follows: Develop all seven CanMEDS core competencies while learning the basic skills required for the diagnosis and management of a broad range of nephrology conditions affecting adolescents and adults. Demonstrate a thorough understanding of relevant basic sciences, including pathophysiology, drug therapy, and the microbial basis of diseases involving the key presenting problems and disease conditions shown in the table below. Order appropriate and selective investigations and interpret the findings in the context of the patient s problems. Perform a complete health assessment that includes a focused physical examination and an assessment of the patient s mental state. Formulate appropriate provisional and alternative diagnoses for key presenting problems and underlying conditions. Render immediate management to patients who are in need of such care. Document patient findings in medical records in a legible and timely manner. Proactively communicate and liaise with patients and families regarding the patient s condition, management plan, and disposition. Respect the roles and responsibilities of other healthcare professionals, including nurses, pharmacists, and allied health professionals. Promote prevention and health maintenance, including dietary factors, lifestyle modification, and smoking cessation, during every consultation. Develop patient-centered care that values individual and family preferences and societal and religious norms. SAUDI DIABETES FELLOWSHIP CURRICULUM 59

63 GENERAL TRAINING REQUIREMENTS Presenting Problem Underlying Key Condition Primary Focus in Learning Venue Acute psychiatric illnesses in DM individuals - Acute depression with suicidal ideation - Anxiety - Etiology - Manifestation - Diagnosis - Complications - Evidence-based management - AHD - CBL - DCC - OBL - RCC Chronic psychiatric illnesses in DM individuals - Chronic depression - Chronic anxiety - Screening - Etiology - Manifestation - Diagnosis - Evidence-based management - Prevention - Gain knowledge about common drugs used for depression/anxiet y - AHD - CBL - DCC - OBL - RCC Psychological issues in adolescents with DM - - Etiology - Manifestation - Diagnosis - Complications - Evidence-based management - Communication skills - AHD - CBL - DCC - OBL - RCC AHD: academic half-day activities; CBL: clinic-based learning; DCC: didactic-centralized component; OBL: on-call-based learning; RCC: rotational component of the curriculum 60 SAUDI DIABETES FELLOWSHIP CURRICULUM

64 GENERAL TRAINING REQUIREMENTS Family Medicine Rotation DURATION: A minimum of 2 months of rotation at the senior level (F2). DESCRIPTION: Fellows on rotation in the family medicine departments must develop all CanMEDS core competencies while learning the basic skills required for the diagnosis and management of a broad range of family medicine conditions affecting adolescents and adults with diabetes mellitus. Fellows should focus on undifferentiated patient problems as well as those that emerge in previously diagnosed patients. Fellows should practice progressive responsibility and self-directedness in dealing with patients and their families, and be able to act as primary care providers for patients with multiple comorbidities. The list of presenting problems and underlying conditions is to be used as a guide. Fellows are expected to attend to any patient that is assigned to him or her, regardless of whether the patient s problem is included in the list. Each presenting problem could involve a number of underlying conditions; the list is created to provide senior fellows (F2) with a clearer focus during their training. Fellows should view the list as representative and use it as a guide in furthering their learning. Competencies: The specific competencies of this rotation are as follows: Develop all seven CanMEDS core competencies while learning the basic skills required for the diagnosis and management of a broad range of diabetes-related issues in primary care setting affecting adolescents and adults. Demonstrate a thorough understanding of relevant basic sciences, including pathophysiology, drug therapy, and the microbial basis of diseases involving the key presenting problems and disease conditions shown in the table below. Order appropriate and selective investigations, and interpret the findings in the context of the patient s problems. Perform a complete health assessment that includes a focused physical examination and an assessment of the patient s mental state. Formulate appropriate provisional and alternative diagnoses for key presenting problems and underlying conditions. Render immediate management to patients who are in need of such care. Document patient findings in medical records in a legible and timely manner. Pro-actively communicate and liaise with patients and families regarding the patient s condition, management plan, and disposition. Respect the roles and responsibilities of other healthcare professionals, including nurses, pharmacists, and allied health professionals. Promote prevention and health maintenance, including dietary factors, lifestyle modification, and smoking cessation, during every consultation. Develop patient-centered care that values individual and family preferences and societal and religious norms. SAUDI DIABETES FELLOWSHIP CURRICULUM 61

65 GENERAL TRAINING REQUIREMENTS Presenting Problem Diabetes in primary care setting Underlying Key Condition Primary Focus in Learning - Etiology - Pathophysiology - Classification - Manifestation - Diagnosis - Complications - Management Venue - CBL - DCC - RCC Dyslipidemia - Familial - Secondary - Etiology - Pathophysiology - Classification - Manifestation - Diagnosis - Complications - Management - CBL - DCC - RCC Metabolic syndrome and pre-diabetes - Etiology - Pathophysiology - Classification - Manifestation - Diagnosis - Complications - Management Obesity - Etiology - Classification - Manifestation - Diagnosis - Complications - Evidence-based management - Prevention - Nutritional therapy - AHD - CBL - DCC - RCC Common infections Vaccinations - Upper respiratory tract infections - Simple pneumonia - Gastroenteritis - Influenza vaccine - Pneumococcal vaccine - Etiology - Classification - Manifestation - Diagnosis - Complications - Evidence-based management - Prevention - Indications - Contraindications - Complications - AHD - CBL - DCC - RCC - CBL - DCC - RCC AHD: academic half-day activities; CBL: clinic-based learning; DCC: didactic-centralized component; OBL: on-call-based learning; RCC: rotational component of the curriculum 62 SAUDI DIABETES FELLOWSHIP CURRICULUM

66 TEACHING AND LEARNING ACTIVITIES TEACHING AND LEARNING ACTIVITIES SAUDI DIABETES FELLOWSHIP CURRICULUM 63

67 TEACHING AND LEARNING ACTIVITIES Teaching and learning objectives arise from several teaching activities, which include the following: General Didactic-centralized Components of the Curriculum 1. Daily Morning Meetings: 1.1. Morning report The morning report is a universal component of internal medicine and the related branches training. Although there is a wide variation in format, attendance, and timing, all fellows share the common goal of case presentation for the purposes of educating resident physicians, monitoring patient care, and reviewing management decisions and their outcomes. The morning report is conducted from Sunday to Thursday mornings each week and lasts for min. The team that has been on call the previous night briefly presents and discusses all admitted patients with the audience, with an emphasis on history, clinical findings, differential diagnoses, acute management, and future plans. The morning report moderator decides the format or theme of the meeting. The meeting should include short cases, long cases, data interpretation, and a topic presentation lasting 5 min. The objectives of the morning meetings are as follows: Educate all attending fellows, monitor patient care, and review management decisions and their outcomes. Develop competence in a short presentation of details regarding all admitted patients in a scientific and informative fashion. Learn and gain confidence in presenting long cases in a systematic fashion. Develop appropriate differential diagnoses and suitable management plans. Present a topic presentation of the disease of interest lasting 5 min Morbidity and Mortality Conferences These conferences are conducted at least once every 4 8 weeks. The program director and department chairperson assign the task to a group of trainees who prepare and present the cases to all department members. The proceedings are generally kept confidential by law. The objectives of the mortality and morbidity conferences are as follows: Focus on the goal of improving patient care and identifying areas of improvement for clinicians involved in case management 64 SAUDI DIABETES FELLOWSHIP CURRICULUM

68 TEACHING AND LEARNING ACTIVITIES Prevent errors that lead to complications Modify behavior and judgment based on previous experience Identify system issues, such as outdated policies and changes in patient identification procedures, that may affect patient care 1.3. Grand Rounds/Guest Speaker Lectures These events are presented by experienced senior staff members from different internal medicine disciplines on a weekly basis. The topics will be selected from the core curriculum knowledge. The objectives of the grand rounds are as follows: Increase the physicians medical knowledge and skills and ultimately improve patient care. Understand and apply current practice guidelines in the field of internal medicine and its branches. Describe the latest advances and research in the field of internal medicine. Identify and explain areas of controversy in the field of internal medicine Case Presentation This is conducted weekly by an assigned fellow under the supervision of specialized seniors. The cases presented are those that involve interesting findings, unusual presentation, or difficult diagnosis or management. The objectives of case presentation are as follows: Present a comprehensive history and physical examination with details pertinent to the patient s problem. Formulate a list of all of the problems identified in the patient s history and physical examination. Develop an appropriate differential diagnosis for each problem. Formulate a diagnosis and treatment plan for each problem. Present a follow-up patient s case in a focused, problem-based manner that includes pertinent new findings and diagnostic and treatment plans. Demonstrate a commitment to improving case presentation skills by regularly seeking feedback regarding presentations. Record and present data accurately and objectively Journal Clubs, Critical Appraisal, and Evidence-based Medicine The journal club meeting is conducted at least once every 4 weeks. The fellow or the program director chooses a new article from a reputed journal and forwards it to one of the fellows at least 2 weeks SAUDI DIABETES FELLOWSHIP CURRICULUM 65

69 TEACHING AND LEARNING ACTIVITIES before the scheduled meeting. The objectives of the journal club are as follows: Promoting continuing professional development Remaining abreast of current literature Disseminating information and building a debate on good practice Ensuring that professional practice is evidence based Learning and practicing critical appraisal skills Providing an enjoyable educational and social occasion 1.6. Joint specialty meetings (radiology, pathology, and surgery) These meetings involving radiologists, pathologists, or surgeons are conducted once per month and include professionals from other subspecialties, such as gastroenterology and pulmonary medicine. The objectives of the joint specialty meeting are as follows: Provide the knowledge, technical skills, and experience necessary for diabetes fellows to interpret and correlate pathological changes with clinical findings and laboratory dates for procedures, such as radiological imaging. Promote effective communication and share expertise with peers and colleagues. Promote the development of investigative skills to improve fellows understanding of pathological processes as they apply to both individual patients and the general patient population. Promote the acquisition of knowledge and provide experience in laboratory direction and management, and encourage fellows to assume a leadership role in the education of other physicians and allied health professionals. 2. Academic Half-Day Activities (AHD) The academic half day consists of several types of sessions scheduled by the program director, is based on previous years feedback from fellows, and includes basic science, emergency lectures, communication skills demonstrations, practice of procedures, clinical problem solving, medical research, and statistics. This is protected teaching time and attendance is mandatory for all diabetes fellowship trainees. The activities are conducted on a weekly basis between 1:00 and 4:00 p.m. a. Emergency and Non-Emergency Topics Lectures (Tables 1 & 2 ) Lectures concerning emergency and nonemergency conditions are prepared and presented by a senior staff member. The series of topics is repeated 66 SAUDI DIABETES FELLOWSHIP CURRICULUM

70 TEACHING AND LEARNING ACTIVITIES annually to ensure adequate attainment. The objectives of these sessions are as follows: Review common emergency and nonemergency situations with respect to diagnosis and management. SAUDI DIABETES FELLOWSHIP CURRICULUM 67

71 TEACHING AND LEARNING ACTIVITIES Table 1: Emergency Diabetes-related Topics TOPIC PRESENTER DATE GENERAL DIABETES Diabetes Emergencies Diabetes ketoacidosis Hyperglycemic hyperosmolar state Hypoglycemia DIABETIC FOOT Acute Charcot joint Acute lower limb ischemia OPHTHALMOLOGY Retinal hemorrhage Retinal detachment NEPHROLOGY Acute renal failure Hypertensive emergency 68 SAUDI DIABETES FELLOWSHIP CURRICULUM

72 TEACHING AND LEARNING ACTIVITIES Table 2: Non-Emergency Diabetes-related Topics TOPIC PRESENTER DATE GENERAL DIABETES H isto ry o f diabetes D iagno sis o f diabetes P atho physio lo gy o f diabetes C lassificatio n o f diabetes T ype 1 diabetes T ype 2 diabetes Other types o f diabetes Gestatio nal diabetes M ature o n-set diabetes (yo uth) Latent auto immune diabetes (adult) Keto sis-pro ne diabetes Gestatio nal D iabetes M ellitus (GD M ) D iagno sis o f gestatio nal diabetes C o mplicatio ns o f GD M M anagement o f GD M during pregnancy M anagement o f GD M during labo r M anagement o f D iabetes T ype 1 D iabetes Insulin regimens C o ntinuo us subcutaneo us insulin infusio n M anagement o f D iabetes T ype 2 D iabetes Oral hypo glycemic agents Insulin therapy fo r type 2 diabetes C o mplicatio ns o f D iabetes M acro -vascular co mplicatio ns Ischemic heart disease C erebro vascular accidents P eripheral vascular disease M icro -vascular co mplicatio ns D iabetic neuro pathy A uto no mic co mplicatio ns D iabetic gastro pathy Erectile dysfunctio n P reventio n and Screening fo r D M F ungal Infectio ns in D iabetes P atients SAUDI DIABETES FELLOWSHIP CURRICULUM 69

73 TEACHING AND LEARNING ACTIVITIES TOPIC PRESENTER DATE DIABETIC FOOT C hro nic C harco t jo int D iabetic fo o t ulcers Ophthalmology P ro liferative diabetic retino pathy N o n-pro liferative diabetic retino pathy M acular edema Nephrology M anagement o f hypertensio n in D M patients D M nephro pathy M anagement o f D M in endstage renal failure patients PEDIATRICS T ype 1 diabetes in pediatric and ado lescents P sycho lo gical issues in ado lescents with D M T 2 D M in pediatric and ado lescents age gro up BARIATRIC MEDICINE Etio lo gy and preventio n o f o besity P harmaco lo gical treatment o f o besity N o n-pharmaco lo gical treatment o f o besity T ypes o f bariatric surgeries C o mplicatio ns o f bariatric surgeries NUTRITION N utritio nal therapy fo r D M ENDOCRINOLOGY T hyro idal illnesses in patients with diabetes P o lycystic o vary syndro me Endo crine causes o f diabetes C ushing s syndro me A cro megaly D yslipidemia in D M patients 70 SAUDI DIABETES FELLOWSHIP CURRICULUM

74 TEACHING AND LEARNING ACTIVITIES b. Procedures (Table 3 ) Objectives: Apply knowledge and technical expertise in performing procedures, interpreting results, and understanding relevant limitations. Demonstrate effective, appropriate, and timely performance of therapeutic procedures. Demonstrate evidence-based physical examination skills that are relevant and precise. Demonstrate procedures on a task trainer. Learn ultrasound-guided procedures and develop familiarity with general ultrasound technology. The fellow should master the following for each procedure: indications, contraindications, complications and complication rate, procedural technique, sterile technique, consent for the procedure, and reporting complications. Table 3: Procedure List PROCEDURES TO BE PERFORMED INDEPENDENTLY Venipuncture ECG Cardiopulmonary resuscitation Blood gas sampling Urine analysis and microscopy Direct Funduscopy examination External cardioversion/defibrillator Fundus photography PROCEDURES TO BE PERFORMED UNDER SUPERVISION Central venous line insertion Indirect funduscopy Simple debridement of foot ulcer/gangrene and callus SAUDI DIABETES FELLOWSHIP CURRICULUM 71

75 TEACHING AND LEARNING ACTIVITIES Dressing of diabetic foot In growing nail removal PROCEDURES TO BE OBSERVED Principles of endocrine dynamic tests Insulin Tolerance Test Oral Glucose Tolerance Test with Growth Hormone Level Low-Dose Dexamethasone Suppression Test Synacthen Test Metyrapone Suppression Test Water Deprivation Test Above and below knee amputations Sleeve Gastrectomy CNS: central nervous system; ECG: electrocardiogram; EEG: electroencephalography; EMG: Electromyography; GI: gastrointestinal Resources: New England Journal of Medicine videos: - Standard books or journal articles. Stanford 25: - Manikins c. Approaches to Common Conditions and Symptoms (Table 4 ) These are lecture series concerning systematic approaches to common diabetes-related conditions, with symptoms prepared and presented by a fellow during academic half days under the supervision of a specialized senior staff member. These series are repeated annually. 72 SAUDI DIABETES FELLOWSHIP CURRICULUM

76 TEACHING AND LEARNING ACTIVITIES Table 4: Approach Topics in Academic Half-day Activity TOPIC PRESENTER DATE Approach to hypertension in DM patients Approach to diabetic foot ulcer Assessment of nutritional status in DM patients Approach to weight gain and loss Approach to renal failure Approach to acid-base disturbance Approach to hyponatremia/hypernatremia Approach to hypokalemia/hyperkalemia Approach to hypocalcemia/hypercalcemia Approach to the management of gestational DM Approach to dyslipidemia DM: diabetes mellitus The objectives of this activity are as follows: Demonstrate diagnostic and therapeutic skills Access and apply relevant information to clinical practice Practice contemporary, evidence-based, and cost-effective medicine Avoid unnecessary or harmful investigations or management d. Clinical Skills (Table 5 ) Most clinical skills sessions will be conducted at the bedside. This includes taking history, conducting physical examinations, and communication skills. However, lectures and video demonstrations can be added to academic half-day activities before bedside practice. SAUDI DIABETES FELLOWSHIP CURRICULUM 73

77 TEACHING AND LEARNING ACTIVITIES Table 5: Clinical Skills Please refer to the following link: CLINICAL SKILL PRESENTER DATE Comprehensive diabetes history taking General physical examination Cardiovascular examination: Examination of pulses Examination of JVP Pericardial examination Abdominal examination Respiratory examination Neurological examination Higher mental function testing Cranial nerves examination Motor examination Coordination Sensory examination Thyroid examination Foot examination JVP: jugular venous pressure 74 SAUDI DIABETES FELLOWSHIP CURRICULUM

78 TEACHING AND LEARNING ACTIVITIES The objectives of the clinical skills session are as follows: Recognize the many facets of the doctor-patient relationship and be able to apply a bio-psychosocial model to issues in health and medicine. Master basic interview and communication skills, and demonstrate competence in advanced interview and communication skills. Master basic physical examination skills and be able to perform and interpret focused examinations of the cardiovascular, pulmonary, musculoskeletal, and neurological systems; breasts; and genitalia in men and women. Exhibit professional behaviors, including the demonstration of respect for patients, colleagues, faculty members, and others in all settings. Help fellows to pass clinical exams. e. Communication Skills (Table 6 ) The competencies for this role are essential for establishing rapport and trust, formulating a diagnosis, delivering information, striving for mutual understanding, and facilitating a shared care plan. Poor communication can lead to undesirable results, and effective communication is critical for optimal patient outcomes. Physicians enable patient-centered therapeutic communication via decision making and effective dynamic interactions with patients, families, caregivers, fellow professionals, and other important individuals. A series of communication skills lectures concerning common situations is delivered by experienced staff members regularly during academic half days and repeated annually. SAUDI DIABETES FELLOWSHIP CURRICULUM 75

79 TEACHING AND LEARNING ACTIVITIES Table 6: Communication Situations TOPIC PRESENTER DATE Dealing with medical errors Documentation Breaking bad news Expressing empathy Dealing with patient emotions (anger, fear, and sadness) Cultural diversity End-of-life discussion Informed consent Special needs patients (learning disabilities and low literacy) Disclosing adverse events Establishing boundaries Explaining diagnosis, investigation, and treatment Involving the patient in decision making Communicating with relatives and dealing with difficult patients/families Communicating with other healthcare professionals Seeking informed consent/clarification for an invasive procedure or obtaining consent for a postmortem Providing instructions regarding discharge Providing advice regarding lifestyle, health promotion, or risk factors 76 SAUDI DIABETES FELLOWSHIP CURRICULUM

80 TEACHING AND LEARNING ACTIVITIES f. Medical Ethics (Table 7 ) Ethical issues are frequently encountered during clinical practice, and discussing medico-legal aspects of care with experts is of paramount importance for better and safer training and practice. A senior staff member will raise a particular medico-legal issue to be discussed interactively with fellows during academic half days. Table 7: Ethical Issues in Medicine ETHICAL ISSUES PRESENTER DATE 1. Principles of medical ethics 2. Code of conduct and professionalism 3. Good death 4. Principles of research ethics 5. Consent 6. Truth telling 7. Confidentiality and patient autonomy 8. Improving ethical practices in ward setting 9. Ethics and moral aspects of genetics 10. Ethics in treating mentally ill patients 11. Medical negligence and professional misconduct 12. Ethics of transplantation and organ donation 13. Principles of resource allocation in healthcare systems SAUDI DIABETES FELLOWSHIP CURRICULUM 77

81 TEACHING AND LEARNING ACTIVITIES ETHICAL ISSUES PRESENTER DATE 14. Resource allocation in healthcare systems 15. Withholding treatment and euthanasia Code of conduct and professionalism Good death Principles of research ethics Consent Truth telling Confidentiality and patient autonomy Improving ethical practices in ward settings Ethics in treating terminally ill patients Ethics and moral aspects of genetics Ethics in treating mentally ill patients Medical negligence and professional misconduct Ethics of transplantation and organ donation Principles of resource allocation in healthcare systems 16. Professional misconduct and negligence The competencies of this activity are as follows: Recognize the humanistic and ethical aspects of a career in medicine. Examine and affirm personal professional moral commitments. Equip fellows with a foundation of philosophical, social, and legal knowledge. Apply knowledge that has been gained in clinical reasoning and provide fellows with the skills required to apply this insight, knowledge, and reasoning to clinical care. 78 SAUDI DIABETES FELLOWSHIP CURRICULUM

82 TEACHING AND LEARNING ACTIVITIES g. Data Interpretation A full range of laboratory data encountered during daily practice (e.g., blood tests, arterial blood gas [ABG], fundal photos, and electrocardiograms [ECGs]) is presented during academic half-days. A case-based approach is used to assist trainees in digesting and understanding the plethora of investigations with which they should be familiar. All fellows are expected to participate in this activity. The objectives of the activity are as follows: Gain knowledge of the various investigational tools used in internal medicine. Enhance proper interpretation of different investigational data. Enhance proper use of investigational tools. Discuss the advantages and limitations of various investigational tools. h. Research and evidence-based practice (Table 8 ) The Saudi Commission for Health Specialties promotes and supports research conducted by trainees. Therefore, fellows are expected to participate in annual research projects. The presentation and dissemination of the work produced occurs during formal research days held annually at various centers. These projects are not necessarily required to result in publications or national or international presentations. However, outstanding projects and interested fellows are supported and mentored if presentations or publications are appropriate. SAUDI DIABETES FELLOWSHIP CURRICULUM 79

83 TEACHING AND LEARNING ACTIVITIES Table 8: Evidence-based Medicine and Clinical Research TOPIC PRESENTER DATE 1. Evidence-based practice definition and applications 2. Biostatistics 3. Research methodology 4. How to start your research project 5. How to write and publish your paper The objectives of the research aspect of the internal medicine program are as follows: Become familiar with the generation and dissemination of research via oral presentations, poster presentations, and abstract preparation, and attend core academic teaching applicable to research, including ethics, study design, abstract writing, and presentation skills. Gain competence in conducting literature reviews, data synthesis and analysis, and interpretation. i. Workshops During the training period, the fellow should attend a continuous subcutaneous insulin infusion (CSII) workshop, which is usually conducted in the diabetes centers. The workshops are usually conducted over one or two days, and the program director should release the fellow to attend. The objectives of (CSII) workshop are as follows: Gain knowledge about the different types of insulin pumps and how they work. Understand the indications and contraindications of CSII. Gain the necessary skills to operate the available types of insulin pumps. Identify the complications of CSII. Interpret the continuous glucose monitoring system in patients using insulin pumps. Set an appropriate management and follow-up plan for each patient. 80 SAUDI DIABETES FELLOWSHIP CURRICULUM

84 TEACHING AND LEARNING ACTIVITIES Rotational (Practice-based) Components of the Curriculum Daily round-based learning The daily round is a good opportunity to conduct bedside teaching for small groups of fellows (usually those involved in caring for patients). The objectives are as follows: Document historical and physical examination findings, including complete written databases; problem lists; and focused subjective, objective, assessment, and plan notes according to accepted formats. Generate differential diagnoses appropriate to the level of training. Review admission notes, discharge summaries, and medical reports. Develop evidence-based management plans. Interpret lab investigation results (e.g., imaging and blood tests). Consult with professionals of other disciplines. Communicate, including discussing risk factors and prevention, with patients and their families. Write discharge and follow-up plans. On-call duty-based learning All fellows are required to undertake a minimum of 7 10 on-call duty shifts, each lasting 8 12 hours, per month. Fellow (F1) Elicit a comprehensive history and perform a complete physical examination on admission, record the patient s assessment and a differential diagnosis of medical problems clearly, and initiate the management plan. Discuss the management plan, including investigations and the treatment plan, with seniors. Communicate the plan to the nurse assigned to patient care. Perform the basic procedures necessary for diagnosis and management. SAUDI DIABETES FELLOWSHIP CURRICULUM 81

85 TEACHING AND LEARNING ACTIVITIES Fellow (F2) Supervise residents and fellows admission notes and orders and discuss/supervise the implementation of proposed management plans. Supervise junior residents and fellows skills in taking history and conducting physical examinations. Assist junior residents and fellows in interpreting laboratory investigations and performing bedside diagnostic and therapeutic procedures. Attend to consultations, including those involving emergencies, within and outside the department, and participate in outpatient clinics once or twice per week. Clinic-Based Learning (CBL) Fellow (F1): Minimum 5 clinics per week Fellows are strictly prohibited from covering outpatient clinics without supervision. Elicit a focused history and perform a physical examination. Present clinical findings, in brief, to the attending consultant or senior staff. Discuss differential diagnoses and management plans with attending consultants. Record patients assessments, differential diagnoses, and management plans. Develop communication skills with the attending consultant. Fellow (F2): Minimum 5 clinics per week, including longitudinal clinics Fellows are strictly prohibited from covering outpatient clinics without supervision. Senior fellows conduct patient follow up under the supervision of the attending consultant for a prolonged period. Supervise junior residents and fellows notes and orders. Record concise notes for inpatients at least three times per week while on call. Discuss management plans, including investigations, treatment, and referral to other disciplines, with the consultant. Discuss the need for specialized procedures with the consultant. Elicit clinical signs for junior fellows/residents. Interpret and discuss laboratory results with junior fellows. Assess the performance of junior fellows in terms of communication skills, focused history taking, and physical examination. Fellows' longitudinal clinics Each fellow in the training program should have one longitudinal clinic per week for the whole training period. 82 SAUDI DIABETES FELLOWSHIP CURRICULUM

86 TEACHING AND LEARNING ACTIVITIES The fellow should attend the clinic even if he or she rotating in a different department. The training center should provide the necessary regulation for fellows to conduct the clinic. The program director of the center or an assigned consultant should be the reference for the fellow in case he or she needs assistance or advice and he/she should monitor the performance of the fellow. The program director/assigned consultant should provide an annual report about the performance of the fellow to the regional training committee. The objectives of doing this clinic are as follows: Encourage fellows to assess and manage diabetes patients independently Practice communication skills with patients and colleagues Practice appropriate liaison with other services Advise patients about self-management plan Self-Directed Learning Achieving personal learning goals beyond those of the essential core curriculum Maintenance of a personal portfolio (self-assessment, reflective learning, and personal development plan) Auditing and researching projects Reading journals Attendance at training programs organized on a regional basis (e.g., symposia, conferences, and board reviews) Undertaking universal topics SAUDI DIABETES FELLOWSHIP CURRICULUM 83

87 TEACHING AND LEARNING ACTIVITIES The Saudi Commission of Health Specialties intends to deliver an e-learning platform to provide high-value interdisciplinary topics of utmost importance for the trainees to ensure that all receive high-quality teaching and develop essential core knowledge. These topics are common to all specialties and are delivered in a modular fashion. At the end of each unit, there is an online formative assessment. Upon completion of all topics, trainees undergo a combined summative assessment in the form of context-rich multiple-choice questions (MCQ) in which they should attain minimum competency. The following are mandatory modules to be completed at each level: F1: Module 1, Module 2, and Module 3 F2: Module 4, Module 5, and Module 6 84 SAUDI DIABETES FELLOWSHIP CURRICULUM

88 UNIVERSAL TOPICS UNIVERSAL TOPICS SAUDI DIABETES FELLOWSHIP CURRICULUM 85

89 UNIVERSAL TOPICS Intent These are high-value interdisciplinary topics of outmost importance to the trainee. The reason for delivering the topics centrally is to ensure that every trainee receives high-quality teaching and develops their essential core knowledge. These topics are common to all specialties. Topics included here meet one or more of the following criteria: Impactful: topics that are common or life threatening. Inter-disciplinary: topics that are difficult to teach by a single discipline. Orphan: topics that are poorly represented in the undergraduate curriculum. Practical: topics that trainees will encounter in hospital practice. Development and Delivery Core topics for PG curriculum will be developed and delivered centrally by the Commission through the e-learning platform. A set of preliminary learning outcomes for each topic will be developed. Content experts, in collaboration with the central team, may modify the learning outcomes. These topics will be didactic in nature with a focus on the practical aspects of care. These topics will be more content heavy compared to workshops and other face-toface interactive sessions planned. The suggested duration of each topic is 90 min. Assessment The topics will be delivered in a modular fashion. At the end of each learning unit there will be on-line formative assessment. After completion of all topics, there will be a combined summative assessment in the form of context-rich MCQ. All trainees must attain minimum competency in the summative assessment. Alternatively, these topics can be assessed in a summative manner along with a specialty examination. Some ideas: May include case studies, high-quality images, worked examples of prescribing drugs in disease states, and Internet resources. Module 1: Introduction 1. Safe Drug Prescribing 2. Hospital Acquired Infections 3. Sepsis; SIRS; DIVC 4. Antibiotic Stewardship 5. Blood Transfusions 86 SAUDI DIABETES FELLOWSHIP CURRICULUM

90 UNIVERSAL TOPICS Safe Drug Prescribing: At the end of the learning unit, you should be able to do the following: a) Recognize the importance of safe drug prescribing in healthcare. b) Describe the various adverse drug reactions with examples of commonly prescribed drugs that can cause such reactions. c) Apply principles of drug-drug interactions, drug-disease interactions, and drug-food interactions into common situations. d) Apply principles of prescribing drugs in special situations, such as renal failure and liver failure. e) Apply principles of prescribing drugs in elderly, pediatrics age group patents, and in pregnancy and lactation. f) Promote evidence-based cost effective prescribing. g) Discuss ethical and legal framework governing safe-drug prescribing in Saudi Arabia. Hospital Acquired Infections (HAI): At the end of the learning unit, you should be able to do the following: a) Discuss the epidemiology of HAI with special reference to HAI in Saudi Arabia. b) Recognize HAI as one of the major emerging threats in healthcare. c) Identify the common sources and set-ups of HAI. d) Describe the risk factors of common HAIs, such as ventilator-associated pneumonia, MRSA, CLABSI, Vancomycin-resistant Enterococcus (VRE). e) Identify the role of healthcare workers in the prevention of HAI. f) Determine appropriate pharmacological (e.g., selected antibiotic) and non-pharmacological (e.g., removal of indwelling catheter) measures in the treatment of HAI. g) Propose a plan to prevent HAI in the workplace. Sepsis, SIRS, DIVC: At the end of the learning unit, you should be able to do the following: a) Explain the pathogenesis of sepsis, SIRS, and DIVC. b) Identify patient-related and non-patient related predisposing factors of sepsis, SIRS, and DIVC. c) Recognize a patient at risk of developing sepsis, SIRS, and DIVC. d) Describe the complications of sepsis, SIRS, and DIVC. e) Apply the principles of management of patients with sepsis, SIRS, and DIVC. f) Describe the prognosis of sepsis, SIRS, and DIVC. Antibiotic Stewardship: At the end of the learning unit, you should be able to do the following: a) Recognize antibiotic resistance as one of the most pressing public health threats globally. b) Describe the mechanism of antibiotic resistance. SAUDI DIABETES FELLOWSHIP CURRICULUM 87

91 UNIVERSAL TOPICS c) Determine the appropriate and inappropriate use of antibiotics. d) Develop a plan for safe and proper antibiotic usage, including the right indications, duration, types of antibiotic, and discontinuation. e) Appraise the local guidelines in the prevention of antibiotic resistance. Blood Transfusion: At the end of the learning unit, you should be able to do the following: a) Review the different components of blood products available for transfusion. b) Recognize the indications and contraindications of blood product transfusion. c) Discuss the benefits, risks, and alternative to transfusion. d) Undertake consent for specific blood product transfusion. e) Perform steps necessary for safe transfusion. f) Develop understanding of special precautions and procedures necessary during massive transfusions. g) Recognize transfusion-associated reactions and provide immediate management. Module 2: Diabetes and Metabolic Disorders 6. Recognition and Management of Diabetic Emergencies 7. Management of Diabetic Complications 8. Comorbidities of Obesity 9. Abnormal ECG Recognition and Management of Diabetic Emergencies: At the end of the learning unit, you should be able to do the following: a) Describe pathogenesis of common diabetic emergencies, including their complications. b) Identify risk factors and groups of patients vulnerable to such emergencies. c) Recognize a patient presenting with diabetic emergencies. d) Institute immediate management. e) Refer the patient to the appropriate next level of care. f) Counsel patient and families to prevent such emergencies. 88 SAUDI DIABETES FELLOWSHIP CURRICULUM

92 UNIVERSAL TOPICS Management of Diabetic Complications: At the end of the learning unit, you should be able to do the following: a) Describe the pathogenesis of important complications of Type 2 diabetes mellitus. b) Screen patients for such complications. c) Provide preventive measures for such complications. d) Treat such complications. e) Counsel patients and families with special emphasis on prevention. Comorbidities of Obesity: At the end of the learning unit, you should be able to do the following: a) Screen patients for the presence of common and important comorbidities of obesity. b) Manage obesity-related comorbidities. c) Provide dietary and life-style advice for prevention and management of obesity. Abnormal ECG: At the end of the learning unit, you should be able to do the following: a) Recognize common and important ECG abnormalities. b) Institute immediate management, if necessary. Module 3: Medical and Surgical Emergencies 10. Management of Acute Chest Pain 11. Management of Acute Breathlessness 12. Management of Altered Sensorium 13. Management of Hypotension and Hypertension 14. Management of Upper GI Bleeding 15. Management of Lower GI Bleeding For all of the above, the following learning outcomes apply. At the end of the learning unit, you should be able to do the following: a) Triage and categorize patients. b) Identify patients who need prompt medical and surgical attention. c) Generate a preliminary diagnoses-based history and physical examination. d) Order and interpret urgent investigations. e) Provide appropriate immediate management to patients. f) Refer the patients to the next level of care, if needed. SAUDI DIABETES FELLOWSHIP CURRICULUM 89

93 UNIVERSAL TOPICS Module 4: Acute Care 16. Pre-Operative Assessment 17. Post-Operative Care 18. Acute Pain Management 19. Chronic Pain Management 20. Management of Fluid in the Hospitalized Patients 21. Management of Electrolyte Imbalances Pre-Operative Assessment: At the end of the learning unit, you should be able to do the following: a) Describe the basic principles of pre-operative assessment. b) Perform pre-operative assessment on an uncomplicated patient with special emphasis on the following: i. General health assessment ii. Cardiorespiratory assessment iii. Medications and medical device assessment iv. Drug allergy v. Pain relief needs c) Categorize patients according to risks. Post-Operative Care: At the end of the learning unit, you should be able to do the following: a) Devise a post-operative care plan, including monitoring of vitals, pain management, fluid management, medications, and laboratory investigations. b) Hand-over the patients properly to the appropriate facilities. c) Describe the process of post-operative recovery in a patient. d) Identify common post-operative complications. e) Monitor patients for possible post-operative complications. f) Institute immediate management for post-operative complications. Acute Pain Management: At the end of the learning unit, you should be able to do the following: a) Review the physiological basis of pain perception. b) Proactively identify patients who might be in acute pain. c) Assess a patient with acute pain. d) Apply various pharmacological and non-pharmacological modalities available for acute pain management. e) Provide adequate pain relief for uncomplicated patients with acute pain. f) Identify and refer patients with acute pain who can benefit from specialized pain services. 90 SAUDI DIABETES FELLOWSHIP CURRICULUM

94 UNIVERSAL TOPICS Chronic Pain Management: At the end of the learning unit, you should be able to do the following: a) Review the bio-psychosocial and physiological basis of chronic pain perception. b) Discuss various pharmacological and non-pharmacological options available for chronic pain management. c) Provide adequate pain relief for uncomplicated patients with chronic pain. d) Identify and refer patients with chronic pain who can benefit from specialized pain services. Management of Fluid in Hospitalized Patients: At the end of the learning unit, you should be able to do the following: a) Review the physiological basis of water balance in the body. b) Assess a patient for his/her hydration status. c) Recognize a patient with over and under hydration. d) Order fluid therapy (oral as well as intravenous) for a hospitalized patient. e) Monitor fluid status and response to therapy through history, physical examination, and selected laboratory investigations. Management of Acid-Base Electrolyte Imbalances: At the end of the learning unit, you should be able to do the following: a) Review the physiological basis of electrolyte and acid-base balance in the body. b) Identify diseases and conditions that are likely to cause or be associated with acid/base and electrolyte imbalances. c) Correct electrolyte and acid-base imbalances. d) Perform careful calculations, checks, and other safety measures while correcting acid-base and electrolyte imbalances. e) Monitor responses to therapy through history, physical examination, and selected laboratory investigations. Module 5: Frail Elderly 22. Assessment of Frail Elderly 23. Mini-Mental State Examination 24. Prescribing Drugs in the Elderly 25. Care of the Elderly SAUDI DIABETES FELLOWSHIP CURRICULUM 91

95 UNIVERSAL TOPICS Assessment of Frail Elderly: At the end of the learning unit, you should be able to do the following: a) Enumerate the differences and similarities between comprehensive assessment of the elderly and assessment of other patients. b) Perform comprehensive assessment, in conjunction with other members of the health care team, of frail elderly persons with a special emphasis on social factors, functional status, quality of life, diet and nutrition, and medication history. c) Develop a problem list based on the assessment of the elderly. Mini-Mental State Examination: At the end of the learning unit, you should be able to do the following: a) Review the appropriate usages, advantages, and potential pitfalls of the mini-mse. b) Identify patients suitable for the mini-mse. c) Screen patients for cognitive impairment through the mini-mse. Prescribing Drugs in the Elderly: At the end of the learning unit, you should be able to do the following: a) Discuss the principles of prescribing in the elderly. b) Recognize poly-pharmacy, prescribing cascade, inappropriate dosages, inappropriate drugs, and deliberate drug exclusion as major causes of morbidity in the elderly. c) Describe the physiological and functional declines in the elderly that contribute to increased drug-related adverse events. d) Discuss drug interactions and drug-disease interactions among the elderly. e) Be familiar with the Beers Criteria. f) Develop a rational prescribing habit for the elderly. g) Counsel elderly patients and family on safe medication usage. Care of the Elderly: At the end of the learning unit, you should be able to do the following: a) Describe the factors that need to be considered while planning care for the elderly. b) Recognize the needs and wellbeing of caregivers. c) Identify the local and community resources available in the care of the elderly. d) Develop, with inputs from other health care professionals, individualized care plan for an elderly patient. Module 6: Ethics and Healthcare 26. Occupational Hazards of HCW 27. Evidence-based Approach to Smoking Cessation 92 SAUDI DIABETES FELLOWSHIP CURRICULUM

96 UNIVERSAL TOPICS 28. Patient Advocacy 29. Ethical Issues: Transplantation/Organ Harvesting; Withdrawal of Care 30. Ethical Issues: Treatment Refusal; Patient Autonomy 31. Role of Doctors in Death and Dying Occupation Hazards of Health Care Workers (HCW): At the end of the learning unit, you should be able to do the following: a) Recognize common sources and risk factors of occupational hazards among the HCW. b) Describe common occupational hazards in the workplace. c) Develop familiarity with legal and regulatory frameworks governing occupational hazards among the HCW. d) Develop a proactive attitude to promoting workplace safety. e) Protect yourself and colleagues against potential occupational hazards in the workplace. Evidence-based Approach to Smoking Cessation: At the end of the learning unit, you should be able to do the following: a) Describe the epidemiology of smoking and tobacco usage in Saudi Arabia. b) Review the effects of smoking on the smoker and family members. c) Effectively use pharmacologic and non-pharmacologic measures to treat tobacco usage and dependence. d) Effectively use pharmacologic and non-pharmacologic measures to treat tobacco usage and dependence among special population groups, such as pregnant women, adolescents, and patients with psychiatric disorders. Patient Advocacy: At the end of the learning unit, you should be able to do the following: a) Define patient advocacy. b) Recognize patient advocacy as a core value governing medical practice. c) Describe the role of patient advocates in the care of the patients. d) Develop a positive attitude toward patient advocacy. e) Be a patient advocate in conflicting situations. f) Be familiar with local and national patient advocacy groups. SAUDI DIABETES FELLOWSHIP CURRICULUM 93

97 UNIVERSAL TOPICS Ethical issues: transplantation/organ harvesting; withdrawal of care: At the end of the learning unit, you should be able to do the following: a) Apply key ethical and religious principles governing organ transplantation and withdrawal of care. b) Be familiar with the legal and regulatory guidelines regarding organ transplantation and withdrawal of care. c) Counsel patients and families in the light of applicable ethical and religious principles. d) Guide patients and families to make informed decisions. Ethical issues: treatment refusal; patient autonomy: At the end of the learning unit, you should be able to do the following: a) Predict situations where a patient or family is likely to decline prescribed treatment. b) Describe the concept of rational adult in the context of patient autonomy and treatment refusal. c) Analyze key ethical, moral, and regulatory dilemmas in treatment refusal. d) Recognize the importance of patient autonomy in the decision-making process. e) Counsel patients and families declining medical treatment in light of the patients best interests. Role of Doctors in Death and Dying: At the end of the learning unit, you should be able to do the following: a) Recognize the important role a doctor can play during a dying process. b) Provide emotional as well as physical care to a dying patient and family. c) Provide appropriate pain management in a dying patient. d) Identify suitable patients and refer patients to palliative care services. 94 SAUDI DIABETES FELLOWSHIP CURRICULUM

98 ASSESSMENT ASSESSMENT SAUDI DIABETES FELLOWSHIP CURRICULUM 95

99 ASSESSMENT Description: Evaluation and assessment of fellows throughout the program are undertaken in accordance with the Commission's training and examination rules and regulations. This includes the following: Annual Assessment: 2. Continuous Appraisal This assessment is conducted toward the end of each training rotation throughout the academic year and at the end of each academic year as a continuous means of both formative and summative evaluation Continuous formative evaluation: To fulfill the CanMEDS competencies based on the end-of-rotation evaluation, the fellow's performance will be evaluated jointly by relevant staff members who will assess the following competencies: Performance of the trainee during daily work Performance and participation in academic activities (see the Evaluation of the presenter by staff supervisor form below) Performance in 10 to 20 minutes of directly observed trainee patient interaction. Trainers are encouraged to perform at least one assessment per clinical rotation, preferably near the end of the rotation. Trainers should provide timely and specific feedback to the trainee following each assessment of trainee patient encounters (Mini Clinical Evaluation Exercise [Mini-CEX] and case-based discussions) Trainee s performance of diagnostic and therapeutic procedural skills. Timely and specific feedback from the trainer to the trainee is mandatory following each procedure (direct observation of procedural skills). 96 SAUDI DIABETES FELLOWSHIP CURRICULUM

100 ASSESSMENT The CanMEDS-based competencies end-of-rotation evaluation form must be completed (preferably in electronic format), with the signatures of at least two consultants, within two weeks of the end of each rotation. The program director discusses evaluations with fellows as necessary. The evaluation form is submitted to the SCFHS Regional Training Supervisory Committee within four weeks of the end of the rotation Academic and clinical assignments should be documented on an electronic tracking system (e-logbook, when applicable) on an annual basis (Appendix 1). Evaluations are based on accomplishment of the minimum requirements for the procedures and clinical skills, as determined by the program Summative continuous evaluation: A summative continuous evaluation report is prepared for each fellow at the end of each academic year and may also involve clinical or oral examinations, an objective structured practical examination, or an objective structured clinical examination. 2. End-of-first-year examination: The end-of-year examination will be limited to F1 fellows. The number of examination items, eligibility, and passing score are established in accordance with the Commission's training and examination rules and regulations. Examination details and a blueprint are published on the Commission website, Final In-training Evaluation Report (FITER)/Comprehensive Competency Report (CCR) In addition to the local supervising committee s approval of the completion of the clinical requirements (via the fellow s logbook), the program directors prepare a FITER for each fellow at the end of the final year of fellowship (F2). This could also involve clinical or oral examinations or completion of other academic assignments. SAUDI DIABETES FELLOWSHIP CURRICULUM 97

101 ASSESSMENT Final Diabetes Fellowship Examination (Final Saudi Diabetes Fellowship Examination) The final Saudi Board examination consists of two parts: 1. Written Examination This examination assesses the trainee s theoretical knowledge base (including recent advances) and problem-solving capabilities in the diabetes medicine specialty; it is delivered in MCQ format and is held at least once per year. The number of examination items, eligibility, and passing score are established in accordance with the Commission's training, and examination rules and regulations. Examination details and a blueprint are published on the Commission s website, 2. Oral Structure Clinical Examination (OSCE): Certification This examination assesses a broad range of high-level clinical skills, including data gathering, patient management, communication, and counseling. The examination is held at least once per year, as an objective structured clinical examination (OSCE) in the form of patient management problems (PMPs). Eligibility and the passing score are established in accordance with the Commission's training and examination rules and regulations. Examination details and a blueprint are published on the Commission website, A certificate acknowledging training completion will only be issued to the fellow upon successful fulfillment of all program requirements. Candidates passing all components of the final specialty examination are awarded the Saudi Fellowship of Diabetes certificate. 98 SAUDI DIABETES FELLOWSHIP CURRICULUM

102 SUGGESTED LEARNING RESOURCES SUGGESTED LEARNING RESOURCES SAUDI DIABETES FELLOWSHIP CURRICULUM 99

103 SUGGESTED LEARNING RESOURCES Fellows are requested to use major textbooks and electronic resources suggested by the faculty. These include: Endocrinology textbooks (Williams or Becker) Up-to-date practice guidelines of the American Diabetes Association ( American Association of Clinical Endocrinologists ( The Endocrine Society ( The European Association for the Study of Diabetes ( Fellows are encouraged to read monthly The Journal of Clinical Endocrinology and Metabolism Endocrine Reviews Diabetes Diabetes Care Diabetes Reviews The Journal of Clinical Investigation Others depending on their specific interests Universal online topics Macleod s Clinical Examination Hutchison s Clinical Methods Bates Clinical Examination SAUDI DIABETES FELLOWSHIP CURRICULUM

104 APPENDICES APPENDICES SAUDI DIABETES FELLOWSHIP CURRICULUM 101

105 APPENDICES Objectives Of The Log Book The objectives of the e-logbook system are as follows: Maintain records and document all academic activities (e.g., procedures, lectures, journal clubs, meetings, training courses, workshops, symposia, and case presentations) undertaken during the training program: - Assist the fellow in identifying his or her deficiencies in specific areas. - Assist the program director/evaluator in documenting the contribution and evaluation of trainees. - Provide the evaluator with guidance regarding appropriate and fair assessment of trainees. - Provide the program director with guidance regarding deficiencies in training. Guidelines For Fellows - Fellows are required to maintain log books during the entire training period. - Log book entries concerning recorded activities should be completed on the day on which the activities occur. - All entries must be signed by a mentor within one week. - Fellows should discuss their training progress, as indicated in the log book, with the mentor and/or program director every month. - Fellows should submit their completed log books to the program director at the end of rotations and training, for subsequent submission to the regional supervisory committee. - If a log book is not signed by the program director, the fellow will be ineligible for endof-training certification and final examination. 102 SAUDI DIABETES FELLOWSHIP CURRICULUM

106 APPENDICES Appendix 2/Evaluation Forms END OF ROTATION EVALUATION FORM Center: Fellowship Level: Name: Registration: Rotation: Period: Level Clear failure (1) Borderline (2) Clear Pass (3) Exceeds Expectations (4) Not applicable A. Medical Expert Basic and Clinical Knowledge 1. Understands the basic and clinical science and pathophysiology of common diabetesrelated diseases. 2. Understands the clinical presentation, natural history, and prognosis of common diabetesrelated entities. 3. Demonstrates expertise in all aspects of the diagnosis and management of common diabetesrelated entities. 4. Practices contemporary evidence-based and cost-effective medicine. SAUDI DIABETES FELLOWSHIP CURRICULUM 103

107 APPENDICES Level Clear failure (1) Borderline (2) Clear Pass (3) Exceeds Expectations (4) Not applicable 5. Avoids unnecessary or harmful investigations or management. 6. Provides care to diverse communities. 7. Demonstrates appropriate knowledge, skills, and attitudes regarding gender, culture, and ethnicity issues. 8. Completes accurate histories and physical examinations. 9. Formulates appropriate differential diagnoses. 10. Develops an appropriate plan of investigation and interprets the results. 11. Develops a therapeutic plan. 12. Develops a plan of secondary prevention. 13. Demonstrates appropriate clinical judgment. 104 SAUDI DIABETES FELLOWSHIP CURRICULUM

108 APPENDICES Level Clear failure (1) Borderline (2) Clear Pass (3) Exceeds Expectations (4) Not applicable 14. Demonstrates knowledge of medications used, mechanisms of action, clinically relevant pharmacokinetics, indications, contraindications, and adverse effects. Procedural Skills 15. Understands the indications, contraindications, and complications of specific procedures. 16. Demonstrates mastery of specific procedure techniques. B. Communicator 17. Records appropriate progress notes, and transfer and discharge summaries. 18. Communicates with junior medical, nursing, and allied health staff in an appropriate manner. SAUDI DIABETES FELLOWSHIP CURRICULUM 105

109 APPENDICES 19. Communicates with patients appropriately. 20. Communicates with patients families appropriately. 21. Establishes therapeutic relationships with patients and their families. 22. Delivers understandable information to patients and their families. 23. Provides effective counseling to patients and their families. 24. Maintains professional relationships with other health care providers. 25. Provides clear and complete records, reports, and informed and written consent. C. Collaborator 26. Works effectively in a team environment. 106 SAUDI DIABETES FELLOWSHIP CURRICULUM

110 APPENDICES 27. Is able to work with allied health care staff. 28. Is able to work with nursing staff. 29. Is able to work with attending and junior medical staff. 30. Consults with other physicians and health care providers effectively. D. Manager 31. Participates in activities that contribute to the effectiveness of healthcare organizations and systems. 32. Manages his or her practice and career effectively. 33. Allocates finite health care resources appropriately. 34. Serves in administration and leadership roles as appropriate. 35. Uses information technology to optimize patient care, lifelong learning, and other activities. E. Health Advocate SAUDI DIABETES FELLOWSHIP CURRICULUM 107

111 APPENDICES 36. Attentive to preventive measures. 37. Demonstrates adequate patient education regarding compliance and the role of medication. 38. Attentive to issues in public health policy. 39. Recognizes important social, environmental, and biological determinants of health. 40. Demonstrates concern that patients have access to appropriate support, information, and services. 41. Offers advocacy on behalf of patients at practice and general population levels. F. Scholar 42. Attends and contributes to rounds, seminars, and other learning events. 43. Presents elected topics in an appropriate manner, as requested. 44. Demonstrates adequate ability to search literature. 45. Demonstrates efforts to increase knowledge base. 108 SAUDI DIABETES FELLOWSHIP CURRICULUM

112 APPENDICES 46. Accepts and acts on constructive feedback. 47. Reads about patient cases and takes an evidence-based approach to management problems. 48. Contributes to the education of patients, house staff, students, and other health professionals. 49. Contributes to the development of new knowledge. G. Professional 50. Recognizes his or her own limitations and seeks advice and consultation when necessary. 51. Understands the professional, legal, and ethical obligations of physicians. 52. Delivers evidencebased care with integrity, honesty, and compassion. 53. Demonstrates appropriate insight into his or her own strengths and weaknesses. 54. Shows initiative within the limits of knowledge and training. 55. Discharges duties and assignments responsibly, and in a timely and ethical manner. SAUDI DIABETES FELLOWSHIP CURRICULUM 109

113 APPENDICES 56. Reports facts accurately, including his or her own errors. 57. Maintains appropriate boundaries in work and learning situations. 58. Respects diversity in race, age, gender, disability, intelligence, and socioeconomic status. 110 SAUDI DIABETES FELLOWSHIP CURRICULUM

114 APPENDICES Overall Rating = Total Points # of Evaluated Items Total Score = x 25 = Comments: I certify that I have read all parts of this evaluation report and have discussed it with the evaluators. Fellow's Name: Signature: Evaluator s- Name: Signature: Evaluator s- Name: Signature: Program-Director s Name: Signature: SAUDI DIABETES FELLOWSHIP CURRICULUM 111

115 APPENDICES MINI CLINICAL EVALUATION EXERCISE (MINI-CEX) Evaluator s Name: Evaluator Position: Date: Trainee s Name: Registration No.: Residency Level: BRIEF SUMMARY OF THE CASE o New o Follow-up Assessment Setting: o Inpatient o Ambulatory o ICU o CCU o Emergency Department o Others: Complexity: olow omoderate ohigh Focus: Data Gathering: Diagnosis: Therapy: Counseling: Assessment: SCORE FOR TRAINING STAGE Questions Taking history Physical examination skills Communicati on skills Critical judgment Humanistic quality/profes sionalism Organization and efficiency Overall clinical care Unsatisfactory Satisfactory Superior Mini-CEX time: Observing: min; Providing feedback: min Evaluator satisfaction with Mini-CEX: Low High Trainee satisfaction with Mini-CEX: Low High 112 SAUDI DIABETES FELLOWSHIP CURRICULUM

116 APPENDICES Trainees: Evaluator: Remarks: Question Description Taking history Facilitates patients in telling their stories; uses appropriate questions to obtain accurate, adequate information effectively; and responds to verbal and nonverbal cues appropriately. Physical examination skills Communication skills Follows an efficient, logical sequence; examinations are appropriate for clinical problems; provides patients with explanations; and is sensitive to patients comfort and modesty. Explores patients perspectives; jargon-free speech; open and honest; empathic; and agrees with management plans and therapies with patients. Critical judgment Forms appropriate diagnoses and suitable management plans, orders selectively and performs appropriate diagnostic studies, and considers risks and benefits. Humanistic quality/professionalism Organization and efficiency Overall clinical care Shows respect, compassion, and empathy; establishes trust; attends to patient s comfort needs; respects confidentiality; behaves in an ethical manner; and is aware of legal frameworks and his or her own limitations. Prioritizes, is timely and succinct, and summarizes. Demonstrates global judgment based on the above topics. SAUDI DIABETES FELLOWSHIP CURRICULUM 113

117 APPENDICES Direct Observation Of Procedural Skills Assessment Form Trainee s Name: Observation: Observed by: Registration No. Registration No. Date: Signature of supervising: Description Satisfactory Unsatisfactory Comment Understood the indications for the procedure and clinical alternatives. Explained plans and potential risks to the patient clearly and in an understandable manner. Good understanding of the theoretical background, including anatomy, physiology, and imaging, of the procedure. Good advance preparation for the procedure. Communicated the procedure plan to relevant staff. Aware of risks of cross infection and demonstrated an effective aseptic technique during the procedure. Procedure success or failure was understood in the current setting. Coped well with unexpected problems. Skillful and handled patient and tissues gently. Maintained accurate and legible records, including descriptions of problems or difficulties. Issued clear post-procedural instructions to the patient and/or staff. 114 SAUDI DIABETES FELLOWSHIP CURRICULUM

118 APPENDICES Sought to work to the highest professional standards at all times. ASSESSMENT Practice was satisfactory. Practice was unsatisfactory. Examples of good practice: Areas of practice requiring improvement: Further learning and experience should focus on the following: SAUDI DIABETES FELLOWSHIP CURRICULUM 115

119 APPENDICES Fellow Presentation Evaluation by Staff Supervisor Fellow's Name: Level: Supervisor: Date of Presentation: Topic: Please use the following scale to evaluate the presentation: Very Weak Weak Acceptable Good Very Good Medical Expert Demonstrated a thorough knowledge of the topic - Presented at the appropriate level and with adequate details - Comments (optional) Communicator - Provided objectives and an outline - Presentation was clear and organized - Used clear, concise, and legible materials - Used effective methods and presentation style - Established a good rapport with the audience 116 SAUDI DIABETES FELLOWSHIP CURRICULUM

120 APPENDICES Collaborator - Invited comments from learners and led discussions - Worked with staff supervisor effectively in preparing the sessions - Comments (optional) Health Advocate - Managed time effectively - Addressed preventive aspects of care, if relevant - Comments (optional) Scholar - Posed appropriate learning questions - Accessed and interpreted the relevant literature - Comments (optional) Professional - Maintained patient confidentiality if clinical material was used - Identified and managed relevant conflicts of interest - Comments (optional) SAUDI DIABETES FELLOWSHIP CURRICULUM 117

121 APPENDICES Fellow Evaluation Of The Different Components Of The Core Curriculum FELLOW EVALUATION OF THE DIFFERENT COMPONENTS OF THE CORE CURRICULUM Fellow's Name: Level: Staff Supervisor: Date of Session: Name of Session: A. How would you evaluate the value of this session? 1 = Very low, 2 = Low, 3 = Moderate, 4 = High, 5 = Very high B. How well did this session meet your educational needs? 1 = Not at all, 2 = Slightly, 3 = Moderately, 4 = Very, 5 = Extremely C. Should this session be continued in the future? Yes/No D. At which level should this session be aimed? E. At what time of the year should this session be conducted? F. Have you had an opportunity to practice this skill? Yes/No G. Do you have any suggestions on how to improve this session? 118 SAUDI DIABETES FELLOWSHIP CURRICULUM

122 APPENDICES SAUDI DIABETES FELLOWSHIP CURRICULUM 119

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