Leadership Corner – March 2023

March 7, 2023

A Follow-Up Commentary on the Endocrinology Subspecialty Exam ABIM Pass Rates – The Sobering News Continues for the 2022 Exam

Greg Hong, MD, PhD
Associate Professor
Program Director, Endocrinology & Metabolism Fellowship
Pituitary Program, Division of Endocrinology, Department of Medicine
University of Virginia Health System

One year later after my initial commentary on the surprising decline in our Endocrinology ABIM pass rates (https://www.apdem.org/program-director-corner/a-commentary-on-the-2021-endocrinology-subspecialty-exam-abim-pass-rates/#:~:text=Of%20note%2C%20the%20pass%20rate,nadir%20of%2074%25%20for%202021) the Endocrinology Program Director (PD) community finds ourselves in a similarly grim situation – the pass rate for 1st time test takers in 2022 remains a discouraging 74% (same as 2021), which represents the lowest pass rate of any internal medicine subspecialty.  In comparison, the average Endocrinology pass rate for the 3 year period from 2018 through 2020 was 88%.  This decline in pass rates over the past 2 years (an almost 15% drop in absolute pass rates) is particularly noteworthy as it is limited to Endocrinology and was not seen to a similar degree in other internal medicine subspecialties.  Certainly it can be noted that other specialties have seen declines in their pass rates over the past 2 years, but none of them have fallen as precipitously as Endocrinology.

Over the past year, the ABIM, with participation from APDEM, has begun analysis of potential reasons for this surprising decline.  Of note, the data obtained so far is specific to the 2021 exam, as we do not have detailed analysis of the most recent 2022 exam available yet.  However I expect that whatever factors contributed to poor 2021 performance are likely still contributing to the poor performance in 2022. A summary of the findings to date, which were presented at the annual APDEM meeting in May 2022, are presented below, with my commentary also included. 

1. Per the ABIM, there have been no changes to the ABIM board exam content or format since 2018 which would explain the marked drop in pass rates.  Of note, candidate perception of the “fairness” of the ABIM board exam has steadily fallen between 2019 to 2021.  While it is certainly tempting to blame the exam itself (especially in light of the candidates’ perception), there does not seem to be any hard data suggesting that the exam itself is the reason for the sudden decline in pass rates.  It is my understanding that analysis of the exam itself continues to be an ongoing endeavor by the ABIM.
2. A greater % than usual of 2020 graduates deferred taking their exam until the 2021 period.  Historically, those who delay taking their board exam perform worse than those who do not.  Hence it could be feasible that lower pass rates were a reflection of an unusual pool of test takers with a higher % of historically poorly performing candidates.  However 2 key findings weaken this possibility: (1) All subspecialties, not just Endocrinology, had a similar make up of test takers (e.g. 2020 graduate deferment was seen across the board and not just limited to Endocrinology) and (2) the 2020 graduates actually outperformed the 2021 graduates – and surprisingly, this better-than-expected performance of the 2020 graduates (e.g. those who had deferred for a year) was limited only to Endocrinology.
3. 2021 graduates performed significantly lower in certain content areas (adrenal, pituitary, female & male reproduction) when compared to 2020 & 2019 graduates.  This suggests that targeted review in these specific areas may be of value to PDs and fellows across the nation.
4. Between 2019 to 2021, in-person review course attendance steadily fell while at home review steadily increased.  While it is unclear whether this is truly playing a role in declining pass rates, it raises the question of whether in-person course attendance is worth funding, particularly for fellows of concern.  Preliminary studies of education in general indicate that in-person learning is often superior to virtual learning (as an example, see Gross et. al, Am J of Distance Education, 37(1):66-77).  This also raises the possibility that the current resources most commonly used for at home review (e.g. ESAP, Endocrine Board Review – both of which come out with new editions every 1-2 years) may not adequately reflect the current ABIM exam content.

At this time we are left without clear answers on the cause of the pass rate decline.  Of significant concern are numerous anecdotal reports from other PDs of excellent fellows failing the ABIM exam (GH: personal communications), suggesting that ABIM exam results do not correlate with our (PD) perception of clinical excellence.  In my opinion, further discussion of the following questions would be of substantial benefit to both the PD community and the Endocrinology community as a whole:

1. How can we identify those in danger of failing the ABIM exam early on?  Previous data indicated that ITE performance correlated with ABIM performance (Horton WB, et al, JES 2021).  Does this relationship still hold in the new environment where the pass rate is now only 74%?  Would there be value in keeping the ITE question pool relatively static (e.g. not using an entirely new question pool every year) such that we could predict future ABIM performance based on past analysis of performance on a static ITE question pool?  What does the current 2022 data say about a correlation between ABIM Internal Medicine Exam performance and Endocrinology Subspecialty Exam performance, and is this similar to years past?
2. Is there a current disconnect between everyday clinical practice/training and what is tested on the ABIM exam?  Should the ABIM content areas (or questions) be adapted to better reflect the current knowledge needed for competency in modern clinical practice situations?  Or do we need to adjust our current educational model (including re-examining the most commonly used board preparation materials) to ensure that we are adequately teaching the ABIM specified content areas (https://www.abim.org/Media/wxbjt5o3/endocrinology-diabetes-metabolism.pdf).

Unfortunately we are left in an unenvious place – faced with a serious problem without knowing the root cause(s), thereby making formulation of specific solutions difficult.  Further investigation into the root cause(s) of the pass rate decline is urgently needed, and APDEM will partner with the ABIM and Endocrine Society to address this critical issue moving forward.  The APDEM council also welcomes any ideas and suggestions on additional steps for APDEM to take to better support those responsible for the future of endocrinology – our PDs and the trainees they educate. 

Please feel free to join the discussion on the APDEM facebook community, or to contact me directly at gkh7z@virginia.edu.

Dr. Greg Hong is a member of APDEM’s Council, and also serves on the Membership Recruitment Committee and is co-chair of the APDEM Fellow Recruitment Subcommittee. 

APDEM Facebook Group – If you are interested in joining the APDEM Facebook group, please search for ‘Association of Program Directors in Endocrinology, Diabetes and Metabolism’ in Facebook. You will be asked a series of questions, and then admitted once your membership in APDEM has been confirmed. If you have any questions about this group, please email David Lieb, Chair, Newsletter Committee, at liebdc@evms.edu.

Leadership Corner – June 2023 TEST FILE

June 26, 2023

A Follow-Up Commentary on the Endocrinology Subspecialty Exam ABIM Pass Rates – The Sobering News Continues for the 2022 Exam

Greg Hong, MD, PhD
Associate Professor
Program Director, Endocrinology & Metabolism Fellowship
Pituitary Program, Division of Endocrinology, Department of Medicine
University of Virginia Health System

One year later after my initial commentary on the surprising decline in our Endocrinology ABIM pass rates (https://www.apdem.org/program-director-corner/a-commentary-on-the-2021-endocrinology-subspecialty-exam-abim-pass-rates/#:~:text=Of%20note%2C%20the%20pass%20rate,nadir%20of%2074%25%20for%202021) the Endocrinology Program Director (PD) community finds ourselves in a similarly grim situation – the pass rate for 1st time test takers in 2022 remains a discouraging 74% (same as 2021), which represents the lowest pass rate of any internal medicine subspecialty.  In comparison, the average Endocrinology pass rate for the 3 year period from 2018 through 2020 was 88%.  This decline in pass rates over the past 2 years (an almost 15% drop in absolute pass rates) is particularly noteworthy as it is limited to Endocrinology and was not seen to a similar degree in other internal medicine subspecialties.  Certainly it can be noted that other specialties have seen declines in their pass rates over the past 2 years, but none of them have fallen as precipitously as Endocrinology.

Over the past year, the ABIM, with participation from APDEM, has begun analysis of potential reasons for this surprising decline.  Of note, the data obtained so far is specific to the 2021 exam, as we do not have detailed analysis of the most recent 2022 exam available yet.  However I expect that whatever factors contributed to poor 2021 performance are likely still contributing to the poor performance in 2022. A summary of the findings to date, which were presented at the annual APDEM meeting in May 2022, are presented below, with my commentary also included. 

Leadership Corner – March 2023

March 7, 2023

A Follow-Up Commentary on the Endocrinology Subspecialty Exam ABIM Pass Rates – The Sobering News Continues for the 2022 Exam

Greg Hong, MD, PhD
Associate Professor
Program Director, Endocrinology & Metabolism Fellowship
Pituitary Program, Division of Endocrinology, Department of Medicine
University of Virginia Health System

One year later after my initial commentary on the surprising decline in our Endocrinology ABIM pass rates (https://www.apdem.org/program-director-corner/a-commentary-on-the-2021-endocrinology-subspecialty-exam-abim-pass-rates/#:~:text=Of%20note%2C%20the%20pass%20rate,nadir%20of%2074%25%20for%202021) the Endocrinology Program Director (PD) community finds ourselves in a similarly grim situation – the pass rate for 1st time test takers in 2022 remains a discouraging 74% (same as 2021), which represents the lowest pass rate of any internal medicine subspecialty.  In comparison, the average Endocrinology pass rate for the 3 year period from 2018 through 2020 was 88%.  This decline in pass rates over the past 2 years (an almost 15% drop in absolute pass rates) is particularly noteworthy as it is limited to Endocrinology and was not seen to a similar degree in other internal medicine subspecialties.  Certainly it can be noted that other specialties have seen declines in their pass rates over the past 2 years, but none of them have fallen as precipitously as Endocrinology.

Over the past year, the ABIM, with participation from APDEM, has begun analysis of potential reasons for this surprising decline.  Of note, the data obtained so far is specific to the 2021 exam, as we do not have detailed analysis of the most recent 2022 exam available yet.  However I expect that whatever factors contributed to poor 2021 performance are likely still contributing to the poor performance in 2022. A summary of the findings to date, which were presented at the annual APDEM meeting in May 2022, are presented below, with my commentary also included. 

1. Per the ABIM, there have been no changes to the ABIM board exam content or format since 2018 which would explain the marked drop in pass rates.  Of note, candidate perception of the “fairness” of the ABIM board exam has steadily fallen between 2019 to 2021.  While it is certainly tempting to blame the exam itself (especially in light of the candidates’ perception), there does not seem to be any hard data suggesting that the exam itself is the reason for the sudden decline in pass rates.  It is my understanding that analysis of the exam itself continues to be an ongoing endeavor by the ABIM.
2. A greater % than usual of 2020 graduates deferred taking their exam until the 2021 period.  Historically, those who delay taking their board exam perform worse than those who do not.  Hence it could be feasible that lower pass rates were a reflection of an unusual pool of test takers with a higher % of historically poorly performing candidates.  However 2 key findings weaken this possibility: (1) All subspecialties, not just Endocrinology, had a similar make up of test takers (e.g. 2020 graduate deferment was seen across the board and not just limited to Endocrinology) and (2) the 2020 graduates actually outperformed the 2021 graduates – and surprisingly, this better-than-expected performance of the 2020 graduates (e.g. those who had deferred for a year) was limited only to Endocrinology.
3. 2021 graduates performed significantly lower in certain content areas (adrenal, pituitary, female & male reproduction) when compared to 2020 & 2019 graduates.  This suggests that targeted review in these specific areas may be of value to PDs and fellows across the nation.
4. Between 2019 to 2021, in-person review course attendance steadily fell while at home review steadily increased.  While it is unclear whether this is truly playing a role in declining pass rates, it raises the question of whether in-person course attendance is worth funding, particularly for fellows of concern.  Preliminary studies of education in general indicate that in-person learning is often superior to virtual learning (as an example, see Gross et. al, Am J of Distance Education, 37(1):66-77).  This also raises the possibility that the current resources most commonly used for at home review (e.g. ESAP, Endocrine Board Review – both of which come out with new editions every 1-2 years) may not adequately reflect the current ABIM exam content.

At this time we are left without clear answers on the cause of the pass rate decline.  Of significant concern are numerous anecdotal reports from other PDs of excellent fellows failing the ABIM exam (GH: personal communications), suggesting that ABIM exam results do not correlate with our (PD) perception of clinical excellence.  In my opinion, further discussion of the following questions would be of substantial benefit to both the PD community and the Endocrinology community as a whole:

1. How can we identify those in danger of failing the ABIM exam early on?  Previous data indicated that ITE performance correlated with ABIM performance (Horton WB, et al, JES 2021).  Does this relationship still hold in the new environment where the pass rate is now only 74%?  Would there be value in keeping the ITE question pool relatively static (e.g. not using an entirely new question pool every year) such that we could predict future ABIM performance based on past analysis of performance on a static ITE question pool?  What does the current 2022 data say about a correlation between ABIM Internal Medicine Exam performance and Endocrinology Subspecialty Exam performance, and is this similar to years past?
2. Is there a current disconnect between everyday clinical practice/training and what is tested on the ABIM exam?  Should the ABIM content areas (or questions) be adapted to better reflect the current knowledge needed for competency in modern clinical practice situations?  Or do we need to adjust our current educational model (including re-examining the most commonly used board preparation materials) to ensure that we are adequately teaching the ABIM specified content areas (https://www.abim.org/Media/wxbjt5o3/endocrinology-diabetes-metabolism.pdf).

Unfortunately we are left in an unenvious place – faced with a serious problem without knowing the root cause(s), thereby making formulation of specific solutions difficult.  Further investigation into the root cause(s) of the pass rate decline is urgently needed, and APDEM will partner with the ABIM and Endocrine Society to address this critical issue moving forward.  The APDEM council also welcomes any ideas and suggestions on additional steps for APDEM to take to better support those responsible for the future of endocrinology – our PDs and the trainees they educate. 

Please feel free to join the discussion on the APDEM facebook community, or to contact me directly at gkh7z@virginia.edu.

Dr. Greg Hong is a member of APDEM’s Council, and also serves on the Membership Recruitment Committee and is co-chair of the APDEM Fellow Recruitment Subcommittee. 

APDEM Facebook Group – If you are interested in joining the APDEM Facebook group, please search for ‘Association of Program Directors in Endocrinology, Diabetes and Metabolism’ in Facebook. You will be asked a series of questions, and then admitted once your membership in APDEM has been confirmed. If you have any questions about this group, please email David Lieb, Chair, Newsletter Committee, at liebdc@evms.edu.

Leadership Corner – December 2022

APDEM’s Professional Development Event: How to Effectively Provide Feedback

Julie Chen, MD
Assistant Clinical Professor, Medicine, Endocrinology, Gerontology & Metabolism
Stanford Medicine Health Care
Associate Program Director – Stanford University Endocrine Fellowship Program

The Membership Recruitment Committee was very excited to host APDEM’s first professional development event on feedback in November.  One of the things that I most enjoyed about the event was the chance to connect with other program directors across the country in the small breakout groups. This was an opportunity to commiserate in shared challenges but also exchange ideas on potential solutions we could take back and develop within our own programs!

We invited Dr. Addie McClintock from the University of Washington to walk us through how to provide a framework for providing feedback. She also led us through a series of interactive exercises so we could practice our skills.

We discussed the importance of learners having a “growth mindset” that is activated by challenge and view setbacks as a natural part of learning.  This contrasts with a “fixed mindset” which is focused on performance. In a fixed mindset, learners feel the need to hide their deficiencies, avoid critical feedback, and withdraw from challenge.  To encourage a growth mindset, psychological safety and a positive learning environment is foundational.

We reviewed what steps we, as leaders, can take to build psychological safety in the learning environment. The steps include the following:

1. Setting the stage: Set clear and shared expectations upfront. Define what success is at each level. Focus on the shared purpose of learning and providing excellent patient care.
2. Inviting participation: demonstrate humility and acknowledge gaps when they appear (e.g. model “not knowing”). Actively listen and avoid interruptions. Encourage autonomy when appropriate. Elicit trainee specific learning goals. Ask questions to the group rather than to individuals.
3. Responding productively: express appreciation through listening, acknowledging, and being emphatic towards “trainee life.” Destigmatize failure by offering help and brainstorming next steps.

We also reviewed the ADAPT Framework for putting everything together:

An exercise we did together which I found helpful was to practice the observed behaviors without judgement or assumptions. For example, rather than a judgement-based feedback such as “you looked nervous,” we were encouraged to reframe the feedback into an observation such as “I noticed you were looking at the floor and not at the family.”

Finally, we discussed challenging scenarios such as the sensitive learner, the defensive learner, and the clueless learner. For the sensitive learner, strategies included setting the expectation that everybody gets feedback, eliciting bi-directional feedback, and providing positive feedback. For the defensive learner, strategies included emphasizing observations, keeping things concrete, making sure the learner is ready for the feedback, and providing the feedback from an ally or inquiry perspective. For the clueless learner, strategies included providing frequent feedback, having a clear list of next steps and goals, and documentation when appropriate.

We hope that these strategies are ones that you will take with you as you prepare for the semi-annual evaluations with your fellows.  The APDEM professional development event is the first of many to come and we hope to see you at the next one!

Dr. Chen currently serves as chair of APDEM’s Membership Recruitment Committee.

Leadership Corner – October 2022

Transgender Curriculum Implementation

Vin Tangpricha, MD, PhD
Professor of Medicine
Program Director
Emory University School of Medicine

With increasing numbers of transgender and gender diverse youth and adults seeking gender affirming health services over the past several years and recent inclusion of transgender medicine on the ABIM blueprint for the endocrinology board certification exam, APDEM decided to create a transgender medicine curriculum for endocrinology fellowship program directors to implement at their institutions. This past Spring, the APDEM council assembled a task force of experts to provide educational resources and case vignettes that would cover important aspects of transgender medicine. The members of the taskforce included Marina Charitou, Caroline Davidge-Pitts, Ole-Petter Hamnvik, Joshua Safer, and Vin Tangpricha. This new curriculum is and exclusive APDEM member benefit and can be requested by emailing APDEM@endocrine.org. The recommendations for PDs include educational resources on transgender medicine from the Endocrine Society and WPATH guidelines and key review articles. Additional recommendations include didactic lectures as part of the core curriculum, clinical electives with a local transgender expert/team, and a participation in case-based discussions. The case-based discussions are a particularly useful educational exercise for programs that might not have dedicated transgender programs. These 7 cases cover the initiation of gender affirming hormone therapy, addressing fertility concerns, and managing potential complications. Each case is followed by a multi-choice question, discussion of key learning points, and references. Additional resources for program directors are in an appendix which includes links to guidelines, terminology, online content, research articles, and reviews.

As a member of the taskforce, I’m delighted to see that APDEM is providing these resources to our endocrine education community. Transgender care is normal healthcare. All endocrinologists should feel comfortable with prescribing and monitoring sex hormone therapy in all individuals. Providing these educational resources to our trainees is an important key step in normalizing the care for this very vulnerable group of patients who have a difficult time accessing health care services. We hope that these tools are a useful educational resource for your programs.

Leadership Corner – September 2022

Inclusion in Endocrinology Fellowships

David C. Lieb, MD, FACE, FACP
Aaron Vinik, MD, PhD Professor of Internal Medicine
Program Director, Endocrinology Fellowship Program
Eastern Virginia Medical School

For the last month I’ve been involved in something pretty great. The Boy Scouts of America – now called Scouts BSA – has added a new merit badge for all scouts that want to reach the pinnacle of scouting – the Eagle Scout. There have been some famous Eagle Scouts over the years – Neil Armstrong, Bill Gates, and Steven Spielberg to name just a few. My three boys are all very involved in Cub Scouts and Scouts BSA, and hope to join the lofty ranks of Eagle Scouts that have come before them. In order to become an Eagle Scout, they must complete a certain number of 135 available activities, termed merit badges. Some are what you may consider more traditional – involving sports, camping and the arts. But there are more unique badges, like chess, coin collecting, cooking, and even dog care. The goal is to develop well-rounded individuals – and importantly, future leaders.

So what’s the new merit badge? It’s called Citizenship in Society – and per Scouts BSA – the goal of the badge is “to help educate Scouts on what diversity, equity, and inclusion are; why they are important; and how to lead ethically and inclusively to contribute to the cultivation of an environment of belonging for all Scouts”. I’m proud to help co-facilitate the 6 sessions our Troop is holding over the next two months.  In addition to DEI, we’re discussing what it means to be an upstander and an ethical leader.  It’s really great and I’m enjoying the discussions I’ve had with the kids in our troop.

So what does this have to do with endocrinology fellowships? Well, when I had to talk about DEI with a group of 12-15 year olds, I had to think more critically about what it actually means.  And in particular, I have focused on ‘inclusion’. I read a great article about inclusion in the Harvard Business Review (HBR) in preparation for my department’s monthly Leadership Club called ‘A Seat at the Table Is Not Enough’, that focused on inclusion. Basically, corporate boards are more diverse than ever before – but – more diversity does not equal greater inclusion. For example, a study done of 54 US public companies found that while company boards were more diverse, the women and Black directors on the boards typically did not speak as much as the white men on those same boards. There are multiple reasons for this – but the bottom line is that without being inclusive, a more diverse board will lose all of the benefits and significance of that diversity.

In endocrinology, and in APDEM, we are striving to create more diverse fellowship programs – which includes more diverse trainees, leaders and teaching faculty. And as we succeed – we’ll need to ensure that we don’t forget that last part of DEI – the inclusion.  So – how can we be more inclusive? We must include everyone in our program in discussions that create needed change. We need to hear everyone’s opinions and recommendations. This may include hearing someone’s perspective that is different from own – perhaps from their experiences going through medical training in another country, or experiences that they bring with them from a previous career prior to medicine. We must listen to others and provide them with time to talk at each and every gathering we hold. This includes didactics as well as on rounds, and also in important meetings such as our CCC and PEC meetings. Sometimes as a leader it may feel like our role is to speak up, and, well, lead. But – leading often means listening. In fact, from what I’ve experienced thus far as a program director – listening is usually much more important than talking.

Scouts are ‘always prepared’. That’s their motto and has been for over 100 years. As we develop much needed diversity in endocrinology, we need to be prepared to be inclusive as well.

Dr. Lieb serves on APDEM’s Council and is chair of the COVID Task Force, Co-chair of the Newsletter Committee and a member of APDEM’s Diversity, Equity & Inclusion Committee.  He also leads APDEM’s Facebook Group. 

APDEM Facebook Group – If you are interested in joining the APDEM Facebook group, please search for ‘Association of Program Directors in Endocrinology, Diabetes and Metabolism’ in Facebook. You will be asked a series of questions, and then admitted once your membership in APDEM has been confirmed. If you have any questions about this group, please email David Lieb, Newsletter Committee Chair, at liebdc@evms.edu.

President’s Corner – August 2022

Odelia B. Cooper, MD
APDEM President

As the newly minted president of APDEM, I would like to welcome our members and provide some thoughts for the new academic year on fulfilling our role as program directors and associate PDs. We have now on-boarded our new fellows, turning now to the next class to recruit, and juggling our myriad of deadlines for ACGME and program evaluations. And that is in addition to our usual faculty expectations of clinic, teaching, research, and administration. And oh yes, we also have our own personal lives in the background.

We have all learned to adapt and change, especially over the last two years, and we feel more comfortable with our workflows and backup plans as we handle surges, and surges upon surges, staff shortages, supply shortages, variant strains, amidst all the other turmoil of this world.

As PDs, we try to be the role models for our fellows and faculty, maintaining our “aequanimitas.” We aim to live up to the expectations laid out by the ACGME requirements that “the program director model outstanding professionalism, high quality patient care, educational excellence, and a scholarly approach to work…”

That is quite a tall order. I know that I feel satisfied if by the end of the day I answered most of my patient emails, addressed the super urgent Outlook emails, closed my patient encounters, and met the deadlines that were due yesterday.  Was I a role model that day?  Was I compassionate?  I do not usually feel that way. But I think it is our trainees who remind us daily for what we should be striving. Without them, I believe we would miss out on these key aspects of a physician. I will give one example. I was supervising the teaching endocrine clinic one morning and went back into the exam room with the fellow, resident, and medical student in tow. The new patient was struggling with her diabetes and had social and personal challenges. I really wanted to be brief as I knew other patients were waiting, and we were backed up. But I looked behind me, saw the eager, compassionate faces of my trainees, and I just took a seat next to the patient, held her hand, and listened to her concerns. I did not look at the clock and just focused on the patient and worked on building her trust, to show her that we were a team and would help guide her on her journey to controlling her diabetes. Yes, there were tears –the patient, not mine nor the trainees. But she felt reassured and cared for. Later in the day, the medical student wrote to me : “You have already done so much for my education, and I am so grateful for the support, and incredibly fortunate I was able to work with you. I hope to work with you again in the future as well and continue to learn/grow from you!” So yes-I got behind with my patients, but at least for that moment, I did feel like a role model. And who knows, perhaps inspired another student to pursue endocrinology.

Another point to encourage you all is to take time for wellness. I know we hear all about it, and it is even a milestone now for our trainees. However, we should not forget to care for ourselves if we wish to have strength to support our trainees. We need to watch over our care and take advantage of the wellness resources that our institutions offer. Even for 5 minutes a day, as the day winds down, try to  sit, reflect, and do perhaps some guided meditations.

Finally, a way to find fulfillment is to contribute and be part of a greater whole. Giving is the main part of what we do in our field, giving to our trainees, supporting our faculty, encouraging our staff, and helping our patients. I have to say that my work in APDEM over the last several years has given me even more purpose, encourages me to grow and help, and brings meaning to the endless deadlines and paperwork for fellowship.  I feel part of a larger community and not alone. My fellow council members and committee members have become my APDEM friends. And I believe that is what you all are looking for as well as we review your feedback on the surveys and from our discussions at the APDEM booth at ENDO. We are social creatures (even for introverts like myself) and want to share our mutual experiences and concerns and find ways to help each other.

So thank you all for opening up, devoting time to join our committees, and supporting APDEM.  We have a lot of activities and initiatives planned for this year to engage all members and provide the resources you need for optimizing your programs and wellbeing. We look forward to working with you, supporting you, and becoming a closer knit PD community.

Wishing you all a productive, healthy, and safe year. And please reach out anytime to me or anyone on council with suggestions, concerns, or questions at apdem@endocrine.org.

Sincerely,
Odelia B. Cooper, MD
President, APDEM

Odelia B. Cooper, MD is Associate Professor of Medicine and Program Director, Endocrinology, Diabetes, and Metabolism Fellowship at Cedars-Sinai in Los Angeles, California.

Program Director’s Corner – May 2021

APDEM Annual Meeting Summary

Odelia Cooper, MD
Program Director, Endocrine Fellowship Program
Cedars-Sinai Medical Center

On April 29^th APDEM held our Annual Meeting, and though we missed seeing everyone in-person, we were grateful to have a virtual format to communicate with the 132 PDs, associate PDs, and program coordinators that participated. Below is a summary of the meeting.

Our president, Dr. Andrew Gianoukakis, welcomed our new PDs (Drs. Lindsay Bischoff, Brandon Barthel, Christopher Coyne, Sanjay Mediwala, and Tracy Tylee) and APDs (Drs. Elizabeth Lamos and Dragana Lovre) as well as new APDEM council members (Drs. Ricardo Correa, Matthew Levine, and David Lieb), and officers (Drs. Marina Charitou-Secretary/Treasurer and Odelia Cooper-President-Elect).   We bid farewell and thanked the valuable contributions of our outgoing officers – Drs. Christopher McCartney, Mira Torres, and Abid Yaqub.

The financial state of APDEM was reported by our treasurer to be strong.  Our primary investments in 2020 were the annual meeting and administrative time and upkeep from staff.  APDEM membership is robust with 100 active PD members. Please make sure to renew your membership!

The treasurer also presented the updates of the Finance Committee which is responsible for assessing APDEM’s financial well-being and identifying potential fiscal opportunities that will support the mission of the organization.  The committee met earlier this year and approved the 2021 budget. The committee will meet again later this year to review the audit and prepare the 2022 budget. Our focus is to increase membership in APDEM and support from sister societies. We are seeking input for any initiatives, projects, or products that the finance committee should explore. So please – email your ideas to APDEM. (apdem@endocrine.org)

We thanked the continued support from our sister organizations: the American Association of Clinical Endocrinology (AACE), the American Diabetes Association (ADA), and the Endocrine Society, and welcomed our new sister society – the  Pituitary Society and representatives of each organization presented their updates.

Dr. Susan Samson, secretary of AACE, presented very positive feedback received on the virtual Endocrine University and informed us that EU for year two fellows in November will be virtual.  AACE’s annual meeting will be held May 26-29, 2021 and includes the APDEM-AACE program leadership meeting and events for fellow career development. The AACE cardiometabolic conference will be held October 8-10, 2021 virtually. The Lewis Braverman Fund supporting fellows’ educational experiences away from their home programs will open applications in July 2021. There is also now a monthly virtual AACE board review series for fellows based upon their new AACE-Self Assessment Program.

Dr. Victor Bernet from the American Thyroid Association (ATA) highlighted the resources for programs and trainees, including research grants, their webinar series, COVID-19 resources, trainee and early career programs, the ATA Career Links Job Board, virtual education library, thyroid calculators, and patient education resources. The ATA annual virtual meeting will be on Sept. 30-October 3, 2021.

Dr. Carol Wysham, president of the Endocrine Society, highlighted the FLARE program (Future Leaders Advancing Research in Endocrinology) that reaches out to basic scientists, post-doctoral fellows, and junior faculty from underrepresented minorities and provides leadership development training, skill building, and mentorship.  Applications open in August 2021. The Endocrine Society encourages fellows to engage in advocacy efforts to influence practice and policy. The Society also provides the Fellows Training Series, the In-Training Exam, and a Career Development Workshop Library. The Endocrine Feedback Loop is a new monthly journal club podcast which features an expert educator and topic specialist to review recently published articles and discuss implications for clinical practice. The annual ENDO 2021 meeting in March had over 7000 attendees, and sessions are now accessible to members. Finally, Dr. Wysham announced that the Clinical Endocrinology Update and Endocrine Board Review 2021 will be virtual this year and reminded us of the complimentary membership for first-year fellows.

Dr. Maria Fleseriu, director of programs for the Pituitary Society, presented the opportunities for fellow education that they offer.  The Fellows’ Master Course was held in April 2021 which provided 5 hours of recorded lectures and 8 hours of interactive teaching in large and small groups. There are webinars on pituitary disease and complimentary access to the journal Pituitary for members and patient education booklets.

Dr. Gianoukakis then presented the active committees of APDEM and their 54 members who are graciously volunteering their time to further initiatives in fellow education. In addition to our Council, we have an All-In-Match Oversight Task Force, the COVID-19 Task Force, the Diversity, Equity, and Inclusion Committee, Finance Committee, and Newsletter Committee.

The revised 2020 APDEM curriculum is available to PDs, and additional sections are being added, including sections involving transgender endocrinology and health equity. To receive a copy, please email: apdem@endocrine.org

The APDEM Newsletter Committee under the enthusiastic guidance of Dr. David Lieb continues to be a forum to update APDEM members on initiatives and provide resources. All PDs, APDs and program coordinators are encouraged to submit articles, editorials, letters, and to share their COVID-19 experiences and program innovations. You can reach Dr. Lieb at apdem@endocrine.org .

Dr. Matthew Levine, the chair of the All-In-Match Oversight Task Force, presented the findings of the surveillance conducted by the task force. The first round was over the first two months of the academic year, and the second was this past spring, reviewing compliance over a two-year period. Twelve programs were noted to have discrepancies and have been contacted to provide clarifications. Dr. Levine reminded us of the exceptions to AIM policy with the newest exception being if a program is newly accredited or receives complement increase approval from ACGME, they can request an exception to recruit a candidate from match day until June 30 of the same academic year.  As a reminder, any program that meets criteria for an exception to AIM does need to submit a formal request to the AIM committee.

Dr. Rana Malek, co-chair of the Diversity, Equity, and Inclusion (DEI) committee, together with Dr. Ricardo Correa, discussed how this committee helps address the ACGME’s common program requirement to educate fellows on health disparities as part of the professionalism competency (now in Milestones 2.0) as well as a similar call by Association of American Medical Colleges (AAMC). The DEI has two subcommittees, including diversity/inclusion, and health equity. The DEI Committee has sent a survey to PDs and fellows to establish diversity metrics, to understand current state of health equity training in fellowships, and to gauge interest in curriculum development for health equity. Please complete your survey if you have not done so. The chairs of DEI welcome APDEM members to offer their suggestions and input to the committee (apdem@endocrine.org) .

We next focused on the initiatives and actions of our COVID-19 Task Force.  The Task Force was chaired this past year by Drs. David Lieb and Chris McCartney and consisted of 4 subcommittees: Pandemic Emergency Committee (chaired by Drs. Aaron Schulman and Vafa Tabatabaie), Fellow Didactics Committee (chaired by Drs. Ricardo Correa and Deepika Reddy), Patient Care Committee (chaired by Drs. Stephanie Smooke Praw and Emily Szmuilowicz), and Fellow Recruitment Committee (chaired by Drs. Marina Charitou and Saira Khan).

The Fellow Recruitment Committee provided toolkits and guidance for this past year’s interview season. To help formulate recommendations for the upcoming interview season, a survey was sent out to PDs and incoming fellows. Overall, 94% of fellows and 57% of PDs were very satisfied with the match results with the majority of incoming fellows feeling they know the program well. The preferred format for FY22 in the survey was: 1/3 opted to keep all virtual interviews, 1/3 to have an in-person and virtual hybrid model, 25% preferred a virtual interview with optional in-person tour, and 12-15% preferring all in-person. The majority of PDs would like a unified model for interviews. During the meeting, a poll was administered asking if PDs prefer all virtual or hybrid, and 72% responded they prefer all virtual.  The next step of the committee will be to draft an APDEM position statement in time for July and update our recruitment toolkits.

The Fellow Didactics Committee followed up on the response of PDs last year at the annual meeting to create a shared didactic program for our fellowships.  APDEM divided endocrine fellowship programs into 10 geographical regions, and the committee met with each region to help kick off the program. One to two programs took the lead for each region. The New England Endocrine Alliance presented their successful program as an example to help guide other regions. APDEM will continue to facilitate and support each region as the year unfolds.  APDEM members are encouraged to reach out to the chairs with any questions, suggestions, and ideas.  Please see our COVID-19 section on the APDEM website for access to resources: https://www.apdem.org/news-and-information/covid-19-support/

Finally, past APDEM president Dr. Geetha Gopalakrishnan provided an update on Milestones 2.0 just released by the ACGME. The Milestone Working Group developed endocrine-specific milestones, provided more specificity for understanding the milestones, utilized harmonized milestones for the competencies, provided positive language to define fellow progression, and limited the number of sub-competencies.  There are now 19 endocrinology milestones with  shorter verbiage and milestones that address personal and professional well-being and health disparities. For further information, please see Endocrinology, Diabetes, and Metabolism Milestones and Endocrinology, Diabetes, and Metabolism Supplemental Guide . The milestones will start July 2021 with the first reporting in January 2022.  

In summary, the APDEM annual meeting was successful in communicating to endocrine PDs the support and resources in navigating the new world we are facing.  We all feel a part of this close knit community, are all facing the same struggles and challenges, and are looking to each other for comfort and comradery.  In a world that is physically distant, APDEM continues to bring us all together.

And let us hope that next year we can indeed meet in-person.

Dr. Odelia Cooper serves as president-elect, APDEM Council.

Program Director’s Corner – April 2021

Implementing Anti-discrimination Policies

Rana Malek, MD
Program Director, Endocrinology, Diabetes, and Metabolism Fellowship
University of Maryland School of Medicine

On March 16, 2021, 8 people were murdered in a mass shooting that took place in several Atlanta based massage parlors.  Six of the eight victims were women of Asian descent.  This incident is one more violent example of rising anti-Asian sentiment in the United States.

The rise in hate incidents against Asian-Americans began with the emergence of the COVID-19 pandemic in the United States.  According to reports from the Asian Pacific Policy and Planning Council, from 3/19/20 to 5/13/20, more than 1700 anti-Asian hate incidents were documented in the U.S.  However, anti-Asian sentiment is not a new phenomenon and was formalized by the Chinese Exclusion Act of 1882 which suspended Chinese immigration for 10 years and made Chinese immigrants ineligible for naturalization.   Sixty years later, President Franklin Roosevelt signed Executive Order 9066 which forced the relocation of Japanese-Americans, the majority of whom were U.S. citizens, to internment camps.

As program directors we have had to navigate numerous crises over the past year.  We have worked to keep our trainees and colleagues safe in the setting of COVID-19. We have stood in solidarity during Black Lives Matter protests during the summer.  We again stand in solidarity with Asian-Americans and condemn racism.

We need to be more proactive in protecting our trainees, colleagues, and hospital staff from discrimination that they may face.  Many providers have experienced discriminatory behavior from patients who refuse to be seen by female, non-Christian, or non-white physicians.  Providers who have faced this discrimination have felt unprepared for how to handle it, or worse, when it happens to trainees, the trainee may feel abandoned by the system.

The clinical learning environment can play a role in supporting its staff from discrimination.  An excellent model comes from Johns Hopkins Medicine’s Office of Diversity, Inclusion, and Health Equity.  In March 2020, they launched the “Prohibiting Discrimination by Patients Against Employees” policy.  In it, they affirm a patient’s right to be an active participant in their treatment, while also reaffirming their commitment to protect their faculty, staff, and trainees from discrimination by patients and/or health care decision makers

As we think about how to go beyond expression of solidarity, implementing anti-discrimination policies is a concrete example of change we can make as programs directors. Reviewing this thoughtful approach made me reach out to my own GME office to consider establishing a similar hospital wide policy. Having a hospital wide approach means that all staff, not just faculty and trainees but also our nurses, medical assistants, and supporting patient care staff share equal protection.    This is one step we can take in our institutions to implement meaningful benefit to our colleagues that work so hard to deliver quality healthcare.

Dr. Rana Malek is a current member of the APDEM Council.  

Program Directors’ Corner 

Giving Thanks

David C. Lieb, MD, FACE, FACP
Program Director, Endocrinology Fellowship Program
Eastern Virginia Medical School

When people talk about 2020 years from now I’m sure it will bring up terrible memories and thoughts of hardship and grief. The COVID-19 pandemic, the murder of George Floyd, and our contentious election for the presidency have all captured our attention and our hearts. I’m sure I’m not alone when I say that there are parts of 2020 that I hope to forget. I am, however, also thankful. I am thankful for what I’ve learned about myself and about others during these very trying times. I have found a strength and sense of community among my fellow endocrinologists and our endocrine community that I sensed was there before but perhaps never felt in such a palpable, real, practical way. I believe that we all survive, grow, develop and thrive through the relationships we have with others, and this has never been more true than it is now. And I am appreciative for all that I have learned.

I am thankful for my endocrine patients – many of whom typically drive over two hours so that we can discuss their blood glucose values or their last thyroglobulin – many crossing one or more bodies of water – to spend 20 minutes with me. Many of these individuals were thrilled to meet with me virtually over the last six months – and to give me virtual tours of their homes. I met family that I had never met, but had heard their stories. And I am thankful for all of my patients who are essential workers, many of whom have multiple risk factors should they become ill with COVID. I think of them each day as I put on my own mask, clip my insulin pump to my belt, and enter the hospital.

I am thankful for our fellows here at EVMS, and nation- and worldwide. Our four fellows here are all international medical graduates. They often aren’t able to see their families for years at a time, and have relied on Skype and Facebook Messenger to introduce new children and significant others, and at times to grieve and to say goodbye. Until this year I have never in my life been in a situation where I could not get in my car and drive a short distance, or hop on a plane, and see my own family within the day. I am appreciative for all of the sacrifices our fellows make, day in and day out in caring for their patients, for their families and for us – their teachers. Endocrine fellows are always the frontline and that has never been more true than this year. Many of our fellows that had to unexpectedly discontinue their training and become intensivists and hospitalists. For this I will be forever grateful.

I am thankful for all of you, and for APDEM. I feel we accomplished so much through our COVID Task Force – from helping PDs prepare for our difficult virtual interview season, to developing shared didactics and guidance for clinical care to providing advice to programs preparing to enter a more severe stage of the pandemic at their institution. While I gained so much from our Zoom calls and emails – what I appreciated most was the sense of togetherness. I was not alone.  I had all of you to lean on, to vent to, and to learn from. I cannot thank you enough for that strong sense of community and belonging when so much of those feelings have been taken away from us by the pandemic. And I am so proud that APDEM has a new Diversity, Equity and Inclusion Committee. I am thankful for all I have learned from the many, diverse voices on the committee, and know that I will continue to learn from everyone in the future.  Perhaps most important I now feel that I can begin to enact real change to ensure diversity and equity for our patients, our endocrine providers and teachers, and my community. I am learning ways to instruct our fellows and my fellow endocrinologists in issues involving health equity, and also determining how best to ensure continued diversity in our fellowship and faculty.

It’s been a difficult, terrible year. I am hopeful that 2021 will be better. But I know that I am part of a strong, caring, thoughtful endocrine community that will help me through the tough times ahead. And for that I am very thankful.

David C. Lieb, MD, FACE, FACP is an Associate Professor of Internal Medicine and Program Director of the Endocrinology Fellowship Program at Eastern Virginia Medical School in Norfolk, Virginia.  Dr. Lieb serves as Chair of the APDEM Newsletter Committee.