Program Director’s Corner – May 2020
Faculty expertise and fellow supervision requirements: a potential mismatch
Roberto Salvatori, MD
Program Director, Endocrine Fellowship Program
Johns Hopkins University School of Medical
The ACGME requirements for Endocrinology fellowship programs state that: “Faculty members ensure that patients receive the level of care expected from a specialist in the field. They recognize and respond to the needs of the patients, fellows, community, and institution. Faculty members provide appropriate levels of supervision to promote patient safety.”
Diabetes care has evolved over that past few years, with routine use of high technology devices such as insulin pumps, continuous glucose monitoring apparatuses, and possible connections between the two. Appropriate diabetes care requires a deep knowledge of these devices by the care taker. In centers like ours, where faculty member subspecialize in specific areas of endocrinology, attendings who do not take care of diabetes patients in their own practice (like myself) may be unable to properly supervise fellows during the care of diabetes patients who use these devices in the fellows’ continuity clinic. We have therefore made a substantial change to the fellows’ continuity clinic.
Fellows now alternate the location of their weekly continuity clinic between the general endocrine clinic (where they see non-diabetes patients) and the diabetes clinic. In the latter location they are supervised only by faculty members who are diabetes experts and have expert knowledge of diabetes technology and new drug developments. In diabetes clinic fellows have the additional benefit of having a nutritionist and a diabetes educator to whom they can easily refer patients for additional education and support. The fellows have unanimously and enthusiastically liked this change, finding that it has significantly improved both their education and patients’ safety.
Obviously, a similar approach could be considered for other areas of endocrinology (for instance supervising the care of thyroid patients by faculty members who have a specific thyroid sonogram expertise), but practical issues would prevent the application of this model to each area of endocrinology. Nevertheless, the issue of highly subspecialized faculty members—those who know their area of focus exceptionally well but may not have adequately kept up with general endocrine issues—overseeing fellows on general endocrine consults or in continuity clinic is an important one. A PD must decide if a faculty member is suitable or not for such supervision on a case by case basis, listening to the opinions of the fellows, who ultimately are the best judges of the quality of the teaching they receive.