Current Status of Endocrinology in the Region

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Endocrinology and Metabolism Subspecialty Training in Taiwan

TIen-sHang Huang

Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital

Endocrinology and Metabolism board began to be certified as a subspecialty of Internal Medicine since 1988 in Taiwan. After Board certified in Internal medicine, it requires two years training in Endocrinology and Metabolism division of an accredited teaching hospital to be qualified for certification in this subspecialty. The certification process includes a paper test and an oral examination. There is no definite curriculum, but it usually includes the following trainings. 1. Administrative training: Manage the Endocrinology and Metabolism ward, such as admission and dischange of patients; corresponding to NHIB (National Health Insurance Bureau), Endocrine Society、Diabetic Association and TJCHA (Taiwan Joint cornmission on Hospital Accreditation), etc; arrange Clerk、Intern、PGY training course; arrange ward round; attend the department meeting. 2. Teaching training: In charge of Morning meeting, Clerk、Intern、PGY and Resident teaching include correct medical record, feedback, bedside teaching; Endocrine conference; Metabolism conference; medical Grand Round; minisymposium, etc. 3. Clinical skill training: Diabetic complication screening, ultrasound examination of thyroid and neck, Fine needle aspiration of thyroid, lymph node and tumor, Cytology examination of aspirate and stump smear. 4. Clinical training: Familiar with Endocrine and Metabolism diseases’ diagnosis, differential diagnosis, endocrine tests, various guidelines and aware the individualized therapy, Consultation training, In ward and out patient clinic training. Complete the required protofolio. 5. Research training: Every fellow has to participate one attending’s research project and presents (oral or poster) in National or international meeting. Every fellow has to publish at least one paper before the end of training.

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The Current Status of Endocrinology in India

sarITa baJaJ

President, South Asian Federation of Endocrine Societies Department of Medicine, MLN Medical College, Allahabad, India

India has a long tradition of formal medical education, dating back to the times of Ayurveda.

Formal post graduate endocrinology training in the country, too, is nearing a half century of existence, but has gained importance only in the last 3 decades. Bioassays were required for diagnostics which was the major block for development in this branch.

The first post graduate fellowship programme, labeled DM (Doctor of Medicine), was begun in 1968 at Chandigarh (a Union Territory). In 1971 the Endocrine Society of India (ESI) was set up in Mangalore. To date, there are about 1000 life members.

As of today (January 2015), a total of 23 institutes offer a DM programme, spread over the length and breadth of the country. Fifty five seats are available for DM courses in 22 departments each year, excluding the autonomous All India Institute of Medical Sciences, New Delhi, which has an intake of 12 students spread over three years

Indian medical education is rigorous and competitive. A 5.5 year undergraduate course (4.5 years of study, followed by 1 year of clinical internship) leads to the award of an MBBS (Bachelor of Medicine, Bachelor of Surgery) degree. Interested students compete for admission to a three year long MD (Doctor of Medicine) programme in Internal Medicine or Paediatrics. After completing this post graduate course, students again appear for national entrance examinations to the three year DM or DNB (Diplomate National Board) course. Thus, it takes a minimum of 11.5 years, assuming no breaks in study, to become an endocrinologist in India.

Endocrinology training in India includes comprehensive education in clinical skills, laboratory endocrinology (including biochemistry, radioimmunoassay and nuclear medicine) and research. There is no central curriculum for the country. Indian endocrinology students are able to compete with the rest of the world at various platforms. Indian trainees are now a common sight at international meetings, presenting their data, asking questions sharing their knowledge, and improving their skills. These interactions help enhancement of endocrinology in the country.

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The Current Status of Endocrinology in Indonesia

aCHMad rudIJanTo

President, Indonesian Society of Endocrinology Endocrinology and Metabolic Department, Faculty of Medicine Brawijaya University, Indonesia

Introduction: The Endocrinology and Metabolism training program offers 2-3 years clinically and research program for individuals who are interested in career development inclinicalor research of endocrinology and metabolism.The program provides didactic and self-directed teaching for clinical and research skills

Applicants must have an Internal Medicine Specialist degree from an accredited domestic or foreign institution, and have a strong commitment to well manage of patients or research in the field of Endocrinology, Diabetes, and Metabolism endocrinologist training: We offer the incoming endocrinology subspecialty resident a comprehensive program leading to eligibility for the Indonesian College of Internal Medicine certification in Endocrinology and Metabolism

The Program is to provide comprehensive training in the management and research of the broad spectrum of endocrine diseases and diabetes. After completion of our 2-year program, the trainee will be well prepared to pursue a career in Clinical Endocrinology or undertake further research training.

Hospitals: There are eleven University in Indonesia provides Endocrinology and Metabolism training. The academic hospital of the University is the main hospital for Endocrinology and Metabolism training program. This hospital provides tertiary level care in the field of endocrinology and metabolism. Other training sites include the hospital as networking of university academic hospital that provides secondary care of endocrinology and metabolism.

Core Competencies: In the University of Brawijaya Indonesia, the core competencies of the trainee will cover all area of: 1. Medical knowledge (basic, clinical and contextual knowledge). 2. Intellectual and Interpersonal skills (procedures and communication) 3. Professionalism 4. Evidence based practice 5. Systems based practice

Clinical training: The clinical training program covers all areas of endocrinology with the major focus on diabetes, thyroid diseases, dyslipidemia, and obesity.

In the first year, the fellows spend mostly of their time on inpatient care and consultations, less part of time on outpatient and ambulatory care and procedures skill.

In the second year, the time is allocated for research and continues the clinical inpatient and outpatient care work.

research training and publication: The trainee must do research and should present or publish his/her work on research at national or international level, at least once during period of training. The research focus may in the field of clinical or basic endocrinology. They also should publish of two or more case report during traineeship program, and all are encouraged to present at national or regional meeting.

Courses, seminars and Teaching activity: The trainee has to participate in endocrine meeting each year at a local, regional or international level and must have at least one-month (1-3 months) endocrine rounds at endocrinology center abroad.The trainee must be participate actively in departmental or divisional teaching activities to teach junior staff, medical students and other medical personnel. supervision of Training: Heads of Departments or Consultants who are accredited Endocrinologists should supervise training. exit evaluation in endocrinology: The evaluation will be carried out in several ways for each level. The supervisor’s repot and logbook are in order. They must demonstrate competency in endocrinology and metabolism cases management including in endocrine emergency handling through case report and structured exit evaluation. National Board Examination by Indonesian College of Internal Medicine in Endocrinology and Metabolism, carry out at the end of program. Certification: Certification of completing the program, will be given by university and cetificate of competencies given by Indonesian College of Internal Medicine in Endocrinology and Metabolism

Keyword: endocrinology training, Indonesia

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The Current Status of Endocrinology in Korea

Young Kee sHong

Chairman of the Board, Korean Endocrine Society (KES) Division of Endocrinology, Asan Medical Center, Korea

Korean Endocrine Society is youngest medical speciality group in Korea. It was founded at 1982 as with approximately 150 members. Since then it had annual meeting regularly. Thyroid Research Group was incorporated to KES at 1986, although later in 2008, Korean Thyroid Association became an independent organization again with endocrinologists, surgeons, nuclear medicine physicians and radiologists. So far KES hosted the 4th AOTA meeting at 1989 and the 11th AOCE meeting at 1998. Since 2013, KESD is organizing Seoul International Congress of Endocrinology and Metabolism (SICEM) annually and in this year this congress will be held at early May. KES publishes society journal named “Endocrinology and Metabolism: EnM” in English. It is published quarterly and welcomes submission from any country over any related topic. It is indexed in PubMed, PubMed Central and so on. KES is very willing to collaborate with sister societies in our region. KES welcomes participation to SICEM, submission of manuscript to EnM and would be happy to support research stay in Korea.

Korea has two different educational system for medical doctors. The first one is 2+4 system. High school graduate enters pre-medical course of 2 years then goes to college of medicine. After 4-yearstudy, they graduate and get medical license if they pass National License Examination. Another is 4+4 system. College graduate with various bachelor degree may enter medical school. After 4-year study, they graduate and get medical license if they pass National License Examination. Those who has medical license and completed one-year rotating internship may apply for residency for speciality. Resident training lasts usually 4 years. After residency, they apply examination for speciality board certification. Those who are board certified in Internal Medicine may apply fellowship for subspeciality training. It usually last two years fellowship with various clinical and research activities. After completion of fellowship, they are eligible for the examination.

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Current Status of Endocrinologist in Myanmar

THan THan aYe

President, Myanmar Society of Endocrinology and Metabolism (MSEM) Department of Medicine and Department of Endocrinology, North Okkalapa General Hospital University of Medicine 2, Yangon, Myanmar

Myanmar has been challenged by the burden of endocrine diseases, mainly Type 2 Diabetes Mellitus which is one of the commonest non-communicable diseases (NCD) in Myanmar .There are other endocrine disorders such as Thyroid diseases and various endocrine disorders which are common but being underdiagnosed and not being effectively managed .The endocrinologists training has been inadequate in Myanmar for so many reasons. It was due to weaknesses in the health system and government bureaucracy previously. There was an inadequate production of specialists and the priority has been given to production of general physicians, according to the needs of the country. Only a few selected doctors had a chance to get training abroad for specialties through scholarship program. Although they had been trained for endocrinology, mainly from U.K., they were appointed as general physician with special interest in endocrinology. There are about 30 Specialists with special interest in endocrinology. After 2010 General Election, Myanmar has undergone major political change with the opening of Myanmar’s doors. Many specialists are now having more chances of attending international conferences and short courses to update their knowledge and practice. With the initiative of leading Endocrinologists the Department of Endocrinology and Metabolism was founded in University of Medicine 2 , Yangon in 2012. Post graduate course on Endocrinology (Dr.Med Sc) has been started in 2014.The selection criteria are those who have obtained the M Med Sc (Internal Medicine) and also got through the selection exam (both theory and viva). The training program and curriculum will be presented.

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The Current Status of Endocrinology in The Philippines

bIen J. MaTawaran

Vice- President, Philippine Society of Endocrinology, Diabetes and Metabolism Department of Medicine, Jose R. Reyes Memorial Medical Center, Rizal Ave, Manila, The Philippines

The Philippines is an archipelago of 7,107 islands inhabited by just over a hundred million people scattered unevenly in both urban and rural areas. Together with the economic difficulties of most developing countries like the Philippines compounded by the geographic challenges of our islands, the demands for skilled and trained endocrinologists is truly a staggering task to overcome. Based on the latest National Nutrition and Health Survey (NNHeS) done 2013, the prevalence of hypertension is 22 percent and diabetes mellitus at around 5.4 percent. These two most common non-communicable diseases are the bread and butter of endocrinologists in the country.

Though the Philippines has established the Philippine Society of Endocrinology and Metabolism since 1962 and is now in the first few years of our sixth decade, the number of board certified endocrinologists is still disproportionate to the number of patients and locations in the Philippines. Currently we have 225 board-certified endocrinologists designated as full fellows (192) and diplomates (33). In addition, we also have associates members (36) that are board-eligible and 39 fellows-in-training. For several years, endocrinologists usually come from 5 training institutions in Manila--- University of the PhilippinesPhilippine General Hospital (UP_PGH), Makati Medical Center (MMC), University of Santo Tomas Hospital (USTH) and St. Luke’s Medical Center (SLMC). But because of the great demand for most internal medicine residency, we now have three additional institutions for training, The Medical City (TMC) and Chinese General Hospital (CGH), both from Manila and Chong Hua Hospital (CHH) in Cebu City. Fellowsin training are allowed to enter training after completion of a 3 year residency program in internal medicine and after passing the specialty board of the Philippine Specialty Board of Internal Medicine (PSBIM). Endocrinology fellowship is a 2- year in-hospital program in an accredited fellowship-training program and board eligibility is after completion of this trainings plus proof of a published research in a reputable peer-reviewed journal. Though less frequent, there are endocrinologists who completed training abroad and after evaluation of the minimum requirement set by the Philippine Specialty Board of Endocrinology and Metabolism (PSBEM) based on the core curriculum of training, foreign graduates are likewise allowed to take the specialty boards given every 2 years only. Even though we are trying to increase the number of well-trained endocrinologists, there are certain challenges and threats within the Philippine medical setting where other groups are calling themselves as sub-specialists or diabetologists, who unfortunately have no valid training in endocrinology and even internal medicine. We do acknowledge the need for better knowledge and management of diabetes especially by primary care physicians and generalists, however proper representation and accreditation should be a priority so as not to confuse other medical practitioners and more so our patients.

In this light, as we move forward as a society and to reiterate our training and expertise in diabetes we now call ourselves as the Philippine Society of Endocrinology, Diabetes and Metabolism. More than just a name change, this is our commitment to ensure that each member of our society are truly well-trained, accredited and skilled in the practice of endocrinology and this assurance will translate to better patient care and outcome.

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The Current Status of Endocrinology in Thailand

THavaTCHaI PeeraPaTdIT

President, The Endocrine Society of Thailand Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand

As of December 31st, 2014, there are only 218 endocrinologists among the 48,116 practicing physicians in Thailand, who can give medical care to the population of about 67.2 million. Of all the practicing physicians, 22,797 stay in Bangkok. Fellowship training in endocrinology and metabolism in Thailand is a 2-year program to get the Diploma of the Thai Subspecialty Board of Endocrinology and Metabolism, administered by the Endocrine society of Thailand(EST), under the Royal College of Physician of Thailand (RCPT) and Medical Council of Thailand. To be enrolled, graduated doctors must have a certificate of 3-year training from Board of Internal Medicine.

Now there are 8 training centers with 49 trainers for endocrinology fellowship training, which can produce about 16-17 endocrinologists per year. Every year, there are also about 2-3 endocrinologists, who finished training from the USA Endocrine Society, entering the process to be qualified as endocrinologists in Thailand. Most of the endocrinologists work in medical schools and public hospitals.

EST holds an annual meeting around November. Members can attend all the activities, both academic and non-academic, free of charge. During the year, we have inter-hospital endocrine conference every two months, hosted by the training centers in Bangkok. Thai endocrinologists can keep their knowledge up-to-date by attending the activities from EST, RCPT, Diabetes Association of Thailand, and other activities in USA, European countries, and regional meetings.