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Tillotson CV, Becetti I, Hwu K, Page L, Krishnan S, Stafford D, Stanley T, Vuguin P, Barker JM. Pediatric Endocrinology Milestones 2.0-guide to their implementation. BMC Med Educ 2023; 23:985. [PMID: 38124091 PMCID: PMC10734147 DOI: 10.1186/s12909-023-04862-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023]
Abstract
The Milestones were initiated by the Accreditation Council for Graduate Medical Education (ACGME) to provide a framework for monitoring a trainee's progression throughout residency/fellowship. The Milestones describe stepwise skill progression through six core domains of clinical competency: Patient Care, Medical Knowledge, Interpersonal and Communication Skills, Practice-based Learning and Improvement, Professionalism, and Systems-based Practice. Since their introduction in 2013, several barriers to implementation have emerged. Thus, the ACGME launched the Milestones 2.0 project to develop updated specialty-specific milestones. The Pediatric Endocrinology Milestones 2.0 project aimed to improve upon Milestones 1.0 by addressing common limitations, providing resources for faculty to easily incorporate milestones into their assessment of trainees, and adding sub-competencies in health disparities, patient safety, and physician well-being.This paper reviews the development of the Pediatric Endocrinology Milestones 2.0 including the major changes from Milestones 1.0, development of the Supplemental Guide, and how Milestones 2.0 can be applied at the program level. Although use of the Milestones are required only for ACGME programs, the tools provided in Milestones 2.0 are applicable to fellowship programs worldwide.
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Affiliation(s)
- Cara V Tillotson
- Pediatric Endocrinology, New York Presbyterian - Columbia University Medical Center, 622 West 168th street, PH 17 West, Room 307, New York, NY, 10032, USA
| | - Imen Becetti
- Pediatric Endocrinology, Massachusetts General Hospital, Boston, MA, USA
| | - Katherine Hwu
- Pediatric Endocrinology, Baylor College of Medicine, Houston, TX, USA
| | - Laura Page
- Pediatric Endocrinology, Duke University School of Medicine, Durham, NC, USA
| | - Sowmya Krishnan
- Pediatric Endocrinology, The University of Texas Southwesteren Medical Center, Dallas, TX, USA
| | - Dianne Stafford
- Pediatric Endocrinology, Stanford University School of Medicine, Stanford, CA, USA.
| | - Takara Stanley
- Pediatric Endocrinology, Massachusetts General Hospital, Boston, MA, USA
| | - Patricia Vuguin
- Pediatric Endocrinology, New York Presbyterian - Columbia University Medical Center, 622 West 168th street, PH 17 West, Room 307, New York, NY, 10032, USA
| | - Jennifer M Barker
- Pediatric Endocrinology, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA
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Moran GW, Steinman JB, Tillotson CV, Carpenter CP, Hays T, Ham JN, Li B. Virilization of a 46,XX Fetus Following Aromatase Inhibitor Treatment of Breast Cancer. Pediatrics 2023:191231. [PMID: 37128841 DOI: 10.1542/peds.2022-060568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 05/03/2023] Open
Abstract
Virilization of the 46,XX infant may be attributed to maternal or fetoplacental origin. Maternal sources may be endogenous, as with an androgen-producing tumor, or drug-related. Iatrogenic virilization by maternal drug exposure is rarely reported, with individual case reports and case series demonstrating the effects of progesterone and other medications affecting the pituitary-ovarian axis.1-3 The class of medications known as aromatase inhibitors are recognized as effective in treating hormone receptor-positive breast cancer by preventing the conversion of androgens into estrogens by aromatase. In fetal development, placental aromatase plays a critical role in preventing virilization of the XX fetus by maternal and fetal androgens during development. In the setting of placental aromatase deficiency, the XX fetus may be virilized. It is conceivable, therefore, that maternal exposure to aromatase inhibitors early in gestation may lead to in utero virilization, though there have been no known reports of this phenomenon to date. We present a case of virilization of a 46,XX infant attributed to pharmacologic aromatase inhibition. The infant's parents provided informed consent for the reporting of this case.
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Affiliation(s)
| | - Jonathan B Steinman
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, and
| | - Cara V Tillotson
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, and
| | | | - Thomas Hays
- Division of Neonatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - J Nina Ham
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, and
| | - Belinda Li
- Division of Pediatric Urology, Department of Urology
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