PDF(Pubmed)
Abstract：
BACKGROUND: Hypopituitarism, including growth hormone deficiency (GHD), is a common sequela of traumatic brain injury (TBI). This study explored the coverage of education and training of TBI-induced hypopituitarism in general and GHD in particular, in postgraduate program curricula to identify knowledge gaps and opportunities.
METHODS: An online survey and qualitative interviews (focus groups) were conducted among endocrinology, neurology, and physiatry postgraduate program directors in the United States (US). The study received an IRB exemption.
RESULTS: A total of 419 fellowship and residency programs were invited to participate; 60 program directors completed the survey and 11 of these participated in the focus groups. About half of the respondents considered TBI-induced hypopituitarism important or fairly important to include in the curriculum, and nearly two-thirds considered it an appropriate training component. Neurology program directors considered education regarding hypopituitarism following TBI less important and relevant for their curricula compared with endocrinology and physiatry program directors. About half (53%) of the programs responded that they included TBI-induced pituitary disorders in their curricula. About two-thirds (68%) of endocrinology programs, compared with only one-quarter (25%) of neurology programs, covered TBI-induced pituitary disorders. Respondents identified multiple barriers to expanding hypopituitarism following TBI in the curriculum, including the rarity of condition and lack of time/room in the curriculum. Respondents reported that consensus clinical guidelines and the availability of more data on TBI-induced hypopituitarism, including GHD, would greatly impact the development of educational curricula on this topic.
CONCLUSIONS: To improve the management of TBI-induced hypopituitarism, education and training should be expanded in US fellowship and residency programs to prepare trainees to effectively screen, diagnose, and treat TBI-induced hypopituitarism, including GHD.
A traumatic brain injury (TBI) can occur with a sudden blow to the head or the body. Most people recover from TBI within weeks, but the injury can cause long-term effects by reducing the body’s production of growth hormone (GH), which can interfere with daily activities and impair quality of life. This study explored education and training of doctors in the US to identify gaps in knowledge about GH deficiency and opportunities for improvement. Online survey and interviews (focus groups) were conducted among directors of 3 postgraduate (after medical school) training programs: endocrinology, neurology, and physiatry (the diagnosis, prevention, and treatment of all types of impairment related to the brain, nerves, bones, and muscles).A total of 60 program directors completed the survey and 11 of these participated in the focus groups. About half of the respondents felt education about GH deficiency caused by TBI is important, and nearly two-thirds thought it was appropriate to include in medical training. Half of the programs said that hormone disorders caused by TBI were currently included in their training. Respondents identified multiple barriers to expanding education on this topic in training programs. The main barriers were that the condition is thought to be uncommon and not having time for more training. Respondents thought that clinical guidelines and availability of more information on the condition would greatly impact the development of training about GH deficiency after TBI.To improve the management of GH deficiency caused by TBI, education and training should be expanded to prepare doctors in training to be better able to screen, diagnose, and treat GH deficiency caused by TBI.
METHODS: An online survey and qualitative interviews (focus groups) were conducted among endocrinology, neurology, and physiatry postgraduate program directors in the United States (US). The study received an IRB exemption.
RESULTS: A total of 419 fellowship and residency programs were invited to participate; 60 program directors completed the survey and 11 of these participated in the focus groups. About half of the respondents considered TBI-induced hypopituitarism important or fairly important to include in the curriculum, and nearly two-thirds considered it an appropriate training component. Neurology program directors considered education regarding hypopituitarism following TBI less important and relevant for their curricula compared with endocrinology and physiatry program directors. About half (53%) of the programs responded that they included TBI-induced pituitary disorders in their curricula. About two-thirds (68%) of endocrinology programs, compared with only one-quarter (25%) of neurology programs, covered TBI-induced pituitary disorders. Respondents identified multiple barriers to expanding hypopituitarism following TBI in the curriculum, including the rarity of condition and lack of time/room in the curriculum. Respondents reported that consensus clinical guidelines and the availability of more data on TBI-induced hypopituitarism, including GHD, would greatly impact the development of educational curricula on this topic.
CONCLUSIONS: To improve the management of TBI-induced hypopituitarism, education and training should be expanded in US fellowship and residency programs to prepare trainees to effectively screen, diagnose, and treat TBI-induced hypopituitarism, including GHD.
A traumatic brain injury (TBI) can occur with a sudden blow to the head or the body. Most people recover from TBI within weeks, but the injury can cause long-term effects by reducing the body’s production of growth hormone (GH), which can interfere with daily activities and impair quality of life. This study explored education and training of doctors in the US to identify gaps in knowledge about GH deficiency and opportunities for improvement. Online survey and interviews (focus groups) were conducted among directors of 3 postgraduate (after medical school) training programs: endocrinology, neurology, and physiatry (the diagnosis, prevention, and treatment of all types of impairment related to the brain, nerves, bones, and muscles).A total of 60 program directors completed the survey and 11 of these participated in the focus groups. About half of the respondents felt education about GH deficiency caused by TBI is important, and nearly two-thirds thought it was appropriate to include in medical training. Half of the programs said that hormone disorders caused by TBI were currently included in their training. Respondents identified multiple barriers to expanding education on this topic in training programs. The main barriers were that the condition is thought to be uncommon and not having time for more training. Respondents thought that clinical guidelines and availability of more information on the condition would greatly impact the development of training about GH deficiency after TBI.To improve the management of GH deficiency caused by TBI, education and training should be expanded to prepare doctors in training to be better able to screen, diagnose, and treat GH deficiency caused by TBI.
摘要：
背景：垂体功能低下，包括生长激素缺乏症（GHD），是创伤性脑损伤（TBI）的常见后遗症。这项研究探讨了TBI引起的垂体功能低下的教育和培训的覆盖面，尤其是GHD，在研究生课程中确定知识差距和机会。
方法：对内分泌科进行了在线调查和定性访谈（焦点小组），神经学,和美国（US）的理疗研究生课程主任。该研究获得了IRB豁免。
结果：总共邀请了419个研究金和居留计划参加；60个计划负责人完成了调查，其中11个参加了焦点小组。大约一半的受访者认为TBI引起的垂体功能减退症很重要或相当重要，近三分之二的人认为这是一个适当的培训部分。与内分泌学和生理学项目主管相比，神经学项目主管认为，TBI后垂体功能低下的教育与他们的课程不那么重要和相关。大约一半（53％）的计划回应说，他们在课程中包括了TBI诱发的垂体疾病。大约三分之二(68%)的内分泌学项目，与只有四分之一（25%）的神经学项目相比，涵盖TBI诱导的垂体疾病。受访者在课程中发现了TBI后扩大垂体功能减退的多种障碍，包括条件的稀有性和课程中缺乏时间/空间。受访者报告说，关于TBI诱导的垂体功能减退症的共识临床指南和更多数据的可用性，包括GHD,将极大地影响教育课程的发展。
结论：为了改善TBI引起的垂体功能减退的管理，教育和培训应该在美国奖学金和居留计划中扩大，以准备学员有效筛选，诊断,治疗TBI诱导的垂体功能减退，包括GHD。
创伤性脑损伤(TBI)可伴随头部或身体的突然打击而发生。大多数人在几周内从TBI中恢复过来，但是这种损伤可以通过减少人体生长激素（GH）的产生而引起长期影响，这会干扰日常活动并损害生活质量。这项研究探索了美国医生的教育和培训，以确定有关GH缺乏症的知识差距和改善机会。在线调查和访谈（焦点小组）进行了3个研究生（医学院后）培训计划的主任：内分泌学，神经学,和生理(诊断，预防,和治疗与大脑相关的所有类型的损伤，神经,骨头,和肌肉）。共有60名计划负责人完成了调查，其中11名参加了焦点小组。大约一半的受访者认为关于TBI引起的GH缺乏症的教育很重要，近三分之二的人认为纳入医疗培训是合适的。一半的项目表示，由TBI引起的激素紊乱目前包括在他们的训练中。受访者在培训计划中发现了扩大有关该主题的教育的多种障碍。主要障碍是这种情况被认为是罕见的，没有时间进行更多的培训。受访者认为，临床指南和有关该病的更多信息的可用性将极大地影响TBI后GH缺乏症的培训的发展。改善TBI引起的GH缺乏症的管理，应该扩大教育和培训，让医生在培训中做好准备，诊断,治疗TBI引起的GH缺乏症。
方法：对内分泌科进行了在线调查和定性访谈（焦点小组），神经学,和美国（US）的理疗研究生课程主任。该研究获得了IRB豁免。
结果：总共邀请了419个研究金和居留计划参加；60个计划负责人完成了调查，其中11个参加了焦点小组。大约一半的受访者认为TBI引起的垂体功能减退症很重要或相当重要，近三分之二的人认为这是一个适当的培训部分。与内分泌学和生理学项目主管相比，神经学项目主管认为，TBI后垂体功能低下的教育与他们的课程不那么重要和相关。大约一半（53％）的计划回应说，他们在课程中包括了TBI诱发的垂体疾病。大约三分之二(68%)的内分泌学项目，与只有四分之一（25%）的神经学项目相比，涵盖TBI诱导的垂体疾病。受访者在课程中发现了TBI后扩大垂体功能减退的多种障碍，包括条件的稀有性和课程中缺乏时间/空间。受访者报告说，关于TBI诱导的垂体功能减退症的共识临床指南和更多数据的可用性，包括GHD,将极大地影响教育课程的发展。
结论：为了改善TBI引起的垂体功能减退的管理，教育和培训应该在美国奖学金和居留计划中扩大，以准备学员有效筛选，诊断,治疗TBI诱导的垂体功能减退，包括GHD。
创伤性脑损伤(TBI)可伴随头部或身体的突然打击而发生。大多数人在几周内从TBI中恢复过来，但是这种损伤可以通过减少人体生长激素（GH）的产生而引起长期影响，这会干扰日常活动并损害生活质量。这项研究探索了美国医生的教育和培训，以确定有关GH缺乏症的知识差距和改善机会。在线调查和访谈（焦点小组）进行了3个研究生（医学院后）培训计划的主任：内分泌学，神经学,和生理(诊断，预防,和治疗与大脑相关的所有类型的损伤，神经,骨头,和肌肉）。共有60名计划负责人完成了调查，其中11名参加了焦点小组。大约一半的受访者认为关于TBI引起的GH缺乏症的教育很重要，近三分之二的人认为纳入医疗培训是合适的。一半的项目表示，由TBI引起的激素紊乱目前包括在他们的训练中。受访者在培训计划中发现了扩大有关该主题的教育的多种障碍。主要障碍是这种情况被认为是罕见的，没有时间进行更多的培训。受访者认为，临床指南和有关该病的更多信息的可用性将极大地影响TBI后GH缺乏症的培训的发展。改善TBI引起的GH缺乏症的管理，应该扩大教育和培训，让医生在培训中做好准备，诊断,治疗TBI引起的GH缺乏症。
