Developing learning objectives in postgraduate medical education for family medicine (Tunisia).

Introduction-Aim: The third cycle of medical studies (TCMS) lasts 3 years for the specialty of family medicine (FM) in Tunisia. The members of the FM committee of the Faculty of Medicine of Monastir (FMM) aimed to detail the learning objectives (LO) of residents in FM. METHOD: We used the Delphi method in 2 rounds including a group of experts called FM Learning Objectives Writing Group (FMLOWG) at the FMM. The FMLOWG included 74 university hospital physicians and FM internship supervisors. These members actively participated in the 10 meetings held during the month of March 2022. Three points were discussed: the identification of LOs; the development of training titles and the proposal of the teaching methods to be adopted. The writing was subdivided into 5 domains of LO: transversal, public health, typical population and by system. RESULTS: We identified 1359 LOs for FM residency, for which 552 were LOs per system (40.5%). The learning included 618 training session titles. Residents will have an academic training day every 3 weeks during 9 months for each TCMS year. CONCLUSION: A detailed, MF-specific consensus has been developed by majority of medical specialties. It will be a learning base for learners, a reference for supervisors and TCMS teachers.

Acromegaly: an endocrine pathology with serious consequences / L'acromégalie : une pathologie endocrinienne à lourdes conséquences

Acromegaly is a rare endocrine disorder leading to an acquired physical disfigurement and multisystem damage. It is caused in over 95% of cases by a secreting pituitary adenoma. Latency period between disease onset and diagnosis is mainly 10 years due to progressive chronic evolution and exposure to high levels of GH and IGF-1. Here we present a case of acromegaly with over 25 years of diagnostic delay in 69-years-old male with typical features and recurrent urolithiasis. Biochemical diagnosis was confirmed by high levels of IGF-1and lack of suppression of GH during an oral glucose load. Imaging and histological study revealed a co-secreting GH/ prolactine macroadenoma. After three months of complete transphenoidal surgical resection, biochemical remission was not obtained and the patient was treated by a somatostatin receptor ligand. Based on this severe case with atypical manifestations, the diagnosis of acromegaly should be always considered.

L'acromégalie est une maladie endocrinienne rare caractérisée par un syndrome dysmorphique acquis et des atteintes multi-systémiques invalidantes en rapport, dans 95 % des cas, avec un macroadénome hypophysaire. La lente progression et l'exposition chronique aux fortes concentrations de l'hormone de croissance (Growth Hormone : GH) et de l'Insuline Growth Factor-1 (IGF-1) expliquent le retard du diagnostic de 10 ans en moyenne. Nous rapportons le cas d'une acromégalie chez un sujet âgé de 69 ans diagnostiqué après plus de 25 ans d'installation du syndrome dysmorphique et de lithiases urinaires récidivantes. Le diagnostic a été confirmé biologiquement par des concentrations très élevées et non freinables de GH et par la présence d'un macroadénome hypophysaire exprimant doublement la GH et la prolactine. Après résection chirurgicale complète, l'évaluation biologique n'a pas objectivé de rémission, d'où le recours à un traitement adjuvant par un analogue de la somatostatine. En présence de multiples atteintes atypiques et sévères comme chez ce patient, le diagnostic d'acromégalie doit toujours être évoqué.