Ambulatory Endocrinology, Diabetes, and Metabolic Diseases Rotation

Educational Purpose:

This rotation is designed to give medical residents experience with a broad variety of endocrine, diabetic, and metabolic disorders. It is organized in such a way that training and experience is gained by direct patient contact, most often in an outpatient setting, with direct faculty supervision. This case-related system of learning is supplemented by didactic lectures, Endocrine Grand Rounds, and journal clubs in order to provide the necessary knowledge base for the medical resident to function well in this subspecialty area as it relates to the delivery of primary care.

Goal: Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

Residents are expected to:

PGY 1

1. To recognize the signs, symptoms, and appropriate therapy of hypothyroidism and hyperthyroidism.

PGY 2 and 3

1. To recognize the signs, symptoms, and appropriate therapy of hypothyroidism and hyperthyroidism.

Medical Knowledge Goals and Objectives:

Goal:  Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. 

Residents are expected to:

PGY 1

1. To understand the presentation, pathophysiology, natural history and treatment of Type 1 and Type 2 Diabets Mellitus.

2. To recognize and learn appropriate therapy for various types of hyperlipidemia.

3. To gain exposure to the diagnosis and management of diseases of bone mineral metabolism including osteoporosis, parathyroid disease, and Paget’s disease.

4. To learn the common causes and understand management of pituitary dysfunction including hypopituitarism and hormonal overproduction.

5. To recognize the causes, work-up, and therapy of hirsutism and virilizing states.

6. To learn appropriate evaluation of adrenal syndromesincluding adrenal insufficiency, hypercortisolism, mineralocoricoid excess, and incidental adrenal masses.

PGY 2 and 3

1. To understand the presentation, pathophysiology, natural history and treatment of Type 1 and Type 2 Diabets Mellitus.

2. To recognize and learn appropriate therapy for various types of hyperlipidemia.

3. To gain exposure to the diagnosis and management of diseases of bone mineral metabolism including osteoporosis, parathyroid disease, and Paget’s disease.

4. To learn the common causes and understand management of pituitary dysfunction including hypopituitarism and hormonal overproduction.

5. To recognize the causes, work-up, and therapy of hirsutism and virilizing states.

6. To learn appropriate evaluation of adrenal syndromesincluding adrenal insufficiency, hypercortisolism, mineralocoricoid excess, and incidental adrenal masses.

Practice-Based Learning and Improvement Goals and Objectives:

Goal: Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning.

Residents are expected to develop skills and habits to be able to:

PGY 1

PGY 2 and 3

Systems Based Practice Goals and Objectives:

Goal: Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.

Residents are expected to:

PGY 1

PGY 2 and 3

1. Supervise interns and medical students during consults and in the outpatient setting.

Professionalism Goals and Objectives:

Goal: Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.

Residents are expected to demonstrate:

PGY 1

PGY 2 and 3

Interpersonal and Communication Skills Goals and Objectives:

Goal:  Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. 

Residents are expected to:

PGY 1

PGY 2 and 3

Teaching Methods:

It’s a case-related system of learning, which incorporates direct trainee involvement, immediate supervision, and direct relevant reading and/or didactic sessions.

Mix of Diseases and Pathological Material:

Abnormal hormone levels; lipid disorders; breast discharge; change in menstrual, gonadal/sexual function; disorders of thyroid function; goiter (diffuse, nodular); hirsutism; hypertension refractory to primary therapy; hypotension; incidentally discovered masses in adrenal, thyroid, and pituitary; osteopenia/osteoperosis; polyuria, polydypsia; symptoms of hyper-hypoglycemia; symptoms of hypermetabolism; symptoms of hypometabolism; urinary tract stone; weight gain, obesity.

Patient Characteristics:

There is a wide range of endocrinopathies in an aging population with chronic disease. Residents care for a diverse patient population with respect to age, ethnicity, and gender.

Types of Clinical Encounters:

Residents will evaluate new consults from a variety of inpatient Medical and Surgical services. Residents are expected to develop a care plan for each patient encounter to discuss with their fellow and attendings. In addition, there are several opportunities to participate in outpatient clinics as well

Procedures and Services:

Residents will have the opportunity to interpret and discuss various modalities of imaging including CT/MRI/ultrasound as well as thyroid ultrasound with biopsy/FNA.

Supervision:

Direct patient experiences are always supervised by attending faculty that guide evaluations, treatment, and provide teaching. 

Educational Resources to be Used and Reading Lists:

There are four required conferences for the resident. Weekly Endocrinology Grand Rounds reviews challenging cases discussed in depth by the resident and/or fellow, with attending input. All Division teaching faculty attend this conference, as do faculty and fellows from Pediatric Endocrinology and Endocrine Surgery.

Bi-monthly journal club provides a forum where recent key articles are presented and critically discussed in detail by residents, fellows, and the faculty. Emphasis is on study design, data analysis, and translation.

A monthly Basic Science Lecture is given by a faculty member from our division or basic science department. These lectures target key areas of basic endocrine science relevant to practice and research.

A monthly research conference is presented by local or nationally prominent, invited faculty that are actively involved in funded biomedical research of cutting edge quality.

Method of Evaluation of Resident Competence:

In addition to daily feedback, we provide written evaluations on each resident. Patient Care is assessed based on direct observation and complete review of all records. Medical Knowledge is assessed through direct questioning and observation. Interpersonal Skills and Communication is assessed by observation of interactions with consulting physicians, patients, and families. The attending physician evaluates Professionalism through direct interaction and observation of the resident. Systems-Based Practice is evaluated based on interactions with the primary team and the ability to provide medical care in the consultative setting. Practice-Based Learning is evaluated based on the ability to consult the literature and to improve their performance throughout the rotation. The residents evaluate the rotation and the attending physician through the E*Value system. The consult attendings review the rotation evaluations and each attending anonymously receives his or her evaluations We use the standard format recommended by the American Board of Internal Medicine for evaluation of trainees, which is t racked through the E*Value electronic evaluation system supported by the Graduate Medical Education Office.

Evaluations of the rotation are completed by each resident at the end of the rotation. These evaluations are distributed through the E*Value system by the Department of Medicine and feedback is provided to the Division on a regular basis.