Goals and Objectives

Updated 2011 by: Dr. Martin Surks
Written (2006) by: (Dr. Martin Surks), Reviewed by: (Dr. Sharon Silbiger, Dr. Marta Rico. Dr. Erica Spatz)
Albert Einstein College of Medicine
Montefiore Medical Center
INTERNAL MEDICINE RESIDENCY PROGRAM:
ENDOCRINOLOGY ELECTIVE CURRICULUM

ROTATION: ENDOCRINOLOGY ELECTIVE

I. Goals and Objectives:

A. Overview:
The program in Endocrinology is designed to provide the house officer with the knowledge and skills needed to diagnose and treat diseases of the endocrine system, including diabetes mellitus, thyroid disease, and disorders of mineral metabolism including parathyroid dysfunction, osteoporosis and pituitary disease. The house officer will learn to manage a wide variety of commonly encountered endocrine problems without the need for endocrine consultation. This 1 block elective (approximately 4 weeks) involves participation in the in-patient endocrine consultation service, weekly out-patient endocrinology and diabetes clinic sessions, and weekly conferences.

The Endocrinology elective is available to all Internal Medicine PGY2s and 3s.

B. Competency based goals and objectives:
Patient Care: Recognize the relative significance of a given patient’s list of medical conditions as it relates to endocrinology; recognize the acuity and levels of endocrine illnesses, understand the indications of various disease-specific testing, as well as the indications and complications of thyroid aspiration biopsy. Residents should be able to interpret common endocrine testing and understand how the results relate to specific endocrine illnesses.

Medical Knowledge: Use the literature and reference sources to increase knowledge base and share knowledge with colleagues and junior trainees; develop sophisticated knowledge in the areas of endocrine physiology and pathophysiol ogy and the clinical aspects of endocrine disease states; apply knowledge to the treatment of patients.

Professionalism: Establish trust with endocrine patients and staff; exhibit honesty, reliability and responsibility in patient care; demonstrate respect for patients, staff and medical students who you are supervising; work with the team to fulfill the needs of the endocrine patients; work closely with the Endocrine fellow to care for the patients; understand limitations and ask supervisors for help when indicated; accept assignments graciously; attend conferences.

Interpersonal Skills: Write understandable and legible consult and follow-up notes; listen to patients and staff and communicate verbally and non-verbally in a productive manner; counsel patients with endocrine problems; work effectively as a member of the health care team.

Practice Based Learning and Improvement: Understand limitations of knowledge and use references and literature to improve your practice patterns; accept feedback and change behavior; ask for help when needed; learn from he outcomes of endocrine patients under your care and alter practice patterns to improve outcomes in the future; aid junior trainees in evaluating their practice patterns.

Systems Based Practice: Advocate for endocrine patients; develop a sophisticated understanding about the health care system/structure and how it relates to patients requiring diagnostic studies and hormone replacement therapy; develop the ability to utilize ancillary services appropriately



II. AREAS COVERED DURING ROTATION:
Principles, Physiology and Basic Sciences
Develop an understanding of:
  • Hormones and hormone action
  • Feedback loops as a basis for diagnosis of endocrine disease
  • Glucose metabolism and diabetes mellitus

Practice skills unique to Endocrinology

  • History and physical examination: with attention to BP, examination of the thyroid, breasts, testes and ovaries and uterus
  • Development of differential diagnosis and appropriate selection of endocrine tests
  • When to do appropriate imaging of the endocrine system
  • Patient education: diet, adherence to principles of diabetes management
  • Interpretation of Bone Density
  • Interpretation of thyroid aspiration biopsy and general endocrine pathology
  • Attitudes/values: understand the psychosocial issues surrounding chronic endocrine illness, with particular regard to diabetes mellitus and thyroid cancer.
Approach to presenting complaints/problems in Endocrinology:
  • Pressure or pain in anterior neck; new dysphagia or dysphonia
  • Heat intolerance, excessive perspiration and tremor
  • Inappropriate weight gain or loss
  • Progressive worsening nocturia or polyuria
  • Diplopia and headache
  • Erectile dysfunction and infertility
  • Galactorrhea
  • Kidney stones



Specific Diagnoses in Endocrinology:
  • Hyperthyroidism
  • Graves’ disease
  • Toxic nodular goiter
  • Thyroiditis
  • Hypothyroidism
  • Primary: post-I-131; thyroidectomy; Hashimoto’s disease
  • Secondary: hypopituitarism; pituitary tumors
  • Thyroid Nodules: cysts, goiter, neoplasms
  • Thyroid cancer: Papillary, follicular, medullary, anaplastic 
  • Diabetes mellitus: Type 1 and Type 2
  • Diet and nutritional management 
  • · Exercise programs
  • · Oral medications 
  • · Insulin therapy
  • Management of risk factors for heart disease
  • Parathyroid disease
  • Hyperparathyroidism (Adenoma and hyperplasia)
  • Differential diagnosis of hypercalcemia
  • Determination for observation or surgery
  • Hypoparathyroidism (Postoperative, idiopathic autoimmune, pseudohypopparathyroidism)
  • Pituitary disease
  • Workup and management of tumors
  • Acromegaly, prolactinoma, Cushing’s,
  • Hypopituitarism: workup and management
  • Gonadal disease
  • Primary and secondary gonadal failure
  • Osteoporosis and vitamin D Deficiency
  • Lipid disorders

5. Emergencies/Therapeutic Interventions:

  • Diabetic ketoacidosis
  • Hypoglycemia
  • Hypercalcemia/hypocalcemia
  • Thyroid storm
  • Myxedema coma
  • Adrenal crisis
  • Pituitary apoplexy

6) Technical Skills:
  • Familiarity with thyroid aspiration biopsy
  • Familiarity with thyroid ultrasound
  • Familiarity with hormone infusion studies



III. SCHEDULE OF ACTIVITIES

The following schedule is for the internal medicine residents enrolled in the endocrinology elective. Attendance at the west campus clinics and conferences is mandatory. You should be available for inpatient consults at Montefiore and NCB during the scheduled times.

Monday

8-9- Diabetes Clinical Conference at CFCC

9-12-General Endocrinology Clinic at CFCC

1-330- Inpatients Consults **

4-5-Endocrine Fellows Conference (See Schedule for exact dates/locations of conferences – Held September – May only)

Tuesday

9-12- Inpatient Consults

1-5- Jacobi Endocrinology Clinic in Building 5, 3rd Fl./A-wing

Wednesday

9-5 Inpatient Consults, independent study, conference preparation

Thursday

8:15-9 Diabetes Journal Club* at Montefiore at DTC, 460

9-12 Diabetes Clinic at Montefiore at DTC, 460

1-5 Inpatient Consults

Friday

8-9 Endocrine Conference* at Belfer 712

9-10 Diabetes Research Conference at Belfer, 712 (Held September – May only)

10-1 Inpatient Consults**

1-4 Endocrine Clinic at Montefiore at DTC, 460

4-5 Endocrine Conference at Montefiore at DTC, 460

*You are expected to present one diabetes journal club and one endocrinology case during your rotation.

** Time blocked for inpatient consults will include attending rounds, independent reading and preparation for conferences. Patients that you see in consultation should be followed until resolution of their primary endocrine issues.



IV. METHODS OF TEACHING COMPETENCIES &
COMPETENCY ASSESSMENT
VENUES ASSESSMENT

Patient care consults, clinics, attg rds monthly eval
Med knowledge article packet, journal club, monthly eval
Attg rds, clinics
Professionalism consults, clinics monthly eval
Interpersonal skills attg rds, clinics, consults monthly eval
PBL+I attg rds, clinics, consults monthly eval
Systems based practice attg rds, clinics, consults monthly eval
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