The Endocrine elective is offered to PGY1s - PGY3s as a 2 or 4 week elective at Moses and Weiler campus (at discretion of elective coordinators).
Sample Weekly Didactic and Clinic Schedule:
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)
9-12- Inpatient Consults
1-5- Jacobi Endocrinology Clinic in Building 5, 3rd Fl./A-wing
9-5 Inpatient Consults, independent study, conference preparation
8:15-9 Diabetes Journal Club* at Montefiore at DTC, 460
9-12 Diabetes Clinic at Montefiore at DTC, 460
1-5 Inpatient Consults
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
II. Goals and Objectives
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 (2 or 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 PGY 1, 2s and 3s.
B. Competency based 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 and Communication Skills: Write understandable and timely 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: Recognize 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 the 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
III. AREAS COVERED DURING ROTATION:
1. Principles, Physiology and Basic Sciences
Hormones and hormone action
Feedback loops as a basis for diagnosis of endocrine disease
Glucose metabolism and diabetes mellitus
2. 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.
3. 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
4. Specific Diagnoses in Endocrinology:
Toxic nodular goiter
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
Management of risk factors for heart disease
Hyperparathyroidism (Adenoma and hyperplasia)
Differential diagnosis of hypercalcemia
Determination for observation or surgery
Hypoparathyroidism (Postoperative, idiopathic autoimmune, pseudohypopparathyroidism)
Workup and management of tumors
Acromegaly, prolactinoma, Cushing’s,
Hypopituitarism: workup and management
Primary and secondary gonadal failure
Osteoporosis and vitamin D Deficiency
5. Emergencies/Therapeutic Interventions:
6. Technical Skills
Familiarity with thyroid aspiration biopsy
Familiarity with thyroid ultrasound
Familiarity with hormone infusion studies
IV. METHODS OF ASSESSMENT
The house officer is evaluated continuously during their time on the Endocrinology elective. Importantly, formative feedback is given to the rotating house officer throughout the rotation experience. The final evaluation is entered through www.new-innov.com and a summary performance assessment is discussed in a meeting with the house officer. This evaluation will assess overall clinical competence as reflected by the following subcategories: patient care, medical knowledge, clinical skills, communication skills, professionalism, participation in rounds and presentation of journal club.