I. Background

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

A. Overview/Goals:

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


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


Kidney stones

4. Specific Diagnoses in Endocrinology:


Graves’ disease

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

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



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


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.