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  1. 1. Name of Rotation and Course Director: Endocrinology and Metabolism/Larry K. Cantley, MD Overview: Principle Teaching/Learning Activities: see below Principle Educational Goals by Relevant Competency 1) Patient Care Principle Educational Goals Learning Activities* Effectively obtain an accurate history in patients with Attend Endocrine clinics, symptoms of Endocrine diseases. conferences, consult service. Directed reading in Endocrine topics (The Endocrine Handout/notebook, MKSAP, selected journal articles Effectively perform a complete physical examination in Regular attendance at patients with Endocrine disorders, with an emphasis on scheduled Endocrine clinics understanding the pathophysiology of Endocrine disorders and consult rounds, where and their physical manifestations. these disorders are routinely encountered. Again, reading of appropriate resources to understand the disorders and the physical manifestations. Appropriately select and interpret laboratory, imaging, and Regular attendance at pathologic studies for the evaluation of Endocrine disorders. clinics, conferences, consult rounds, where the appropriate lab evaluation of patients with these diseases is regularly reviewed and discussed. Also reading of provided handouts and recommended resources Learn the indications and contraindications for treatment of Regular attendance at Endocrine disorders. clinics, conferences, consult
  2. 2. rounds; keeping up with assigned readings Appropriately select medical and surgical management As above strategies for patients with Endocrine disorders. 2) Medical Knowledge **Please see Appendix A for specific organ-based and symptom-based learning objectives** Principle Educational Goals Learning Activities* Expand clinically applicable knowledge of the basic physiology See patients with these of the Endocrine system and its diseases/disorders. diseases; attend the clinics and consult rounds where we encounter these diseases. Read appropriate assigned topics. Attend conferences where these topics are regularly discussed for the educational benefit of the house staff (and medical students) Expand the ability to construct a clinically relevant differential Through reading and seeing diagnosis for patients presenting with Endocrine diseases. patients with these diseases Gain a basic understanding of the diagnostic modalities Again, by regular employed in the evaluation of Endocrinopathies. participation in the structured activities provided Gain a basic understanding of the pharmacologic agents used As above in the treatment of Endocrine disorders. Gain an understanding of the evidence which guides the As above evaluation and management of patients with Endocrine disorders. Gain a working knowledge of current guidelines proposed for As above. Where possible, the evaluation, management, and prevention of Endocrine implementation of disorders. established guidelines 3) Practice-Based Learning and Improvement Principle Educational Goals Learning Activities* Identify and acknowledge gaps in personal knowledge and Observation of house staff skills in the care of patients with disorders of the Endocrine during patient systems. examinations, case presentations. One-on-one teaching, as well as small
  3. 3. group and classroom-style teaching and question/answer sessions. Provide opportunity for house staff to ask questions in a non-threatening environment, open for learning opportunities Use the principles of evidence-based medicine to formulate Where possible, utilize data clinical questions which arise in the care of patients with from randomized, Endocrine disorders, search the medical literature, critically prospective, double-blind, appraise such literature, and apply the information to specific placebo-controlled clinical patients trials designed to measure outcomes to guide options of management. Critically review current literature to formulate plans for evaluation and management Use evidence-based texts to guide the diagnosis and treatment Careful literature review for of Endocrine diseases. those current and evidence- based texts (or current reviews of selected topics which may serve in the absence of evidence-based texts) on Endocrine topics Develop real-time strategies for filling knowledge gaps that Assigned notebook will benefit patients with disorders of the Endocrine systems. containing 38 selected articles (approximately 1 article per day for the 30 days each house officer spends on the Endocrine rotation) 4) Interpersonal Skills and Communication Principle Educational Goals Learning Activities* Communicate effectively with patients and families Request feedback regarding effectiveness of communication from patients and families Communicate effectively with physician colleagues and Requirement for letters to members of other health care professions to assure timely, the referring physician for comprehensive patient care each patient seen in clinic consultation (or in urgent case, immediate telephone call of important
  4. 4. information) to the referring physician, or to another physician more directly involved in the issue of urgency. Communication skills are routinely evaluated at the completion of each house officer rotation on the Endocrine rotation. Present patient information concisely and clearly, verbally and Elicit feedback in terms of in writing effectiveness of patient presentations (verbally and in writing). This is provided at the evaluation performed at the completion of each house officer rotation Gain skills in effective consultation, communicating in a Each house officer is supportive, helpful fashion with members of the primary team assigned new and F/U patients seen for Endocrine consultation in both in- patient and out-patient settings. Communication of findings and recommendations is carefully taught and reviewed to provide effective patient care. Gain an appreciation for the importance of a clearly defined An often-encountered and question from the requesting team in effective consultation. sometimes elusive question: specifically what does the primary team want us (the consulting team) to provide? In non- academic settings, this often entails "consult and manage", not just "evaluate and recommend". Careful communication with the primary team before completing the consultation is encouraged, to avoid unsatisfactory results Gain an enhanced understanding of the importance of true Effective communication informed consent when considering invasive procedures of the actual procedure
  5. 5. being provided, including the risks, side -effects, and alternatives available 5) Professionalism Principle Educational Goals Learning Activities* Behave professionally towards patients, families, Profession behavior is colleagues, and all members of the health care team routinely evaluated at the completion of each house officer Endocrine rotation Consider patient autonomy, beneficence, and social justice as Respect for patient the guiding principles of dealing with ethical challenges preference and the right to informed decision is promoted regularly 6) Systems-Based Practice Principle Educational Goals Learning Activities* Gain an enhanced understanding of the integral role of a Regular attendance on consultant in the care of patients with Endocrine disorders. consult duties, with regular evaluation of each house officer performance of these educational experiences Collaborate with other members of the health care team to Regular participation in assure comprehensive patient care clinics and consult rounds is required, and house officer performance is regularly evaluated Learn to appropriately utilize diagnostic and therapeutic Essentially all of the care resources available within our institution in the care of provided to our patients patients with diseases of the Endocrine systems to assure high occurs within our quality patient care and optimum patient safety institution, with diagnostic reports (and scans themselves) available electronically for immediate review and discussion. Teaching is provided on- the-spot as reports and scans become available. Gain an appreciation for the importance of effective Evaluate each house collaboration with other members of the healthcare team. officer's abilities to effectively work within the health care system to properly utilize health care
  6. 6. resources, including other medical/surgical disciplines, associated healthcare personnel, outside organizations with whom communication of patient information regarding health care is required. Use evidence-based, cost-conscious strategies in the care of Use of established patients with Endocrine diseases. guidelines for evaluation and management of Endocrine disorders (provided in the handout or during teaching rounds) Recommended Resources 1. We recommend that each resident read through the Endocrine syllabus of MKSAP 13 during the month-long rotation. 2. We recommend that UpToDate be used as an evidence-based resource for practice- based learning to answer questions which come up during patient-care activities. 3. We also provide a handout containing 38 selected articles pertaining to the evaluation or management (or both) of Endocrine disorders to each house officer at the beginning of each month rotation and encourage each house officer to read one article daily so as to cover this body of information by the completion of the month rotation. Evaluation Methods Evaluations are based on personal observation by the Endocrine faculty of the resident’s performance in both the inpatient and outpatient clinical settings. Medical knowledge is also assessed based on the resident’s performance in the board review format of the Endocrine Teaching Rounds, and based on their score on the Endocrine Selective Final Exam (performed at the completion of each house officer Endocrine rotation). These factors serve as the basis for completing the standard Department of Medicine resident evaluation form. The completed evaluation is then sent to the medicine program director for review. APPENDIX A
  7. 7. Specific Learning Objectives Goals1 The educational goals of the Endocrine Elective are for house officers to develop the ability to independently evaluate, treat and monitor common endocrine disorders (diabetes, thyroid dysfunction, lipid abnormalities, metabolic bone disease, and calcium disorders) and to be familiar enough with the less common endocrinopathies (adrenal disease, pituitary disease and gonadal dysfunction) to recognize the abnormality and initiate evaluation prior to sub-specialty consultation. Learning Objectives 1. Diabetes mellitus. Differences between Type 1 and Type 2 diabetes. Natural course of diabetes and its complications. Appropriate monitoring methodologies to include home glucose monitoring, glycated proteins and microalbumin. Dietary management and pharmacological therapy to include intensive insulin programs. Patient recommendations for "sick days" and hypoglycemia. Management of commonly associated disorders (hyperlipidemia and hypertension) and their interaction with diabetic therapy. Appropriate and timely referrals to ophthalmology, podiatry, dietary and the diabetes education program. 2. Thyroid disease. Diagnostic evaluation and management of the functional thyroid disorders (hypothyroidism and hyperthyroidism). Treatment options for hyperthyroidism. Evaluation of anatomic thyroid abnormalities (simple goiter, multinodular goiter and solitary thyroid nodule) to include use of nuclear medicine procedures, ultrasound studies and fine needle aspiration. Evaluation of thyroid function tests in the intensive care setting. 3. Lipid disorders. NCEP guidelines. Secondary hyperlipidemia, Dietary and pharmacologic management of dyslipidemias. 4. Metabolic bone diseases. Diagnostic evaluation and treatment options of osteoporosis. Risk factors for osteoporosis. The use of bone densitometry. Osteomalacia. Paget's disease. 5. Calcium disorders. Diagnosis and management of hypercalcemia and hypocalcemia. Management of hyperparathyroidism (medical vs. surgical). Management of critical hypocalcemia and hypercalcemia. Diagnosis and management of vitamin D deficiency.
  8. 8. 6. Adrenal disease. Diagnosis and management of Cushing's syndromes, adrenal failure and pheochromocytoma. Diagnosis and management of adrenal emergencies (Addisonian or pheochromocytoma crisis). Evaluations of the incidental adrenal mass. 7. Pituitary disease. Diagnostic evaluation of pituitary tumors to include the incidental pituitary mass. The role of surgery, radiation therapy and medical management. Diagnosis and management of pituitary apoplexy. Empty sella syndrome. Diagnosis and evaluation or posterior pituitary dysfunction (SIADH and diabetes insipidus). 8. Gonadal dysfunction. Diagnostic evaluation of gynecomastia, hirsutism, amenorrhea and impotence. Androgen and estrogen replacement therapy. 1 Ober KP 2000 "Endocrine Elective" (handout provided to each new house officer as part of Endocrine service orientation).