CURRICULUM FOR FELLOWS IN THE ENDOCRINOLOGY TRAINING PROGRAM AT
JCESOM AT MARSHALL UNIVERSITY
OVERALL GOAL: To train residents to acquire the competency of a specialist in the field
of endocrinology, diabetes and metabolism. Competencies will include:
1. Overall assessment of patient care that is effective, safe, timely, efficient, equitable and
2. Medical knowledge about established and evolving biomedical, clinical and cognate
sciences (e.g., epidemiological and social-behavioral) and the application of this
knowledge to patient care.
3. Interpersonal and communication skills that result in effective information exchange and
teaming with patient, their families and other health professionals
4. Professionalism, as manifested through a commitment to carrying out professional
responsibilities, adherence to ethical principles and sensitivity to a diverse patient
population, providing cost-effective, ethical and humanistic care.
5. System-based practice, as manifested by actions that demonstrate an awareness of and
responsiveness to the larger context and system of health care and the ability to
effectively call on system resources to provide care that is of optimal value
6. Practice-based learning and improvement that involves investigation and evaluation of
their own patient care, appraisal and assimilation of scientific evidence and improvement
in patient care.
1. To meet this overall goal, the fellows will be given opportunities to assume
responsibility for and follow patients throughout the training period. Fellows will
see both inpatients and outpatients to observe the evolution and natural history of
endocrine disorders as well as the effectiveness of therapeutic interventions. The
program will provide a minimum of 2 half days of ambulatory care per week
averaged over the 2 years of training.
2. The fellows will be given opportunities to function in the role of an
endocrinology consultant in both the inpatient and outpatient settings.
3. The curriculum will provide the fellows with formal instruction and clinical
experience to enable them to demonstrate:
a. Competence in the evaluation (E) and management (M) of the following
1. Hypothalamus and pituitary
3. Adrenal cortex and medulla
4. Pancreatic islets
5. Ovaries and testes
b. Competence in the E and M of type 1 and 2 diabetes including:
1. Acute, life-threatening complications of hyper and hypoglycemia
2. Intensive insulin management in critical care and surgical patients
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3. Long term goals, counseling, education and monitoring
4. Intensive management of glycemic control in the ambulatory setting
5. Prevention and surveillance of microvascular and macro vascular disease
6. Diabetes detection and management during pregnancy
7. Multidisciplinary diabetes education and treatment program
c. Competence in E and M of multifactorial disorders associated with hormonal
1. Disorders of fluid, electrolyte, and acid-base metabolism
2. Disorders of bone and mineral metabolism with particular emphasis on the
diagnosis and management of osteoporosis and primary and secondary
hyperparathyroidism and other metabolic bone diseases
3. Primary and Secondary Hypertension
4. Nutritional Disorders
Autoimmune disease and their role in pathogenesis of endocrine excess and
deficiency and poly glandular syndromes
5. Calcium, phosphorus and magnesium imbalance
6. Diagnosis and treatment of ectopic hormone production due to neoplasms
7. Endocrine adaptations and maladaptations to systemic disease
8. Endocrine Aspects of Psychiatric disorders
9. Endocrine aspects of aging
B.Technical and Other Skills
The fellow will have formal instruction on the appropriate utilization and interpretation of
clinical laboratory, radionulcide and radiological studies for diagnosis and treatment of
endocrine and metabolic diseases combined with clinical experience to demonstrate
competence in the interpretation of:
1. Hormone assays, including results of provocative and supression tests
2. Interpretation of radiological studies for diagnosis and treatment including
radionulcide localization of endocrine tissues and ultrasound of the neck
C. 4. Formal Instruction will be provided in biochemistry, physiology, and molecular and
cell biology. This will be incorporated into the curriculum as they relate to endocrinology,
diabetes and metabolism. Should know scientific basis of disease and pathophysiological
basis of endocrinologic and metabolic problems and disease, particularly diabetes.
a. Genetics as it relates to endocrine diseases
b. Developmental endocrinology including growth and development, sexual differentiation
and pubertal maturation
c. Endocrine physiology and pathophysiology in systemic diseases and principles of
d. Biochemistry and physiology, including cell and molecular biology and immunology in
relation to endocrinology and metabolism
e. Signal transduction pathways and biology of hormone receptors, performance of
endocrine clinical laboratory and radionulcide studies and basic laboratory techniques
including quality control, quality assurance and proficiency standards
f. Pathogenesis and epidemiology of diabetes mellitus
g. Whole organ and islet pancreatic transplantation.
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SPECIFIC GOALS AND SPECIFIC OBJECTIVES
1a. Goals of that educational endeavor.
1b. Description of specific, measurable knowledge objectives for particular educational
2a. Define specific skills objectives and procedures to be learned.
2b. Description of objectives for particular educational skills
3. Define the educational environment and specify implementation of the curriculum
4. Define evaluation of the learner and the curriculum.
5. Specify feedback process for the learner.
This subspecialty program is designed to provide advanced training and experience at a level
for the trainee to acquire the knowledge skills, attitudes and experience required for all of the
competencies needed by a consultant. At the completion of the program, the fellow should be
able to enter the clinical practice of endocrinology, function as a clinician-educator, or enter
academic medicine as a clinician scientist. The fellow will learn basic and advanced endocrine
biochemistry, physiology and pathophysiology that provide the basis for understanding
endocrine disease. The fellow will learn a critical mass of fundamental information and
practical approaches for diagnosis, management and prevention of endocrine disease. The
fellow will acquire the technical and practical skills that are required by a consultant in
endocrinology, diabetes and metabolism. This will include knowledge and skills necessary for
critical analysis for laboratory testing and the endocrine literature. This knowledge and skills
will be acquired in a progressive fashion and with increasing responsibility throughout the
training period. The fellow will acquire knowledge and skills necessary for providing cost-
effective, ethical and humanistic care of patients.
The curriculum will:
1. Enable the resident to recognize congenital or acquired endocrine problems, diseases and
syndromes due to infections, endocrine disrupters, trauma, and neoplasms or other causes
of dysfunction and to initiate the decision-making sequential steps in the diagnostic
2. Enable the resident to evaluate and manage uncomplicated common and rare endocrine
deficiencies and select first line hormone replacement and chose alternative options if first
line therapy fails.
3. Enable the resident to evaluate and manage acute and chronic complications of diabetes
in the ambulatory and hospital setting.
4. Enable the resident to design and perform hypothesis-drive endocrine research and
participate in such research or equivalent scholarly activity such as grant writing and
Diabetes and Hypoglycemia
1. Should be able to classify type 1 and 2 diabetes on the basis of etiology and pathogenesis
2. Comprehensive assessment of control and management of blood sugar levels in keeping
with ADA guidelines. Should be able to determine the goals for blood sugar, blood
pressure, and lipid control and target levels to attain those goals.
3. Comprehensive assessment, treatment, and surveillance of the microvascular and
macrovascular complications of diabetes. Should have knowledge and skills to document
retinopathy, nephropathy, neuropathy including mononeuritis of cranial nerves,
dermopathy, and macrovascular disease involving the coronary arteries, cerebral and
JCESOM at Marshall University 3
peripheral extremity vessels. Should be able to stratify patients by severity of the
complication and manage each complication accordingly.
4. Should be able to diagnose types of neuropathy and manage peripheral and autonomic
neuropathy and the diabetic foot with and without ulcers and infection.
5. Should have knowledge of the effects of insulin in metabolism, its action on liver glucose
production and muscle uptake, its clearance by the kidney, and the relation to the
pathophysiology to hyperglycemia and hypoglycemia.
6. Identify causes of hypoglycemia (including insulinoma, mutations of the sulfonylurea
receptor) and how diet, exercise and insulin dosing can cause hypoglycemia.
7. Know the duration of action of glargine, ultralente, NPH, lente, regular, and lispro,
aspartated and glulisine insulins and different patterns of BS response to different long-
acting insulins (normal, delayed, transient) and different treatment regimens.
a. Recognize diabetes and causes for poor control (including waning insulin action, the
dawn phenomenon, and rebound hyperglycemia).
b. Be able to recognize and discern problems in sick diabetic patients who call in for
advice, and advise and manage sick patients on the sick day diet and insulin
management to prevent DKA by telephone communication.
c. Recognize causes for resistance (including infection) and appropriate management of
causes and insulin resistance.
8. Be able to implement intensive management of glycemic control in the ambulatory setting.
9. Be able to implement intensive insulin management including insulin infusion protocols in
critical care and surgical patients perioperatively and intraoperatively.
10. Should recognize the importance and methods of diabetes detection during pregnancy and
manage patients the patient throughout pregnancy.
11. Evaluate and manage acute, life threatening complications of hyper- and hypoglycemia.
12. Should be proficient in the use of insulin pumps and continuous glucose monitoring
13. Understand the need for and organization and function of a multidisciplinary diabetes
education and treatment program. Learn the team approach to diabetes management, the
role of patient education, dietary principles and management, psychosocial and ethical
14. Should be able to set long-term goals, counsel patients, and provide education and
methods of monitoring.
Disorders of fluid, electrolyte, and acid-base metabolism
1. Should be able to evaluate hypernatremia and hyponatremia, hyperkalemia and
hypokalemia, metabolic acidosis and alkalosis, and have knowledge of their
interrelationships and treatment.
2. Endocrine Emergencies
Primary and Secondary Hypertension and Hypotension
1. Should be able to differentiate between and know the diagnostic strategies for diagnosis
and treatment of essential hypertension and secondary hypertension including adrenal
causes of hypertension and renovascular hypertension.
2. Should have knowledge of the causes of hyptentssion including autonomic dysunction,
idiopathic hypotention, Shy-Drager, neurogenic syncope, adrenal insufficiency
1. Should have knowledge of the genetic and non-genetic basis of obesity and its diagnosis
JCESOM at Marshall University 4
2. Should be able to make the diagnosis of eating disorders (e.g., anorexia and bulimia).
3. Should have knowledge of the indications of enteral and parenteral nutrition and skills in
administering nutrition, fluids, and minerals.
1. Clinical knowledge and skills to diagnose variety of types of hyperthyroidism and
hypothyroidism and be aware of atypical presentations.
2. Should have knowledge of different approaches to the treatment of hyperthyroidism
including antithyroid medication, surgery and radioactive iodine treatment.
3. Should have knowledge of different presentations and skills to diagnose autoimmune,
subacute or acute thyroiditis and be manage different stages of the disease.
4. Should have knowledge of the pituitary-thyroid axis and management (fine-tuning) of
thyroid patients with thyroxine using serum free T4 and 2nd and 3rd generation TSH
5. Should have knowledge of the causes, diagnostic approaches, and management of thyroid
nodules, and risk factors for cancer.
6. Should have knowledge of types of thyroid cancer, natural history, and management with
monitoring of thyroglobulin and diagnostic scans and therapy over time.
7. Should have knowledge and skills to interpret tests and assess sick patients for abnormal
thyroid function tests due to non-thyroidal illness.
8. Should have knowledge and skills to assess changing requirements and treatment with
thyroxin, the effects of thyroid status on pregnancy and fetal development and outcome,
effects of pregnancy on thyroid function.
Hypothalamic and Pituitary Disease
1. Should have knowledge of causes of primary and acquired target organ failure (e.g.,
craniopharyngiomas and other space occupying and infiltrative disorders) due to
hypothalamic or pituitary disease, and their clinical presentations (including galactorrhea)
and diagnostic steps in their evaluation.
2. Should have knowledge of the approach to diagnosis and management of different
secreting (prolactinoma, acromegaly, Cushings disease, alpha subunit, FSH, TSH) and
non-secreting pituitary tumors, including surgical approaches to remove pituitary tumors;
diagnostic imaging with CT and MRI; radiation modes of therapy; and specific medical
3. Should understand the role of vasopressin and diagnosis and treatment of diabetes
insipidus (DI) or action (nephrogenic DI), or excess (SIADH).
4. Should have knowledge of the causes and treatment of gynecomastia and prolactinemia.
Adrenal Cortex and Medulla Disease
1. Should have knowledge of the pathophysiological basis of disease and steps in the
diagnosis of Cushings syndrome and primary adrenal insufficiency (including adrenogenital
2. Should be familiar with emergency management of acute adrenal insufficiency using
3. Should be able to initiate and withdraw a variety of steroids and be aware of metabolic and
other complications of steroid treatment and their avoidance.
4. Should have knowledge of presentation and causes of primary aldosteronism and
pheochromocytoma and their diagnosis and management.
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Disorders of Bone and Mineral Metabolism with particular emphasis on the diagnosis
and management of osteoporosis and primary and secondary hyperparathyroidism and
other metabolic bone diseases
1. Understanding of disorders of magnesium and calcium/vitamin D metabolism and
parathyroid hormone secretion, including hyper- and hypomagnesemia,
hyperparathyroidism, hypoparathyroidism, osteoporosis, osteomalacia, hypophosphatemia,
2. Knowledge of the importance of calcium and vitamin D maintenance and treatment with
bisphosphonates, raloxifene, PTH 1-34 and calcitonin in the intervention of osteoporosis
3. Knowledge of the tests to diagnose primary and recurrent hyperparathyroidism and
indications for surgery and tests for surveillance.
4. Knowledge of Pagets disease, its presentation and management.
1. Knowledge of the causes of and source of ovarian dysfunction, androgen excess and
hirsutism, including the adrenal, ovary, and peripheral production and diagnostic and
management approaches based on the pathophysiology of disease.
2. Knowledge of the causes of primary and acquired amenorrhea and the steps in the
evaluation and management.
Hypogonadism and Impotence
1. Knowledge of the causes of impotence including hypogonadism, neuropathy, vascular
insufficiency, and other causes and steps in the evaluation and variety of approaches to
treat erectile dysfunction and impotence.
2. Should know the role of estrogens and clinical manifestations (including dysfunctional
uterine bleeding) of estrogen lack or excess and its management in the perimenopausal
and menopausal period.
3. Knowledge of reproductive endocrinology and causes of infertility including congenital
absence of the vas deferens, spermatogenic arrest, adrenogenital disease, and acquired
causes, and approaches to diagnosis and treatment of infertility.
4. Knowledge of the causes of primary ovarian and testicular failure including Turners
syndrome, Klinefelters syndrome, spermatogenic arrest.
5. Knowledge of different types of testicular and ovarian tumors and their presentation.
Lipid and Lipoprotein Metabolism
1. Should have knowledge of the patterns and common and rare causes of hyperlipidemia
and risk of development of subsequent vascular disease.
2. Should have knowledge of general approaches to therapy of common and rare lipid
disorders and combination therapy if initial therapy fails.
1. Know the impact of psychiatric disorders and drugs used for psychiatric disorders on
endocrine function and laboratory tests (including effects on parathyroid secretion, insulin
secretion, renal handling of sodium excretion, the pituitary-adrenal and gonadal axis,
ovulation, and thyroid hormone secretion, action and function tests).
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1. Should have knowledge of endocrine aspects of aging as it relates to care of geriatric
patients, including those with diabetes, thyroid disease, and osteoporosis.
Autoimmune Polyglandular Failure Syndromes
1. Should have knowledge of the autoimmune basis for single and syndromes associated with
multiple organ deficiencies.
1. Should be able to assess and manage patients for hormone-producing neoplasms,
including carcinoid syndromes, ectopic hormone production, islet cell tumors and MEN1,
MEA 2a and 2b.
1. Should have knowledge of effects of systemic illness and disease (adaptations and
maladaptations) and their impact on the thyroid, adrenal and gonadal axes.
2. Technical and Other Skills
2a. Goals – Providing skills of examination and interpretation of tests and procedures
necessary for evaluation and management of patients.
1. Appropriate clinical examination of a patient with endocrinologic disease and diabetes.
2. Appropriate performance and interpretation of stimulation and suppression tests and/or
interpretation of procedures including RIA, ELISA, chemiluminescent assays and IRMA
hormone assays and test results used for diagnosis and management of endocrinologic
diseases and diabetes, including effects of nonendocrine disorders on these studies.
3. FNA of thyroid nodules.
4. Appropriate performance of ultrasound of thyroid and other soft tissues of the neck.
5. Approprate use and interpretation for radionulcide studies for detection of endocrine
tissues and the diagnosis and treatment of endocrine disorders.
6. Perform ultrasound guided FNA of the thyroid and interpret cytological evaluation of thyroid
fine needle aspiration.
7. Appropriate measurement and interpretation of bone mineral densitometry or DXA and the
interpretation of bone biopsy and other tests used in the management of osteoporosis and
other metabolic bone disease.
8. Appropriate experience in evaluation for disease of endocrine target organs using
radiological studies for detection and localization of normal and abnormal tissue using
radionuclides, CAT, PET and MRI.
9. Methods of gene analyses.
10. Epidemiological assessment and statistical analyses.
11. Evaluation of medical literature-Understanding of existing and emerging endocrine
12. Personal scholarship, self instruction and evaluation of quality and performance.
2b. Objectives for particular educational skills
1. Proper interpretation of thyroid function tests, performance of ultrasound of soft tissues of
the neck, and review of thyroid aspiration cytology.
2. Proper interpretation of tests used for blood sugar control and management of diabetes
mellitus - Fasting and postprandial glucose levels and patterns, hemoglobin A1C;
fructosamine, glucose tolerance test, serum and urine ketones, qualitative or quantitative,
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3. Proper interpretation of lipid profile.
4. Proper interpretation of procedures (low and conventional doses of ACTH used for ACTH
stimulation test for adrenal insufficiency and adrenogenital syndrome; GHRH/arginine
stimulation test, insulin stimulation test for GH and cortisol deficiency; clonidine
suppression and glucagon stimulation test for pheochromocytoma; TRH stimulation test for
hyperthyroidism) and tests used in the differential diagnosis and evaluation of endocrine
etiologies of pituitary disease (GnRH stimulation test, FSH and LH, testosterone, prolactin)
and adrenal insufficiency and hyponatremia, hypertension (serum and plasma osmolality,
plasma rennin, aldosterone, urine sodium and potassium, plasma free metanephrine and
urine metanephrines, VMA and catecholamines), and hyperthyroidism.
5. Proper interpretation of serum calcium, phosphorus, alkaline phosphatase, urinary calcium,
bone markers, and review of bone biopsy reports used to diagnose and manage disorders
or bone and calcium metabolism.
6. Proper interpretation of serum and urine uric acid used to diagnose and manage metabolic
diseases of uric acid metabolism.
7. Identify abnormalities in thyroid size and consistency, fundoscopic retinal and lens
abnormalties in diabetes, extra-occular movements and conjunctival abnormalities in
Graves disease, hirsutism, testes abnormalities in primary and secondary hypogonadism.
8. Management of adolescent and adult patients of all ages with diabetes mellitus.
a. Appropriate interpretation of finger stick blood sugars patterns in conjunction with
proper use of long, intermediate and short acting insulin products alone or in
b. Should be able to determine appropriateness of either oral medication or insulin and
prescribe sulfonylureas, metformin, thiazolidinediones, or insulins of different types
alone or in combination with different modes of delivery.
c. Should know the rationale for calculation of diabetic diets with and without dyslipemia
and be able to prescribe a diabetic diet and exercise program.
d. Use autoimmune markers of islet cell rejection and C-peptide for the diagnosis of the
type of diabetes, its management and counseling.
e. Use intravenous insulin in acute decompensated diabetes.
f. Prescribe a glucose-monitoring device for SGM to meet the patients’ needs.
g. Perform a fundoscopic examination, and recognize and appropriately refer patients
with diabetic retinopathy.
h. Examine the diabetic foot and recognize problems requiring inserts of addressing by a
i. Be aware of the psychosocial effects of diabetes mellitus on patients and families.
j. Participate in community education.
9. Proper interpretation of gene sequencing and restriction analysis and patient counseling for
10. Proper analyses of publication results including study design and statistical analyses.
11. Proper indications and interpretation of MRI and CT for diagnosis and management of
12. Should engage life-long in independent learning, continuing scholarship, and continuous
quality improve of practice and practice performance.
Core Competencies – Definitions
HTTP://WWW.ACGME.ORG/OUTCOME/ASSESS/TOOLBOX.ASP and evaluation methods
OSHA regulations and universal precautions and protection of health care workers.
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Quality Assessment and Improvement, Continuous quality improvement, Performance
Health Care Policy
Clinical Trial and Study Design
Cultural, Social, Family, Behavioral, and Economic Issues
Principles of Palliative Care for Terminally Ill Patients
3. Educational Environment and Implementation
1. Endocrine and Diabetes Clinics at UPIM – Monday 8:00-12:00 Noon and 1:00 PM-5:00
PM, Wednesday 8:00-12:00 and 1:00 PM-5:00 PM , Thursday 8:00-12:00, and Friday
2. VA Medical Center Endocrine and Diabetes Clinics - Wednesday and Thursday 1:00-
3. St. Mary's Hospital Indigent Patient Endocrinology Clinic -Second Friday of each month
12:30 - 4:00 PM
4. DXA scan and radionuclide image interpretation on Tuesdays between 10:30am-12 noon
5. Inpatient Consultations and Co-care at St. Mary's, CHH, and the VA hospitals
6. Daily work rounds and teaching rounds with fellow and attending physicians.
7. Core Curriculum Conference twice monthly for two consecutive hour sessions at UPIM.
8. Clinical Case Conference once weekly on Tuesdays between 9:00-10:00 am
9. Research Conference on 3rd Tuesday of each month between 12:30-1:30 PM
10. Journal Club on first Tuesday of each month between 12:30-1:30 PM
3b. Methods (Teaching)
1. Interactive discussion.
2. Individual discussion.
3. Self directed inquiry learning and testing.
4. Role modeling
5. Oral case presentation.
6. Didactic lectures
7. Use of computers, software programs including Excel, Access, PowerPoint, and on line
services including Medline, ADA, AACE, and Endocrine Society web sites.
3c. Resources and Facilities
1. Teaching Faculty, Visiting Professors
3. Reading Materials – faculty, Health Science Library, endocrine syllabus
4. Recommended reading- bibliography- see attached
5. Departments and National Meetings CME
6. MKSAP, ACE, and Endocrine Society self assessment questions and answers,
7. MUSOM Web Site
8. ACGME web site on competencies and tool box methods for assessing competencies
9. Diagnostic Laboratory Services
10. Complete biochemistry laboratory and facilities for hormonal immunoassay
11. Access to karyotyping and immunohistologic studies
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12. Imaging services including nuclear, ultrasound, and radiological facilities including bone
13. Surgical and Pathological Services
14. Dietary and Nutrition Services
15. Specialties in surgery, nephrology, neurology, neurosurgery, obstetrics and gynecology,
ophthalmology, pediatrics, podiatry and urology
16. Sufficient population of adults and adolescent in- and outpatients with the full range of
4. Assessment of Competencies of Fellow and Curriculum
1. Direct interaction during rounds or when appropriate
2. Evaluation of topic presentation (quarterly)
3. Quarterly evaluation of portfolios
4. Evaluation of competencies by faculty using ABIM-ACGME form
5. Formative evaluation of competencies at 6 months and 18 months.
6. Summative formative review of competencies at 1 year and 2 years.
4b. Curriculum and Teacher
1. Formal Annual Review
4c. Fellow Feedback
1. Any time
2. Quarterly feedback
3. Semi-Annual and Annual Summative Formative Review by Program Director and Fellows
Endocrinology. ed. DeGroot. 5th edition. 2005. WB Saunders Company. Harcourt Brace and
Williams Textbook of Endocrinology. 10th Edition. ed. Wilson and Foster. 2002. WB Saunders
Company. Harcourt Jovanovich Inc. Philadelphia
Werner and Ingbar. The thyroid. A Fundamental and Clinical Text. 9th Edition. 2005. ed
Braverman and Utiger. Lippincott, NY, NY.
Molecular Endocrinology. Basic Concepts and Clinical Correlations. ed. Weintraub. 1995.
Raven Press LTD. NY, NY.
Surgical Management of the Diabetic Patient. ed. Bergman and Sicard. 1991. Raven Press
LTD. NY, NY.
Statistics for Research. ed. Dowdy and Wearden. 1983. John Wiley and Sons, Inc
J. Clin Endocrinol and Metabol. Clinical Reviews.
JCESOM at Marshall University 10
Endocrinology and Metabolism Clinics of North America. Saunders Company. Harcourt
Jovanovich Inc. Philadelphia
Baskin, Jack. Ultrasound of the thyroid.
See PDF file of reprints
APDEM recommended readings. See supplement.
Revised November 2008.
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