Rotation:
Endocrinology Subspecialty Selective
Goals:
The educational goals of the rotation in Endocrinology and Metabolism for the house officer are to 1) develop the ability to independently evaluate, treat, and monitor common endocrine disorders, 2) to acquire the knowledge of the underlying processes that contribute to the pathophysiology of the different endocrine diseases, and 3) to describe research tools for studying the underlying mechanisms of different endocrine disorders.
Objectives:
A. Medical knowledge and patient care
1. Diabetes mellitus:
Recognize differences in the pathogenesis and clinical presentation between type
1 and 2 diabetes.
Develop the skills to diagnose and treat acute and chronic complications of diabetes such as diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar syndrome (HHS) and hypoglycemia.
Manage diabetes using diet, oral antidiabetic agents and insulin administration.
Refer appropriately and timely to ophthalmology, podiatry, dietary and diabetic education.
Apply monitoring methodologies properly to include home glucose monitoring, glycated proteins and microalbuminuria.
2. Thyroid disorders:
Interpret thyroid function tests.
Evaluate and manage hypothyroidism, hyperthyroidism, thyroiditis and thyroid cancer.
Evaluate anatomic thyroid abnormalities (goiter, multinodular and solitary thyroid nodules) and correctly use nuclear medicine procedures, ultrasound studies and fine needle aspiration biopsies.
Summarize management of thyroid emergencies (thyroid storm and myxedema).
3. Lipid disorders:
Manage dietary and pharmacological therapy of dyslipidemias. State the NCEP guidelines.
Recognize and manage secondary hyperlipidemias.
4. Hypertension:
Diagnose and treat secondary-endocrine hypertension (primary aldosteronism, pheochromocytoma, Cushing's syndrome).
Express recent JNC guidelines.
5. Metabolic bone disorders:
Recognize the risk factors and perform diagnostic evaluation of osteopenia and osteoporosis. Tell indications for bone densitometry.
Describe treatment option for osteoporosis (postmenopausal, corticosteriod-induced).
Diagnose and manage osteomalacia and vitamin D deficiency.
Diagnose and manage Paget's disease.
6. Adrenal disorders:
Diagnose and manage Cushing's syndromes and adrenal insufficiency.
Describe how to recognize and manage addisonian crisis.
Evaluate the incidental adrenal mass.
Describe the clinical signs, symptoms and differential diagnosis of pheochromocytoma.
7. Pituitary disorders:
Recognize the clinical symptoms and signs of hypoituitarysm and excess pituitary hormone disorders (acromegaly, Cushing's disease, prolactinoma).
Describe the hormonal and radiological evaluation of pituitary tumors. Describe the role of medical treatment, surgery and radiation therapy of pituitary tumors.
Diagnose and evaluate posterior pituitary dysfunction (SIADH, diabetes insipidus).
Diagnose and manage pituitary apoplexy and empty sella.
Describe the causes and management of hyponatremia.
8. Gonadal dysfunction:
Diagnose and manage gynecomastia, hirsutism, amenorrhea and impotence.
Describe androgen and estrogen replacement therapy.
Explain the pathophysiology of, diagnose and manage polycystic ovarian syndrome (PCOs) and associated disorders (insulin resistance, metabolic syndrome, infertility).
9. Calcium disorders:
Describe the differential diagnosis and management of hypercalcemia and hypocalcemia.
Diagnose and manage hyperparathyroidism (laboratory and imaging studies) (medical vs. surgical)
Manage critical hypocalcemia and hypercalcemia.
Diagnose and manage vitamin D deficiency.
B. Other competencies
1. Demonstrate practice-based learning and improvement, interpersonal and communication skills, professionalism, and system based practice through interaction with patients, attendings, and other health care personnel and through delivery of appropriate subspecialty care in a variety of venues.
Learning Venues:
Outpatient Endocrine-Diabetes Clinics:
Residents will be assigned to attend 4 to 5 outpatient clinics per week as part of a two to four week block rotation.
Outpatient clinics are the most essential component of the rotation. Clinics provide residents with the opportunity to assess new and established patients with a great variety of endocrine disorders. It is the resident's responsibility to evaluate the patients, sign out to the attending physician, write or dictate a clinic note, follow up labs, and communicate with the patient and referring physician.
Residents can take similar rotations at Washington University or Saint Louis University School of Medicine. The same goals and objectives and competency evaluation apply.
Inpatient consultations:
Residents will follow inpatient consults as part of their 2-4 week block rotation.
Conferences:
Endocrine Lectures:
Noon lecture serie
Reading List:
Completion of the reading list is an essential component of the Endocrine elective. It consists mostly of review articles concerning important endocrine and metabolic issues.
MSKAP - Endocrinology section
Recommended Endocrinology Textbooks:
Williams Textbook of Endocrinology by Wilson and Foster
Basic Clinical Endocrinology by Greenspan and Baxter
Diabetes Mellitus: A Fundamental and Clinical Text by LeRoth, Taylor and Olefky
Competency Evaluation:
At the end of each rotation, residents will be evaluated by the attending physician of the month and by supervising attending physicians in the outpatient clinic. A composite evaluation report will be submitted to the residency office.
Final Exam: At the conclusion of the elective, there will be a written test covering material from the reading list and didactic lectures. The expected score will be > 80%.
Outcomes Assessment:
The educational success of our elective in endocrinology will be based on two criteria:
(1) endocrinology subsections scores on the in-service examination of all residents who have successfully complete the elective and (2) endocrinology subsections scores on the ABIM certifying examination in internal medicine taken by medical graduates. Our goal is all residents scoring at the 50th percentile or higher.