Endocrinology Eval

Faculty Chair:

Leandrita Ortega, MD

Contacts:

Andrew Lancaster, MD

Required Experiences:

Gerald Champion Regional Medical Center

Optional Experience:

Elective rotations

Weekly Schedule PGY 2 or 3:

Requirements:

AOA

Internal Medicine

The program must provide at least thirty-two weeks of clinical training in internal medicine disciplines, including at least eight weeks of general internal medicine experiences during the OGME-1 year. This requirement can be met by either inpatient internal medicine or inpatient family medicine service.

At a minimum internal medicine training must include:

• Twenty-four weeks of inpatient experience.
• Four weeks of training in critical care medicine.
• Didactic and clinical training.

Internal medicine training shall include exposure to the following disciplines, in either inpatient or outpatient settings:

• Allergy and immunology.
• Cardiology.
• Dermatology.
• Endocrinology.
• Gastroenterology.
• Hematology.
• Infectious diseases.
• Nephrology.
• Neurology.
• Oncology.
• Pulmonology.
• Rheumatology.

ACGME

There must be specific subspecialty curricula to address the breadth of patients seen in family medicine. (Core)

The program must ensure that every resident has exposure to a variety of medical and surgical subspecialties throughout the educational program. (Detail)

Description of Rotation or Educational Experience:

Expectations:

Residents

Residents are expected to arrive to Endocrinology and continuity clinics on time and to dress and act in a professional manner. They are expected to contact the endocrinology preceptors’ office prior to their first day on the rotation in order to arrange the initial meeting time and location of the rotation. It is expected that while at the preceptors’ office the residents will be respectful of the office space and personnel. The resident is responsible for maintaining a procedure log as well as completing assigned readings.

Faculty:

Family medicine faculty will provide precepting of neurologic cases and procedures as seen in resident continuity clinics. Dr. Lancaster, and possibly other providers in his practice, will provide precepting during the focused Endocrinology rotation. The faculty and preceptors are expected to allow the resident to participate in active patient care and procedures when appropriate. The preceptors should also provide time and allowance for explanation and teaching of neurologic conditions and their treatments.

Call:

There is no call specific to this rotation.

Medical Knowledge and Patient Care

Goal

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to:

Acquire skills in data collection, including history-taking, physical examination, the appropriate ordering and interpretation of laboratory and imaging studies, and medical decision making. Learn a basic core of knowledge of endocrine diseases; their clinical manifestations, pathophysiology, and management. This knowledge base will include both common and uncommon endocrine disorders and will also incorporate instruction in the genetics, biochemistry, pharmacology, and psycho-social aspects of endocrine diseases.

Competencies

• Be able to perform standardized comprehensive endocrinologic assessments, obtain necessary further investigation and develop acute and long-term comprehensive treatment plans based on the basis of presenting and progressively deteriorating neurological processes.

Objectives

In the appropriate setting, the resident should demonstrate the ability to independently

perform or appropriately refer:

1. The resident will completely evaluate and manage common endocrine medical problems, including the following:
   1. Cardiovascular Endocrinology
      1. Causes of secondary hypertension
         1. Primary aldosteronism
         2. Primary Hyperparathyroidism
         3. Cushing syndrome
         4. Pheochromocytoma
      2. Hyperlipidemias
      3. The Metabolic Syndrome
   2. Diabetes Type I and Type II
      1. DKA
      2. Hyperosmolar Hyperglycemic Non-Ketotic Syndrome
   3. Growth Disorders
      1. Acromegaly
      2. Growth Hormone Deficiency in Children
      3. Idiopathic Short Stature
      4. Precocious (Early) Puberty
      5. Turner Syndrome Growth Disorders
   4. Hormone Abuse
      1. Anabolic Steroids and Young Adults
      2. Growth Hormone Use and Abuse
      3. Supplements, Steroid Precursors and Adolescent Health
   5. Menopause
      1. Bioidentical Hormones and Menopause
      2. Breast Cancer Prevention
      3. Complementary and Alternative Medicine (CAM) for Menopausal Symptoms
      4. Hormones, Women and Breast Cancer
      5. Menopause and Bone Loss
      6. Menopause Management: Hormone Therapy and Alternative Treatments
      7. Menopause Management: Treatment Options for Early Menopause
      8. Osteoporosis and Women’s Health
      9. Premature Ovarian Insufficiency
   6. Osteoporosis
      1. Bioidentical Hormones and Menopause
      2. Bisphosphonates for Osteoporosis
      3. Glucorticoid-Induced Osteoporosis
      4. Vitamin D, Calcium and Bone Health
      5. Hormone Therapy for Menopausal Symptoms
      6. Menopause and Bone Loss
      7. Osteoporosis in Men
      8. Vitamin D, Calcium, and Bone Health
   7. Pituitary Disorders
      1. Acromegaly
      2. Cushing’s Syndrome
      3. Hyperprolactinemia
      4. Diabetes insipidus
      5. SIADH
   8. Reproductive Endocrinology
      1. Endometriosis
      2. Erectile Dysfunction
      3. Gynecomastia
      4. Infertility and Men
      5. Infertility and Women
      6. Klinefelter Syndrome
      7. Low Testosterone and Men’s Health
      8. Polycystic Ovary Syndrome
      9. Primary Ovarian Insufficiency
      10. Vaginal Atrophy
      11. Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)
   9. Thyroid Conditions/Disorders
      1. Congenital Hypothyroidism
      2. Goiter
      3. Graves’ Disease
      4. Hashimoto’s Disease
      5. Hyperthyroidism
      6. Hypothyroidism
      7. Postpartum Thyroiditis
      8. Thyroid Cancer
      9. Thyroid Nodules
   10. Other Conditions
       1. Acromegaly
       2. Adrenal Insufficiency
       3. Ambiguous Genitalia
       4. Bariatric Surgery and the Endocrine System
       5. Congenital Adrenal Hyperplasia
       6. Cushing’s Syndrome
       7. Enlarged Prostate (Benign Prostatic Hyperplasia)
       8. Klinefelter Syndrome

Practice Based Learning and Improvement

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning. Residents are expected to develop skills and habits to be able to:

Competencies

• • Be able to recognize his or her own practice limitations and seek consultation with other health care providers to provide optimal care.

Objectives

• • Complete assigned reading topics and apply learned material in the clinical setting
  • Demonstrate ability to identify limitations in own knowledge and take steps to fill these gaps.

System Based Practice

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected to:

Competencies

• • Be able to optimize treatment plans based on knowledge of local resources that include local, state and federal agencies.
  • Coordinate ambulatory, in-patient and institutional care across health care providers, institutions and governmental agencies.

Objectives

• • Make appropriate referrals to and coordinate care with neurologists for those conditions that fall out of the scope of family medicine or do not respond to that treatment which family physicians can provide
  • Demonstrate cost effective care and diagnostic testing

Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate:

Competencies

The list below reflects competencies that fall under Professionalism. Which of the following competencies are relevant for the rotation or educational experience you have chosen? (Pick one or two)

• • Compassion, integrity, and respect for others
  • Responsiveness to patient needs that supersedes self-interest
  • Respect for patient privacy and autonomy

Objectives

• • Display sensitivity for patient privacy and autonomy during exams and procedures
  • Engage in interviewing techniques which demonstrate cultural and social sensitivity

Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. Residents are expected to:

Competencies

The list below reflects competencies that fall under Interpersonal and Communication Skills. Which of the following competencies are relevant for the rotation or educational experience you have chosen? (Pick one or two)

• • Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds
  • Act in a consultative role to other physicians and health professionals

Objectives

Communicate with patients and their families in a respectful, and concise manner that facilitates understanding with minimal jargon.

Teaching Methods

Residents will provide medical care to patients under the direct supervision of the attending physician. They will be supervised on all procedures performed. They will participate in weekly conferences. Residents will be assigned specific reading topics to be completed by the end of their month on the service.

Assessment Method (residents)

Direct observation with a ongoing global assessment based on the REDI system. All procedures will be recorded on New Innovations and independence for each procedure assessed using the REDI system. Evaluation from each of the community preceptors to be completed at the end of the rotation. Review of documentation by family medicine preceptors as part of continuity clinic supervision.

Assessment Method (Program Evaluation)

Residents will be provided with an evaluation of their experiences and given the opportunity to provide feedback of the rotation during their quarterly IEP assessments.

Level of Supervision

The resident is directly supervised by the attending physician during all procedures performed. An Attending will be available the entire time the resident is on the rotation. An Attending will be available at all times during continuity clinic visits.

Educational Resources

Selected Resources/Readings

AFP Monographs

Fluids and Electrolytes (320) January 2006

Obesity (349) June 2008

Type 2 Diabetes (358) March 2009

Endocrine Disorders (310) March 2005

Web Resources

Healthy People 2010: US Department of Health and Human Services

http://www.healthypeople.gov

American Dietetic Association (ADA)

http://www.eatright.org

Arbor Nutrition Guide

http://www.arborcom.com

Readings:

Week 1

Week 2

Week 3

Week 4

Text Books

Web Sites