Endocrinology
I.
Rationale
Family physicians encounter a significant number of endocrinologic problems in the course of practice.
Millions of work days are lost per year due to diabetes, metabolic-related and nutrition-related disorders.
The morbidity of endocrinologic and metabolic disorders results in numerous hospitalizations annually.
Each family medicine resident should be aware of the impact of this group of diseases on the patient and
the family and be capable of performing a history and physical examination with special attention to the
endocrine system. The resident should be able to perform appropriate laboratory tests and basic
diagnostic procedures and to initiate a management and therapeutic plan for patients who have these
diseases.
Given the number of patients with medical complications related to these disorders, primary care
physicians cannot rely on referral to endocrinologist or nutritionist to identify, diagnose and manage this
growing health need. The family medicine physician is an integral part of the health care team that needs
to recognize the importance of early diagnosis, treatment and holistic care of the patient with
endocrinologic, metabolic, and nutritional disorders. As part of a comprehensive treatment plan, family
medicine physicians need competency in assessing patient understanding of these diseases and how to
participate in the treatment plan through self- management skills.
Family medicine physicians need to continually update their clinical knowledge given the new advances in
endocrine, metabolic and nutrition-related diagnoses and treatments. These patients require fullspectrum care that emphasizes the use of appropriate medications and identifying when psychological,
educational, and other therapies are necessary. Because family medicine physicians focus on
comprehensive treatment, they have the unique skills to meet the demands of these patients.
II.
Competencies
Medical Knowledge and Patient Care
Goal: 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.
Objectives:
A. The resident will completely evaluate and manage common endocrine medical problems, including the
following:
1. Cardiovascular Endocrinology
a. Causes of secondary hypertension
Primary aldosteronism
Primary Hyperparathyroidism
Cushing syndrome
Pheochromocytoma
b. Hyperlipidemias
c. The Metabolic Syndrome
2. Diabetes Type I and Type II
Last Updated April 19, 2013
3.
4.
5.
6.
7.
8.
9.
a. DKA
b. Hyperosmolar Hyperglycemic Non-Ketotic Syndrome
Growth Disorders
a. Acromegaly
b. Growth Hormone Deficiency in Children
c. Idiopathic Short Stature
d. Precocious (Early) Puberty
e. Turner Syndrome Growth Disorders
Hormone Abuse
a. Anabolic Steroids and Young Adults
b. Growth Hormone Use and Abuse
c. Supplements, Steroid Precursors and Adolescent Health
Menopause
a. Bioidentical Hormones and Menopause
b. Breast Cancer Prevention
c. Complementary and Alternative Medicine (CAM) for Menopausal Symptoms
d. Hormones, Women and Breast Cancer
e. Menopause and Bone Loss
f.
Menopause Management: Hormone Therapy and Alternative Treatments
g. Menopause Management: Treatment Options for Early Menopause
h. Osteoporosis and Women's Health
i. Premature Ovarian Insufficiency
Osteoporosis
a. Bioidentical Hormones and Menopause
b. Bisphosphonates for Osteoporosis
c. Glucorticoid-Induced Osteoporosis
d. Vitamin D, Calcium and Bone Health
e. Hormone Therapy for Menopausal Symptoms
f.
Menopause and Bone Loss
g. Osteoporosis in Men
h. Vitamin D, Calcium, and Bone Health
Pituitary Disorders
a. Acromegaly
b. Cushing’s Syndrome
c. Hyperprolactinemia
d. Diabetes insipidus
e. SIADH
Reproductive Endocrinology
a. Endometriosis
b. Erectile Dysfunction
c. Gynecomastia
d. Infertility and Men
e. Infertility and Women
f.
Klinefelter Syndrome
g. Low Testosterone and Men’s Health
h. Polycystic Ovary Syndrome
i.
Primary Ovarian Insufficiency
j.
Vaginal Atrophy
k. Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)
Thyroid Conditions/Disorders
a. Congenital Hypothyroidism
b. Goiter
c. Graves' Disease
Last Updated April 19, 2013
d. Hashimoto's Disease
e. Hyperthyroidism
f.
Hypothyroidism
g. Postpartum Thyroiditis
h. Thyroid Cancer
i.
Thyroid Nodules
10. Other Conditions
a. Acromegaly
b. Adrenal Insufficiency
c. Ambiguous Genitalia
d. Bariatric Surgery and the Endocrine System
e. Congenital Adrenal Hyperplasia
f.
Cushing's Syndrome
g. Enlarged Prostate (Benign Prostatic Hyperplasia)
h. Klinefelter Syndrome
B. The resident will articulate proper use of endocrinology consultations (inpatient and outpatient).
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
X
Didactics
Other
Evaluation Methods
X
Attending Evaluation
X
Program Director
Review
360 ᵒ evaluation
Other
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
X
X
Directly Supervised Procedures
In-Training Exam
X
Videotape Review
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Interpersonal and Communication Skills
Goal: Develop skills for adequate written documentation in charting, dictations, and computerized
medical records. Develop oral communication skills and appropriate interpersonal interactions with
patients, peers, and other health care professionals.
Objectives:
A. Develop skills for interviewing patients that allow accurate, complete collection of information
regarding symptoms, and the community environment that affect the patient’s metabolic and
nutritional health.
B. Develop skills in communicating results, educating patients and their families, and dealing with
sensitive issues for patients and families, and negotiating a plan of treatment with the patient and
family.
C. Residents will understand the need for a multidisciplinary, integrated approach to disease prevention
and rehabilitation including: nutritionists, behavioral scientists, educators, endocrinologists, and
family physicians.
Last Updated April 19, 2013
D. Develop skills in educating patients and their families, in dealing with sensitive issues for patients and
families, and in negotiating a plan of investigation and treatment with the patient and family.
E. Develop professional relationships with co-workers, consultants, ancillary staff and other
Professionals to enable assembling of health care teams and mobilization of community resources to
optimize care of the patient.
F. Use professional language and demeanor when communicating with other residents, with Family
Medicine attending physicians, with physicians from other services, with non-physician clinical staff,
with non-physician non-clinical staff, and with patients and their families.
G. Create and sustain a therapeutic and ethically sound relationship with patients.
H. Use effective listening skills and elicit and provide information using effective nonverbal, explanatory,
questioning, and writing skills.
I. Work effectively with others as a member or leader of a health care team or other professional group.
J. Improve skills for providing patient education regarding prevention of endocrinological diseases
associated with other medical conditions.
K. Learn how to effectively and efficiently communicate and coordinate with endocrinology consultants.
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
X
Didactics
Other
Evaluation Methods
X
Attending Evaluation
X
Program Director
Review
X
360 ᵒ evaluation
Other
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
X
X
Directly Supervised Procedures
In-Training Exam
X
Videotape Review
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Systems-Based Practice
Goal: Demonstrate an awareness of and responsiveness to the larger context and system for health care
and the ability to effectively call on system resources to provide care that is of optimal value.
Objectives:
A. Understand how their patient care and other professional practices affect other health care
professionals, the health care organization, and the larger society and how these elements of the
system affect their own practice.
B. Know how types of medical practice and delivery systems differ from one another, including methods
of controlling health care costs and allocating resources.
C. Practice cost-effective health care and resource allocation that does not compromise quality of care.
D. Advocate for quality patient care and assist patients in dealing with system complexities.
E. Know how to partner with health care managers and health care providers to assess, coordinate, and
improve health care and know how these activities can affect system performance.
Last Updated April 19, 2013
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
X
Didactics
Other
Evaluation Methods
X
Attending Evaluation
X
Program Director
Review
360 ᵒ evaluation
Other
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
X
X
Directly Supervised Procedures
In-Training Exam
X
Videotape Review
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Professionalism
Goal: Residents will demonstrate a commitment to carrying out professional responsibilities, adherence
to ethical principles, and sensitivity to a diverse patient population.
Objectives:
A. Understand the need for continuing medical education to stay abreast of the constant changes in
therapy for endocrinological diseases.
B. Become familiar with resources available in the community for patients with chronic illness and learn
how to incorporate them into the treatment plan when needed.
C. Demonstrate integrity, honesty, respect and a commitment to excellence in all activities.
D. Demonstrate sensitivity, respect and adapt appropriately to the social and cultural issues of each
patient.
E. Display initiative and resourcefulness in patient care and in solving problems.
F. Be timely in attendance of activities and completion of tasks.
G. Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and
society that supersedes self-interest; accountability to patients, society, and the profession; and a
commitment to excellence and on-going professional development.
H. Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care,
confidentiality of patient information, informed consent, and business practices.
I. Arrive at the rotation in a timely fashion.
J. Work effectively as a member of a team.
K. Respect patient privacy by guarding medical records and discussion of personal information
L. about patients.
M. Assist patients and their families in planning for future care needs and care decisions based
on prognosis for the disease.
N. Support the patient in their healthcare decisions.
O. Demonstrate professional, respectful demeanor when addressing team members, patients,
ancillary staff, and consultants.
P. Appear professionally dressed and well groomed.
Q. Attends required conferences.
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Last Updated April 19, 2013
Research Conference
Ethics/Comm Conference
X
X
Outpatient Clinics
Direct Patient care
X
Grand Rounds
Sub-Specialty Conference
Morning Report
Didactics
Other
Evaluation Methods
X
Attending Evaluation
X
Program Director
Review
360 ᵒ evaluation
Other
X
X
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
Directly Supervised Procedures
In-Training Exam
X
Videotape Review
X
X
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Practice-based Learning and Improvement
Goal: The resident should develop skills in evaluating their own patient care, appraising and assimilation
of scientific evidence to improve patient care.
Objectives:
A. Analyze practice experience and perform practice-based improvement activities using a systematic
methodology.
B. Locate, appraise, and assimilate evidence from scientific studies related to their patients' health
problems.
C. Obtain and use information about their own population of patients and the larger population from
which their patients are drawn.
D. Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and
other information on diagnostic and therapeutic effectiveness.
E. Use information technology to manage information, access on-line medical information; and support
their own education.
F. Learn to incorporate health promotion and disease prevention into patient care.
G. Use evidence-based medicine, evaluation of available evidence, and use of best-available evidence at
morning report meetings and during routine clinical care.
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
X
Didactics
Other
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
Evaluation Methods
X
Attending Evaluation
X
Directly Supervised Procedures
X
Program Director
X
In-Training Exam
Review
360 ᵒ evaluation
Videotape Review
Other
III.
Instructional Strategies (see above)
Last Updated April 19, 2013
X
X
X
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
The primary strategy will be precepted patient care and procedures on the endocrinology rotation and in
the Family Medicine Clinic. This will be complemented by didactic presentations and supplemental reading
materials.
IV.
Evaluation Strategies (see above)
A.
B.
C.
E.
F.
Direct observation by Endocrinology and Family Practice preceptors
Chart review
End of rotation summative evaluation by Endocrinology preceptor
Resident evaluation of rotation by evaluation form.
Resident-advisor meetings (before and after rotation). At the midpoint of each rotation (as
a minimum) and as frequently as possible throughout, the resident should be given specific
and constructive feedback by the Endocrinology preceptor on his/her progress, to include
recommendations for improvement and personal growth.
G. If the resident does not receive this midpoint 2 week evaluation, he/she should request it
from his/her staff preceptor.
H. ABFP in-training exam
I. Resident self-evaluation
V.
Implementation Strategies
A. This is a PGY II/PGY III elective rotation. The rotation will be done in the clinics of Dr.
Victoria Musey
B. PGY II residents will spend 6 half days/week for 1 four week block in the Endocrinology
clinic and 4 half days/week in the Family Medicine Clinic. PGY III residents will spend 5
half days/week in the Endocrine clinic and 5 half days/week in the Family Medicine Clinic.
C. The resident will attend didactics 1 half day/week on Thursday mornings.
D. 1 week of vacation is allowed during the Endocrinology rotation.
E. Location: Emory University Hospital Midtown, Suite 1010.
F. Resident responsibilities:
1. Meet with endocrine advisor and know the endocrinology rotation expectations.
2. Examine patients, formulate an initial plan for work-up, diagnosis and management, and then
present the patients to the preceptor.
3. Call will take place on the Family Medicine Service at Emory University Hospital Midtown.
4. Spend 4-5 half-days per week in FPC.
5. Document all procedures and diagnoses of patients managed.
6. Actively seek feedback from preceptors.
7. Complete rotation evaluation at the end of rotation.
VI.
Selected Resources/Readings
1.
AFP Monographs
Fluids and Electrolytes (320) January 2006
Obesity (349) June 2008
Type 2 Diabetes (358) March 2009
Endocrine Disorders (310) March 2005
2.
Web Sites
Healthy People 2010: US Department of Health and Human Services
http://www.healthypeople.gov
Last Updated April 19, 2013
American Dietetic Association (ADA)
http://www.eatright.org
Arbor Nutrition Guide
http://www.arborcom.com
Last Updated April 19, 2013