Revised March 11, 2008
GOALS AND OBJECTIVES
RESIDENT CURRICULUM FOR ENDOCRINOLOGY, DIABETES AND
METABOLISM
Rotation Coordinator:
Michael Jakoby, M.D.
Associate Professor of Medicine
Division of Endocrinology
University of Nevada School of Medicine
Las Vegas, Nevada
OVERVIEW
Purpose
The purpose of this four-week rotation is to provide education and experience in the care
of patients with known or suspected endocrine disease. Residents will see patients in
consultation as well as in the Endocrine outpatient clinic. At the conclusion of this
rotation residents will have gained insight into the diagnosis and management of patients
with endocrine disorders, the role as subspecialty consultant, diagnostic methods of
endocrinology, the natural history of endocrine disease, and strategies for cost-effective
and evidence-based evaluation and treatment. This curriculum is based, in part, upon the
report of the Federated Council for Internal Medicine Task Force on the Internal
Medicine Residency Curriculum.
Teaching Methods
The rotation will be under the supervision of the attending endocrinologist. The
resident(s) will accompany the rheumatologist to patient care locations in the outpatient
setting - patient care center (PCC – faculty practice) and Lied Specialty Clinic - and
inpatient consultations at UMC. The resident will see consultations and patients as
assigned by the attending endocrinologist. The resident will obtain the initial data, write
a consultation note, and present the patient to the attending physician. The attending will
confirm the findings, teach about the case, and with the resident, craft the final
recommendations. The resident will see the patient daily, write the follow up consult
notes, and review them with the attending endocrinologist.
Daily rounds will occur with the attending physician at which time instruction in the
unique aspects of the consultative process will be provided. Residents will be required to
continue their regular morning report and noon conference core curriculum. The resident
and attending will review and discuss any required reading.
Mix of Diseases
The patients seen will represent the very wide spectrum of endocrine disorders
encountered in our inpatient setting and outpatient clinics.
The resident will become knowledgeable with the diagnosis, management, and
complications of the following endocrine disorders:
1. Type 1, 2, and gestational diabetes mellitus and hypoglycemic disorders
2. Disorders of lipid metabolism
3. Care of the surgical patient with diabetes
4. Thyroid disorders (hyperthyroidism, hypothyroidism, thyroid nodules,
thyroiditis, and thyroid cancer)
5. Disorders of calcium and skeletal metabolism (hyperparathyroidism,
osteoporosis, hypercalcemia of malignancy, hypocalcemia, hypomagnesemia);
6. Disorders of the pituitary (prolactinomas, acromegaly, non-secreting tumors,
pre-operative evaluation and post-operative care);
7. Hyponatremia, diabetes insipidus, SIADH;
8. Disorders of the adrenal gland (adrenal insufficiency, Cushing’s syndrome,
hirsutism, endocrine hypertension, incidental adrenal masses);
9. Hypogonadism, and sexual dysfunction;
10. Endocrine emergencies (diabetic ketoacidosis, hyperosmolar coma, adrenal
insufficiency, pituitary apoplexy, thyroid storm, myxedema coma).
The resident will learn to evaluate and manage common endocrine disorders but
recognize one’s limitations and learn to refer appropriately.
The resident will learn to identify the endocrinologic implications of abnormal
serum electrolytes, hypertension, and fatigue.
The resident will become proficient in the use of the major pharmacotherapies
used to treat endocrine diseases especially diabetes mellitus, and hyperlipidemia.
The resident should know their indications, contraindications, dosages, side
effects and toxicities.
Patient Characteristics
There is a diverse patient population, male and female, of all ages from adolescent
to geriatric, representing most ethnic and racial backgrounds, from all social and
economic strata. The hospital serves primarily the indigent population of the city
of Las Vegas.
Types of Clinical Encounters
This rotation is predominantly an outpatient experience. Residents, under the
supervision of full-time faculty board-certified in endocrinology, attend a variety
of outpatient endocrine clinics each week. The resident will have first contact
experience with most patients. They will be responsible for reviewing the patient
record to obtain pertinent information, obtaining the patient history and
performing a physical examination. They will write a progress note consisting of
a concise synthesis of the above, an assessment and a management plan. They
will then present the case to the attending physician. On occasion, the resident
will merely “shadow” the attending physician.
Residents will also provide inpatient consultations for patients on the resident
services as well as patients admitted to private services. In conjunction with the
attending physician, the resident can evaluate the patient record, obtain a patient
history and perform a physical examination. The resident should write and dictate
an initial history and physical examination, and any follow-up progress notes.
Subsequent visits will occur at a rate appropriate to ensure excellence in patient
care and education. Residents are encouraged to do literature searches, provide
articles and should then relay the final recommendations to the consulting
physician and/or team primarily responsible for the patient.
Residents are encouraged to write a case report or participate in a clinical research
project. During the rotation the resident will choose a case or case to be presented
and discussed at Morning Report.
Close interaction with various other healthcare team members including care
managers, discharge planners, home health agencies, inpatient nurses, respiratory
therapists, physical therapists, and patient care technicians occurs daily.
Procedures
No procedures are currently performed during this rotation.
Resident Supervision
Residents have daily personal supervision in their patient care activities. The rotation will
be under the supervision of the attending endocrinologist. The resident(s) will accompany the
endocrinologist to patient care locations in the outpatient setting; patient care center (PCC), Lied
Clinic and inpatient consultations at UMC as assigned. The resident will see consultations and
patients as assigned by the attending rheumatologist write initial and follow up consult notes and
review them with the attending rheumatologist.
TRAINING SITES
University Medical Center
All of the inpatient endocrine consultation experience occurs at University
Medical Center (UMC) under the supervision of one of the full-time endocrine
faculty. The resident will also participate in the UMC outpatient endocrinology
clinic on the second and fourth Thursday of each month.
UNSOM Faculty clinic (Patient Care Clinic) and Lied Specialty Care Clinic
The resident will participate in this endocrine outpatient clinic under the
supervision of the full-time endocrine faculty.
CORE EDUCATIONAL MATERIAL
Didactic Teaching
Morning Report
Residents rotating on the endocrinology service are required to maintain greater
than 60 % attendance at morning report. Morning Report begins at 8 a.m. on
Monday through Thursday and at 8:30 a.m. on Friday.
Noon Conference
Residents rotating on the endocrinology service are required to maintain greater
than 60 % attendance at noon conference. Noon conference occurs daily, Monday
through Friday. These sessions cover the basic core curriculum, and other
curriculum topics such as ethical issues, geriatrics, computer systems and
informatics, health care systems, occupational and environmental health issues,
and other topics of concern. An endocrinology topic is presented at least once
during each month.
Attending Rounds
Didactic discussions will be held regarding all patients seen in consultation during
the month. Each resident and medical student will be required prepare and
discuss during teaching rounds one article or endocrinology topic each week.
Teaching rounds by the attending physician will occur every day for 45 - 60
minutes after regular management rounds. Each resident is required to review
common endocrinology topics.
Recommended Reading
Listed below is the bibliography used to teach residents during the rotation.
1. Wartofsky L. Update in Endocrinology. Amer Coll of Phy 2001, vol 135, no 8(part
1):601-609.
2. Ford E.S., Giles W.H., Dietz W.H. Prevalence of the Metabolic Syndrome Among US
Adults. JAMA 2002, vol 287. no. 3:356-359.
3. Knowlez W.C., Barrett-Connor E., Fowler S.E., et al. Reduction in the Incidence of
Type 2 Diabetes with Lifestyle Intervention of Metaformin. NEJM 2002, vol 346, no
6:393-403.
4. Stern M.P., Williams K., Haffner S.M. Indentification of Persons at High Risk for
Type 2 Diabetes Mellitus: Do We Need the Oral Glucose Tolerance Test? Amer Coll
of Phy 2002, vol 136, no 8:575-581.
5. Barr R.G., Nathan D.M., Meigs J.B., Singer D.E. Tests of Glycemia for the
Diagnosis of Type 2 Diabetes Mellulitus. Annals of Int Med, vol 157, no 4:263-270.
6. Expert Committee on the Diagnosis and Classification of Diabetes Mellulitis. Report
of the Expert Committee on the Diagnosis and Classification of Diabetes Mellulitis.
Diabetes Care July 1997, vol 20, no 7:1183-1194.
7. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing
risk of macrovascular and microvascular complications in type 2 diabetes UKPDS 39.
Papers.
8. Umpierrez G.E., Isaacs S.D., Bazargan N., et al. Hyperglycemia: An Independent
Marker of In-Hospital Mortality in Patients with Undiagnosed Diabetes. The Journal
of Endocrinology & Metabolism 87(3):978-981.
9. Corcoy R., Cabero L., DeLeiva A. Gestational diabetes. Postgraduate Med 1992. vol
91 no.5 : 393-400.
10. Noth R.H., Krolewski A.S., Kaysen G.A., Meyer T.W. Schambelan M. Diabetic
Nephropathy: Hemodynamic Basis and Implications for Disease Management. Ann
of Intern Med 1989 110: 795-813.
11. The Diabetes Control and Complications Trial. Diabetes 1986 vol 35: 530-45.
12. Field J.B. Hypoglycemia 1989 vol.18 no.1: 27-41.
13. Summary of the Second Report of the NCEP on detection, evaluation, and treatment
of high blood cholesterol in adults. JAMA 1993 vol.269 No.23: 3015-23.
14. Stone N.J. Secondary causes of Hyperlipidemia. Medical Clinics of North Am. 1994.
vol.78 no.1: 117-141.
15. Brody M. B. Reichard R. A. Thyroid Screening. Postgrad Med. vol.98 no.2 : 54-66.
16. Fauchet A., Madec O.A., Lorcy Y et.al. Anithyroid drugs and Graves’ Disease: A
Prospective Randomized Evaluation of the Efficacy of Treatment Duration. JCE&M.
1990 vol.70 no.3: 675-679.
17. Woeber K.A. Thyrotoxicosis and the heart. NEJM 1992 vol.327, no.2: 94-97.
18. Boigon M, Moyer D. Solitary thyroid nodules. Postgrad Med. 1995.vol 98.no.2: 7380.
19. Pronovost P.H., Parrris K.H. Perioperative management of thyroid disease. Postgrad
Med 1995. vol 98.no 2: 83-98.
20. Robbins J, Merino M, Boice, J.D, et.al. Thyroid Cancer: A Lethal Endocrine
Neoplasm. Ann of Intern Med. 1991. vol. 115. no.2: 133-147.
21. Benwitz N.L. Diagnosis and Management of Pheochromocytoma. Hospital Practice.
1990.: 163-177.
22. Trainer P.J. Grossman A. The Diagnosis and Differential Diagnosis of Cushing's
Syndrome. Clinical Endocrinology 1990.317-328.
23. Cutler G.B., Laue L. Congenital Adrenal Hyperplasia due to 21-Hydroxylase
Deficiency. NEJM 1990.vol 323, no. 26: 1806-1814.
24. Ross N.S., Aron D.C. Hormonal Evaluation of the Patient with An Incidentally
Discovered Adrenal Mass . NEJM 1990. vol. 323. no. 20: 1401-1406.
25. Griffing G. T. Adrenocortical insufficiency: How to avert a medical emergency. The
J of Critical Illness 1991. vol 6, no. 6: 540-554.
26. Kaye T.B., Crapo L. The Cushing's Syndrome: An Update on Diagnostic Tests. Ann
of Intern Med. 1990.;112: 434-444.
27.Young W.F., Hogan M.J. Primary Aldosteronism: Diagnosis and Treatment. Mayo
clin Proc. 1990. 65: 96-110.
28. Griffing G.T. Melby J.C. Hirsutism : Causes and Treatments. Hospital Practice. 1991:
43-58.
29. Forrest H.N., Cox M., Hong C., Morrison G., Bia M., Singer I. Superiority of
Demeclocycline over Lithium in the Treatment of Chronic Syndrome of Inappropriate
Secretion of Antidiuretic Hormone. NEJM vol. 298.no. 4: 173-177.
30. Klibanski A., Zervas N.T. Diagnosis and Management of Hormone-Secreting
Pituitary Adenomas. NEJM. 1991. vol. 324, no. 12: 822-830.
31.Webster J., Piscitelli G., Polli A., et.al. A Comparison of Cabergoline and
Bromocriptine in the Treatment of Hyperprolactinemic Amenorrhea. NEJM. 1994.
331:904-9.
32. Belezikian J.P. Management of Acute Hypercalcemia. NEJM. 1992. vol. 326, no. 18,
1196-1204.
33. Liberman U.A., Weiss S.R., Broll J, et.al. Effect of Oral Alendronate on Bone
Mineral Density and the Incidence of Fractures in Postmenupausal Osteoporosis.
NEJM. 1995 333:1437-1443.
34. Riggs B.L., Melton L.J. The Prevention and Treatment of Osteoporosis NEJM 1992.
327. no. 9: 620-628.
35. Diagnosis and Management of Asymptomatic Primary Hyperparathyroidism:
Consensus Development Conference Statement. Ann Intern Med. 1991.114: 593-597.
36. Ellerington M.C., Hillard T.C., Whitcroft S.I.J., et.al. Intranasal Salmon Calcitonin
for the Prevention and Treatment of Postmenopausal Osteoporosis. Calcif Tissue Int
1996. 59: 6-11.
37. Bone. H.G., Kleerekoper M. Paget's Disease of the Bone. JCE&M. 1992.vol. 75. no.
5: 1179-1182.
38. Melmed S. Acromegaly. NEJM. 1990.322: 966-976.
39. Oelkers W. Adrenal Insufficiency. NEJM. 1996 vol 335. no.16: 1206-1212.
40. Ralph A. DeFronzo, MD. Pharmacologic Therapy for type 2 Diabetes Mellitus. Ann
of Intern Med.1999.vol.131. No.4:281-303.
41. Rederick L. Ferris III,M.D., Mathew D. Davis, M.D., and llyoyd M. Aiello, M.D.
Treatment of diabetic Retinopathy. NEJM 1999. Vol 341. No.9: 667-678.
42. Eberhard Ritz, M.D., and Stephan Reinhold Orth, M.D. Nephropathy in Patients with
type 2 Diabetes mellitus. NEJM 99. Vol 341. No.15. 1127-1133.
43. UK Prospective diabetes study (UKPDS) Group. Effect of intensive blood-glucose
control with mergotmin on complication in overweight patients with type 2
diabetes(UKPDS 34). Lancet 1998. Vol.352, no.9131: 854-65.
44. Siri L. Kjos, M.D. and Thomas A. Buchanan, M.D. Gestational Diabetes Mellitus.
NEJM 1999. Vol 341. No.23: 1749-1755.
45. Ilan Shimon, MD and Shlomo Melmed, MD. Management of Pituitary Tumors. 1998.
Ann Intern Med. Vol 129. No.6:472-483.
46. Stephen Marx M.D.(Moderator), Allen M. Spiegel, M.D.et.al (discussants). NIH
Conferene. Multiple Endocrine Neoplasia type I: Clinical and Genetic Topics. Ann of
Intern Med. 1998. Vol 129.no.6:484-494.
Ancillary Educational Materials
Subspecialty Texts of Neurology, Pulmonary Medicine, Nephrology,
Endocrinology, Infectious Diseases, Rheumatology as well as General Medical
References (Harrison’s Principles of Internal Medicine, Cecil’s Textbook of
Medicine) are available 24 hours a day, seven days a week in the resident lounge.
Savitt Medical Library On-Line
Residents have access to the on-line services of Savitt Library (the main library of
the University of Nevada - Reno) via their computer in the resident room, Suite
300 of the 2040 W. Charleston Building. Access to this room is available 24
hours a day, seven days a week.
Full text is available for many peer-review journals including, but no limited to:
ACP Journal Club
Annals of Internal Medicine
British Medical Journal
Cancer
Circulation
Journal of the American College of Cardiology
The Lancet
New England Journal of Medicine
Stroke
Also available on-line:
Harrison’s Principle’s of Internal Medicine, 14th ed.
Merck Manual, 17th ed.
Guide to Clinical Preventive Services, 2nd ed.
The Cochrane Library
Medline and Grateful Med Databases
Pathological Material and Other Educational Resources
Residents are encouraged to review the pathological reports on patients for whom they
have consulted and to follow the hospital care of those patients. If a patient with whom
the resident has consulted should die and have an autopsy, the resident is encouraged to
attend the post-mortem session.
Competency-based Goals and Objectives
Endocrinology Rotation
Learning Venues
Evaluation Methods
1. University Medical Center
2. University of Nevada School of
Medicine Patient Care Center
(ambulatory endocrinology practice)
3. Self study
Competency Patient Care
Level Specificity
A. Attending Evaluation
B. Nursing Evaluation
R-1 = 1
R-2 = 2
C. Patient Evaluation
D. Objective testing
R-3 = 3
Evaluation
Methods
A, B
Level
Obtain an accurate history
Learning
Venues
1,2
Perform competent complaint-focused
1,2
A, B
1,2,3
1,2,3
physical exams
Interpret laboratory and radiology data
accurately
Present cases accurately and succinctly
Demonstrate effective and competent
perioperative care of the patient with
diabetes mellitus
Competency: Medical Knowledge
Demonstrate knowledge of basic
evaluation and treatment of common
endocrine disorders including diabetes
mellitus, thyroid disorders, hyponatremia,
osteoporosis, calcium metabolism, and
hyperlipidemia
Demonstrate knowledge of evaluation
and treatment of less common endocrine
disorders including adrenal disorders,
disorders of the pituitary, and evaluation
and treatment of hypogonadism
Demonstrate effective consultation to
medical and non-medical services
Demonstrate knowledge of the treatment
of common endocrine emergencies
(diabetic ketoacidosis, hyperosmolar
coma, adrenal insufficiency,).
Demonstrate knowledge of the treatment
of uncommon endocrine emergencies
(pituitary apoplexy, thyroid storm,
myxedema coma)
Competency: Interpersonal
Communication Skills
Show understanding for different patient
preference
Maintain accurate medical records
Communicate effectively to patient and
medical support staff
Communicate patients problems clearly
with patient’s family
Treat patients and families with
respect/empathy
Treat colleagues with respect
1,2
A
1,2,3
1,2
1
A
A
1,2,3
Learning
Venues
Evaluation
Methods
Level
1,2,3
A,B,D
1,2,3
A,D
1,2
A
1,2,3
A,D
1,2,3
A,D
Learning
Venues
1.,2
Evaluation
Methods
A,B,C
1,2
1,2
A,B
A, B, C
1,2,3
1,2,3
1,2
A, B, C
1,2,3
1,2
A, B, C
1,2,3
1,2
A, B, C
1,2,3
1,2,3
2,3
2,3
1,2,3
2,3
Level
1,2,3
Respect patient confidentiality
1,2
A, B, C
Competency: Professionalism
Learning
Venues
Evaluation
Methods
Treat team members, primary care1,2
givers, and patients with respect and
empathy
Understand, practice and adhere to a code 1,2
of medical ethics
1,2
Participate actively in consultations and
A,B,C
1,2,3
Level
1,2,3
A,B,C
1,2,3
A
1,2,3
on rounds
1,2,3
Attend and participate in all scheduled
conferences
1
attendance, A
Competency: Practice-Based Learning
Learning
Venues
1, 2
Evaluation
Methods
A
1, 2,3
A,D
1,3
A
1,2,3
Learning
Venues
2
Evaluation
Methods
A,B
Level
Review out comes of care and apply to
care delivery
Identify limitation of knowledge and take
corrective action via the medical
literature
Present case to peers at morning report
with bibliographic review supporting
evidence-based care
Competency: Systems-Based Practice
Participate in and understand the utility
of multidisciplinary diabetes center care
(CDE, CNE, foot care specialist,
endocrinologist)
Level
1,2,3
1,2,3
1,2,3
EVALUATION
A. Of Residents
At the completion of each rotation, all clinical faculty are required to complete the
standard ABIM resident evaluation form. All clinical faculty are encouraged to
provide face-to-face feedback with the residents. The night-float resident is
evaluated by one of the three service attendings. In addition, residents may
receive interim feedback utilizing the ABIM’s Praise and Early Warning cards.
B. Of Rotation and Preceptor
All residents are encouraged to evaluate the rotation, and the clinical faculty
member, at the completion of the rotation. This evaluation form is included at the
end of this document. These evaluations are then converted to type and shared
anonymously with the clinical faculty.
The program director also discusses the rotation with the residents to ensure
rotation quality and satisfaction.
Endocrinology Rotation Resident Check List
1. Evaluation reviewed at mid-month and end of rotation by the supervising faculty
member and resident.
2. Completed assigned readings
3. Attended all assigned activities (excluding scheduled time away, required clinics and
emergencies).
4. Completed required morning report, case report abstracts and/or posters if assigned by
the supervising faculty member.
5. Demonstrated understanding of the basic principals of endocrine consultation,
diagnosis, and management.
6. Receive verbal feedback from attending at end of rotation.
Intern/Resident Signature_________________________
Date___________________
Supervising attending__________________________
Date___________________
All items must be completed for rotation credit and checklist returned to the
Department of Medicine by the rotation’s end.