University of Toronto, Adult Endocrinology and Metabolism
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University of Toronto, Adult Endocrinology and Metabolism Rotation-Specific Goals and Objectives October 1, 2012 Table of Contents 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Program objectives (Endocrine OTR mapped to curriculum and evaluation) Core hospital rotation objectives Longitudinal clinic objectives Pediatric rotation objectives Foot and wound rotation objectives Reproductive endocrinology rotation objectives Community rotation objectives Elective rotation objectives Diabetes Self-Management Week Research Page 2 15 23 27 28 29 30 31 35 36 2008 OTR Endocrinology and Metabolism Medical Expert Endocrinologists are able to: 1. Function effectively as consultants, integrating all of the CanMEDS Roles to provide optimal, ethical and patient-centered medical care 1.1. Perform a consultation effectively, including the presentation of welldocumented assessments and recommendations in written and/or verbal form in response to a request from another health care professional How taught How evaluated Modeled in longitudinal clinic and on all rotations 1.2. Demonstrate effective use of all CanMEDS competencies relevant to their practice Academic half day (AHD) Diabetes week Longitudinal clinic 1.3. Identify and appropriately respond to relevant ethical issues arising in patient care AHD: Ethics AHD: Professionalism 1.4. Demonstrate ability to effectively and appropriately prioritize professional duties when faced with multiple patients and problems 1.5. Demonstrate compassionate and patient-centered care Endocrine week: Wellness seminar Longitudinal clinic Full history and physical watched in Longitudinal clinic MiniCEX for full exam and for components MiniCEX Portfolio Practice written exams ITER 4 Patient evaluations of resident Reflective essay MiniCEX/Clinic evaluation forms 1.6. Recognize and respond to the ethical dimensions in medical decision-making AHD: Ethics AHD: Professionalism Role modeled, esp in Longitudinal clinic Diabetes week AHD: Dr Daneman lecture Advocate project (Diabetes in the school) 1.7 Demonstrate medical expertise in situations other than patient care, such as providing expert legal testimony or advising governments, as needed 2. Establish and maintain clinical knowledge, skills and attitudes appropriate to Endocrinology and Metabolism: 2.1. Apply knowledge of the clinical, sociobehavioural, and fundamental biomedical sciences (including genetics, physiology, biochemistry, and histopathology) relevant to Endocrinology and Metabolism including: Role modeled, esp in Longitudinal clinic Diabetes week AHD Annual Basic science lectures: Basic science for the endocrinologist G-protein coupled receptors and signaling Measurement in molecular biology Nuclear receptors Insulin signaling and the pathogenesis of insulin resistance Beta cell function Pathogenesis of T1DM/prevention trials Metabolic syndrome/integrative physiology Glucogon-like peptides Pathogenesis of diabetes complications 4 Patient evaluations of resident Reflective essay 4 Patient evaluations of resident Reflective essay Advocate project evaluation Practice written exams 2.1.1. Normal growth and development and its variations 2.1.2. Alterations in the endocrine system in persons with systemic disease 2.1.3. Alterations in the endocrine system in pregnant women 2.1.4. Disorders of glucose metabolism including hypoglycemia and hyperglycemia 2.1.5. Disorders of lipid metabolism 2.1.6. Obesity 2.1.7. Type 1 and Type 2 diabetes mellitus including the role of nutrition, exercise, pharmacological management including insulin pump therapy and complications CWER (City-wide endocrine rounds)weekly AHD: Approach to short stature/Growth hormone deficiency Puberty and its disorders Pediatrics rotation AHD: Endocrine care in pediatric cancer survivors Diabetes week Hospital rotations Hospital rotations: SHSC, SMH, MSH AHD: Diabetes in pregnancy, Thyroid disease in pregnancy, Pituitary and adrenal disease in pregnancy (q2yrs) All hospital rotations; Diabetes noon rounds at SMH Foot and wound 2 week block AHD: see Diabetes below Diabetes week CWER (City wide endocrine rounds) Elective in Comprehensive diabetes management is available Hospital rotations, esp SMH Lipid clinic + noon rounds, UHN Long clinic AHD: Lipid physiology and dyslipidemia CWER (City wide endocrine rounds) Hospital rotations AHD: Obesity Bariatric surgery and endocrine complications CWER (City wide endocrine rounds) All hospital rotations; Diabetes noon rounds at SMH Foot and wound 2 week block AHD: DKA Diabetes in the pediatric population (Parts 1 + 2) Diabetic retinopathy Diabetic nephropathy Hypertension in DM Diabetic neuropathy Infection in diabetes Current topics in DM Examination of the patient with diabetes Diabetes week: Living with diabetes Nutrition DM& Cultural & Ethnicity factors Driving & DM New issues and technology in pump therapy Initiation of pump therapy Coping with T2DM Issues with adolescents DM & Eating disorders CWER (City wide endocrine rounds) MiniCEX for growth Practice written exams ITER Practice written exams ITER Practice written exams MiniCEX ITER Practice written exams MiniCEX ITER Practice written exams ITER Practice written exams MiniCEX ITER 2.1.8. Metabolic bone disease and disorders of calcium metabolism including disorders of the parathyroid glands and the Vitamin D system 2.1.9. Disorders of the thyroid gland and metabolism 2.1.10. Disorders of reproduction including disordered sexual development and gender identity, abnormalities of puberty, menstrual disorders, infertility and hyperandrogenic states in females 2.1.11. Disorders of protein metabolism 2.1.12. Disorders of growth in children and adolescents (limited to pediatric Endocrinology and Metabolism) 2.1.13. Disorders of the adrenal cortex and the adrenal medulla 2.1.14. Disorders of the pituitary gland (anterior and posterior) 2.1.15. Endocrine hypertension 2.1.16. Fluid, electrolyte and acid-base Elective in Comprehensive diabetes management is available Bone clinics: SMH, UHN, WCH; weekly noon rounds SMH AHD: Bone cell physiology Metabolic bone disease Bisphosphonates: Risks and benefits Osteoporosis – advanced clinical challenges Hypercalcemia – advanced clinical chlallenges Hypocalcemia and hypoparathyroidism CWER (City wide endocrine rounds) AHD: Thyroid nodules Thyroid cancer Thyroid hormone regulation Hyper- and Hypothyroidism: Advanced clinical cases Examination of the patient with thyroid disease Endocrinology week: Pathology Reproductive biology rotation (2 weeks) Transgender Clinic (TEGH) AHD: Sexual differentiation Male Female: Infertility and PCOS Menopause and perimenopause Ovarian hormone replacement Examination of the male with hypogonadism Male hypogonadism + erectile dysfunction Andropause Has been removed from the next OTR AHD: Pheochromocytoma Hyperaldosteronism (in CSEM meeting 2011-12) Cushing’s syndrome Congenital adrenal hyperplasia SMH monthly: Endocrine Hypertension AHD: Prolactinoma Acromegaly Cushing’s disease Perioperative pituitary care AHD: Hyperaldosteronism Pheochromocytoma (CSEM endocrine teaching day 20112012) SMH endo teaching Dr Goguen AHD: Practice written exams MiniCEX ITER Practice written exams MiniCEX ITER Practice written exams MiniCEX ITER Practice written exams MiniCEX ITER Practice written exams MiniCEX ITER Practice written exams MiniCEX ITER Practice written disorders related to the endocrine system Adrenal insufficiency Disorders of water balance AHD: Thyroid and Adrenal insufficiency lectures SMH Endo teaching Dr Yu exams Lecture/work with the dietitian at all core hospital rotations AHD: Introduction to Genetics in Endocrinology Endocrine oncology clinics with Dr Ezzat and Dr Goguen AHD: Neuroendocrine tumors Endocrine oncology clinics with Dr Ezzat and Dr Goguen Practice written exams Practice written exams 2.2. Describe the CanMEDS framework of competencies relevant to Endocrinology and Metabolism All teaching and objectives are mapped out to the CanMEDS roles Reviewed in orientation Practice written exams 2.3. Apply lifelong learning skills of the Scholar Role to implement a personal program to keep up-to-date, and enhance areas of professional competence Personal learning projects as suggested in MiniCEX/Clinic evaluations Longitudinal clinic PLPs in Portfolio 2.4.Contribute to the enhancement of quality care and patient safety in their practice, integrating the available best evidence and best practices QI Project (collaborative with all the PGY-5s): 3 half days of interactive lectures/activities + group project QI Project evaluation Longitudinal clinic Diabetes week: Living with Diabetes DM & Culture & Ethnicity Coping with T2DM: the emotional & personal side Longitudinal clinic SMH Lipid clinic + Diabetes clinics Diabetes week MiniCEX/Clinic evaluation Patient evaluation of resident Longitudinal clinic SMH Lipid clinic + Diabetes clinics MiniCEX/Clinic evaluation Patient evaluation of resident MiniCEX/Clinic evaluation Patient evaluation of resident MiniCEX/Clinic evaluation Patient evaluation of resident 2.1.17. Screening for endocrine disorders and autoimmunity as it relates to the endocrine system 2.1.18. Nutrition as it applies to endocrine disorders 2.1.19. Genetics as it relates to endocrine disorders 2.1.20. The study of endocrine tumours and cancer 3. Perform a complete and appropriate assessment of a patient: 3.1. Identify and explore issues to be addressed in a patient encounter effectively, including the patient’s context and preferences 3.2. For the purposes of prevention and health promotion, diagnosis and or management, elicit a history that is relevant, clear, concise and accurate to context and preferences 3.3. For the purposes of prevention and health promotion, diagnosis and/or management, perform a focused physical examination that is relevant and accurate 3.4. Select medically appropriate investigative methods in a resource-effective and ethical manner 3.5. Demonstrate effective clinical problem solving and judgment to address patient problems, including interpreting available data and integrating information to generate differential diagnoses and management plans Longitudinal clinic SMH Lipid clinic + Diabetes clinics SMH Lipid and Diabetes noon rounds Longitudinal clinic All hospital rotations Practice written exams MiniCEX ITER Practice written exams MiniCEX ITER MiniCEX/Clinic evaluation Patient evaluation of resident 3.5.1. Interpret diagnostic imaging in the diagnosis of endocrine disorders 3.5.2. Interpret results of hormonal assays in basal, stimulated and suppressed states 4. Use preventive and therapeutic interventions effectively: 4.1. Implement an effective management plan in collaboration with a patient and their family 4.2.Demonstrate effective, appropriate, and timely application of preventive and therapeutic interventions relevant to Endocrinology and Metabolism 4.3. Ensure appropriate informed consent is obtained for therapies 4.4. Ensure patients receive appropriate endof-life care 5. Demonstrate proficient and appropriate use of procedural skills, both diagnostic and therapeutic 5.1. Demonstrate effective, appropriate, and timely performance of diagnostic procedures relevant to Endocrinology and Metabolism, including the ability to perform the following: 5.1.1. Fine needle thyroid biopsy (limited to adult Endocrinology and Metabolism) 5.1.2. Use of radioisotopes in diagnosis and management of endocrine disorders, including knowledge about radiation safety and the regulatory requirements pertaining to the use of radioactive isotopes 5.2. Demonstrate effective, appropriate, and timely performance of therapeutic procedures relevant to Endocrinology and Metabolism 5.3.Ensure informed consent is obtained for procedures Endocrine week: Nuclear medicine (Dr Ehrlich) AHD: MRI sella Pituitary multidisciplinary clinic SMH: MRI sella WCH: BMD is site-specific objective AHD: Adrenal imaging Endocrine week: Lab assay seminar Longitudinal clinic Hospital rotation: Site specific objective for TGH with Dr Millar Practice written exams FITER Longitudinal clinic MiniCEX Patient evaluation of resident MiniCEX ITER Longitudinal clinic Hospital rotations Practice written exams FITER MiniCEX with Dr Millar Thyroid biopsy clinic with Dr Segal: Part of Endocrine week for PGY-4s and clinical experience for PGY-5s Site-specific objective for: SMH; RAI therapy SHSC: HRT therapy WCH Longitudinal clinics AHD: Ethics Longitudinal clinics Hospital rotations MiniCEX: RAI and thyroid biopsy Thyroid cancer clinics: WCH, TGH Endocrine week: Dr Segal (simulation with U/S) Long clinics Hospital rotations SMH Objective Nuclear medicine teaching in Endocrine week (Dr Ehrlich) Longitudinal clinic MiniCEXx3 See 5.1.1 and 5.1.2 Also Insulin pump counseling: Diabetes week AHD: Dr Perkins (exercise) Dr Perkin’s clinic Comprehensive Diabetes elective AHD: Ethics Thyroid biopsy clinic (Dr Segal) See 5.1.1 and 5.1.2 MiniCEX ITER SMH evaluation on ITER MiniCEX MiniCEX: Dr Segal 5.4.Document and disseminate information related to procedures performed and their outcomes AHD: Ethics Thyroid biopsy clinic (Dr Segal) 5.5. Ensure adequate follow-up is arranged for procedures performed AHD: Ethics Thyroid biopsy clinic (Dr Segal) 6. Seek appropriate consultation from other health professionals, recognizing the limits of their expertise 6.1. Demonstrate insight into their own limitations of expertise 6.2. Demonstrate effective, appropriate, and timely consultation of another health professional as needed for optimal patient care 6.3. Arrange appropriate follow-up care services for a patient and their family Communicator Endocrinologists are able to… 1. Develop rapport, trust, and ethical therapeutic relationships with patients and families 1.1. Recognize that being a good communicator is a core clinical skill for physicians, and that effective physicianpatient communication can foster patient satisfaction, physician satisfaction, adherence and improved clinical outcomes 1.2. Establish positive therapeutic relationships with patients and their families with endocrine or metabolic disease that are characterized by understanding, trust, respect, honesty and empathy 1.3. Respect patient confidentiality, privacy and autonomy 1.4. Listen effectively 1.5. Be aware and responsive to nonverbal cues 1.6. Facilitate a structured clinical encounter effectively 2. Accurately elicit and synthesize relevant information and perspectives of patients and families, colleagues, and other professionals 2.1. Gather information about a disease, but also about a patient’s beliefs, concerns, expectations and illness experience 2.2. Seek out and synthesize relevant information from other sources, such as a patient’s family, caregivers and other MiniCEX Long clinic MiniCEX: Dr Segal MiniCEX Long clinic MiniCEX: Dr Segal MiniCEX Long clinic Longitudinal clinic All rotations Diabetes week: lectures from nurse, dietitian, social worker Longitudinal clinic Ambulatory clinics core hospital rotations Longitudinal clinic In-patient consultation services SMH, UHN, SHSC MiniCEX ITER ITER Evaluation by health care professional Diabetes week: Communication course: Clinicianpatient communication (both PGY-4s and 5s) Coping with DM Interview practice with standardized patient Longitudinal clinic 1.3 Privacy module completed on POWER MiniCEX Patient evaluation of resident ITER Diabetes week Living with diabetes DM& Cultural & Ethnicity factors Coping with T2DM Practice written examination MiniCEX Patient evaluation of resident ITER MiniCEX ITER Longitudinal clinic Diabetes week Living with diabetes DM& Cultural & Ethnicity factors ITER professionals Coping with T2DM Longitudinal clinic 3. Convey relevant information and explanations accurately to patients and families, colleagues and other professionals 3.1.Deliver information to a patient and family, colleagues and other professionals in a humane manner and in such a way that it is understandable, encourages discussion and participation in decision-making 4. Develop a common understanding on issues, problems and plans with patients, families, and other professionals to develop a shared plan of care 4.1. Identify and explore problems to be addressed from a patient encounter effectively, including the patient’s context, responses, concerns, and preferences 4.1.1. Demonstrate open-mindedness to consideration of alternative health care practices in the treatment of endocrine diseases 4.2. Respect diversity and difference, including but not limited to the impact of gender, religion and cultural beliefs on decision-making 4.3. Encourage discussion, questions, and interaction in the encounter Diabetes week: Bayer communication module Longitudinal clinic Practice written examination MiniCEX Patient evaluation of resident ITER Diabetes week: Living with Diabetes Coping with T2DM 4.4. Engage patients, families, and relevant health professionals in shared decisionmaking to develop a plan of care Diabetes week: Bayer communication module 4.5. Address challenging communication issues effectively, such as obtaining informed consent, delivering bad news, and addressing anger, confusion and misunderstanding Diabetes week: Bayer communication module Part 1 Endocrine week: Bayer communication module Part 2 MiniCEX Patient evaluation of resident ITER MiniCEX Patient evaluation of resident ITER MiniCEX Patient evaluation of resident ITER MiniCEX Patient evaluation of resident ITER MiniCEX Patient evaluation of resident ITER MiniCEX Patient evaluation of resident ITER SMH: Dr Wolf’s site specific objective Longitudinal clinic MiniCEX ITER Longitudinal clinic Hospital rotations Practice written exam MiniCEX ITER 5. Convey effective oral and written information about a medical encounter 5.1. Maintain clear, accurate, and appropriate records (e.g., written or electronic) of clinical encounters and plans 5.2. Present verbal reports of clinical encounters and plans effectively 5.3. Present medical information effectively to the public or media about a medical issue Collaborator Endocrinologists are able to… 1. Participate effectively and appropriately in an interprofessional healthcare team Diabetes week: Alternative medicine lecture Diabetes week: DM& Cultural & Ethnicity factors Diabetes week: Bayer communication module AHD: Dealing with the press (offered alternate years) 1.1. Describe the specialist’s roles and responsibilities to other professionals 1.2. Describe the roles and responsibilities of other professionals within the health care team 1.3. Recognize and respect the diversity of roles, responsibilities and competencies of other professionals in relation to their own 1.4. Work with others to assess, plan, provide and integrate care for individual patients 1.5. Work with others to assess, plan, provide and review other tasks, such as research problems, educational work, program review or administrative responsibilities 1.6. Participate effectively in interprofessional teams respecting confidentiality, resource allocation and professionalism 1.7. Consult effectively with other professionals particularly those most often associated with Endocrinology and Metabolism 2. Work effectively with other health professionals to prevent, negotiate, and resolve interprofessional conflict 2.1. Demonstrate a respectful attitude towards other colleagues and members of an interprofessional team 2.2. Work with other professionals to prevent conflicts 2.3.Employ collaborative negotiation to resolve conflicts 2.4. Respect differences and address misunderstandings and limitations in other professionals 2.5. Recognize one’s own differences, misunderstanding and limitations that may contribute to interprofessional tension 2.6. Reflect on interprofessional team function Manager Endocrinologists are able to… 1. Participate in activities that contribute to the effectiveness of their healthcare organizations and systems 1.1.Work collaboratively with others in their organizations 1.2. Participate in systemic quality process Diabetes week (taught by nurses, dietitians and social workers) Foot and wound block Reproductive biology block Hospital rotations: SMH Teaching by nurses and chiropodist and dietitians SMH Mental Health: nurses and peers (patients) SMH Multidisciplinary Pituitary Clinic Longitudinal Clinic Health professionals evaluation of resident Practice written exam ITER Bayer Communication course: Part 2; dealing with conflict Health professionals evaluation of resident Practice written exam ITER Diabetes week (taught by nurses, dietitians and social workers) Foot and wound block Reproductive biology block Hospital rotations: SMH Teaching by nurses and chiropodist and dietitians SMH Mental Health: nurses and peers (patients) SMH Multidisciplinary Pituitary Clinic Longitudinal clinic QI project Health professionals evaluation of resident Practice written exam ITER QI project evaluation and improvement, such as patient safety initiatives 1.3. Describe the structure and function of the healthcare system as it relates to Endocrinology and Metabolism, including the roles of physicians 1.4.Describe principles of healthcare financing, including physician remuneration, budgeting and organizational funding 2. Manage their practice and career effectively 2.1. Set priorities and manage time to balance patient care, practice requirements, outside activities and personal life 2.2. Manage a practice including finances and human resources 2.2.1. Recognize the role of audits, budget reviews, quality improvement, risk management, incident reporting, and complaint management in various settings including metabolic day treatment centers, clinical investigation units, the laboratory and the ambulatory care setting 2.3. Implement processes to ensure personal practice improvement 2.4.Employ information technology appropriately for patient care 3. Allocate finite healthcare resources appropriately 3.1. Recognize the importance of just allocation of healthcare resources, balancing effectiveness, efficiency and access with optimal patient care 3.1.1. Demonstrate the use of cost/benefit ratios of diagnostic and therapeutic interventions for endocrine disorders as well as cost containment, efficacy and efficiency as they relate to decision making and quality assurance 3.2. Apply evidence and management processes for cost-appropriate care 4. Serve in administration and leadership roles, as appropriate 4.1.Chair or participate effectively in committees and meetings 4.2. Lead or implement change in health care 4.3. Plan relevant elements of health care delivery (e.g., work schedules) Health Advocate Endocrinologists are able to… 1. Respond to individual patient health needs and issues as part of patient care evaluation ADH: Ontario health care system (Dr Kelly) Longitudinal clinic Annual Endocrine Faculty Development Day MiniCEX Wellness seminar: transitions Semi-annual meeting with PD Longitudinal clinic Community rotation Longitudinal clinic Annual Endocrine Faculty Development Day ITER QI project QI project evaluation MiniCEX Longitudinal clinic ITER AHD: Practice management Longitudinal clinic Community AHD: Practice management Longitudinal clinic Practice written exam MiniCEX ITER Practice written exam MiniCEX ITER AHD: Practice management Longitudinal clinic Practice written exam MiniCEX ITER RPC has 2-3 positions for resident reps Residents are offered other opportunities at the university level as they become available Advocate project Chief resident(s) plan PGY-5 clinic schedule Advocate project evaluation 1.1. Identify the health needs of an individual patient 1.2. Identify opportunities for Advocate, health promotion and disease prevention with individuals to whom they provide care 2. Respond to the health needs of the communities that they serve 2.1. Describe the practice communities that they serve 2.2. Identify opportunities for Advocate, health promotion and disease prevention in the communities that they serve, and respond appropriately 2.3. Appreciate the possibility of competing interests between the communities served and other populations 3. Identify the determinants of health for the populations that they serve 3.1. Identify the determinants of health of the populations, including barriers to access to care and resources 3.1.1. These include those contributing to the burden of illness from common endocrine disorders such as diabetes, thyroid disorders, mellitus, obesity, hypertension, metabolic bone disease and lipid disorders 3.2. Identify vulnerable or marginalized populations within those served and respond appropriately such as children and adults with rare genetic disorders, patients from Aboriginal communities, and psychiatric patients 4. Promote the health of individual patients, communities, and populations 4.1. Describe an approach to implementing a change in a determinant of health of the populations they serve 4.2. Describe how public policy impacts on the health of the populations served 4.3. Identify points of influence in the healthcare system and its structure 4.4. Describe the ethical and professional issues inherent in health Advocate, including altruism, social justice, autonomy, integrity and idealism 4.5. Appreciate the possibility of conflict inherent in their role as a health advocate for a patient or community with that of manager Longitudinal clinic SMH Mental Health clinic Diabetes and Lipid clinics (SMH/UHN/WCH/SHSC) Longitudinal clinic SMH Mental Health clinic Diabetes and Lipid clinics (SMH/UHN/WCH/SHSC) AHD: Practice management AHD: Practice management SMH CONTACT Mental health clinic Advocate project AHD: Practice management SMH CONTACT Mental health clinic Advocate project MiniCEX ITER MiniCEX ITER MiniCEX ITER MiniCEX ITER Diabetes week: DM & Cultural & Ethnicity factors Coping with T2DM –The emotional & personal side Community & Social reources SMH CONTACT Mental Health Project Longitudinal Clinic Diabetes week: DM & Cultural & Ethnicity factors Coping with T2DM –The emotional & personal side Community & Social reources SMH CONTACT Mental Health Project Longitudinal Clinic Practice written exams MiniCEX ITER Advocacy Project (Dr Laredo) SMH CONTACT Mental Health Project Practice written exams SMH CONTACT Mental Health Project Practice written exams Practice written exams SMH CONTACT Mental Health Project AHD: Research & Government Advocate Practice management Practice written exams MiniCEX ITER AHD: Ethics Practice written exams SMH CONTACT Mental Health Project Longitudinal clinic Practice written exams or gatekeeper 4.6. Describe the role of the medical profession in advocating collectively for health and patient safety AHD: Research and government Advocate Advocacy Project (Diabetes in Schools) Practice written exams Scholar Endocrinologists are able to… 1. Maintain and enhance professional activities through ongoing learning 1.1. Describe the principles of maintenance of competence Longitudinal clinic Endocrine Faculty development day Portfolio: Personal learning project Portfolio: Personal learning project Portfolio: Personal learning project QI project evaluation Portfolio: Personal learning project Portfolio: Personal learning project Portfolio: Personal learning project Portfolio: Personal learning project Portfolio: Personal learning project 1.2. Describe the principles and strategies for implementing a personal knowledge management system 1.3. Recognize and reflect learning issues in practice Longitudinal clinic 1.4.Conduct a personal practice audit QI project Longitudinal clinic QI/Advocate and Research projects Longitudinal clinic 1.5. Pose an appropriate learning question Longitudinal clinic 1.6. Access and interpret the relevant evidence QI/Advocate and Research projects Longitudinal clinic 1.7. Integrate new learning into practice QI/Advocate and Research projects Longitudinal clinic 1.8. Evaluate the impact of any change in practice QI/Advocate and Research projects Longitudinal clinic 1.9.Document the learning process QI/Advocate and Research projects Longitudinal clinic 2. Evaluate medical information and its sources critically, and apply this appropriately to practice decisions 2.1. Describe the principles of critical appraisal 2.2.Critically appraise retrieved evidence in order to address a clinical question 2.3. Integrate critical appraisal conclusions into clinical care 3. Facilitate the learning of patients, families, students, residents, other health professionals, the public and others, as appropriate 3.1. Describe principles of learning relevant to medical education Journal club 2 in PGY-4 Formal rounds presentations (8 in PGY-4; 4 in PGY-5) Diabetes week: Critical appraisal: self monitoring, statins, etc Evaluating Diabetes Guidelines Journal club 2 in PGY-4 Formal rounds presentations (8 in PGY-4; 4 in PGY-5) Journal club 2 in PGY-4 Formal rounds presentations (8 in PGY-4; 4 in PGY-5) AHD: Teaching and learning in ambulatory Rounds evaluations Practice written examination Rounds evaluations Practice written examination Rounds evaluations Practice written examination Rounds evaluations 3.2. Identify collaboratively the learning needs and desired learning outcomes of others 3.3. Select effective teaching strategies and content to facilitate others’ learning 3.4. Demonstrate an effective lecture or presentation 3.5. Assess and reflect on a teaching encounter 3.6. Provide effective feedback 3.7. Describe the principles of ethics with respect to teaching care Presenting skills Formal rounds presentations (8 in PGY-4; 4 in PGY-5) PGY-5 year: Case report in AHD Teaching: First year medicine: Metabolism + Nutrition Seminar(s) Junior attending Advocate project: Diabetes in the schools 3.6 PGY-4: for the core residents on service PGY-5: for junior attending team residents Student evaluations of teaching ITER from Junior attending rotation 4. Contribute to the development, dissemination, and translation of new knowledge and practices 4.1.Describe the principles of research and scholarly inquiry 4.2. Describe the principles of research ethics 4.3. Pose a scholarly question 4.4.Conduct a systematic search for evidence 4.5. Select and apply appropriate methods to address the question 4.6. Disseminate the findings of a study appropriately AHD: Study design Database research Journal club PGY-5 research project Practice written exams Research ITER CSEM Resident paper/poster session QI lecture QI project this year: sent in abstract to CDA Peer reviewed posters AHD: Ethics Professionalism Patient evaluation of resident MiniCEX ITER Professional Endocrinologists are able to… 1. Demonstrate a commitment to their patients, profession, and society through ethical practice 1.1. Exhibit appropriate professional behaviors in practice, including honesty, integrity, commitment, compassion, respect and altruism 1.2. Demonstrate a commitment to delivering the highest quality care and maintenance of competence 1.3. Recognize and appropriately respond to ethical issues encountered in practice 1.4.Manage conflicts of interest appropriately 1.5. Recognize the principles and limits of patient confidentiality as defined by professional practice standards and the law 1.6. Maintain appropriate relations with patients 2. Demonstrate a commitment to their patients, profession and society through participation in profession-led regulation 2.1. Appreciate the professional, legal and ethical codes of practice 2.1.1. Abide by the RCPSC-endorsed Annual faculty development day AHD: guidelines of ethical interactions with industry (especially the pharmaceutical industry) with respect to research, education and clinical care 2.2. Fulfill the regulatory and legal obligations required of current practice 2.3. Demonstrate accountability to professional regulatory bodies 2.4. Recognize and respond to others’ unprofessional behaviours in practice 2.5. Participate in peer review 3. Demonstrate a commitment to physician health and sustainable practice 3.1. Balance personal and professional priorities to ensure personal health and a sustainable practice 3.2. Strive to heighten personal and professional awareness and insight 3.3. Recognize other professionals in need and respond appropriately Interactions with the pharmaceutical industry Longitudinal clinic Annual faculty development day Annual faculty development day WCH: site specific objective (office management) Endocrine jeopardy 2 Dinners/Kayaking with PD Dinner with Community Doctors Wellness seminar- Transitions PAIRO Wellness sessions Assessed in semiannual meetings with PD Longitudinal clinic Assessed in Longitudinal clinic Assessed in Longitudinal clinic 2. CORE HOSPITAL ROTATION OBJECTIVES St. Michael’s Hospital SITE-SPECIFIC OBJECTIVES 1. Medical Expert By the end of the rotation, the resident will be able to manage at the PGY-4 level the following endocrine disorders: Thyroid disease: Autoimmune and nodules Peri-operative management of Pituitary tumours, including diabetes insipidus Attend Pituitary surgery Parathyroid disease including secondary hyperparathyroidism due to Vitamin D deficiency and management of hypocalcemia after thyroid or parathyroid surgery Metabolic bone disease: know the physical examination, investigations and management of osteoporosis Diabetes (T1DM, T2DM, Gestational DM, etc.): manage in the inpatient (including perioperatively) and out-patient setting (Diabetes Clinic, Diabetes in Pregnancy Clinic) Emergency management of DKA: demonstrate an understanding of the principles of diagnosis and management of DKA at a consultant level Lipid disorders: Attend Lipid Clinic: develop a classification for lipid disorders, and know the indications for therapy (as per the latest Canadian guidelines) and the therapies that are available Endocrine hypertension: approach to adrenal hyper-function Administration of radioactive iodine for benign and malignant thyroid disease By the end of the rotation, the resident will be able to describe the dietary principles for diabetes, hyperlipidemia and obesity 2. Communicator By the end of the rotation, the resident will be able to: Counsel patients on recognizing and treating hypoglycemia, including the driving implications Obtain informed consent for RAI Counsel patients regarding the safety of radioactive iodine (RAI), and how to administer RAI Know how to construct an specialist-level consultation letter 3. Scholar: The resident will be able to participate in daily teaching rounds which include interactive case-based multidisciplinary learning with focus on evidence-based medicine in metabolic bone disease, lipid disorders endocrinology and diabetes clinics. The resident will be able to participate in discussions regarding landmark osteoporosis trials. The resident will be able to research and present 1-2 Endocrinology rounds (which will also demonstrate teaching and communication skills) 4. Manager: The resident will be able to run the In-patient consultation team: In Hospital consultation skills are developed with the focus on supervision junior housestaff. There is an emphasis on perioperative glycemic control, diabetes in labour, pituitary surgery and thyroid and parathyroid surgery, and an emphasis on the safe discharge of patients, with appropriate follow-up. 5. Collaborator: The resident will able to identify the roles of other health professionals (nurse educators, dietitians, social workers, chiropodist) and be part of an integrated team for the management of diabetes and lipid disorders. 6. Advocate: The resident will be able to identify patients at high risk (e.g., homelessness, mental health issues) and ensure they have adequate social supports. The resident will know how to access social workers and what financial resources are available to assist patients with diabetes mellitus. 7. Professionalism: The resident will demonstrate appropriate respectful attitude and behaviour towards all patients, regardless of their social situation. Sunnybrook Health Sciences Centre SITE-SPECIFIC OBJECTIVES 1. Medical Expert By the end of the rotation, the resident will be able to manage at the PGY-4 level the following endocrine disorders: Diabetes mellitus: Insulin and non-insulin requiring diabetes in patients who are inpatients and outpatients, including peri-operative management of glycemic control Thyroid disease: Understand the effective use of thyroid function tests and thyroid imaging To diagnose and manage patients with thyroid diseases (ie hyperthyroidism hypothyroidism and thyroid nodules) in men and in women in both the non-pregnant and pregnant states To see patients with thyroid cancer and participate in the counseling of patients, planning of treatment including radioactive iodine, follow-up perioperatively and decision making in longterm management To attend ENT surgeries to observe thyroid or parathyroid surgeries Emergency management of hyper- and hypocalcemia: Demonstrate an understanding of the principles of diagnosis and management of calcium disorders at a consultant level Female reproductive endocrinology: including hyperandrogenism, especially in the context of PCOS; infertility To assess women with infertility and estrogen deficiency Endocrinology of pregnancy: To manage pregnant women with type 1 diabetes, type 2 diabetes or gestational diabetes as inpatients and outpatients To manage pregnant women with endocrine conditions (other than diabetes) including thyroid, pituitary, adrenal calcium abnormalities Pituitary disorders: To attend pituitary clinic, managing new or follow up patients with pituitary abnormalities By the end of the rotation, the resident will be able to describe the dietary principles for diabetes, hyperlipidemia and obesity 2. Communicator: By the end of the rotation, the resident will be able to: Counsel patients to facilitate diabetes self-management Counsel patients on the treatment of Graves’ disease, including surgery and radioactive iodine, in addition to thiouracils 3. Scholar: The resident will be able to participate at the PGY-4 level in the following rounds: Monday morning Gab with Gilbert Wednesday morning endocrinology rounds Other endocrinology teaching sessions, including the monthly endocrine pathology rounds and tumour board case conferences The resident will be able to participate in discussions regarding landmark diabetes trials. The resident will be able to present at Wednesday morning rounds at least once during the rotation, demonstrating teaching skills and communication skills. 4. Manager: The resident will be able to run the In-patient consultation team: In-hospital consultation skills are developed with the focus on supervision junior housestaff. There is an emphasis on perioperative glycemic control, diabetes in labour, pituitary surgery and thyroid and parathyroid surgery, and an emphasis on the safe discharge of patients, with appropriate follow-up. 5. Collaborator: The resident will able to work effectively with members of the diabetes care team 6. Advocate: The resident will advocate for resources for their patients with gestational diabetes to ensure best possible outcomes for mother and child. 7. Professional: The resident will show appropriately respectful attitudes and behaviour towards patients, faculty, other health care professionals and other trainees, including junior trainees. University Health Network/Mount Sinai Hospital SITE-SPECIFIC OBJECTIVES 1. Medical Expert By the end of the rotation, the resident will be able to manage at the PGY-4 level the following endocrine disorders: Diabetes mellitus: Management/Counselling of patients with Type 1 and Type 2 Diabetes in outpatient setting and in the peri-operative setting Management of acute and chronic complications of diabetes Management of diabetes in pregnancy, including pre-pregnancy counseling Lipids: Approach to and management of patients with dyslipidemia Thyroid: Approach and management of patient’s with hyperthyroidism/hypothyroidism/thyroid nodules and thyroid cancer Bone disease: Diagnosis and management of patients with hypercalcemia and/or osteoporosis To use clinical tools to assess fracture risk and apply this in clinical practice Endocrine oncology: Diagnosis and management of endocrine oncology disorders, including the Clinical/Pathological correlation in endocrine oncology Male sexuality and reproductive disorders Management of male infertility/erectile dysfunction/andropause Emergency management of Adrenal insufficiency: demonstrate an understanding of the principles of diagnosis and management of adrenal insufficiency at a consultant level Endocrine dynamic testing: administer and interpret the results of endocrine dynamic testing By the end of the rotation, the resident will be able to describe the dietary principles for diabetes, hyperlipidemia and obesity 2. Communicator By the end of the rotation, the resident will be able to: Counsel patients on the use of their insulin pump Get informed consent for dynamic endocrine testing 3. Scholar: The resident will be able to participate in daily teaching rounds which include interactive case-based multidisciplinary learning with focus on evidence-based medicine in metabolic bone disease, lipid disorders endocrinology and diabetes clinics. The resident will be able to participate in discussions regarding landmark lipid trials. The resident will be able to research and present 1-2 Endocrinology rounds (which will also demonstrate teaching and communication skills) 4. Manager: The resident will be able to run the In-patient consultation team: In Hospital consultation skills are developed with the focus on supervision junior housestaff. There is an emphasis on perioperative glycemic control, diabetes in labour, pituitary surgery and thyroid and parathyroid surgery, and an emphasis on the safe discharge of patients, with appropriate follow-up. 5. Advocate: The resident will address cardiovascular risk factor management for patients with dyslipidemia and/or diabetes. 6. Collaborator: The resident will able to identify the roles of other health professionals (nurse educators, dietitians, social workers, chiropodist) and be part of an integrated team for the management of diabetes and lipid disorders. 7. Professionalism: The resident will show appropriately respectful attitudes and behaviour towards patients, faculty, other health care professionals and other trainees, including junior trainees. Women’s College Hospital SITE-SPECIFIC OBJECTIVES 1. Medical Expert By the end of the rotation, the resident will be able to manage at the PGY-4 level the following endocrine disorders: Diabetes: Management of acute and chronic complications of diabetes Management of patients on insulin pumps and understand their unique problems Thyroid and parathyroid: Understand the effective use and interpretation of thyroid function tests and thyroid imaging Diagnose and manage patients with thyroid diseases, including hyperthyroidism, hypothyroidism and thyroid nodules To assess and manage thyroid disease in pregnancy and post-partum To do fine needle aspiration biopsies of thyroid nodules To manage patients with thyroid cancer: participate in counseling, planning of treatment, perioperative follow-up Reproductive lifestages Become familiar with how to accurately diagnose and appropriately manage reproductive disorders including prolactinoma and PCOS To assess and manage patients with menopause and other estrogen deficiency stats, including counseling for HRT To perform an appropriate history and investigations for women referred to a multi disciplinary program for premature ovarian failure (POF) To counsel regarding options, as well as risk/benefits of ovarian replacement therapy in women with POF Metabolic bone disease Assess and manage complex patients referred to a multidisciplinary osteoporosis and metabolic bone disease program To know how to interpret BMD testing and define its limitations To observe how BMD results are obtained (ie. Observe a BMD test) Emergency management of thyroid storm and myxedema coma To demonstrate an understanding of the principles of diagnosis and management of Thyroid emergencies at a consultant level By the end of the rotation, the resident will be able to describe the dietary principles for diabetes, hyperlipidemia and obesity 2. Communicator By the end of the rotation, the resident will be able to: Counsel women about medical risks and other conditions associated with their primary reproductive problem(s) (e.g. metabolic issues in PCOS) and the use of OCP/HRT 3. Scholar: The resident will be able to participate in daily teaching rounds which include interactive case-based multidisciplinary learning with focus on evidence-based medicine in endocrine rounds. The resident will be able to participate in discussions regarding landmark thyroid cancer trials. The resident will be able to research and present 1-2 Endocrinology rounds (which will also demonstrate teaching and communication skills) 4. Manager: By the end of the rotation, the resident will be able to: Manage complex patients in a time efficient manner Meet current standards for charting (CPSO: Peer Review) Incorporate a CPP and managing flow sheets for chronic patients 5. Collaborator: To manage patients with type 1 and type 2 diabetes mellitus in collaboration with a Diabetes Health Team and to understand the role of the Diabetes Health Team in the management of insulin and noninsulin requiring diabetes and its acute and chronic complications 6. Advocate By the end of the rotation, the resident will be able to: Practice a patience empowerment model of diabetes self management Learn about assistance programs for people with limited resources 7. Professionalism: By the end of the rotation, the resident will be able to: Communicate effectively with patients: informed consent 3. LONGITUDINAL CLINIC OBJECTIVES By the end of the academic year, the endocrine resident will be able to demonstrate growth in the PGY-4 year and competency at the consultant level at the PGY-5 year in the CanMEDS objectives: Medical Expert: 1. Demonstrate complete history taking ability for endocrine conditions: witnessed history taking twice a year. 2. Perform a complete physical exam as it pertains to endocrine problems 3. Interpret history and physical exam findings 4. Design appropriate endocrine investigations 5. Evaluate complex endocrine investigation 6. Facilitate on-going management of endocrine problems 7. Demonstrate appropriate knowledge Communicator: 8. Demonstrate effective patient communication skills through: a. witnessed history and physical exam b. observed counseling (verbal and non-verbal) 9. Demonstrate commitment to patient-centered care Scholar: 10. Critically evaluate literature pertaining to endocrine clinical problems by formal discussion at the end of clinic 11. Integrate medical knowledge into clinical practice by accurate information to patients. Collaborator: 12. Collaborate effectively with other health professionals: Manager: 13. Examine issues related to management of an ambulatory practice: a. Manage time effectively in clinic b. Manage patient phone calls and queries Health Advocate: 14. Promote Health Advocate role where appropriate 15. Demonstrate knowledge of programs and websites that will promote Advocate and assist patients with securing access to needed resources Professional: 16. Demonstrate a commitment to arrive at clinic in a timely fashion 17. Demonstrate an ability to provide patient-centered care with adequate discussion and negation 18. Initiate ethical discussions where appropriate Annual Calendar for Longitudinal Clinic- Suggested curriculum PGY-4 Year PGY-5 Year July Aug Sept Oct Nov Dec Jan Watch a complete history and physical exam 2 Mini-CEX direct observations Review dictate letter 2 Mini-CEX direct observations Patient Evaluation of Resident Review Email policy: between doctors and having patients email you 2 Mini-CEX direct observations Advocate: Review “Diabetes: It’s expensive!” Pamphlet on endocrine website 2 Mini-CEX direct observations Review DOCOMP Diary Pick a “Communicator” Issue from the List 2 Mini-CEX direct observations Patient Evaluation of Resident Review Long Clinic ITER 2 Mini-CEX direct observations Pick a “Collaborator” Issue from the List 2 Mini-CEX direct observations Feb Pick a “Manager” Issue from the List 2 Mini-CEX direct observations Mar Pick an “Advocate” Issue from the List Patient Evaluation of Resident 2 Mini-CEX direct observations Pick a “Communicator” Issue from the List 2 Mini-CEX direct observations Pick a “Professionalism” Issue from the List 2 Mini-CEX direct observations Patient Evaluation of Resident Review Long Clinic ITER 2 Mini-CEX direct observations Apr May June Review and start shadow billing 4 Clinic Evaluations with learning objectives Review DOCOMP Diary Pick a “Manager” Issue from the List 4 Clinic Evaluations with learning objectives Patient Evaluation of Resident Pick a “Advocate” Issue from the List 4 Clinic Evaluations with learning objectives Schedule periodic Manager Clinic (no patients) Pick a “Communicator” Issue from the List 4 Clinic Evaluations with learning objectives generated Discuss Office Management Issues Pick a “Professionalism” Issue from the List 4 Clinic Evaluations with learning objectives Patient Evaluation of Resident Review Long Clinic ITER 4 Clinic Evaluations with learning objectives Review DOCOMP Diary Pick a “Collaborator” Issue from the List 4 Clinic Evaluations with learning objectives Patient Evaluation of Resident Pick a “Manager” Issue from the List 4 Clinic Evaluations with learning objectives Pick an “Advocate” Issue from the List Discuss MD-Pharma Interactions and CMA policy 4 Clinic Evaluations with learning objectives Patient Evaluation of Resident Pick a “Communicator” Issue from the List 4 Clinic Evaluations with learning objectives Pick a “Professionalism” Issue from the List 4 Clinic Evaluations with learning objectives Review Long Clinic ITER 4 Clinic Evaluations with learning objectives Competency-based objectives for endocrinology community experiences and longitudinal clinics MANAGER Describe what to look for in a potential office space for an outpatient endocrinology practice (1) Discuss principles of recruiting, hiring and managing support staff personnel (e.g. nurses, assistants, secretaries, etc.) (2) Demonstrate appropriate billing practices, including criteria for commonly-used billing codes (2) Design an efficient office schedule (2) Describe strategies to balance time between professional activities, including inpatient and outpatient responsibilities (2) Describe strategies to effectively balance time between professional and personal/home life (3) Compare the benefits and drawbacks of different patient charting options (such as electronic v.s. paper based systems) (2) Determine appropriate time period(s) to arrange follow-up appointments (2) Describe strategies to locate and utilize community resources to help optimize patient care (2) Discuss principles of how to negotiate a lease for office space (2) Describe strategies to advertise your practice to referring physicians when starting a practice (2) Discuss principles of dealing with patients who do not show up for scheduled appointments (in terms of documentation and charging patients) (2) Demonstrate how to appropriately bill for uninsured services (2) Demonstrate how to effectively follow up lab and test results in a time-appropriate manner, based on urgency (3) Demonstrate how to respond appropriately to lab and test results of differing urgencies i.e. do you call them with results? Do you rebook them within a week? How are abnormal labs flagged and dealt with? (3) Recognize and evaluate administrative opportunities within community hospital or government settings (3) Insurance issues with the non-Canadian patient HEALTH ADVOCATE Discuss strategies to create and tailor programs to meet the needs of the surrounding community (e.g. language or cultural needs) (2) Describe how to engage in local Advocate work for the surrounding community (2) Discuss different strategies for advocating for your patients (for example, those in financial need or with special needs) (3) Complete the steps required to request coverage for specific drugs not routinely covered by provincial health care plans (3) COMMUNICATOR: Create an effective consultation letter to the referring physician in an efficient manner (3) Provide advice to another health care provider (e.g. primary care physician) via telephone consultation (3) Effectively discuss coordination of care or shared care of a patient with his/her other care provider (e.g. primary care physician) (3) Describe situations for which urgent communication with a patient’s primary care physician is appropriate (3) COLLABORATOR: Effectively collaborate with allied health professionals outside of the office setting (2) Describe how to locate allied health professionals in the community with whom to collaborate in patient management (2) Describe how to set up and/or engage in a network of endocrinologists and health care professionals in the community to support lifelong learning and continuing professional development (2) MEDICAL EXPERT: Demonstrate medical expertise in the recognition and management of common and uncommon presentations of common endocrine problems (3) Describe how to deal with urgent outpatient issues (3) SCHOLAR Describe strategies, opportunities and methods to promote lifelong learning in a community setting (2) Describe how to accommodate medical students and residents in a community practice (2) Describe how to locate mentorship opportunities in the community setting (2) PROFESSIONAL Discuss strategies to promote ethical practice when interacting with representatives from the pharmaceutical industry (3) Describe how to appropriately end a physician-patient relationship (3) Discuss privacy issues with emailing 4. Pediatric Rotation Sick Kids SITE-SPECIFIC OBJECTIVES Goals: The adult endocrine trainee will integrate into the pediatric endocrine training program and recognize common pediatric endocrine problems as they present through childhood and adolescence. The resident should have an active role in the evaluation of patients in the ambulatory setting. This is the prime site for their learning. They should also see appropriate patients on the inpatient consult service. 1. Medical Expert By the end of the rotation, the resident will be able to know the basic principles of how to manage the following disorders in the pediatric patient: Type 1 and type 2 diabetes mellitus (acute and chronic management), including counseling techniques to promote effective patient self-management Hypoglycemia and other disorders of glucose metabolism Disorders of they thyroid, including hypo/hyperthyroidism, thyroid nodules and thyroid cancer Disorders of calcium metabolism and metabolic bone disease Disorders of the hypothalamic-pituitary axis Congenital adrenal Disorders of sexuality and reproduction including infertility, hirsutism, amenorrhea, gynecomastia, precocious and delayed puberty, androgen resistance, gonadal steroid deficiency, contraception Hereditary endocrinopathy including polyglandular autoimmune syndromes and MEN Obesity Delayed growth Endocrine disorders in systemic disease Residents will obtain mini-CEX documentation of proficiency in Tanner staging (male and female). 2. Communicator By the end of the rotation, the resident will be able to recognize and apply the communication skills that are required to interact effectively with pediatric patients and their families. 3. Scholar: The resident will be able to participate in daily teaching rounds which include interactive case-based multidisciplinary learning with focus on evidence-based medicine in diabetes, growth and development and other common endocrine disorders in the pediatric patient. The resident will be able to research and present 1 Pediatric Endocrinology round (which will also demonstrate teaching and communication skills) 4. Collaborator: The resident will able to identify the roles of other health professionals (nurse educators, dietitians, social workers) and family members, and be part of an integrated team for the management of diabetes. 5. Advocate: The resident will be able to identify patients at high risk (e.g., in challenging family situations, eating disorders and T1DM) and ensure they have adequate social supports. Know how to access social workers and what financial resources are available to assist patients pediatric with diabetes mellitus. 6. Manager: Residents will be able to discuss principles leading to satisfactory transition of care from pediatric endocrinologist to the adult endocriologist. 7. Professional: Understand and recognize your limitations treating pediatric conditions, and know when to ask for help 5. FOOT AND WOUND BLOCK OBJECTIVES Objectives: By the end of the rotation, the trainee will be able to: 1. Medical Expert: Assess and triage the at-risk foot. Assess the foot ulcer (including diagnose if infected). Design a management plan consisting of the following components: a. Debridement b. Dressings c. Offloading d. Vascular assessment e. Requirements for antibiotics, and how to prescribe them f. Management of glycemic control g. Know when to get assistance: i. To whom they should be referred ii. Urgency of referral 2. Communicator By the end of the rotation, the resident will be able to: Counsel patients on proper foot care, including how to treat an ulcered foot Write clear instructions to the referring doctor regarding foot care 3. Scholar: Evaluate the literature on diabetic foot assessment and diabetic neuropathy 4. Manager: Understand the flow of care for collaborative foot clinics 5. Collaborator: Identify the role of the different health professionals involved in the diabetic foot, including: nurse, chiropodist or podiatrist, plastic surgeon, vascular surgeon, endocrinologist 6. Advocate: Identify resources for the patient with a diabetes foot ulcer, including knowing contact information for local community foot care specialists, as well as how much their services cost 7.Professional: Understand their own limitations, and when to refer to a Foot Care specialist. 6. REPRODUCTIVE BIOLOGY Objectives: By the end of the rotation, the trainee will be able to: 1. Medical Expert: Develop a differential diagnosis for disorders of reproductive function and infertility in both men and women. Describe the genetic abnormalities associated with male infertility. Determine the appropriate diagnostic work-up for the assessment of both male and female infertility. Develop an integrative approach to the investigation of male and female factor infertility. Describe appropriate therapies for both male and female infertility. 2. Communicator Counsel patients on basic fertility treatment provided by endocrinologists 3. Scholar: Evaluate the literature and prepare a presentation on one aspect of reproductive biology 4. Advocate: Identify resources for the patients with infertility, and be aware of when to refer to a tertiary care centre 5. Collaborator: Know the role of the different health professionals involved in infertility, including gynecologist, urologist and nurses. 6. Manager: Be able to efficiently assess the couple with infertility 7. Professional: Consistently demonstrate empathy through attitude and behaviour towards patients trying to cope with infertility Understand ethical issues around fertility treatment 7. COMMUNITY ROTATION OBJECTIVES The resident will have the opportunity to participate first hand in a broad array of clinical endocrine diagnoses in an office setting. They will interact with a number of experienced clinical endocrinologists who are interested in teaching and who are willing to share their experiences with clinical trainees. They will gain exposure to in-hospital clinical endocrine consulting practice. They will not be expected to participate in the after hours on-call schedule. (Note: List of competencies (page 25 above) resident and supervisor can choose to work from; typically, the resident will cover 3-4 of these competencies over the one month rotation) For example: By the end of the rotation, the trainee will be able to: 1. Medical Expert: Describe how to deal with urgent outpatient issues 2. Communicator By the end of the rotation, the resident will be able to: Provide advice to another health care provider (e.g. primary care physician) via telephone consultation Write succinct follow-up letter to the referring doctor 3. Manager: Describe strategies to balance time between professional activities, including inpatient and outpatient responsibilities and personal/home life. Describe what to look for in a potential office space for an outpatient endocrinology practice. Discuss principles of recruiting, hiring and managing support staff personnel (e.g. nurses, assistants, secretaries, etc.) 4. Collaborator: Describe how to set up and/or engage in a network of endocrinologists and health care professionals in the community to support lifelong learning and continuing professional development 5. Scholar: Describe strategies, opportunities and methods to promote lifelong learning in a community setting. Describe how to accommodate medical students and residents in a community practice. 6. Advocate: Ensure patients obtain the financial resources they need to treat the endocrine conditions in the community. 7. Professional: Consistently demonstrate respectful behaviour and attitudes towards patients and colleagues. 8. ELECTIVE OBJECTIVES Comprehensive Diabetes Mellitus Elective - 2 weeks Goal: This elective is offered to senior endocrine residents looking to gain more expertise in facilitating intensive diabetes management and in managing diabetes complications. All components of the elective will involve working in multidisciplinary and interdisciplinary teams. Location: SMH, UHN, WCH Objectives: By the end of this rotation, the resident will be able to: 1. Medical Expert: Interpret results of continuous monitoring of blood glucose (CMBG) results in the context of the patient’s food and activity diary. (TRIDEC) Initiate insulin pump treatment or assist with insulin pump adjustments based on patient interview and glucose logs. (TRIDEC) Manage diabetic patients with complications - attend complication clinic at TGH and WCH - attend diabetic retinal clinic at SMH Construct a treatment plan for exercise, carbohydrate and insulin adjustment under the supervision of a diabetes educator and a faculty member Discuss basic concepts involved in carbohydrate counting 2. Communicator Provide advice to another health care provider (e.g. primary care physician) via telephone consultation for diabetes care Counsel a patient about insulin pump start, treating hypoglycemia and safe driving practices 3. Scholar: Evaluate the literature on an aspect of one the medical competencies listed above, and write a brief 24 page report 4. Collaborator: Identify the role of the different health professionals involved in intensive diabetes management including the nurse educator, dietitian, social worker, pharmacist and other physicians. 5, Advocate: Use the “Diabetes is expensive” handout prepared by past endocrine trainees to ensure your patients have access to financial resources for the treatment of their diabetes 6. Manager: Design a prototype new patient and follow diabetes flow sheet for your future practice. 7.Professional: Understand ethical issues regarding use of limited resources for the treatment of diabetes (eg, who get insulin pumps) PITUITARY ELECTIVE – 2 weeks Dr. Goguen The goal of this elective is for the resident to have an intensive two-week experience in pituitary disorders in endocrinology offices, multidisciplinary clinics, community neurosurgery clinic, surgery and gamma-knife center, and to become more comfortable with the management of pituitary disorders. Objectives: By the end of this rotation, the resident will be able to: 1. Medical Expert: Describe the principles of the management of common pituitary diseases, including the non-secretory tumor, acromegaly, Cushing’s disease, prolactinoma, hypopituitarism, craniopharyngioma. Perform and interpret the triple bolus test Interpret formal visual field tests. Interpret normal sellar and peri-sellar anatomy on the MRI of the sella and be able to identify a pituitary adenoma on MRI. 2. Communicator: Demonstrate oral counseling skills necessary to counsel patients regarding the ongoing management of pituitary disease 3. Scholar: Evaluate the literature on an aspect of pituitary disease and provide a 2-4 page written report on what you have learned. 4.Manager: Design history and physical flow sheets for your future office to improve office flow for patients with pituitary disease 5. Advocate: Know how to obtain funding sources for expensive medical therapies for the patient with acromegaly 6. Collaborator: Describe the role of the neurosurgeon and understand when surgery is appropriate, and what the risks and benefits of surgery are. Describe the role of the radiation oncologist and understand when radiation (fractionated and gamma-knife) is appropriate, and what the risks and benefits of radiation are. 7. Professional: Demonstrate appropriately empathetic attitude and behaviour towards patients trying to cope with their diagnosis of a pituitary tumour THYROID CANCER ELECTIVE Dr. Catherine Kelly 2 weeks The Thyroid Cancer Elective offers the endocrine fellow the opportunity to work in and environment that promotes a multidisciplinary approach to thyroid cancer. During this elective, you will attend some of the following clinics/rounds: Offices Drs. Kelly, Briones, Zahedi, Segal, Ezzat, Sawka WCH Thyroid Clinic (Thursday AM) RAI admission at SMH (Friday PM) Thyroid surgery Head and Neck Pathology Rounds (PMH last Mon of the month 5 PM) U/S guided biopsy clinic Dr. Segal (with cytopathologist) (Friday PM) Rotation Objectives: Objectives: By the end of the rotation, the resident will be able to: 1. Medical Expert: Describe an approach to the management of thyroid nodules and thyroid cancer. Perform a thyroid biopsy and interpret the cytologist’s report. Describe how to safely administer radioactive iodine 2. Scholar: Evaluate the literature on an aspect of pituitary disease and provide a 2-4 page written report on what you have learned. 3. Communicator: Be able to counsel patients about thyroid cancer, including about the roles of surgery and radioactive iodine therapy. 4. Collaborator: Know the roles of colleagues including ENT surgeons, radiation oncologist, nuclear medicine personnel 5. Manager: Know how to arrange home radioactive iodine 6. Advocate: Know how to advocate for patients who do not have insurance coverage for thyrogen 7. Professional: Consistently demonstrate sensitivity in attitude and behaviour towards patients coping with the diagnosis of thyroid cancer 9. FACILITATING DIABETES SELF-MANAGEMENT AND ENHANCING COMMUNICATION COURSE Objectives: During the week/by the end of the week, the resident will be able to: 1. Collaborator: Observe the structure of a highly sophisticated diabetes education program Actively participate under close observation in the counseling and education of patients with diabetes and their family members. 2. Communicator: Participate in 2 half-day formal communications sessions during the week. Develop a significant knowledge of and appreciation for the roles of all members of the diabetes healthcare team. The members of this diabetes team will provide a significant amount of the teaching for this course 3. Scholar: Appraise practical devices for diabetes management, including insulin pumps. Analyze some aspects of the CDA guidelines and the evidence for common medications and tasks such as self-monitoring of blood glucose using critical appraisal skills and the AGREE instrument Appraise the evidence for certain alternative or complementary medications used for diabetes (NCAM) 4. Advocate: Participate in a ‘living with diabetes’ exercise over several days that will greatly heighten your awareness of the difficulties and barriers encountered by you patients (experiential learning). The aim of this exercise is to increase not only your knowledge but alter your professional patient-centered practice behaviour. Learn about available programs and resources for people living with diabetes. 10. RESEARCH BLOCK Rotation Objectives: By the end of the rotation, the resident will be able to: 1. Medical Expert Understand and describe the medical basis for their research Demonstrate industry and perseverance in their research methodology Demonstrate adequate technical skills related to research Start demonstrating independence in research design Show interest and motivation Demonstrate judgment and critical thinking Demonstrate originality 2. Communicator Describe their research clearly in an oral presentation Communicate with the public and media Write good quality reports (grant writing, publications) Communicate clearly with other members of the research team 3. Collaborator Collaborate successfully with other research teams 4. Manager Demonstrate organizational ability regarding research projects Demonstrate supervisory skills regarding more junior colleagues on the project 5. Health Advocate Advocate to patients and the public relating to the importance of health research 6. Scholar Demonstrate knowledge of your research topic Critically evaluate related scientific papers Understand the principles behind the statistics and measurement tools you are using Complete your project, including the final write-up 7. Professionalism Carry out duties in a professional manner Demonstrate integrity, honesty, responsibility and compassion Be able to handle criticism Have insight into own abilities
