Stanford University School of Medicine
Endocrinology, Diabetes and Metabolism Fellowship Program
Rotation and Curriculum: Stanford Hospital – Year 1
Description
This subspecialty training program in endocrinology, diabetes and metabolism is designed to provide
advanced training and experience at a level for the trainee to acquire the knowledge, skills, attitudes
and experience required for all of the competencies needed by a consultant in this field. This program
includes both inpatient and ambulatory care instruction and is designed to fulfill the needs of those
trainees who anticipate their future activities to be solely the clinical practice of this specialty, those
who expect to function as clinician-educators and those who intend to pursue careers in clinical
and/or basic endocrine research.
Fellow Role and Expectations
Fellow will be supervised directly by endocrine faculty and be expected to:
Prepare for history-taking by reviewing available records
Perform histories and exams with direct observation and feedback from the attending
Participate in documentation of visits and dictation of reports to referring providers
Take call as scheduled
Have patient management and teaching duties
Attend endocrinology section conferences and participate in case conference presentations,
journal clubs, endocrine grand rounds/research conference, and teaching sessions for house staff and
medical students
Document results of patient evaluations in the medical chart
Have the opportunity for bidirectional structured feedback
Contacts
Laurence Katznelson, MD
Office phone: 650-725-0701
Pager: 415-607-9175
Email : LKatznelson@stanford.edu
Amber Ayars
Fellowship Coordinator
Office phone: 650-498-4353
Email: aayars@stanford.edu
Required Readings
Read reviews, literature supplied by faculty and obtained by fellow medical searches, based on topics
relevant to patients seen both in the ambulatory and inpatient services.
Rotation & Curriculum SUH Yr 1 7/01/09 1
Time
Activities
Location
Schedule Day
8:30 am – 12:00
SUH- Boswell 3,
Mon
SUH Pituitary Clinic
2:00 pm – 4:00 pm
Neurosciences North
Afternoon Team
SUH – CR Alway
Rounds
M015C
8:00 am – 8:30 am
SUH- Boswell, 1st flTues
Clinical Case
8:30 am – 12:00 pm
A175 (A181)
Conference
SUH- Boswell, 1st flGeneral Endo, Bone,
A175
Diabetes &
Lipids, Neuroendo
Clinic
3:30 pm – 4:30 pm
Wed
Thurs
12:30 pm– 1:30 pm
Fri
SUH- rm H0105
Stanford Multidisciplinary
diabetes
task force meeting
(monthly)***
8:00 am – 9:00 am
SUH- Braun Aud,
Medicine Grand
2:00 pm – 4:00 pm
Mudd Chemistry Bldg
Rounds*
4:00 pm –5:00 pm
SUH- CR Alway
Afternoon Team
5:00 pm –6:00 pm
M015C
Rounds
Didactic Conference
CR Alway M051
Endocrine Grand
Medicine house staff
Rounds
office, S101
8:30 am – 12:00 pm
SUH- Boswell, 1st flEndocrine/Thyroid
A175 (A105)
Clinic
Journal Club (monthly)**
SUH- CR Alway M015A
8:30 am – 12:00 pm
General Endocrine
VMC- 751 S. Bascom,
2:00 pm –4:00 pm
Afternoon Team
Outpatient
Rounds
Clinic- Desk H
SUH- CR Alway
M015C
Instructional Activities
Exposure to cases in outpatient clinics (detailed above) and inpatient setting
Conference participation (detailed above)
Patient-based faculty teaching, including direct observation, education, and feedback.
Reading reviews such as Up-to-Date and other sleeved reviews and primary articles pertinent
to the patients seen, in addition to literature supplied by the teaching staff
Meetings with program director (see below)
Rotation & Curriculum SUH Yr 1 7/01/09 2
Learning Objectives
During the first year of endocrinology fellowship, fellows will learn basic clinical evaluation
and management of endocrine disease.
1. Patient Care
Fellows will be introduced to compassionate, appropriate, and effective management of patients with
endocrine disease. By the end of the first year, fellows are expected to:
.
Perform a complete history and focused physical examination regarding common outpatient
and inpatient endocrine conditions
.
Order and interpret endocrine laboratory tests in the setting of both common disorders and
acute illness
.
Recognize presence of endocrine dysfunction in setting of acute illness (e.g. hypokalemia in
ectopic ACTH syndrome, hyperthyroidism as component of atrial fibrillation, etc.)
.
Assist in perioperative management of patients undergoing neuroendocrine surgery at
Stanford
.
Recognize and differentiate common disease states referable to endocrine disorders
.
Recognize and justify indications for endocrine procedures (fine needle aspiration of thyroid,
DEXA, sophisticated radiologic studies) and for acute endocrine disorders
.
Demonstrate ability to perform fine needle aspiration of the thyroid gland. Fellows are
expected to perform 10 biopsies by the end of year 2, with the majority being performed during year
1
.
Demonstrate the ability to interpret DEXA studies
Assessment: Patient care education will be assessed by at the end of each inpatient rotation by:
.
Direct critique of performance by the monthly inpatient attending, and in ambulatory care
through semi-annual evaluations by the program director, following input from the clinic attendings.
.
Multi-rater evaluation
.
Review of biopsy log sheet at semi-annual review
2. Medical Knowledge
Fellows must demonstrate knowledge of established and evolving biomedical, clinical,
epidemiological, and social-behavioral sciences, as well as the application of this knowledge to
patient care. By the end of the first year, fellows are expected to:
.
Accumulate a critical mass of experience and fundamental information, and demonstrate the
ability to apply the basic and clinically supportive sciences required for the diagnosis, management,
and prevention of endocrine and metabolic diseases in the ambulatory and inpatient setting
.
Understand and appropiately use pharmacotherapy, surgery, radiation therapy, treatment with
radioisotopes, etc. to care for individuals with endocrinopathies
Rotation & Curriculum SUH Yr 1 7/01/09 3
.
Learn basic and advanced endocrine biochemistry, physiology and pathophysiology, which
provide the basis for understanding endocrine disease
.
Learn and apply principles of hormone action
.
Acquire knowledge and skills necessary for critical analysis of laboratory testing and the
endocrine literature
Assessment: Accrual of medical knowledge will be assessed by
.
Performance on inpatient rounds, ambulatory clinic discussions with attendings, performance
at endocrine grand rounds (each fellow will perform two grand rounds), journal club, and clinical
case conference. Fellows will receive direct feedback by the inpatient attending at the end of the
month, and by the program director at a semiannual basis.
.
Pre and Post- Knowledge Test
3. Practice Based Learning
Fellows must be able to investigate and evaluate their patient care practices, appraise and assimilate
scientific evidence, and improve their patient care practices, especially as relevant to the
subspeciality practice of endocrinology, diabetes and metabolism. By the end of the first year,
fellows are expected to:
.
Locate, appraise, and assimilate evidence from scientific studies related to their patients’
health problems, present at weekly clinical case conference and endocrine grand rounds (two per
year)
.
Apply knowledge of study design and statistical methods to the appraisal of clinical studies
and other information on diagnostic and therapeutic effectiveness, and utilize these methods for
presentation at journal club and clinical case conference
.
Use information technology to manage information, access on-line medical information; and
support their own education
.
Facilitate the learning of students and residents rotating on the endocrine elective, as well as
other health care professionals
.
Utilize existing and emerging endocrine literature, clinical and basic research, and personal
scholarship and self-instruction to improve practice
Instructional Tool: Fellows will fill out and submit to the PD after each rotation a questionnaire that
asks Fellows to give an example in that rotation of how he/she was able to improve their own quality
of patient care based on either self-reflection, review of evidence based medicine, or clinical teaching
(from a mentor or through their own teaching). Outcomes will be based on self-reflection on
improvement in patient care.
Assessment:
.
The monthly endocrine attending will provide a direct critique inpatient, ambulatory, and
case conference performance.
.
The program director will review on a semi-annual basis performance at grand rounds and
journal club.
.
Multi-rater evaluation
Rotation & Curriculum SUH Yr 1 7/01/09 4
.
Self-reflection/assessment
4. Interpersonal and Communication Skills
Fellows must be able to demonstrate interpersonal and communication skills that result in effective
information exchange and teaming with patients, patients’ families, and professional associates.
Fellows are expected to:
.
Create and sustain a therapeutic and ethically sound relationship with patients
.
Work effectively with others as a member or leader of a health care team or other
professional group
.
Demonstrate effective communication with patients, their families, peers, and other health
care providers
.
Teach residents on inpatient and ambulatory care blocks
Assessment: The program director will provide direct critique on a semi-annual basis.
.
Multi-rater evaluation will be used to assess ICS
5. Professionalism
Fellows must demonstrate commitment to carrying out professional responsibilities, adherence to
ethical principles, and sensitivity to a diverse patient population. Fellows are expected to:
.
Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and
society that supercedes self-interest; accountability to patients, society, and the profession; and a
commitment to excellence and on-going professional development
.
Demonstrate respect for the privacy and confidentiality of patients
.
Demonstrate a commitment to ethical principles pertaining to provision or withholding of
clinical care, confidentiality of patient information, informed consent, and business practices
.
Demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and disabilities
Assessment: The program director will provide direct critique on a semi-annual basis.
.
Multi-rater evaluation will be used to assess Professionalism
.
Faculty evaluations
1. Systems-Based Practice
By the end of the first year, fellows will:
.
Learn to work in an interprofessional teams to enhance patient safety and care quality
.
Practice cost-effective health care and resource allocation that does not compromise quality
of care (with particular emphasis on pharmaco-economics given limited financial resources of
patients at SCVMC)
.
Facilitate seamless transition from inpatient to ambulatory care setting (especially critical for
patients with newly diagnosed diabetes or patients who recently underwent pituitary surgery)
Rotation & Curriculum SUH Yr 1 7/01/09 5Rotation & Curriculum SUH Yr 1 7/01/09 6
Instructional Tool:
1) Diabetes Task Force: a multidisciplinary task force with the goal of improving all aspects of
inpatient diabetes management at Stanford Hospital. The fellow will be an active participating in
these group meetings and have the opportunity for a leadership role.
2) The PD will meet with fellows at the end of each rotation as a group to identify an area of practice
that they would like to improve and, with the appropriate Faculty and/or hospital resources, continue
to monitor and address the areas that the fellows have identified. The purpose of these meetings is to
promote education in improving the systems that affect patient care, and how to work within the
hospital resources to improve such care.
Assessment: The program director will provide direct critique on a semi-annual basis.
.
Multi-rater evaluations will be used to assess Fellows’ performance.
.
PD evaluations based on input at the quarterly meetings with the Fellows.
.
Self-reflection based on instructional activity
Evaluation
.
Monthly in patient faculty evaluation (direct with faculty)
.
Global division evaluation every 6 months (direct with program director, to include review of
procedures and ambulatory clinic performance)
.
Multi-rater evaluation (includes evaluation by nursing staff and patients). This will be
reviewed directly with the program director every 6 months
.
Fellows will have the opportunity for bidirectional structured feedback
.
Medical knowledge will be assessed by performance on the endocrinology and metabolism
boards and Pre and Post-rotation Tests.
.
Self-reflection
.
Meetings with the PD to address SBP, as outlined above.