McGill Endocrinology and Metabolism
Training Program
Rotation Specific Goals and Objectives
1.
General Objectives
2.
General Endocrinology Objectives – CanMeds Format
3.
Longitudinal Clinic Objectives
4.
In-Patient Consultation Objectives
5.
General Endocrinology Clinic Objectives
6.
Diabetes Clinic Objectives
7.
Lipid Clinic Objectives
8.
Neuroendocrine Clinic Objectives
9.
Gestational Diabetes Clinic Objectives
10.
Calcium and Bone Metabolism Clinic Objectives
11.
Thyroid Clinic Objectives
12.
Montreal Children’s Hospital Endocrinology Rotation Objectives
13.
Reproductive Endocrinology and Infertility Rotation Objectives
14.
Endocrinology Clinical Laboratory Rotation Objectives
15.
Research Block Objectives
16.
Insulin Pump Rotation Objectives
Revised – September 2013
McGill Endocrinology & Metabolism
Training Program
General Objectives
Medical Expert
As Medical Experts, Endocrinologists integrate all of the CanMEDS roles, applying medical
knowledge, clinical skills, and professional attitudes in their provision of patient-centered
care. Medical Expert is the central physician role in the CanMEDS framework.
Key and Enabling Competencies: 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
1.2
1.3
1.4
1.5
1.6
1.7
2.
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.
Demonstrate effective use of all CanMEDS competencies relevant to their
practice.
Identify and appropriately respond to relevant ethical issues arising in patient
care.
Demonstrate ability to effectively and appropriately prioritize professional
duties when faced with multiple patients and problems.
Demonstrate compassionate and patient-centered care.
Recognize and respond to the ethical dimensions in medical decision-making.
Demonstrate medical expertise in situations other than patient care.
Establish and maintain clinical knowledge, skills and attitudes appropriate to
Endocrinology and Metabolism.
2.1
Apply knowledge of the clinical, socio-behavioural, and fundamental
biomedical sciences (including genetics, physiology, biochemistry and
histopathology) relevant to Endocrinology and Metabolism including:
2.1.1
2.1.2
2.1.3
2.1.4
2.1.5
2.1.6
2.1.7
Normal linear growth and development.
Alterations in the endocrine system in persons with systemic disease.
Alterations in the endocrine system in persons with critical illness.
Alterations in the endocrine system in pregnant women.
Disorders of glucose metabolism including hypoglycaemia and
hyperglycemia.
Disorders of lipid metabolism.
Disorders of obesity.
2.1.8
2.1.9
2.1.10
2.1.11
2.1.12
2.1.13
2.1.14
2.1.15
2.1.16
2.1.17
2.1.18
2.1.19
2.1.20
2.1.21
2.1.22
2.2
2.3
2.4
3.
Type 1 and Type 2 diabetes mellitus including the role of nutrition,
exercise, pharmacological management including but not limited to
insulin pump therapy and complications.
Metabolic bone disease and disorders of calcium metabolism
including but not limited to disorders of the parathyroid glands and
the Vitamin D system.
Disorders of the thyroid gland.
Disorders of reproduction in females, including disordered sexual
development and gender identity, abnormalities of puberty, menstrual
disorders, hypogonadism, infertility and hyperandrogenic states.
Disorders of protein metabolism.
Disorders of growth in children and adolescents (limited to pediatric
Endocrinology and Metabolism).
Disorders of the adrenal cortex and the adrenal medulla.
Disorders of the pituitary gland (anterior and posterior).
Hypertension related to endocrine disorders.
Fluid, electrolyte and acid-base disorders to the endocrine system.
Screening for endocrine disorders and autoimmunity as it relates to
the endocrine system.
Nutrition as it applies to endocrine disorders.
Genetics as it relates to endocrine disorders.
Endocrine tumors and cancers.
Radiation safety in the use of radioactive isotopes in endocrine
disorders.
Describe the CanMEDS framework of competencies relevant to
Endocrinology and Metabolism.
Apply lifelong learning skills of the Scholar Roles to implement a personal
program to keep up-to-date and enhance areas of professional competence.
Contribute to the enhancement of quality care and patient safety in their
practice, integrating the available best evidence and best practices.
Perform a complete and appropriate assessment of a patient
3.1
3.2
3.3
3.4
3.5
Identify and explore issues to be addressed in a patient encounter effectively,
including the patient’s context and preferences.
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.
For the purposes of prevention and health promotion, diagnosis and/or
management, perform a focused physical examination that is relevant and
accurate.
Select medically appropriate investigations in a resource-effective and ethical
manner.
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
including but not limited to:
3.5.1 Interpret diagnostic imaging in the diagnosis of endocrine disorders.
3.5.2 Interpret results of hormonal assays in basal states.
3.5.3 Interpreting results of dynamic endocrine testing.
3.5.4 Interpreting pathology reports in the diagnosis of endocrine disorders.
3.5.5 Interpreting and providing advice on glucose monitoring results.
3.5.6 Interpreting bone density reports.
4.
Use preventive and therapeutic interventions effectively
4.1
Implement an effective management plan in collaboration with a patient and
their family.
4.1.1 Provide intensive diabetes care and management including insulin
pump therapy.
4.2
Demonstrate effective, appropriate and timely application of preventive and
therapeutic interventions relevant to Endocrinology and Metabolism
including but not limited to:
4.2.1
4.2.2
4.2.3
4.2.4
4.2.5
4.3
4.4
4.5
5.
Ensure appropriate informed consent is obtained for therapies.
Use radioisotopes in the diagnosis of endocrine disorders.
Provide referral and transfer to appropriate end-of-life care.
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
5.1.2
5.2
5.3
5.4
6.
Counselling patients on preventative behaviour.
Smoking cessation.
Dietary modifications.
Exercise.
Weight loss.
Fine needle thyroid biopsy (Limited to adult Endocrinology and
Metabolism).
Dynamic endocrine testing.
Ensure informed consent is obtained for procedures.
Document and disseminate information related to procedures performed and
their outcomes.
Ensure adequate follow-up is arranged for procedures performed.
Seek appropriate consultation from other health professionals, recognizing
the limits of their expertise
6.1
6.2
Demonstrate insight into their own limitations of expertise.
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
As Communicators, Endocrinologists effectively facilitate the doctor-patient relationship
and the dynamic exchanges that occur before, during and after the medical encounter.
Key and Enabling Competencies: Endocrinologists are able to:
1.
Develop rapport, trust and ethical therapeutic relationships with patients and
families
1.1
1.2
1.3
1.4
1.5
1.6
1.7
2.
Accurately elicit and synthesize relevant information and perspectives of
patients and families, colleagues and other professionals
2.1
2.2
3.
Gather information about a disease, but also about a patient’s beliefs,
concerns expectations and illness experience.
Seek out and synthesize relevant information from other sources, such as a
patient’s family, caregivers and other professionals.
Convey relevant information and explanations accurately to patients and
families, colleagues and other professionals
3.1
3.2
4.
Recognize that being a good communicator is a core clinical skill for
physicians and that effective physician-patient communication can foster
patient satisfaction, physician satisfaction, adherence and improved clinical
outcomes.
Establish positive therapeutic relationships with patients and their families
that are characterized by understanding, trust, respect, honesty and empathy.
Respect patient confidentiality, privacy and autonomy.
Listen effectively.
Use patient appropriate language.
Recognize and respond to non-verbal cues.
Facilitate a structured clinical encounter effectively.
Deliver information to a patient and family, colleagues and other
professionals in a empathetic manner and in such a way that it is
understandable, encourages discussion and participation in decision-making.
Counsels patients and/or families in an empathetic, accurate and supportive
manner with attention to age, disability, gender, gender identity, sexual
orientation, ethnicity, religion, level of education and cultural beliefs.
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
4.2
4.3
4.4
4.5
5.
Engage in dialogue with respect to patient’s use of alternative health
care practices in the treatment of endocrine diseases.
Respect diversity and difference, including but not limited to the impact of
age, gender, gender identity, sexual orientation, religion and cultural beliefs.
Encourage discussion, questions and interaction in the encounter.
Engage patients, families and relevant health professionals in shared
decision-making to develop a plan of care.
Address challenging communication issues effectively, such as obtaining
informed consent, delivering bad news and addressing anger, confusion and
misunderstanding.
Convey effective oral and written information about a medical encounter
5.1
5.2
5.3
5.4
Maintain clear, accurate and appropriate written or electronic records of
clinical encounters and plans.
Present verbal reports of clinical encounters and plans effectively.
Develops and communicates a management plan for patients being
discharged from his/her care.
Present medical information effectively to the public or media.
Collaborator
As Collaborators, Endocrinologists effectively work within a healthcare team to achieve
optimal patient care.
Key and Enabling Competencies: Endocrinologists are able to:
1.
Participate effectively and appropriately in an interprofessional healthcare
team
1.1
1.2
1.3
1.4
1.5
1.6
1.7
Describe the Endocrinologist’s roles and responsibilities to other
professionals.
Describe the roles and responsibilities of other professionals within the
health care team including but not limited to: diabetes educators, dietician,
endocrine testing nurse, genetic counselor, mental health professional,
pharmacist, physiotherapist, registered nurse and social worker.
Recognize and respect the diversity of roles, responsibilities and
competencies of other professionals in relation to their own.
Work with others to assess, plan, provide and integrate care for individual
patients or groups of patients.
Work with others to assess, plan, provide and review other tasks, such as
research problems, educational work, program review or administrative
responsibilities.
Participate effectively in inter-professional teams respecting confidentiality,
resource allocation and professionalism.
Consult effectively with other professionals particularly those most often
associated with Endocrinology and Metabolism including but not limited to:
1.8
1.9
1.10
2.
diagnostic imaging specialists, obstetricians-gynecologists, oncologists,
ophthalmologists, pathologists, primary health care providers and surgeons.
Describe the principles of team dynamics.
Respect tram ethics, including confidentiality, resource allocation and
professionalism.
Demonstrate leadership in a health care team, as appropriate.
Work effectively with other health professionals to prevent, negotiate and
resolve inter-professional conflict
2.1
2.2
2.3
2.4
2.5
2.6
Demonstrate a respectful attitude towards other colleagues and members of
an inter-professional team.
Work with other professionals to prevent conflicts.
Employ collaborative negotiation to resolve conflicts.
Respect differences and address misunderstandings and limitations in other
professionals.
Recognize one’s own differences, misunderstanding and ;imitations that may
contribute to inter-professional tension.
Reflect on inter-professional team function.
Manager
As Managers, Endocrinologists are integral participants in healthcare organizations,
organizing sustainable practices, making decisions about allocating resources and
contributing to the effectiveness of the healthcare system.
Key and Enabling Competencies: Endocrinologists are able to:
1.
Participate in activities that contribute to the effectiveness of their healthcare
organizations and systems
1.1
1.2
Work collaboratively with others in their organizations including diabetes
education centres.
Participate in systemic quality process evaluation and improvement, such as
patient safety initiatives.
1.2.1
1.3
1.4
2.
Recognize the role of audits, budget reviews, quality improvement,
risk management, incident reporting and complaint management in
various settings including diabetes centres, endocrine testing units,
the laboratories and ambulatory care settings.
Describe the structure and function of the healthcare system as it relates to
Endocrinology and Metabolism, including the roles of physicians.
Describe principles of healthcare financing, including physician remuneration,
budgeting and organizational funding.
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 clinical practice effectively and efficiently by:
2.2.1
2.2.2
2.2.3
2.2.4
2.2.5
2.3
2.4
2.5
3.
Avoiding duplication of services.
Involving other caregivers when appropriate.
Using appropriate information technology.
Delegating responsibility effectively and appropriately as a team
leader to optimize patient care.
Prioritizing patient visits appropriately.
Implement processes to ensure personal practice improvement.
Employ information technology appropriately for patient care.
Manage a practice including finances and human resources.
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
3.2
4.
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.
Apply evidence and management processes for cost-appropriate care.
Serve in administration and leadership roles, as appropriate
4.1
4.2
4.3
Chair or participate effectively in committees and meetings.
Lead or implement change in health care.
Plan relevant elements of health care delivery not limited to work schedules
and participation in on-going monitoring of clinical care in Endocrinology
and Metabolism.
Health Advocate
As Health Advocate, Endocrinologists responsibly use their expertise and influence to
advance the health and well-being of individual patients, communities and populations.
Key and Enabling Competencies: Endocrinologists are able to:
1.
Respond to individual patient health needs and issues as part of patient care
1.1
1.2
Identify the health needs of an individual patient.
Identify opportunities for advocacy, health promotion and disease
prevention with individuals to whom they provide care including the –
1.2.1
1.2.2
1.2.3
1.2.4
1.2.5
Hypoglycemia in diabetes.
Driving and diabetes.
Diabetes sick day management.
Adrenal insufficiency.
Medication and supply reimbursement for endocrine conditions.
2.
Respond to the health needs of the communities that they serve
2.1
2.2
2.3
3.
Describe the practice communities that they serve including ethnicity and
socioeconomic status.
Identify opportunities for advocacy, health promotion and disease
prevention in the communities that they serve and respond appropriately.
Appreciate the possibility of competing interests between the communities
served and other populations.
Identify the determinants of health for the populations with endocrine disease
that they serve
3.1
Identify the determinants of health of the populations, including barriers to
access to care and resources.
3.1.1
3.2
Identify and respond appropriately to vulnerable or marginalized populations
including:
3.2.1
3.2.2
3.2.3
3.2.4
4.
The high burden of illness from common endocrine disorders such
as diabetes mellitus, thyroid disorders, obesity, hypertension,
metabolic bone disease and lipid disorders that may strongly
contribute to inadequate access to care and resources.
Aboriginal communities.
Patient with language, cultural or social barriers.
Patients with mental health concerns.
Patients with orphan diseases with significant endocrine involvement.
Promote the health of individual patients, communities and populations at
risk for endocrine disease
4.1
4.2
4.3
4.4
4.5
4.6
Describe an approach to implementing a change in a determinant of health
of the populations they serve.
Describe how public policy impacts on the health of the populations served.
Identify points of influence in the healthcare system and its structure.
Describe the ethical and professional issues inherent in health advocacy,
including altruism, social justice, autonomy, integrity and idealism.
Appreciate the possibility of conflict inherent in their role as a health
advocate for a patient or community with that of manager or gatekeeper.
Describe the role of the medical profession in advocating collectively for
health and patient safety.
Scholar
As Scholar, Endocrinologists demonstrate a lifelong commitment to reflective learning, as
well as the creation, dissemination, application and translation of medical knowledge.
Key and Enabling Competencies: Endocrinologists are able to:
1.
Maintain and enhance professional activities through ongoing learning
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
2.
Evaluate medical information and its sources critically and apply this
appropriately to practice decisions
2.1
2.2
2.3
3.
Describe the principles of critical appraisal.
Critically appraise retrieved evidence in order to address a clinical question.
Integrate critical appraisal conclusions into clinical care.
Facilitate the learning of patients, families, students, residents, other health
professionals, the public and others, as appropriate
3.1
3.2
3.3
3.4
3.5
3.6
3.7
4.
Describe the principles of maintenance of competence.
Describe the principles and strategies for implementing a personal
knowledge management system.
Recognize and reflect learning issues in practice.
Conduct a personal practice audit.
Pose an appropriate learning question.
Access and interpret the relevant evidence.
Integrate new learning into practice.
Evaluate the impact of any change in practice.
Document the learning process.
Describe principles of learning relevant to medical education.
Identify collaboratively the learning needs and desired learning outcomes of
others.
Select effective teaching strategies and content to facilitate others’ learning.
Deliver an effective lecture or presentation.
Assess and reflect on a teaching encounter.
Provide effective feedback.
Describe the principles of ethics with respect to teaching.
Contribute to the development, dissemination and translation of new
knowledge and practices. This requires the completion or significant
participation in a scholarly project related to any aspect (research, education,
or creative professional activity) of Endocrinology and Metabolism
4.1
4.2
4.3
4.4
4.5
4.6
Describe the principles of research and scholarly inquiry.
Describe the principles of research ethics.
Pose a scholarly question.
Conduct a systematic search for evidence.
Select and apply appropriate methods to address the question.
Disseminate the findings of a study appropriately.
Professional
As Professionals, Endocrinologists are committed to the health and well-being of individuals
and society through ethical practice, profession-led regulation and high personal standards of
behaviour.
Key and Enabling Competencies: Endocrinologists are able to:
1.
Demonstrate a commitment to their patients, profession and society through
ethical practice
1.1
1.2
1.3
1.4
1.5
1.6
2.
Exhibit appropriate professional behaviours in practice, including honesty,
integrity, commitment, compassion, respect and altruism.
Demonstrate a commitment to delivering the highest quality care and
maintenance of competence.
Recognize and appropriately respond to ethical issues encountered in
practice.
Manage conflicts of interest appropriately.
Recognize the principles and limits of patient confidentiality as defined by
professional practice standards and the law.
Maintain appropriate relations with patients.
Demonstrate a commitment to their patients, profession and society through
participation in profession-led regulation
2.1
Demonstrate knowledge and an understanding of the professional, legal and
ethical codes of practice.
2.1.1
2.2
2.3
2.4
2.5
3.
Abide by the RCPSC-endorsed guidelines of ethical interactions with
industry (especially the pharmaceutical industry) with respect to
research, education and clinical care.
Fulfill the regulatory and legal obligations required of current practice.
Demonstrate accountability to professional regulatory bodies.
Recognize and respond to others’ unprofessional behaviours in practice.
Participate in peer review.
Demonstrate a commitment to physician health and sustainable practice
3.1
3.2
3.3
Balance personal and professional priorities to ensure personal health and a
sustainable practice.
Strive to heighten personal and professional awareness and insight.
Recognize other professionals in need and respond appropriately.
The practice of endocrinology and metabolism involves the evaluation, diagnosis and
treatment of patients with diseases of the endocrine glands, disorders of hormone systems
and their target organs, and disorders of metabolism. During the course of residency in
endocrinology and metabolism, the candidate must acquire clinical competence in
management of endocrine disease and related problems, together with a sound background
in the relevant basic sciences.
During the residency training, in addition to knowledge base, several areas of clinical
competence recognized to be of importance for a consultant endocrinologist are promoted
and evaluated:
-
The resident must demonstrate that he/she is able to perform a medical history that
is relevant, concise, accurate and appropriate.
The resident must demonstrate the ability to perform a comprehensive physical
examination relevant to the endocrine problem.
The resident should demonstrate the capability of developing effective therapeutic
relationships with patients and their families in order that appropriate information
and counsel may be given concerning chronic endocrine or metabolic diseases.
Residents must learn to serve as consultants to general medicine, medical specialties and
others specialty services (e.g. surgery, obstetrics, psychiatry).
Considering this,
communication skills should be improved during the fellowship training in order that the
resident:
-
Be able to write a thorough, clear note, communicating all of the important elements
of a consultation in an effective, focused manner relating to endocrinology patients.
Be able to present verbally the case of a patient with an endocrine disorder, including
all the pertinent clinical and laboratory information, as well as the diagnostic
impressions, investigative strategy, and therapeutic recommendations.
Several areas of knowledge and clinical skills are recognized with which the resident must
become familiar, experienced and comfortable over the course of the 2 year Fellowship in
Endocrinology and Metabolism. The following specific objectives of training are meant to
guide but not restrict the resident in the acquisition of this knowledge and of these clinical
skills and attitudes. These objectives are also meant to reflect the training requirements and
objective standards found at the national level. The evaluation of performance throughout
residency is based on the achievement of these clinical skills and the knowledge base
demonstrated during rotations, presentations, and during the in-training examination.
General Endocrinology
Objectives
CanMeds Format
DISEASE-SPECIFIC OBJECTIVES
CanMeds Role
MEDICAL EXPERT
General Requirements
Objective
At the end of training, the Endocrine resident will be able
to
a) Knowledge
•Demonstrate diagnostic and therapeutic skills for ethical and
effective patient care.
•Access and apply relevant information to clinical practice.
•Demonstrate effective consultation services with respect to
patient care, education and legal opinions.
b) Skills
•Perform a medical history that is relevant, concise, accurate
and appropriate to the endocrine problem.
•Perform a comprehensive physical examination relevant to
the endocrine problem.
•Interpret the results of hormonal assays in basal, stimulated
and suppressed states.
•Understand the use of radioisotopes in diagnosis and
management of endocrine disorders.
•Understand standard endocrine clinical laboratory assays.
•Understand the basic concepts of the genetics of endocrine
disorders and some of the diagnostic tests used to evaluate
these.
•Interpret neuroradiographic, nuclear medicine, and
ultrasound tests in the diagnosis of endocrine disorders.
•Interpret bone mineral density measurements and plain x-rays
in the evaluation of metabolic bone disease.
•Demonstrate effective consultation skills and services in
presenting timely assessments and recommendations for
patients with endocrine disorders in response to a request
from another health care provider with respect to patient care,
education of provider and legal opinions.
MEDICAL EXPERT
Disease Specific
Requirements
a) Knowledge
Diabetes
•Describe the anatomy and histology of the pancreas.
Describe the structure of insulin, draw the insulin receptor and
describe the mechanism of action at the cellular level.
•Describe the diagnostic criteria for diabetes mellitus.
Compare Type 1 and Type 2 diabetes with respect to
epidemiology, etiology, pathogenesis, pathological changes in
the pancreas, natural history, treatment and complications.
•Describe other conditions – heritable or acquired that can
give rise to diabetes mellitus.
•Describe the epidemiology, pathophysiology, clinical
presentation, screening and treatment of microvascular and
macrovascular complications of diabetes.
•Outline the risks of mother and fetus in a pregnancy
complicated by Type 1, Type 2 or gestational diabetes and
strategies to reduce these risks.
•Demonstrate an awareness of new developments in the
prevention and treatment of Type 1 and Type 2 diabetes.
b) Skills
•Perform a focused medical interview and physical
examination of a person with diabetes.
•Counsel a patient effectively on the basic principles of
diabetes mellitus self care including importance of glycemic
control with particular emphasis on the prevention of diabetes
complications.
•Explain the basic principles of a diabetic diet including
carbohydrate counting, and understand how dietary
modification affects glycemic control.
•Interpret home blood glucose readings and adjust insulin and
hypoglycaemic therapy appropriately based on their results.
•Manage a patient with diabetes with diabetic ketoacidosis,
hyperosmolar coma, severe hypoglycaemia, during sick days,
prolonged exercise or fasting and perioperatively.
•Select laboratory tests to effectively assess risk factors and
screen for microvascular complications.
•Outline appropriate treatment strategies for acute and
chronic complications such as ophthalmopathy, painful
neuropathy, incipient nephropathy, overt nephropathy,
hypertension, and hyperlipidemia in a person with diabetes.
•Effectively counsel and manage the adolescent with poor
metabolic control due to lack of compliance with diabetes
regimens.
c) Attitudes
•Collaborate effectively with the multidisciplinary team.
•Appreciate the impact of diabetes on the child/adolescent,
their family and society.
•Recognize that diabetes is a self-care disease requiring
education, and accept and encourage the role of the patient
and family in decision making and goal setting.
•Appreciate the different needs and developmental stages in
the infant, child, adolescent, and young adult with diabetes.
•Recognize the impact the patient’s and families own health
beliefs and support system will have on the goals of therapy.
a) Knowledge
Hypoglycemia
•Explain normal glucose metabolism in the fed and fasting
state including glycolysis, gluconeogenesis, glycogenesis and
glycogenolysis. Understand the interactions between glucose,
protein and fat metabolism in the body.
•Understand the different genetic conditions that can give rise
to hypoglycaemia and be able to describe the molecular
defects giving rise to these conditions.
•Describe an approach to the diagnosis and management of
hypoglycaemia in infants, children, adolescents, and adults.
b) Skills
•Perform a focused history and examination in a patient
referred for hypoglycaemia.
•Select and interpret critical blood samples in the diagnosis of
hypoglycaemia.
•Effectively manage an infant, child or adult with
hypoglycaemia.
c) Attitudes
•Recognize the concerns of parents of children with
hypoglycaemia with respect to the investigation and treatment
of hypoglycaemia and the risk of neurologic consequences.
a) Knowledge
Hypothalamic/Pituitary Disorders
•Explain and diagram the general anatomy, histology and
embryology of the hypothalamus and pituitary gland.
•Understand the role of various genes involved in pituitary –
hypothalamic development and how mutations in these
impact on normal hormone synthesis and release.
•Describe in detail the control mechanisms and physiology
including target organ response for the six anterior pituitary
hormones.
•Describe the etiology, clinical presentation, differential
diagnosis, investigation and management of hypopituitarism
with particular emphasis on acquired conditions.
•Discuss water homeostasis including the role of thirst,
antidiuretic hormone, renin-angiotensin system, plasma
volume and plasma tonicity. Outline the etiology, clinical
presentation, differential diagnosis, investigation and
management of SIADH and diabetes insipidus (central and
nephrogenic).
•Discuss pituitary tumors by describing their histology, clinical
presentatiom, differential diagnosis, investigation (laboratory
and radiographic) and specific treatment modalities including
their success rates.
b) Skills
•Perform a focused history and examination in a patient
referred for possible disorders of the pituitary gland including:
growth
failure,
delayed
or
precocious
puberty,
hypopituitarism, diabetes insipidus, SIADH, brain tumor,
particularly involving the hypothalamus/pituitary, incidental
pituitary lesion, empty sella, Cushing’s syndrome,
hyperprolactinemia and acromegaly.
•Interpret common investigation tools including blood tests of
basal pituitary function, stimulatory and suppressive tests of
pituitary function and water deprivation tests.
•Select appropriate imaging modalities and recognize features
consistent with congenital hypopituitarism (SON, classic triad
of ectopic posterior pituitary), empty sella syndrome, pituitary
adenomas (including micro vs. macro and extension outside
sella) and craniopharyngioma.
•Effectively msnage a child with hypo- or hyper-pituitarism.
c) Attitudes
•Recognize the long-term effects of pituitary disease including
changes in physical appearance, fertility and the necessity of
therapeutic compliance.
a) Knowledge
Growth
•Discuss the approach to disorders of growth in children,
including epidemiology, pathophysiology, investigation and
management.
b) Skills
•Demonstrate the ability to perform an appropriate history
and physical examination of a patient referred for short stature
or overgrowth.
•Select and interpret appropriate investigations of a patient
with short stature or overgrowth.
c) Attitudes
•Recognize the potential psychosocial impact on children and
adolescents with short stature or extreme tall stature.
a) Knowledge
Sexual Development/Fertility
•Explain and diagram the anatomy, histology and embryology
of the ovaries and testes.
•Discuss the biosynthesis, transport, peripheral actions and
control of secretion of the gonadal hormones and how this
can impact on embryology and development.
•Describe the etiology, clinical presentation, differential
diagnosis, investigation and management of ambiguous
genitalia.
•Describe the clinical manifestations, differential diagnosis,
investigation and management of precocious puberty, delayed
puberty, incomplete puberty, menstrual disorders, infertility
and hyperandrogenic states in females and estrogenization of
males.
b) Skills
•Perform a focused history and physical examination in a
patient referred for suspected ambiguous genitalia or aberrant
pubertal development.
•Interpret basal and stimulatory tests used in the diagnosis of
these disorders including gonadal dysgenesis, androgen
insensitivity, premature thelarche, premature adrenarche,
hypogonadotropin hypogonadism, hirsutism, amenorrhea and
gynescomastia.
c) Attitudes
•Recognize the psychosocial impact and the concerns of the
parents of children with ambiguous genitalia with respect to
the diagnosis and treatments.
•Recognize the impact on the children and adolescent with
disorders of puberty especially related to investigations and
treatment.
a) Knowledge
Adrenal
•Explain and diagram the anastomy, histology and ambryology
of the adrenal cortex and medulla.
•Discuss the biosynthesis, transport, peripheral actions via
their receptors and control of secretion of adrencortical
hormones.
•Discuss how these hormones impact on fluid, electrolyte and
acid-base disorders.
•Describe the etiology, clinical presentation, differential
diagnosis, investigation and management of primary and
secondary adrenal insufficiency.
•Describe the clinical manifestations, differential diagnosis,
investigation and management of congenital adrenal
hyperplasis,
hyperandrogenism,
Cushing’s
syndrome,
hypoaldosteronism, hyperaldosteronism, pheochromocytoma
and adrenal masses.
•Outline the etiology and investigation of endocrine causes of
hypertension.
b) Skills
•Perform a focused history and physical examination in a
patient referred for suspected adrenal insufficiency, congenital
adrenal hyperplasia, hyperandrogenism, Cushing’s syndrome,
hyperaldosteronism, pheochromocytoma or adrenal mass.
•Interpret basal, stimulatory and suppressive tests used to
diagnose adrenal insufficiency, congenital adrenal hyperplasia,
hypergonadgenism, Cushing’s syndrome, hypoaldosteronism,
hyperaldosteronism,
hyperandrogenism,
and
pheochromocytoma.
•Select appropriate imaging modalities for adrenal lesions.
•Effectively manage emergency situations such as adrenal
crisis
and
hypertensive
crisis
secondary
to
a
pheochromocytoma.
c) Attitudes
•Recognize the importance of education in the adjustment of
glucocorticoid medication and the necessity for good
compliance.
•Recognize the impact of potential surgery, repeated
examinations and the importance of compliance in children
and adolescents with congenital adrenal hyperplasia.
a) Knowledge
Thyroid
•Explain and diagram the general anatomy histology and
embryology of the thyroid gland.
•Discuss physiology of the normal thyroid including: thyroid
hormone synthesis, mechanism of action and signal
transduction at the level of the thyroid hormone receptor.
•Outline the etiology, clinical presentation, investigation and
treatment of thyroid disease including: hypothyroidism,
hyperthyroidism, thyroid nodules and thyroid cancer.
•Demonstrate an understanding of the biochemical and
nuclear medicine laboratory tests used in the investigation of
thyroid disease.
b) Skills
•Demonstrate the ability to take a focused history in a patient
referred for thyroid disease.
•Demonstrate appropriate technique in examination of the
thyroid and examination of the eyes for evidence of thyroid
disease.
•Describe, select and interpret thyroid function tests in
addition to thyroid scans and ultrasounds.
c) Attitudes
•Demonstrate an understanding of the impact of the diagnosis
of congenital hypothyroidism on the parents of a newborn
infant.
•Demonstrate an understanding of patients’ concerns
regarding lifelong treatment with thyroid hormone, radiation
therapy for both Graves’ disease and thyroid cancer, and
prognosis of thyroid cancer.
a) Knowledge
Calcium and Bone
•Discuss the normal physiology of calcium and bone
metabolism including the control and action of parathyroid
hormone, calcitonin and vitamin D, mechanisms of bone
growth and development.
•Outline the histology of bone development, formation /
destruction and factors controlling bone modeling and
remodelling.
•Discuss the differential diagnosis, investigation and treatment
of hypercalcemia, hypocalcemia, hypo and hyperphosphatemia
and hypo and hyermagnesemia in both the acute and chronic
setting.
•Outline the etiology, investigation and treatment of disorders
of bone and mineral metabolism, primary and secondary
osteoporosis, and skeletal dysplasias.
b) Skills
•Perform a focused history and examination in patients
referred for disorders of mineral disturbances, bone mineral
metabolism, osteoporosis or skeletal dysplasia.
•Describe, select and interpret the appropriate laboratory and
radiological investigation of patients with metabolic bone
disease and mineral disturbances.
•Effectively manage a pediatric patient with osteoporosis or
disorders of bone mineral metabolism.
c) Attitudes
•Demonstrate an understanding and respect for a patient’s
concerns with regard to treatment for skeletal disorders.
a) Knowledge
b) Skills
Obesity
•Discuss the physiology and pathophysiology of energy
balance and the implications for the development of obesity.
•To understand the genetic and environmental factors
contributing to obesity.
•To understand the short- and long-term health implications
of childhood obesity.
•To perform a focused history and physical examination in
patients referred for obesity including the detection of signs
and symptoms indicating an endocrine cause and/or
secondary effects of obesity.
•To identify those patients requiring further diagnostic workup an, in such cases, describe, select and interpret the
appropriate laboratory and radiological investigations.
c) Attitudes
a) Knowledge
•Demonstrate sensitivity, understanding and respect for a
patient’s concerns around the psychosocial and health
implications of obesity.
Lipids
•Discuss lipid metabolism including metabolic pathways
involved and the important receptors, enzymes and control
hormones.
•Outline the etiology, clinical significance, investigation and
management of the dyslipidemias.
•Discuss the available evidence for benefit from lipid
reduction in childhood in primary and secondary prevention
of coronary artery disease later in life.
•Discuss the genetics of the inherited dyslipidemias.
b) Skills
•Perform a focused history and physical examination in a
patient referred for suspected dyslipidemia.
•Recognize the important physical findings in dyslipidemia
including the various types of xanthomas, xanthelasma and
retinal lipemia.
•Describe, select and interpret laboratory tests to determine
etiology and classification of the dyslipidemias.
•Select, educate patients about and follow effectiveness of
pharmacological and non-pharmacological interventions for
dyslipidemias.
c) Attitudes
•Demonstrate an understanding and be able to counsel
patients and families with concerns regarding the effects of
their dyslipidemia and its management on diet and daily living,
long-term complications, family life and inheritance of the
disorder within the family.
a) Knowledge
COMMUNICATOR
General Requirements
Other Endocrine Topics
•Discuss the alterations in the endocrine system in persons
with systemic disease and in pregnant women.
•Discuss nutrition as it applies to endocrine disorders.
•Discuss screening for endocrine disorders and autoimmunity
as it relates to the endocrine system.
•Discuss cytogenetics and molecular genetics as they relate to
disorders of sexual differentiation, infertility and other
inherited endocrine disorders.
•Establish therapeutic relationship with patient and families.
•Obtain and synthesize relevant history from patients, families
and communities.
•Listen effectively.
•Discuss appropriate information with patients and families
and the health care team.
Specific Requirements
COLLABORATOR
General Requirements
Specific Requirements
MANAGER
General Requirements
•Establish therapeutic relationships with patients and their
families and other caregivers that are characterized by
understanding, trust, respect, empathy and confidentiality.
•Listen effectively to patient, families and members of the
health care team.
•Present clinical problems clearly, concisely and correctly in
verbal reports or written letters.
•Demonstrate an ability to provide appropriate support and
counselling to a patient and family with chronic endocrine or
metabolic disease.
•Demonstrate an appreciation of the patient’s perception of
health, concerns and expectations and the impact of the
endocrine disease on the patient and the family while
considering factors such as the patient’s age, gender, cultural
and socioeconomic background and spiritual values.
•Demonstrate open mindedness to consideration of
alternative health care practices in the treatment of endocrine
diseases.
•Demonstrate an understanding of the importance of
communication among health care professionals involved in
the care of individual patients such that the roles of these
professionals are delineated and consistent messages are
delivered to patients and their families.
•Demonstrate effective communication with children and
adolescents of varying ages, and with their families.
•Consult effectively with other physicians and health care
professionals.
•Contribute effectively to other interdisciplinary team
activities.
•Consult effectively with other physicians particularly those
most often associated with endocrinology such as
neurosurgery, neuroradiology, ophthalmology, nephrology,
urology, genetics, obstetrics, paediatrics and psychiatry.
•Contribute effectively to other interdisciplinary team
activities, particularly those most often associated with
endocrinology such as diabetes mellitus, metabolic bone
disease, gastroenterology, neurology, urology, community
general paediatrics and newborn screening.
•Utilize resources effectively to balance patient care, learning
needs and outside activities.
•Allocate finite health care resources wisely.
•Work effectively and efficiently in a health care organization.
•Utilize information technology to optimize patient care, lifelong learning and other activities.
Specific Requirements
HEALTH ADVOCATE
General Requirements
Specific Requirements
SCHOLAR
General Requirements
Specific Requirements
•Allocate finite health care resources wisely in the context of
the health care system for individual patient care, the
institution and the community.
•Work effectively and efficiently in health care organizations
such as inpatient wards, outpatient clinics, metabolic day
treatment centres, acute and chronic care institutions and
regional or provincial health systems.
•Recognize the role of audits, budget reviews, quality
improvement, risk management, incident reporting, and
complaint management in various settings including metabolic
day treatment centres, clinical investigation units, the
laboratory and the ambulatory care setting.
•Demonstrate the use of cost/benefit ratios of diagnostic and
therapeutic interventions for endocrine disorders as well as
cost confinement, efficacy and efficiency as they relate to
decision making and quality assurance.
•Identify the important determinants of health affecting
children and adolescents.
•Contribute effectively to improved health of patients, families
and communities.
•Recognize and respond to those issues where advocacy is
appropriate.
•Identify the important determinants of health affecting
patients, particularly those contributing to the burden of
illness from endocrine disorders such as diabetes mellitus,
hypertension, metabolic bone disease, lipid disorders and
obesity.
•Contribute effectively to improved health of all patients and
communities including education on aspects of prevention of
endocrine disorders, specifically environmental, genetic and
lifestyle risk factors.
•Develop, implement and monitor personal continuing
education strategy.
•Critically appraise sources of medical information.
•Facilitate learning of patients, housestaff/students, and other
health care professionals.
•Contribute to the development of new knowledge.
•Critically appraise sources of medical information particularly
as it pertains to endocrinology and metabolism.
•Educate patients, housestaff, students and other health care
professionals in formal and informal education settings
regarding endocrine disorders and the impact of chronic
disease on the endocrine system.
•Demonstrate an understanding of preferred learning methods
in dealing with students, residents and colleagues.
•Contribute to the development of new knowledge in
endocrinology and metabolism.
PROFESSIONAL
General Requirements
Specific Requirements
•Deliver highest quality health care with integrity, honesty and
compassion.
•Exhibit appropriate personal and interpersonal professional
behaviours.
•Practice medicine ethically consistent with the obligations of
a physician.
•Demonstrate an understanding of the principles of medical
ethics as they relate to patient care and clinical research
including
autonomy,
beneficence/nonmalificence,
confidentiality, truth telling, justice, and respect for persons,
conflict of interest and resource allocation.
•Demonstrate a willingness to accept peer and supervisor
reviews of professional competence.
•Demonstrate recognition of personal limitation of
professional competence and demonstrate a willingness to call
upon others with special expertise.
•Demonstrate flexibility and willingness to adjust to changing
circumstances.
Longitudinal Clinic Objectives
At Six Months
Medical Expert
Communicator
To obtain/demonstrate diagnostic and therapeutic skilld
effectively and ethically, manage a spectrum of endocrinology
out-patient problems.
To establish a therapeutic relationship with patients.
To elicit and synthesize relevant information from the patient
and discuss the appropriate information with the patient.
Collaborator
To ensure proper follow up of patients.
To effectively consult with other physicians.
To effectively interface with allied health professionals
(pathology, radiology, laboratory).
Health Advocate
Manager
To ensure follow up in the out- or in-patient setting (discharge
planning and clinic appointments).
To identify the determinants of health that affect a patient,
such as for obesity, diabetes mellitus, hyperlipidemic patients
and to contribute to improving their health.
To work efficiently and effectively in an out-patient clinic
setting.
To organize time and work management.
To be able to triage consults.
Scholar
Professional
To utilize health care resources in a cost effective manner.
To continue developing a personal continuing education
program.
To deliver the highest quality care with integrity and to
practice medicine in an ethically responsible manner.
To reorganize one’s own limitations.
To answer pages promptly and vet the issues with the staff.
At Twelve Months
Medical Expert
Communicator
Collaborator
Health Advocate
Manager
Scholar
Professional
One Year
Medical Expert
Communicator
Collaborator
Health Advocate
Manager
Scholar
Professional
Twenty-four Months
Medical Expert
To master the knowledge and the skills to deal with most
everyday endocrine/diabetic situations.
To feel comfortable communicating with families / patients
and to synthesize relevant information for the conditions
listed below.
To have integrated into our multidisciplinary teams- diabetes
mellitus, laboratory, pathology, radiology, antenatal clinic and
reproductive endocrinology.
To be fairly comfortable advocating independently for some
routine conditions DKA, dm illness and hospitalization, new
onset dm and teaching and endocrine disorders such as short
stature, hypo and hyperthyroidism, pubertal disorders,
hyperlipidemia, obesity, calcium disorders, hypopituitarism.
To manage housestaff teams and to delegate appropriately.
To have acquired the skill for literature searches, analysis of
articles and appraisal.
To have modified previously acquired professional behaviour
to the Endocrinology environment.
To have mastered the knowledge base and skills to function
independently regarding conditions such as calcium, lipid,
pituitary, thyroid disorders, diabetes early and long term
complications, metabolic bone disease, growth, fluid and
electrolyte disorders. As well as understanding how genetic,
radiology, nuclear medicine and pathology complement the
care of our patients.
To feel comfortable communicating with families / patients
and to synthesize relevant information for the conditions
listed below.
To have integrated into our multidisciplinary teams- diabetes
mellitus, antenatal clinic, laboratory, pathology, radiology and
reproductive endocrinology.
To be fairly comfortable advocating independently for some
routine conditions DKA, dm illness and hospitalization, new
onset dm and teaching and endocrine disorders such as short
stature, hypo and hyperthyroidism, pubertal disorders,
hyperlipidemia, obesity, calcium disorders, hypopituitarism.
To manage housestaff teams and to delegate appropriately.
To have acquired the skill for literature searches, analysis of
articles and appraisal.
To have modified previously acquired professional behaviour
to the Endocrinology environment.
To have further refined the knowledge base but most
importantly refined scholarly skills to be able to tackle any new
health care issue for their patients even if they have had no
previous exposure.
Communicator
Collaborator
Health Advocate
Manager
Scholar
Professional
To not only be able to advocate for an individual or family but
to see how healthcare physicians can impact health at a
community if not at a national or international level.
To have asked at least one clinically important question and
researched this. Usually most trainees will have presented
and/or published this if not more than one over the period of
2 years.
To have polished their skills.
In-Patient Consultation Objectives
Curriculum –
Attend in-patient consultation service concurrently with out-patient clinics in
assigned hospital.
Medical Expert
To obtain/demonstrate diagnostic and therapeutic skills
effectively and ethically manage a spectrum of endocrinology
in-patient problems.
To access and apply relevant information for such said patient
care.
Communicator
To aid in the learning of the trainees on the team.
To establish a therapeutic relationship with patients.
To elicit and synthesize relevant information from the patient
and discuss the appropriate information with the said patient.
Collaborator
To ensure appropriate sign-out to the next team member for
patients.
To effectively consult with other physicians.
To effectively interface with allied health professionals
(pathology, radiology, laboratory).
Health Advocate
Manager
To ensure follow-up in the out- or in-patient setting (discharge
planning and clinic appointments).
To identify the determinants of health that affect a patient,
such as for obesity, diabetes mellitus, hyperlipidemic patients
and to contribute to improving their health.
To work effectively and efficiently in health care setting.
To delegate appropriately within the team.
To ensure that clinics and protected teaching are not
interrupted with pages.
To implement accepted preventative measures.
To organize time and work management.
To be capable of triaging consultations.
Scholar
Professional
To utilize health care resources in a cost effective manner.
To continue developing a personal continuing education
program.
To deliver the highest quality care with integrity and to
practice medicine in an ethically responsible manner.
To recognize one’s own limitations.
To answer pages promptly and vet the issues with the staff.
General Endocrinology Clinic Objectives
Medical Expert
Communicator
To obtain/demonstrate diagnostic and therapeutic skills
effectively and ethically managed a spectrum of endocrinology
out-patient problems.
To access and apply relevant information for such said patient
care.
To establish a therapeutic relationship with patients.
To elicit and synthesize relevant information from the patient
and discuss the appropriate information with the said patient.
To master composing a consultant’s letter.
Collaborator
Health Advocate
Manager
To be cognizant of providing follow-up/letters to referring
physicians.
To effectively consult with other physicians.
To effectively interface with allied health professionals
(pathology, radiology, laboratory).
To identify the determinants of health that affect a patient,
such as for obesity, diabetes mellitus, hyperlipidemic patients
and to contribute to improving their health.
To work effectively and efficiently in health care setting.
To implement accepted preventative measures.
To organize time and work management.
To be capable of triaging consultations.
Scholar
Professional
To utilize health care resources in a cost effective manner.
To continue developing their personal continuing education
program.
To deliver the highest quality care with integrity and to
practice medicine in an ethically responsible manner.
To recognize one’s own limitations.
Diabetes Clinic Objectives
Medical Expert
Establish and maintain clinical knowledge of:
Disorder of glucose metabolism including hypoglycaemia and
hyperglycemia.
Communicator
Type 1 and Type 2 diabetes including the role of nutrition,
exercise, pharmacologic management including insulin pump
therapy and complications.
To establish a therapeutic relationship with patients.
To elicit and synthesize relevant information from the patient
and discuss the appropriate information with the said patient.
To master composing a consultant’s letter.
Collaborator
Health Advocate
Manager
To be cognizant of providing follow-up/letters to referring
physicians.
To effectively consult with other physicians.
To effectively interface with allied health professionals
(pathology, radiology, laboratory).
To identify the determinants of health that affect a patient,
such as for obesity, diabetes mellitus, hyperlipidemic patients
and to contribute to improving their health.
To work effectively and efficiently in health care setting.
To implement accepted preventative measures.
To organize time and work management.
To be capable of triaging consultations.
Scholar
Professional
To utilize health care resources in a cost effective manner.
To continue developing their personal continuing education
program.
To deliver the highest quality care with integrity and to
practice medicine in an ethically responsible manner.
To recognize one’s own limitations.
Lipid Clinic Objectives
Medical Expert
Communicator
Establish and maintain clinical knowledge of disorder of lipid
metabolism.
To establish a therapeutic relationship with patients.
To elicit and synthesize relevant information from the patient
and discuss the appropriate information with the said patient.
To master composing a consultant’s letter.
Collaborator
Health Advocate
Manager
To be cognizant of providing follow-up/letters to referring
physicians.
To effectively consult with other physicians.
To effectively interface with allied health professionals
(pathology, radiology, laboratory).
To identify the determinants of health that affect a patient,
such as for obesity, diabetes mellitus, hyperlipidemic patients
and to contribute to improving their health.
To work effectively and efficiently in health care setting.
To implement accepted preventative measures.
To organize time and work management.
To be capable of triaging consultations.
Scholar
Professional
To utilize health care resources in a cost effective manner.
To continue developing their personal continuing education
program.
To deliver the highest quality care with integrity and to
practice medicine in an ethically responsible manner.
To recognize one’s own limitations.
Neuroendocrine Clinic Objectives
Medical Expert
Establish and maintain clinical knowledge of:
Normal growth and development and its variations.
Communicator
Disorders of the anterior and posterior pituitary gland.
To establish a therapeutic relationship with patients.
To elicit and synthesize relevant information from the patient
and discuss the appropriate information with the said patient.
To master composing a consultant’s letter.
Collaborator
Health Advocate
Manager
To be cognizant of providing follow-up/letters to referring
physicians.
To effectively consult with other physicians.
To effectively interface with allied health professionals
(pathology, radiology, laboratory).
To identify the determinants of health that affect a patient,
such as for obesity, diabetes mellitus, hyperlipidemic patients
and to contribute to improving their health.
To work effectively and efficiently in health care setting.
To implement accepted preventative measures.
To organize time and work management.
To be capable of triaging consultations.
Scholar
Professional
To utilize health care resources in a cost effective manner.
To continue developing their personal continuing education
program.
To deliver the highest quality care with integrity and to
practice medicine in an ethically responsible manner.
To recognize one’s own limitations.
Gestational Diabetes Clinic Objectives
Medical Expert
Establish and maintain clinical knowledge of:
Gestational diabetes and pregestational diabetes.
Treatment of gestational diabetes and pregestational diabetes.
Communicator
Risks to mother and fetus and prevention of these risks.
To establish a therapeutic relationship with patients.
To elicit and synthesize relevant information from the patient
and discuss the appropriate information with the said patient.
To master composing a consultant’s letter.
Collaborator
Health Advocate
Manager
To be cognizant of providing follow-up/letters to referring
physicians.
To effectively consult with other physicians.
To effectively interface with allied health professionals
(pathology, radiology, laboratory).
To identify the determinants of health that affect a patient,
such as for obesity, diabetes mellitus, hyperlipidemic patients
and to contribute to improving their health.
To work effectively and efficiently in health care setting.
To implement accepted preventative measures.
To organize time and work management.
To be capable of triaging consultations.
Scholar
Professional
To utilize health care resources in a cost effective manner.
To continue developing their personal continuing education
program.
To deliver the highest quality care with integrity and to
practice medicine in an ethically responsible manner.
To recognize one’s own limitations.
Calcium and Bone Metabolism Clinic Objectives
Medical Expert
Establish and maintain clinical knowledge of:
Communicator
Metabolic bone disease and disorders of calcium metabolism
including disorders of the parathyroid glands and the vitamin
D system.
To establish a therapeutic relationship with patients.
To elicit and synthesize relevant information from the patient
and discuss the appropriate information with the said patient.
To master composing a consultant’s letter.
Collaborator
Health Advocate
Manager
To be cognizant of providing follow-up/letters to referring
physicians.
To effectively consult with other physicians.
To effectively interface with allied health professionals
(pathology, radiology, laboratory).
To identify the determinants of health that affect a patient,
such as for obesity, diabetes mellitus, hyperlipidemic patients
and to contribute to improving their health.
To work effectively and efficiently in health care setting.
To implement accepted preventative measures.
To organize time and work management.
To be capable of triaging consultations.
Scholar
Professional
To utilize health care resources in a cost effective manner.
To continue developing their personal continuing education
program.
To deliver the highest quality care with integrity and to
practice medicine in an ethically responsible manner.
To recognize one’s own limitations.
Thyroid Clinic Objectives
Medical Expert
Communicator
Establish and maintain clinical knowledge of disorders of the
thyroid gland and metabolism.
Acquire skill in FNA +/- ultrasound guidance.
To establish a therapeutic relationship with patients.
To elicit and synthesize relevant information from the patient
and discuss the appropriate information with the said patient.
To master composing a consultant’s letter.
Collaborator
Health Advocate
Manager
To be cognizant of providing follow-up/letters to referring
physicians.
To effectively consult with other physicians.
To effectively interface with allied health professionals
(pathology, radiology, laboratory).
To identify the determinants of health that affect a patient,
such as for obesity, diabetes mellitus, hyperlipidemic patients
and to contribute to improving their health.
To work effectively and efficiently in health care setting.
To implement accepted preventative measures.
To organize time and work management.
To be capable of triaging consultations.
Scholar
Professional
To utilize health care resources in a cost effective manner.
To continue developing their personal continuing education
program.
To deliver the highest quality care with integrity and to
practice medicine in an ethically responsible manner.
To recognize one’s own limitations.
Pediatric Endocrinology and Metabolism
Objectives for Adult Endocrinology Residents
GENERAL OBJECTIVES
Residents and students performing a rotation in our division will work primarily in the
outpatient setting assessing and managing patients with common endocrine disorders
(growth issues, delayed or precocious puberty and thyroid gland dysfunction) as well as the
diagnosis and management of diabetes mellitus.
1) MEDICAL EXPERT
The resident is expected to achieve medical competence in these domains/topics of
endocrinology. This will be accomplished by direct patient care, clinical case
presentations, teaching sessions and self directed teaching.
Glucose homeostasis
The resident will be able to:
 Diagnose Type 1, Type 2 and glucose intolerance and to provide a differential
diagnosis for these disorders
 Describe the pathophysiology and natural history of these disorders
 Select appropriate therapy and follow up for such said patients
 Provide guidance for illness, exercise or ketosis
 Diagnose hypoglycaemia, to initiate investigations and to be able to interpret
them
 Provide a differential diagnosis
 Understand the various therapeutic modalities available
Pituitary gland dysfunction
The resident will be able to
 Describe the clinical manifestations of congenital or acquired hypopituitarism,
including diabetes insipidus
 Delineate the investigations required to diagnosis hypopituitarism and those
required for follow up monitoring
 Describe the pathophysiology and natural history with special emphasis on
children post chemotherapy and/or radiotherapy
 Understand the concepts related to hormone replacement strategies and potential
side effects
 Understand how exogenous glucocorticoids can cause adrenal suppression, its
manifestations and its treatment
Growth
The resident will be able to
 Describe typical linear height patterns and be able to discuss the use of BMI and
wt : ht curves
 Understand how chronic illness or medications may impact on growth
 Discuss appropriate investigations for children with abnormal growth patterns
 Understand the current usage of growth hormone and its side effects
Thyroid
The resident will be able to
 Be able to examine the thyroid gland
 Understand the symptoms of hypo- and hyperthyroidism and be able to select
and interpret the appropriate laboratory tests
 Describe the pathophysiology and natural history of these disorders
 Prescribe the appropriate medications
Puberty
The resident will be able to
 Expertly perform puberty Tanner staging and to understand the typical ages for
the onset of puberty
 Describe the pathophysiology of several benign pubertal variants (premature
thelarche, premature adrenarche and gynecomastia) and to outline the differential
 Discuss the differential diagnosis of precocious or delayed puberty, galactorrhea,
hirsuitism, primary and secondary amenorrhea and to outline the required
investigations
 Prescribe the appropriate medications
Adrenal
The resident will be able to understand the cortisol/aldosterone synthetic pathway
and to be able to discuss the clinical manifestations of 21-hydroxylase CAH and its
treatment
Ambiguous genitalia and normal genital development
The resident will be able to review how normal genital development occurs. She/he
will be able to understand how ambiguous genitalia may arise because of an
underlying genetic disorder, related to an endocrinopathy or as an idiopathic event.
She/he will appreciate the urgent need for assessment by a variety of health care
professionals.
Obesity
The resident will be able to review the causes of endogenous obesity and to outline
strategies to prevent as well as treat exogenous obesity. She/he will be able to discuss
the kinds of sequelae- short and long term that can arise from obesity.
Bone and mineral homeostasis
The resident will understand the hormones that assist in mineral homeostasis and
how defects in their function can give rise to clinical manifestations. She/he will be
able to counsel families about the correct dietary recommended intakes of calcium
and vitamin D across childhood.
Lipid abnormalities- primary and secondary
The resident will acquire knowledge about causes of primary and secondary lipid
disorders and ways to apply screening methods and follow up for high risk
individuals. She/he will be able to counsel families about sound dietary advice to
prevent and treat hyperlipidemia.
2)
COMMUNICATOR
The resident will be observed and assisted to ensure that he/she demonstrates
appropriate communications skills. Specifically, he/she will establish therapeutic
relationships with the patients and the families and provide them with anticipatory
guidance. Additionally, he/she will communicate findings of the consultation to the
referring physician in an organized letter and/or by telephone. Clear documentation
of care will be written in the medical chart.
3)
SCHOLAR
The resident will participate in all academic activities of the division including
attending weekly rounds, participating in post-clinic conferences, participate in
clinical case discussions and in twice-weekly resident teaching sessions. The resident
will wish to use the ‘log book’ provided to document the cases seen and the material
that was researched to augment her/his database. Analysis of at least one journal
article and or other presentation will foster critical appraisal.
4)
COLLABORATOR
The resident will understand the role of the physician as a member of a
multidisciplinary health care team and recognize and understand the roles and
expertise of the other allied health professionals. The resident must demonstrate
appropriate interactions with other health care professionals throughout the rotation.
5)
PROFESSIONAL
The resident will demonstrate appropriate personal and interpersonal behaviours,
which include honesty, integrity, responsibility, self-discipline, sensitivity to diversity
and a sense of ethics. He/she will demonstrate a willingness to respond to
constructive feedback.
6)
ADVOCATE
The resident will identify the important determinates of health affecting patients and
recognize and respond to those issues where advocacy is appropriate. The resident
will encourage families to see support from all team members, from reliable
information sources and families who are available for advice. The resident will also
ensure that issues such as timely investigation, prompt communication of results to
patients, families and other health care providers and initiation of care are addressed.
7)
MANAGER
The resident will serve as the primary health care coordinator for children with dm
and as the front line consultant for children with endocrinologic disorders. She/he
will be able to manage and integrate the care of patients with multi-system medical
problems. As well, he /she will utilize health care resources appropriately and
implement accepted preventative measures.
Reproductive Endocrinology
Rotation Objectives
By the completion of the six (6) week rotation in reproductive endocrinology, the resident
should have acquired knowledge of the following:
Medical Expert
Normal steroid pathway and interpretation of steroid pathway
anomalies.
The diagnosis of reproductive endocrine disorders including
polycystic ovarian syndrome (PCOS), weight-related and other
menstrual dysfunction, prolactinomas, hypogonadotropic
hypogonadism, premature ovarian failure and hirsutism.
The diagnmostic testing of the above disorders, their
indications and contraindications, their limitations, sources of
errors and interpretation.
For PCOS:
- The resident should be able to assess the metabolic
risk factors including insulin resistance.
- They should be able to induce ovulation using weight
modification, insulin resistance, modification, adrenal
suppression, clomiphene citrate and gonadptropins.
- They should have an understanding of the principles
of ovulation induction with pulsatile LHRH therapy.
- They should be able to treat androgen excess with
anti-androgen therapies.
For prolactinemia:
- The fellows should be able to examine patients with
pituitary disease.
- The appropriate use and interpretation of endocrine
tests.
- The use and interpretation of radiological studies of
the sella tursica.
- The resident should be able to appropriately diagnose
a prolactinoma.
- The institution and monitoring of treatment.
- The indication for surgical therapy.
For hypogonadotropic-hypogonadism:
- The fellows should know the differential diagnosis of
the underlying pathology.
- They should be able to administer hormonal
replacement therapy.
- They should have an understanding of the principles
of LHRH substitution or gonadotropin treatment.
For premature ovarian failure (POF):
- The fellows should know how to define and to
diagnose POF.
- They should know the differential diagnosis of the
underlying pathology.
- They should be able to manage this condition.
- They should know the related endocrinopathies.
For menstrual dysfunction:
- The fellows should be able to investigate
oligomenorrhea and amenorrhea.
- They should be able to manage menstrual dysfunction.
Communicator
For hirsutism and acne:
- The fellows should be able to conduct investigations
and treatment of the condition.
- They should be able to understand their relevance to
PCOS and the associated risks.
Consult patients and their families on a routine basis medically
and psychologically.
Obtain and synthesize relevant history from patients, families
and communities.
Gain respect and trust from the patients and families.
Collaborator
Health Advocate
Be culturally sensitive.
Consult effectively with other physicians, allied health
professionals, non-medical experts and other institutions or
departments.
Contribute and collaborate with others.
Identify important determinants affecting a patient’s health.
Contribute to improved health of patients and communities.
Recognize and respond to issues where advocacy is
appropriate.
Manager
Be aware of regulations and changes in Health Care and
Reproductive Technologies.
Utilize resources effectively and efficiently to balance patient
care.
Allocate resources wisely.
Work effectively and efficiently in health care organization.
Utilize information technology to optimize patient care and
lifelong education.
Scholar
Manage clinical practice.
Develop, implement and monitor personal continuing
education strategy.
Critically appraise medical literature.
Facilitate learning of patients, students and allied health
professionals.
Professional
Contribute to development of new knowledge by
presentations.
Deliver highest quality of care with integrity, honesty,
compassion and ethics.
Exhibit
appropriate
professionalism.
personal
and
interpersonal
Endocrinology Clinical Laboratory
Rotation Objectives
Curriculum –
Attend a two (2) week block in laboratory medicine at three (3) different hospital
sites (RVH, MGH, JGH).
Medical Expert
To obtain knowledge of molecular diagnosis, functional
endocrine testing, endocrine assays.
To understand the steps required in testing/tests, their caveats
and to understand the need for adequate
reference
ranges/protocols
Communicator
Collaborator
Health Advocate
To gain knowledge in the use of radioisotopes in the diagnosis
and management of endocrine disorders, including knowledge
about radiation safety and the regulatory requirements
pertaining to the use of radioactive isotopes.
To encourage communication with nuclear medicine
consultants, pathologists, and laboratory technicians
To effectively consult with other physicians.
To effectively interface with allied health professionals
(pathology, radiology, laboratory).
To observe how healthcare professionals contact allied
healthcare workers to negotiate timely care
To understand how ancillary laboratories function to ensure
appropriate panels of tests and reference ranges for a specific
age group
Manager
To observe how specialized testing can be mandated/arranged
and carried out within current fiscal and hospital limits
To work effectively and efficiently in health care setting.
To implement accepted preventative measures.
To utilize health care resources in a cost effective manner.
To understand the costs and turnaround time involved in
routine and STAT testing
To understand how to prioritize sample testing and analyses
scheduling
Scholar
Professional
To appreciate QA/QI issues and how they impact on
laboratory results
To continue developing their personal continuing education
program.
To use exposure to laboratory medicine to address a QA/QI
question about laboratory function/results
To deliver the highest quality care with integrity and to
practice medicine in an ethically responsible manner.
To recognize one’s own limitations.
Research Block Objectives
Medical Expert
Communicator
Collaborator
Health Advocate
Manager
To assess and apply relevant information to research or
research clinical practice.
To demonstrate medical expertise in situations other than
direct patient care.
To document research ideas as a protocol, manuscript or
lecture
To develop good comunication skills with research subjects,
supervisor, trainees or team members
Possibly – to contribute to other interdisciplinary teams.
To identify determinants of health that affect a patient
To use research as a tool to advocate for health changes/
dissemination of health information
To manage time wisely to address the research question and
any other professional commitments.
To utilize resources effectively when designing and
implementing research project
Scholar
To manage a research operating budget
To formulate a clinical/research question and to formulate a
plan to fill this gap in knowledge.
Professional
To contribute to the development of new knowledge.
To exhibit appropriate personal and interpersonal professional
behaviours.
Insulin Pump Objectives
In the second year of training attend insulin pump information sessions organized by the
Montreal Children’s Hospital, and attend carbohydrate counting sessions. Follow 2-3
insulin pump starts and follow up of these patients.
Medical Expert
Understands the mechanics of insulin delivery by a pump
Understands how to prescribe and to adjust insulin pump
therapy
Understands how to deal with pump malfunctions and
abnormal blood sugars
Understands the limitations of pump therapy
Communicator
Understands the advantages and burdens of pump therapy
To establish a therapeutic relationship with patients and
families
Collaborator
Effectively consults with pump centre diabetic educators
Health Advocate
Works with the pump centre team and the families to
optimize diabetes control
Identifies situations that may be considered high risk for
DKA or hypoglycemia
Works with patients and their families to prevent these
situations
Identifies and practices effective ways of helping patients
with insurance coverage of pump and supplies. Identify
ways of promoting change in the policy of government and
private insurers that will lessen the financial burden of using
the insulin pump.
Scholar
Understands the role of the physician in advocating for
pump options vis a vis insurance companies and the
government
To continue developing their personal continuing education
program
Updated – July 2013