Prepared by:
Jeannette Goguen, MD, FRCPC(C)
Endocrine Training Program Director goguenj@smh.ca
Felomena Teixeira
Program Administrative Assistant fteixeira@uhnresearch.ca
Training Program Office:
Toronto General Hospital
200 Elizabeth Street, E12-243
Toronto, ON M5G 2C4
Tel: 416 340-4800x2611
Fax: (416) 340-3314
June 29 th , 2015
1

INTRODUCTION
1. Preamble
2. University of Toronto Endocrine Training Program Goals & Objectives
3. U of T endocrine Residency Program committee
Page
THE PGY-4 YEAR
4. Overview: structure of the year and your responsibilities
5. Rotation Schedule for 2015
– 2016
THE PGY-5 YEAR
15. City-Wide Endocrine Rounds
16. Endocrine Academic Half Day
17. Endocrine Journal Club
18. Career Counseling
GENERAL ENDOCRINE INFORMATION
8
9
6. Overview: structure of the year and your responsibilities
COMMUNITY AND SPECIALIZED ROTATIONS:
10
7. Community
8. Foot and wound
12
14
15
9. Electives 16
10. Facilitating Diabetes Self-Management And Enhancing Communication Course 19
11. Endocrinology week
12. Reproductive biology
CLINICAL & EDUCATIONAL ACTIVITIES
13. Longitudinal Clinic assignments & Mentorship Program
20
21
Longitudinal Clinic Calendar
Longitudinal clinic/Community Objectives
14. DOCOMP Diary
23
24
27
28
29
30
31
33
19. Holidays and Conferences
20. Methods of Evaluation
21. Mechanisms of Appeal
22. Stress Management and Wellness Advisors
23. Endocrinology Safety Policy
24. Privacy
BASE HOSPITALS: Site-Specific Objectives & Orientation Information
25. SMH
26. Sunnybrook
27. UHN
28. WCH
29. Sick Kids
CONTACT INFORMATION
CURRENT RESIDENTS’ ORIENTATIONS FOR NEW RESIDENTS
3
4
7
42
44
47
50
53
35
36
37
38
39
40
57
67
2

June 2015
Dear Endocrine Resident,
I would like to offer a warm welcome to you, from myself and from the members of the Residency Program
Committee. This program is designed to prepare future endocrinologists for careers in academic and clinical endocrinology. It is our mandate to provide you with the best possible training in endocrinology over the next 2 years, conducted in a friendly, supportive environment, to fully prepare you for your chosen career.
The purpose of this manual is to orient you to the different components of each year, provide information about each hospital, as well as information about selected policies at the University of Toronto, in general.
The first (PGY-4) year of the residency training program is exclusively clinical: you will be assigned to each of the main University of Toronto Hospitals, where you will attend both inpatient and ambulatory clinics.
Other rotations include one month in the community and one in pediatrics, amongst other more specialized blocks.
The second (PGY-5) year is devoted to either: (1) research training (molecular and cell biology, integrative physiology, epidemiology, clinical investigation, quality improvement or research in medical education). You may choose to enroll in a graduate degree program during your research training, although this is not a requirement --- we will work closely with you to best design your postgraduate training experience, or (2) further advanced clinical training, with a smaller research project. All residents conduct a research project, a group QI project, a Group Advocacy project as well as attending ambulatory clinics. Trainees may choose to apply for a further third year of training as a fellow.
Taken together, the clinical and research activities of the University of Toronto Endocrine Division provide exciting opportunities for the training of endocrinology clinicians, educators and clinician scientists.
I look forward to getting to know each of you well as you progress through your training, and I hope that your fellow residents will become your friends as well as colleagues.
Jeannette Goguen
Program Director, Division of Endocrinology and Metabolism
3

Revised: June 2015
Goals:
The trainee will develop knowledge and skills to function as a fully competent consulting endocrinologist, managing both common and complex endocrine problems. The trainee will develop an ability to communicate and collaborate effectively with the patients and with the other health professionals. The endocrine program will also provide the trainee with the ability to pursue a career in academic medicine by providing exposure to both basic science and clinical research, and by providing instruction to optimize teaching and learning. Residents will develop the skills required to be a successful community endocrinologist, which include the ability to manage clinical resources and manage a clinical practice.
General Objectives:
1. Development of a broad knowledge of basic and clinical endocrinology.
2. Participation in a broad experience of clinical exposure in the ambulatory setting.
3. Participation in a longitudinal ambulatory clinic experience that integrates all of the CANMEDS roles and competencies.
4. Participation in an inpatient consultation and investigation service, including managing and teaching a team of residents and collaborating with other medical/ surgical services and other health professionals.
5. Development of team leadership skills and effective teaching skills, including acting as Junior
Attending for 2-4 weeks in the PGY-5 year.
6. Development of critical appraisal skills in evaluating medical information (scholar).
7. Development of an approach to the diagnosis and management of pediatric endocrine problems.
8. The promotion of life-long learning (scholar).
9. The promotion of patient advocacy and the provision of gender-sensitive and culturally sensitive healthcare, including participation in the advocacy project in second year.
10. Demonstration of professionalism with patients and colleagues at all time.
For the complete Royal College Objectives of Training for Adult endocrinology, please go to:
<www.endocrinology.utoronto.ca>
Specific Objectives:
Medical Expert/Clinical Decision-maker
The resident will be proficient in the following, by the end of their training:

Diabetes mellitus (Type 1, Type 2, other causes, gestational, in pregnancy)

Disorders of glucose metabolism including hypoglycemia

Disorders of lipid metabolism

Obesity

Disorders of the thyroid gland and thyroid metabolism including hypothyroidism, hyperthyroidism and thyroid cancer

Metabolic bone disease and disorders of calcium metabolism including disorders of the parathyroid glands and the Vitamin D system

Disorders of the hypothalamic-pituitary axis

Disorders of the adrenal cortex and medulla, including endocrine hypertension

Fluid, electrolyte and acid-base disorders related to the endocrine system

Disorders of reproduction including ambiguous genitalia and gender identity, abnormalities of puberty, menstrual disorders, infertility, hyperandrogenic states, hypogonadism in females

Disorders of reproduction including ambiguous genitalia and gender identity, abnormalities of puberty, infertility, erectile dysfunction, androgen resistance, hypogonadism in males

Hereditary endocrinopathy including polyglandular autoimmune syndromes and MEN

Nutrition as it applies to endocrine disorders

Genetics as it relates to disorders of sexual differentiation, infertility and other inherited endocrine disorders

Alterations in the endocrine system in persons with systemic disease

Alterations in the endocrine system in pregnant women

Disorders of growth and development
4

Demonstrate diagnostic and technical skills for ethical and effective patient care related to endocrinology and metabolism including the ability to perform the following:

A medical history that is relevant, concise, accurate and appropriate to the endocrine problem

A comprehensive physical examination relevant to the endocrine problem

Interpretation of results of hormonal assays in basal, stimulated and suppressed states

Interpretation of neuro-radiographic and ultrasound tests in the diagnosis of endocrine disorders

Use of radioisotopes in diagnosis and management of endocrine disorders

Interpretation of bone density measurements in the evaluation of metabolic bone disease

Ability to do a fine-needle aspirate of thyroid nodules

Ability to manage insulin pump therapy
Communicator

Establish therapeutic relationships with patients and their families that are characterized by understanding, trust, respect, empathy and confidentiality.

Present clinical problems clearly and concisely in verbal reports and written letters.
 Demonstrate an appreciation of patients’ perception of health, concerns and expectations and the impact of endocrine disease on the patient and the family while considering factors such as the patient’s age, gender, cultural & socioeconomic background, and spiritual values.

Demonstrate open-mindedness to consideration of alternative health care practices.

Demonstrate an understanding of the importance of communication among health care professionals involved in the care of individual patients.

Demonstrate the ability to provide appropriate support and counsel to a patient and family with chronic endocrine or metabolic disease.

Obtain informed consent for radioactive iodine administration and fine needle thyroid biopsy

Employ collaborative negotiation to resolve conflicts. This is taught in the Diabetes management week-long course.
Collaborator

Consult effectively with other physicians and health care professionals.

Contribute effectively to other interdisciplinary team activities in endocrinology and metabolism.

Understand the roles of the other health care professionals and appreciate the value of their teaching.
Manager

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 institutions.

Recognize the role of audits, budgets reviews, quality improvement, risk management, adverse event disclosure in various health care settings.

Participate in the group QI project in the PGY-5 year.

Demonstrate the use of cost/benefit ratios of diagnostic and therapeutic interventions.

Plan for your future office and practice, including knowing how to bill.
Health Advocate

Identify the important determinants of health affecting patients.

Recognize and respond to those issues where advocacy is appropriate.

Contribute effectively to improve health of all patients and communities including education on aspects of prevention.

Participate in the group advocacy project in the PGY-5 year.
Scholar

Develop, implement, and monitor a personal continuing education strategy.

Critically appraise sources of medical information as they pertain to endocrinology, with particular emphasis at journal club and rounds presentations.

Educate patients, other trainees, students and other health professionals in formal and informal educational settings regarding endocrine disorders and the impact of chronic disease on the endocrine system. PGY-4s are expected to present a total of 7 rounds: 4 in their main hospital rotations, one at sickkids, one in reproductive medicine and one clinical Journal club
5

 PGY5s are expected to present four new rounds, plus one clinical “case report” and one basic science journal club

Contribute to development of new knowledge in endocrinology and metabolism through a research project and a QI project in the PGY-5 year.
Professional

Demonstrate an understanding of the principles of medical ethics as they relate to patient care.

Demonstrate a willingness to accept peer and supervisor reviews of professional competence.

Demonstrate recognition of personal limitations of professional competence and demonstrate a willingness to call upon others with special expertise.

Demonstrate flexibility and willingness to adjust to changing circumstances.

Demonstrate an understanding of the ethical issues in interactions with industry and comply with the University of Toronto standards. Relationships with industry and the Educational Environment in undergraduate and Postgraduate Medicine.

Write a short reflective piece on personal experience with an issue regarding professionalism.
For example: For example, in Diabetes Mellitus:
Type 1, Type 2, Gestational, Secondary, Genetic types, DM and pregnancy
Endocrine trainees will manage diabetes, and its complications, using a bio-psychosocial approach. They will learn to integrate medical expertise with communication and counseling techniques that are effective in assisting patients with chronic disease to make and maintain health behavior changes . Trainees will work to develop a patient-centered treatment plan. Endocrine trainees will communicate and collaborate with the entire diabetes health care team, having knowledge of eac h discipline’s contribution.
The endocrine trainee will advocate for the patient and ensure that the patient is knowledgeable about known subsidy programs for diabetesrelated resources (eg: ‘syringes for seniors’ program, Canadian
Diabetes Association ‘Monitoring for Health’ Program, Trillium drug coverage Program).
Endocrine trainees will learn about practice management issues vital to ‘best practices’ (quality improvement) including: effective communication to family physicians, other specialists, and other health professionals; effective use of diabetes flow sheets; updating of medication lists; institution of regular follow up schedules: effective use of motivation techniques; effective handling of laboratory results. The trainees will also learn e ffective patient billing using provincials billing codes including ‘Third Party and Other
Uninsured Service’. The trainee will focus on life-long scholarship in the broad field of diabetes.
J. Goguen
June 2015
6

Your training program is closely monitored and revised when appropriate by a working committee called the
Residency Program Committee, chaired by the Program Director. This committee meets 7 times throughout the academic year and consists of representative faculty members from each of the base hospitals. The
Committee also has an elected PGY-4 representative as well as a PGY-5 Chief resident. Resident representatives are responsible for conveying information to the other residents.
Please see the divisional website www.endocrinology.utoronto.ca
for the term of reference for the committee.
All meetings occur on Friday mornings, 9:00 – 10:00 am, Location: 60 Murray St. MSH – 3 rd Floor conference room, directly following Citywide Rounds.
COMMITTEE MEMBERS MEETING DATES
Dr. Jeannette Goguen
– Chair
Dr. Maria Wolfs
– SMH coordinator
Dr. Jeremy Gilbert
– SHSC coordinator
Dr. Shoba Sujana Kumar
– WCH coordinator
October 2 2015
October 16/2015
December 11/2015
January 8/2016 ( PM : Mini-retreat)
Dr. Robert Silver
– UHN/MSH coordinator
Dr. Rene Wong – Education advisor
Dr. Denice Feig – Research coordinator
Dr. Diane Wherrett – HSC coordinator/Peds program director
Dr. Raymond Fung – Community representative
Dr. Sharon Sadry – PGY 5 Endocrine Chief Resident
To be elected- PGY 4 Resident representative
February 5/2016
April 8/2016
June 3/2016
7

For your core training, trainees rotate through each endocrine division at four University of Toronto teaching hospitals, including 9-10 weeks at each of the following: Mount Sinai
– University Health Network, St.
Michael’s Hospital, Sunnybrook Health Sciences Centre and Women’s College Hospital. Pediatric endocrinology training occurs in the one-month rotation at Sick Kids Hospital. There is a one-month community block. The specialized blocks are composed of the following rotations: Foot and wound care (2 weeks) and Reproductive biology (2 week). Each trainee participates in a weekly longitudinal ambulatory clinic experience for two years usually with the same supervisor for both years.
Educational activities : Assessing patients in outpatient endocrinology clinics.
Performing endocrine consultations on hospitalized inpatients.
Attending hospital rounds and endocrine teaching sessions.
Teaching junior house staff and students rotating through the endocrine division
Becoming proficient at teaching patients how to administer insulin and use glucose meters while at the hospital sites
Attending pituitary, thyroid and adrenal surgery when possible (this can be arranged as well in the PGY-5 year).
Career planning needs to start right away in your PGY- 4 year. You are encouraged to meet with 6-10 clinician scientists in the first six months of training. This will allow you to start planning for your PGY-5 year.
The Research projects are coordinated by Dr. Denice Feig. Residents are strongly encouraged to start researching potential topics while in their PGY 4 year. Residents are given guidance in selecting a supervisor, designing a research protocol, writing their proposal, obtaining ethics approval and in carrying out the study. The results will be presented at the Citywide Endocrinology Rounds in June of the PGY5 year. Residents doing Education projects can apply for funding from department of Medicine in January of their PGY4 year.
In addition to their clinical responsibilities outlines above, trainees are expected to do the following :
1. Give four new talks during the hospital blocks all on different topics, plus one at the Sick Kids
Hospital and one in Repro Rotation. The talks are expected to be YOUR synthesis of the literature.
The only allowed copied materials are tables and illustrations from articles (properly referenced) and as a minimal part of the presentation. Present 1 Clinical Journal club article. You are strongly recommended to get as many of the 6 core talks prepared or done before Christmas as possible.
2. Attend City-Wide Rounds every week (mandatory), Fridays 8:00 – 9:00am, 60 Murray St. 3 rd Floor).
3. Attend Academic Half Day every Friday morning (mandatory), 11 th floor classroom MSH.
4. Maintain in the DOCOMP diary (patient log). Dr Goguen will review it every 6 months, and any gaps should be discussed with your Longitudinal Clinic supervisor.
5. Obtain miniCEX evaluations regularly (should have at least 24 by the end of the year). You will also get evaluated by 4 patients.
6. Call: Residents do call from home at SMH (during that rotation) and UHN/MSH (during all other rotations), and will be expected to do call over the Christmas holidays at one of the sites.
7. Attend their longitudinal clinic once a week, for two years. Please inform your supervisor of vacation dates and conference leaves in a timely manner.
8. Attend a oneweek course (the second week of July) on “Facilitating Diabetes Self-Management
Course, July 6 – 10 th , plus Formal Communication Skills Trainin g”, plus a 1-week Endocrine course
(September 8
– 11 th )
. Attend the CSEM, including the residents’ day the day before the conference starts.
9. Checklist for the Program: a. Submit requests for holidays at least 3 months in advance (cannot be during Facilitating
Diabetes course, CSEM, Pediatrics or during the practice exams). See “Holiday” section for details. Refer to the course annual calendar for critical events you must attend. b. Leave $50.00 deposit with the Program Assistant for key to the resident room at TGH c. Obtain hospital IDs ASAP
10. Check your email at the beginning and end of each workday
11. Write the Canadian Endocrine Practice Exam in January and the Toronto Practice Exam in May.
12. Submit your electronic Portfolio at the end of the academic year. It will be reviewed by Dr Goguen.
13. Sign up for ENDOCRINE Pearls – please teach around them in the hospitals as team leader
“medicalpearls.com”
8

Resident 1
PGY-4 Schedule 2015-2016
April 6, 2015
2 3
Angela
July 1-
Aug 9
WCH
Aug 10
– Sep 6
WCH
Sep 7 -
Oct 11
SBK
4
Oct 12 –
Nov 8
SBK
5
Nov 9 –
Dec 6
UHN
6
Dec 7 – Jan
17
UHN
7
Jan 18 –
Feb 14
Peds
8
Feb 15 –
Mar 13
Com
TEGH
9
Mar 14 –
Apr 10
SMH
10
Apr 11 –
May 8
SMH
11
May 9 –
Jun 5
Elective
Bikram Peds Elective WCH WCH SBK SBK UHN UHN
12
Jun 6 –
Jun 30
Repro/
Foot/
SMH
Calvin SMH SMH Com
TEGH
Elective WCH WCH SBK SBK
Christine UHN UHN Peds Com
TEGH
UHN
SMH SMH Elective Repro/
Foot
SMH SMH Jenny SBK SBK UHN Peds Foot /Repro
+ extra clinics week of Xmas
6 # weeks 5 4 5
Resident
Bikram Sidhu
Jenny Wang
Angela Assal
Calvin Ke
Christine Ibrahim
4 4
Year
PGY-4
PGY-4
PGY-4
PGY-4
PGY-4
4 4
Supervisor
Rene Wong
Jeannette Goguen
Afshan Zahedi
Jeremy Gilbert
Shoba Kumar
Bikram Sidhu
Jenny Wang
Angela Assal
Calvin Ke
Repro Foot
March 14 – 25 Mar 26 –Apr 10
Jan 4-17
June 6
– 19
May 9 -22
Dec 7 - 20
Jun 20 -30
May 23-Jun 5
Feb 20-Mar13 Christine Ibrahim Feb 15-19
Repro/
Foot/
UHN
WCH
Com
TEGH
4
Com
TEGH
UHN
SMH
Repro/
Foot
SBK WCH
Elective WCH
4
Time
Thurs AM
Wed PM
Mon PM
Tues AM
Wed PM
4
Peds
SBK
WCH
4
9

OVERVIEW: STRUCTURE OF THE YEAR AND YOUR RESPONSIBILITIES
The second year is devoted to either: (1) intensive research training (molecular, physiology, epidemiology, education, often with enrolment in a graduate degree program), or (2) further clinical training, with a smaller research project. Residents may choose to apply for a further third year of training as a fellow.
Planning for the second year starts at the beginning of the first year, and you should meet with Dr. Lewis, Dr.
Goguen and your mentor (the longitudinal clinic supervisor), as well as other staff endocrinologists then. Dr.
Goguen will also formally meet with you at the end of the PGY – 4 year to advise you on achieving a good clinic-research balance in your second year.
All residents participate in a research project in the fifth year. This can be either a small project (1/3 of the year longitudinally) within a clinical year or can be a larger project done in the context of a research year often as part of a graduate degree program (see also U of T Endocrinology Clinician Scientist Training
Program). Application to graduate programs usually occurs early in the PGY4 year. The PGY5s also do a group quality improvement project, a group advocacy project and each resident presents a challenging case to their peers and the PD within the “Case report” series. The Chief resident organizes the “Second opinion
Rounds
” where the residents discuss 2 – 3 cases amongst themselves then get faculty members input.
The clinic schedule is organized by the Endocrine Chief resident (the PGY-5 Residency Program committee member) who books pooled clinics and takes into account your preferences (you can directly arrange clinics with doctors outside the pool). Residents continue in their longitudinal clinic, plus a minimum of:
Basic Science No extra clinics (can split their longitudinal clinic between two sites). (total of 4 - 6 clinics per month)
Clinical Epidemiology Masters
Clinician Educator Masters/QI Masters
1 extra clinic + Long clinic
3 extra clinics + Long clinic
Clinical stream 4 extra clinics + Long clinic
Residents are encouraged to attend the PMH tumor board rounds held twice monthly (attendance is mandatory for those attending Dr. Ezzat’s clinics).
Residents must have each clinic session they attend evaluated with the PGY5 clinic evaluation form by the faculty, so that they obtain relevant, timely feedback and identify learning objectives from their clinic experience.
The Research projects are coordinated by Dr. Denice Feig. Residents are strongly encouraged to start researching potential topics while in their PGY 4 year. Residents are given guidance in selecting a supervisor, designing a research protocol, writing their proposal, obtaining ethics approval and in carrying out the study. The results will be presented at the Citywide Endocrinology Rounds in June 2016.
Residents doing Education projects can apply for funding from Department of Medicine in January of their
PGY 4 year.
The QI project is a group project, done within the Department of Medicine Postgraduate Quality Program and will be presented at Faculty Development Day May 27 th 2016 and at the Department of Medicine QI Day in June 2016. Residents will complete an Audit during their longitudinal clinic.
The group Advocacy project is done with Dr. Sheila Laredo as a group project. The group chooses a project based on a perceived need in the community, and their own interest. The group will research the need and potential solutions and determine how those needs are best met. The residents will present their project at the Faculty Development Day, May 27 th 2016.
There is a two-week Junior attending block that residents usually do towards the end of the year. You will be acting in the role of junior staff, supervising the core medicine trainees. You are supervised by a staff endocrinologist with an interest in teaching; you will have an appropriately lightened clinic load and take call as staff (second call) in accordance with PARO guidelines. Residents will be provided with an orientation on how to teach in this setting. You have the option of doing a second two-week block if you are interested.
Please talk to D. Goguen if you wish to do an elective experience (you can take up to 4 weeks elective time).
10

ADDITIONAL RESPONSIBILITES:
1. If you want to apply for a third (fellowship) year, this needs to be planned for very early in the year as funding needs to be arranged.
2. Four new talks are given at hospital sites of your choice throughout the year plus one basic science journal club talk plus the Case Report. The talks are expected to be YOUR synthesis of the literature. The only allowed copied materials are tables and illustrations from articles (properly referenced) and this should be a minimal part of the presentation. They should be on four different topics.
3. Attend Journal club (mandatory)
4. Attend Citywide Rounds every week (mandatory), Fridays 8 - 9 AM, 60 Murray St., 3 rd floor classrooms.
5. Attend Academic Half Day every Friday morning. Each PGY 5 does one
“Case Report” as a 30 minute teaching session at the end of one of the Academic Half Days . These are done “morning report” style to maximize participation of your resident colleagues. The purpose is to share cases that you have encountered that are challenging in some way, be it in making a rare diagnosis, or having a rare presentation of a common diagnosis, or having unusual management issues. The program director attends the rounds; please feel free to invite other staff with expertise in the area to attend.
6. Do UHN/MSH home call (second call from 6-11PM; first call 11PM-8AM). Residents are also expected to take call during their Junior attending weeks.
Residents who “moonlight” are expected to do so in a way that does not impact their learning experience in the program. This effectively means moonlighting cannot occur overnight Sun-Thursday, or during the regular work day (9-5)
Mondays-Fridays. Residents are expected to spend Monday through Friday working on their projects or in clinic.
7. Attend their longitudinal clinic once a week (the option exists to switch half day supervisors at the start of the PGY-5 year). Provide adequate warning to supervisors when you will be away. If you need to cancel a clinic with short notice, please find another PGY5 to cover.
8. Write the two written exams: Canadian Endocrine Practice Exam in January and the Toronto
Endocrine Practice Exam in May.
9. Mini-CEX or PGY5 evaluation must be done for 24 clinics throughout the year (ideally, every clinic, to identify a learning objective!).
10. POWER-based logs must be completed for the following (needed for FITER completion) a. 3X successful thyroid biopsies b. 3X insulin pump complex assessments (should be at least one pump start) c. 3X RAI counseling/administration d. 3X Dynamic endocrine testing and interpretation
11. Checklist for the program: a. Submit requests for holidays at least 3 months in advance b. Obtain hospital IDs prior to starting in July c. Check email at the beginning and end of every workday. d.
Hand in the key to the resident’s room at TGH at the end of the year and get your deposit back!
11

PGY4 COMMUNITY AND SPECIALIZED ROTATIONS
The following rotations occur outside the base U of T hospital rotations. The list of rotations, the rotation supervisor and their telephone numbers are below. You are responsible to contact each elective supervisor with whom you will be working 2 weeks before your start date, for first day instructions. You will also find objectives and readings for each individual block experience, in the pages that follow.
BLOCK
1. Pediatrics (4weeks)
2. Community endo (4weeks)
SUPERVISOR
Dr. Diane Wherrett
Dr. Alice Cheng (CVH)
Dr. Raymond Fung (TEGH)
TELEPHONE
(416) 813-8159
(905) 828-7622
(416) 915-5460 rfung@tegh.on.ca
Dr. Donna ArabObrien (St Joe’s) (416) 530-6466
3 . Foot/Wound care (2 weeks) Ann Marie McLaren (416) 864-6060x6399
4. Reproductive Biology (2 weeks) Dr. Kim Liu kliu@mtsinai.on.ca
Elective options (please discuss potential other options with Dr. Goguen):
(416) 586-5367
It is important to give us as much notice as possible for us to be able to set this up.
A. Comprehensive DM Dr. Catherine Kelly (WCH)
Dr. Bruce Perkins (UHN)
(416) 323-7510
(416) 340-4800x8019
B. Pituitary Elective
C. Thyroid Elective
Dr. Jeannette Goguen (416) 867-3714
Dr. Catherine Kelly (416) 323-7510
Design your own elective (eg. Diabetes Rehabilitation/exercise; Diabetes in an underserviced area such as
Northern Ontario).
12

7. COMMUNITY ROTATION
Dr. Donna Arab-
O’Brien St. Joseph’s Health Centre
Dr. Alice Cheng, Credit Valley Hospital
Dr. Raymond Fung, Toronto East General Hospital
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) resident and supervisor can choose to work from; typically, the resident will cover 3-4 of these competencies over the one month rotation)
By the end of the rotation, the resident will be able to
1. Medical Expert:

Deal with urgent outpatient issues
2. Communicator

Provide advice to another health care provider (e.g. primary care physician) via telephone consultation

Write a succinct follow-up letter to the referring doctor
3. 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
4. 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.)
5. Advocate:

Ensure patients obtain the financial resources they need to treat their endocrine conditions in the community.
6. 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.
7. Professional:

Consistently demonstrate respectful behaviour and attitudes towards patients and colleagues.
Contact information:
Please phone (905) 828-
7622 and email Dr. Cheng’s secretary jstefaniuk@cvh.on.ca
one week before your rotation
Please contact Dr. Ray Fung rfung@tegh.on.ca
and his secretary Andrea Guitard at (416) 915-5460 one week before your rotation.
Please contact Dr. Donna ArabO’Brien (416) 530-6466 one week before your rotation
13

8. FOOT AND WOUND BLOCK
(2 WEEKS OF CLINICS, PLUS FULL TEACHING DAY)
Supervisor:
Ms. Ann Marie McLaren (SMH) (416) 864-6060x6399
In addition to this 2-week Foot and Wound Block, there is also a full day Foot and Wound Management
Course that is provided in early September to orient you to treating diabetic foot ulcers. This will be occurring on Tuesday, September 8.

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. Getting assistance when appropriate: h. Knowing to whom the patient should be referred i. Recognizing the urgency of referral
1. Communicator

Counsel patients on proper foot care, including how to treat an ulcered foot

Write clear instructions to the referring doctor regarding foot care
2. Collaborator

Identify the role of the different health professionals involved in the diabetic foot, including: nurse, chiropodist or podiatrist, plastic surgeon, vascular surgeon, endocrinologist
3. Manager

Demonstrate an understanding of the flow of care for collaborative foot clinics
4. Health 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
5. Scholar

Evaluate the literature on diabetic foot assessment and diabetic neuropathy
6. Professional
Demonstrate an understanding of their own limitations, and when to refer to a Foot Care specialist..
14

Schedule for Diabetes Foot and Wound rotation
Please confirm schedule with Ann Marie McLaren before start (by phone is best)
SMH clinics are in Martin centre, Basement, enter through Queen Entrance
AMH: in Martin Center (Basement, Queen Wing)
WCH: 10 th floor
Monday Tuesday Wednesday Thursday
1 st
Week
AM SMH
Wound clinic
Dr Mahoney +
Laura Teague
8:30 – 12:00PM
PM SMH High risk foot 1-5 PM
Dr Daniels +
Suzanne Lu
SMH
Foot treatment
+ assessment clinic
Suzanne Lu +
Meghan Holt
Chiropody
8:00 – 3:30
PM
SMH Vascular Lab or
WCH Foot centre
(store)
SMH Advanced practice Wound clinic
1 PM
– 4:00PM
WCH Wound Clinic
Dr. Sibbald or Dr.
Chung
9:00AM **check dates you have been given
2 nd
Week
AM SMH
Wound clinic
Dr Mahoney +
Laura Teague
8:30
– 12:00PM
PM SMH High risk foot
Dr Daniels
SMH Vascular Lab or
WCH Foot centre
(store)
SMH Advanced practice Wound clinic
1 PM
– 4:00PM
WCH Wound Clinic
Dr. Sibbald or
Dr. Chung 9:00AM
Friday
Academic Half
Day
Academic Half
Day
15

9. ELECTIVES
COMPREHENSIVE DIABETES MELLITUS ELECTIVE
Dr. C. Kelly and Dr. B. Perkins
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: WCH and UHN
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 patients with diabetic complications o attend complication clinic at TGH and WCH o 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. 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.
4. Manager:

Design a prototype new patient and follow-up diabetes flow sheet for future practice.
5. Advocate:
 Use the “Diabetes is expensive” handout prepared by past endocrine trainees to ensure patients have access to financial resources for the treatment of their diabetes
6. Scholar:

Evaluate the literature on an aspect of one the medical competencies listed above, and write a brief 2-4 page report
7. Professional:

Demonstrate an understanding of ethical issues regarding use of limited resources for the treatment of diabetes (e.g., who get insulin pumps)
Evaluation:
Based on feedback from preceptors 1.
2. Based on your knowledge and use of an integrated health model in your approach to diagnosis and management of diabetes. You will be expected to write up an approach to a clinical problem, or to investigate the underlying pathophysiology of a disorder in this field (or feel free to make suggestions about another write-up). (should be 2-4 pages)
16

PITUITARY ELECTIVE
Dr. Goguen
2 weeks
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 nonsecretory 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.

Demonstrate an understanding of when surgery is appropriate and describe the risks and benefits of surgery.

Demonstrate an understanding of when radiation (fractionated and gamma-knife) is appropriate and describe the risks and benefits of radiation.
2. Communicator:

Counsel patients regarding the ongoing management of pituitary disease, especially about pituitary hormone replacement.
3. Collaborator:

Describe the role of the neurosurgeon

Describe the role of the radiation oncologist
4. Manager:

Design history and physical flow sheets for an office to improve office flow for patients with pituitary disease
.
5. Advocate:

Demonstrate knowledge of how to obtain funding sources for expensive medical therapies for the patient with acromegaly
6. Scholar:

Evaluate the literature on an aspect of pituitary disease and provide a 2-4 page written report on what was learned
7. Professional:

Demonstrate appropriately empathetic attitude and behaviour towards patients trying to cope with their diagnosis of a pituitary tumour
Location: St. Michael’s Hospital, Trillium Hospital, UHN-TGH and MSH
You will attend (when available):
1. Pituitary office – Dr. Goguen, other endocrinologist’s offices when available (Dr. Booth, Dr. George,
Dr. Ezzat, Dr. Ridout)
2. Community pituitary neurosurgeon’s office (Dr. Smyth)
3. SMH Multidisciplinary Pituitary Clinic
4. A triple bolus test, which you will perform and interpret.
5. Transphenoidal Surgery (if not seen before)
6. Gamma-knife radiation, if available
Evaluation based on: Your performance in clinics, plus you will be expected to write up an approach to a clinical problem, or to investigate the underlying pathophysiology of a disorder in this (should be 2 – 4 pages
17

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. Communicator:
Counsel patients about thyroid cancer, including about the roles of surgery and radioactive iodine therapy.
3. Collaborator:
Demonstrate knowledge about the roles of colleagues, including ENT surgeons, radiation oncologist, and nuclear medicine personnel
4. Manager:
Arrange home radioactive iodine
5. Advocate:
Advocate for patients who do not have insurance coverage for thyrogen
6. Scholar:
Evaluate the literature on an aspect of pituitary disease and provide a 2-4 page written report on what was learned.
7. Professional:
Consistently demonstrate sensitivity in attitude and behaviour towards patients coping with the diagnosis of thyroid cancer
Evaluation:
Your evaluation will be based on your performance in clinics.
You will be expected to write an approach to a clinical problem or to investigate the underlying pathophysiology of a disorder in this field (or feel free to make suggestions about another write
–up).
(Should be 2 - 4 pages)
18

10. FACILITATING DIABETES SELF-MANAGEMENT AND ENHANCING COMMUNICATION
COURSE
(1 Week)
The development of effective communication skills among post-graduate subspecialty trainees is essential. In endocrinology, the development of these skills is perhaps best illustrated in the care and management of patients with diabetes mellitus. Counseling to promote ongoing health behaviour change is integral to the achievement of successful clinician –patient interactions and health outcomes.
The multidisciplinary model will form the basis for this course.
You will participate in a 5day program entitled “Facilitating Diabetes Self-Management and Enhancing
Communication” that is held at TRIDEC (Tri-hospital Diabetes Education Centre). The program will run from Monday, July 6
– Friday, July 10c, 2015.
The TRIDEC office is at Women’s College Hospital at 4 East (Endocrine Program).
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.
You will be fully excused from your responsibilities at your base hospital or elective during the week.
Counseling skills are not fully developed during one workshop but require on-going practice and require refinement throughout your professional career.
19

11. ENDOCRINOLOGY WEEK
This year a whole didactic week will be dedicated to learning about ancillary knowledge you need to be able to interpret the tests you will be ordering on your patients. The preparatory 1- day long course will ready you for the Foot and Wound rotation.
This is the schedule for the week, which runs from September 8-11, 2015.
Endocrine week
This year a whole didactic week will be dedicated to learning about ancillary knowledge you need to be able to interpret the tests you will be ordering on your patients. The preparatory 1- day long course will ready you for the Foot and Wound rotation.
This is the schedule for the week, which runs from September 8-11, 2015.
Monday Tuesday Wednesday Thursday Friday
Labour Day
Holiday
Foot day
SMH
Pathology
TGH
– 11 th floor
Dept. of Pathology
Dr. Mete
12:30-16:30
Enhancing Exam
Preparation and
Performance
Mr. Chis Hurst
PGME Wellness
Dynamic
Endocrine testing
9:00am
Dr. Millar
60 Murray St,
6 th floor
Nuclear Medicine
SMH
Pathology
TGH
– 11 th floor
Dept. of Pathology
Dr. Mete
9-12
Thyroid FNA
Course 1-5 PM
Dr Segal
20

12. REPRODUCTIVE BIOLOGY
Dr. Kim Liu/ Dr. Keith Jarvi
Rotation Description
This two week rotation in Reproductive Biology will provide exposure to common problems seen in the field of female and male reproductive endocrinology including menstrual disorders, premature ovarian failure, disorders of androgen excess, endometriosis, management of menopause, infertility assessment including assisted reproductive technologies, diagnostic tests used to assess such problems and hyperprolactinemia.
In addition, the endocrine resident will have the opportunity to gain significant exposure to male factor infertility with Dr Keith Jarvi two to three half days, during which time they will have additional exposure to genetic counseling related specifically to male infertility, the completion of investigations now available for male factor infertility as well as exposure to all current treatment options. The endocrine residents will learn to provide appropriate counseling and testing for these genetic conditions.
The endocrine resident will have the opportunity to gain exposure to in vitro fertilization technology.
Finally, the endocrine resident will have the opportunity to participate in the regular teaching rounds.
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. Collaborator:

Identify the role of the different health professionals involved in infertility, including gynecologist, urologist and nurses
4. Manager:

Efficiently assess the couple with infertility, using appropriate resources, keeping in mind the limitations of the health care system.
5. Advocate:

Identify resources for the patients with infertility, and be aware of when to refer to a tertiary care centre
6. Scholar:

Evaluate the literature and prepare a presentation on one aspect of reproductive biology
.
7. Professional:

Consistently demonstrate empathy through attitude and behaviour towards patients trying to cope with infertility

Understand ethical issues around fertility treatment
21

FIRST DAY INSTRUCTIONS
FIRST DAY INSTRUCTIONS
The resident will have received details for orientation and their schedule from Alexandra Rosenfeld
[ARosenfeld@mtsinai.on.ca] in advance of the elective, if there are any further questions or concerns the resident is requested to contact Dr. Kim Liu.
All clinics for the female portion of this elective take place in the Mount Sinai Hospital Centre for Fertility and
Reproductive Health, 250 Dundas St. (corner of Dundas St. and Simcoe streets, just west of University Ave.)
7th floor. The resident is asked to report to Dr. Kim Liu and/or her assistant Taysha Warman at 9am on the first morning of the elective.
The endocrine resident also is requested in advance of the start of the elective to contact Leia Spencer
Clinical Nurse Manager, lspencer@mtsinai.on.ca to confirm attendance at the urology clinics scheduled. All clinics for the male portion of this elective take place at 60 Murray Street, 6th floor.
***You will be giving a one-hour lecture during this rotation. Alexandra Rosenfeld can let you know the date well in advance. The resident is requested to contact Dr. Kim Liu to ensure the topic is suitable.***
Please obtain Mini-CEX/Clinic evaluation forms for each day and give them to Dr Liu at the end of the day on Wednesday of the second week so she can use them to prepare your evaluation.
22

By the end of the academic year, the endocrine resident will demonstrate growth in the PGY-4 year and competency at the consultant level at the PGY-5 year in the CanMEDS objectives:
(Note: List of competencies follows on page 25 that resident and supervisor can choose to work from; the competencies need to be covered in the longitudinal clinic, community rotation, and as well, many will be covered in the academic half day sessions)
OBJECTIVES
:
By the end of the PGY4 academic year the endocrine resident will be able to demonstrate growth in knowledge and skills and by the end of the PGY5 year the resident will demonstrate competency at the consultant level in the CanMEDS objectives.
The resident will be able to:
1.
Medical Expert:

Demonstrate complete history taking ability for endocrine conditions

Perform a complete physical exam as it pertains to endocrine problems

Interpret history and physical exam findings

Design appropriate endocrine investigations

Evaluate complex endocrine investigation

Facilitate on-going management of endocrine problems

Demonstrate appropriate knowledge
2.
Communicator:

Demonstrate effective patient communication skills through:
 witnessed history and physical exam
 observed counseling (verbal and non-verbal)

Demonstrate commitment to patient-centered care
3.
Collaborator:

Collaborate effectively with other health professionals:
4. Manager:

Examine issues related to management of an ambulatory practice:

Manage time effectively in clinic

Manage patient phone calls and queries
5. Health Advocate:

Promote Health Advocate role where appropriate

Demonstrate knowledge of programs and websites that will promote Advocate and assist patients with securing access to needed resources
6. Scholar:

Critically evaluate literature pertaining to endocrine clinical problems by formal discussion at the end of clinic

Integrate medical knowledge into clinical practice by accurate information to patients.

Be aware of the potential role for influencing health policy and ways in which this can be accomplished.
23

7. Professional:

Demonstrate a commitment to arrive at clinic in a timely fashion

Demonstrate an ability to provide patient-centered care with adequate discussion and negation

Initiate ethical discussions where appropriate
July
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
June
PGY-4 Year PGY-5 Year
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
Pick a “Manager” Issue from the List
2 Mini-CEX direct observations
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
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
24

Competency-based objectives for endocrinology community experiences and longitudinal clinics
MEDICAL EXPERT:

Demonstrate medical expertise in the recognition and management of common and uncommon presentations of common endocrine problems

Describe how to deal with urgent outpatient issues
COMMUNICATOR:

Create an effective consultation letter to the referring physician in an efficient manner

Provide advice to another health care provider (e.g. primary care physician) via telephone consultation

Effectively discuss coordination of care or shared care of a patient with his/her other care provider
(e.g. primary care physician)
 Describe situations for which urgent communication with a patient’s primary care physician is appropriate
COLLABORATOR:

Effectively collaborate with allied health professionals outside of the office setting

Describe how to locate allied health professionals in the community with whom to collaborate in patient management

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
MANAGER

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.)

Demonstrate appropriate billing practices, including criteria for commonly-used billing codes

Design an efficient office schedule

Describe strategies to balance time between professional activities, including inpatient and outpatient responsibilities

Describe strategies to effectively balance time between professional and personal/home life

Compare the benefits and drawbacks of different patient charting options (such as electronic vs. paper based systems)

Determine appropriate time period(s) to arrange follow-up appointments

Describe strategies to locate and utilize community resources to help optimize patient care

Discuss principles of how to negotiate a lease for office space

Describe strategies to advertise your practice to referring physicians when starting a practice

Discuss principles of dealing with patients who do not show up for scheduled appointments (in terms of documentation and charging patients)

Demonstrate how to appropriately bill for uninsured services

Demonstrate how to effectively follow up lab and test results in a time-appropriate manner, based on urgency

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?

Recognize and evaluate administrative opportunities within community hospital or government settings

Be able to describe and address insurance issues with the non-Canadian patient
HEALTH ADVOCATE

Discuss strategies to create and tailored programs to meet the needs of the surrounding community (e.g. language or cultural needs)
25


Describe how to engage in local Advocate work for the surrounding community

Discuss different strategies for advocating for patients (for example, those in financial need or with special needs)

Complete the steps required to request coverage for specific drugs not routinely covered by provincial health care plans
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
Describe how to locate mentorship opportunities in the community setting
PROFESSIONAL

Discuss strategies to promote ethical practice when interacting with representatives from the pharmaceutical industry

Describe how to appropriately end a physician-patient relationship

Discuss privacy issues with emailing
26

Faculty Longitudinal supervisors:
Your role is to stimulate enthusiasm, inquiry and reflection with questioning to promote integration of learning. An Ideal learning atmosphere will foster the promotion of critical evaluation of current knowledge and evidence, ethical discussions, and will incorporate gender, race and age-related issues.
Faculty and residents will work together in practicing effective communication/counseling skills.
The supervisor will also discuss practice management and resources available for patients (advocacy).
Each faculty supervisor should observe 1 full patient interaction.
Faculty supervisors are also expected to act as mentors for the resident;
Please review the DOCOMP diary every 2
– 3 months to ensure that the resident is seeing an adequate mix of patients, and covering requirements within all of the CanMEDS roles.
Observation and formal formative feedback on specific skills will be provided to the residents using the mini-
CEX assessment tool in longitudin al clinics and in other clinical sessions. It is the resident’s responsibility to ask for this feedback and review the evaluations with their supervisor and the program director periodically.
The purpose of this is for the resident to have the opportunity to have their clinical skills directly observed.
The faculty supervisor should complete miniCEX form for PGY4s regularly (at least 2/month), and complete the PGY -5 clinic form (or Mini-CEX) every clinic if your resident is a PGY – 5
To ensure the curriculum is covered throughout the year, each longitudinal supervisor and the residents will be emailed on the first day of the month with that month’s learning objectives.
LONGITUDINAL CLINIC ASSIGNMENTS
Afternoon clinics will not start until 1:00pm and will end at 5 P.M.
You will be freed of all your base hospital responsibilities during the longitudinal clinic.
There will be separate evaluation of the longitudinal experience.
Resident Year Supervisor Time
Bikram Sidhu
Jenny Wang
Angela Assal
Calvin Ke
Christine Ibrahim
PGY-4
PGY-4
PGY-4
PGY-4
PGY-4
Rene Wong
Jeannette Goguen
Afshan Zahedi
Jeremy Gilbert
Shoba Kumar
Thurs AM
Wed PM
Mon PM
Tues AM
Wed PM
Alysa Goldberg
Ahmad Alhashemi
Sharon Sadry
Leila Shobab
Vithika Sivabalasundaram
Pamela Tsao
PGY-5
PGY-5
PGY-5
PGY-5
PGY-5
PGY-5
Catherine Kelly
Phil Segal
Lorraine Lipscombe
Catherine Yu
Adam Millar
Sandra Kim
Thurs PM
Tues PM
Mon PM
Wed PM
Mon AM
Tue PM
27

“DOCOMP” stands for Development of Competence. (as compared with the MOC, Maintenance of
Competence diaries developed by the Royal College of Physicians and Surgeons of Canada for the purpose of documenting continuing medical education for specialists)
You will each be given a diary in Excel. Each diary is divided into appropriate sections (eg. diabetes, lipids, thyroid, etc.) and each section contains a checklist of clinical experiences within that specialty area.
Each month or so, please indicate on the Likert scale the comfort level and degree of exposure you have had for each experience.
For the critical experiences that the program has been asked to monitor for your PGY-5 FITER, you will need to use the POWER-based log system. This is required for: a. Thyroid FNA (minimum of 3 successful ones) b. Insulin pump counseling (including at least one start) (minimum of three) c. Nuclear medicine RAI counseling and administration of RAI (3) d. Dynamic endocrine testing (3)
Dr Goguen will review the contents of your diary with you with you in January and June, as well, and feed back to your longitudinal supervisor what content you are missing. This diary serves as a quality assurance tool to ensure both you and the program committee that we are providing a full educational experience. If you note a lack of exposure to certain endocrine problems, please speak to your site co-coordinator or Dr.
Goguen so they can help you correct the deficit.
The success of this type of monitoring system depends entirely on accurate self-reflection. We therefore very much depend on each of you to proactively participate in this monitoring program.
28

Beginning in September, City-Wide Endocrine Rounds occur on Friday mornings from 8 - 9 am., at
Mt. Sinai Hospital, Joseph and Wolfe Lebovic Building, 60 Murray St., 3 rd Floor conference rooms.
Attendance for the activity is mandatory. You are expected to attend at least 80% of the rounds, and sign in on the attendance sheet to indicate you are present.
The focus of these rounds is in the area of basic and clinical research in Endocrinology. Participants in these rounds include prominent basic and clinical scientists at the University of Toronto with focused interest rounds presented by the Banting and Best Diabetes Centre, the University of Toronto Lipid Research Group and the University of Toronto Bone and Mineral Group.
These rounds also feature invited guests from across North America and Europe who have made a significant and outstanding contribution to Endocrine Research on an international level. Not only are they an outstanding learning opportunity, they also offer an opportunity to foster collegiality and “network” with university teachers and scientists.
The updated schedule of City-Wide Rounds is available on the divisional website www.endocrinology.utoronto.ca
29

Beginning on July 4, 2014, the weekly Endocrine interactive lecture series will occur on Friday mornings,
9AM – noon in the Mt. Sinai Hospital, 11 th floor classroom, following city-wide rounds.
Attendance for this activity is mandatory for PGY-4s and for the PGY-5s, it is mandatory for sessions not previously attended, and the PGY-5s are strongly advised to attend all sessions , to learn and to provide support for the PGY-4s, who find the sessions more stimulating with the PGY-
5s’ presence.
Residents will be required to sign the attendance record. All residents must attend the PGY-5 case presentations.
Topic areas will include an introduction to Endocrine Research, Diabetes, Lipoprotein Metabolism, Disorders of Thyroid, Adrenal, Pituitary, Calcium and Bone Metabolism and Gonadal Function and Miscellaneous areas including Ethical issues in Endocrinology, Health outcomes research, Managing your practice, and
Physician-industry interaction.
We have structured the year into blocks, on a disease model whenever possible (eg, diabetes, lipids, thyroid, etc). with clinical, basic science and physical examination sessions incorporated into each block.
We will distribute by e-mail information as early as possible for each session.
Please read up on the material before each session so that you can be suitably prepared to interact with each facilitator. Speakers will generally forward pdfs of important reference material and their notes which can be placed on the course website. Your active participation is vital to the success of this program. The basic s cience sessions will be more didactic and will provide a “bench to bedside” link.
The schedule of speakers/topics will be provided to you in early July. The organizer for the Academic Half-
Day is Dr. M. Wolfs.
The curriculum is supported by the course ipad website which you will be registered to use
(www.medendgine.net). It is password-protected and contains pdf versions of the talks, links to the readings, as well as lots of other very useful information, including:

Updated orientation manual and updated schedule for the academic half-day

Links to other useful websites
 Reading lists of “key” articles

The divisional website www.endocrinology.utoronto.ca contains up to date resident calendar of events and the academic half day schedules
30

Endocrine Journal club for the 2015
– 2016 academic year runs from September until March; there will be 6 sessions this year. The Journal Club will be held from 9:00am – 10:00am in the Mt. Sinai Hospital,
Joseph and Wolfe Lebovic Building, 60 Murray St., 1 st Floor Conference Rooms, following city-wide rounds. Attendance is mandatory for all trainees .
The following is the format for Journal Club: each PGY-4 will present a clinical paper. You have each been assigned staff advisors for each Journal club presentation. It is your responsibility to meet with the staff advisors well in advance of the Journal club date to choose an appropriate article for presentation. Each Journal Club may include papers based on a clinical theme or a basic science theme. Please forward a copy of your article to Fel (PDF), 2-4 weeks prior to the presentation and she will forward it to the faculty.
Selected articles should be recent (published within the preceding 12 months) and should be from highly regarded clinical or basic science journals such as: NEJM, Ann Int Med, JCEM, Diabetes Care,
Science, Nature, Nature Medicine, Cell Molecular Endocrinology, Diabetes or other first rate subspecialty journals. Case reports, small studies of dubious significance, review articles etc. should not be selected.
PGY-4s: For the clinical papers, you will informally present a critique of the paper and have questions ready for the group to answer. There will be no slides used, in order to keep it informal. The research question, methodology and results should be briefly described (assume the audience has read the paper), with your focus on your critique of the paper: you should highlight weaknesses and strengths of each paper as well as your perception of the scientific relevance of the paper. Twenty minutes of questions and discussion by the audience will follow. Please be prepared to lead the discussion, with questions you would like the audience to consider. There are 30 minutes to discuss the paper.
PGY-5s: Your staff advisor for the basic science paper will assist you in selecting articles. Your advisor will review the presentation with you prior to Journal Club and will be present at their assigned Journal club meeting. The faculty commentator will be present at the journal club to provide further insights into the chosen article. When you are choosing your basic science article, please choose an article in the area of expertise of your faculty advisor. Early communication with your advisor will facilitate your choice.
It is not necessary to describe every experiment in the paper in detail, but it is important to describe the methods in enough detail so that the audience can understand the methodology. The basic science articles are presented over 20 minutes, with 10 minute for discussion.
31

Mount Sinai Hospital, Joseph & Wolfe Lebovic Building
60 Murray St, 3 rd Floor classroom
Fridays
– 9:00 -10:00am
Resident Faculty Advisor ** Faculty Commentator
**
Date
2015
October 9
November 6
Ahmad Alhashemi
Basic science
Pam Tsao
Basic science
Christine Imbrahim
Clinical
S. George
M. Woo
D.Feig
December 11
Jenny Wang
Clinical
Leila Shobab
Basic science
Calvin Ke
Clinical
B. Perkins
C. Luk
B. Zinman
2016
January 15
March 4
Bikram Sidhu
Clinical
Angela Assal
Clinical
A. Sawka
L. Lipscombe
A. Advani Vithika Sivabalasundaram
Basic science
Sharon Sadry Basic Science R. Gilbert
Revised: June 12, 2015: Staff still need to be confirmed, please see Journal club posting on www.endocrinology.utoronto.ca
website for final version
D. Ng
D. Drucker
S. Laredo
G. Booth
R Retnakaran
Pending
Pending
B. Shah
P Brubaker
G. Lewis D. Ng
32

Dr Gary Lewis
– Director, Division of Endocrinology University of Toronto
Soon after acceptance into the Endocrine Training Program in the fall, successful applicants should begin to explore options for career paths. The Endocrinology training program provides broad-based clinical training in endocrine and metabolic diseases, which prepares our trainees for a variety of endocrine practice scenarios. Applicants are strongly encouraged and mentored to explore opportunities for research throughout the training program; there is a mandatory research project in the PGY-5 year.
Academic endocrinology:
There are several “job descriptions” currently accepted in most academic hospitals and health science centres. Common to all of these is advanced specialized training. The two key mandates of academic medicine are research and teaching and the job descriptions fall within these areas. In addition, all clinician scientists and clinician teachers/educators are expected to practice a very high standard of clinical care.
Clinician-scientists , depending on prior research experience, require several years of intensive research training in a chosen field of interest. Those training to become clinician scientists may choose to formally register for a PhD program but it is not essential to do so. The most important aspect of one’s preparation for a career as a clinician scientist is the length, quality and productivity of their postdoctoral research training. Clinician-educators (ie those doing research or administration in medical education) also require advanced training in education theory and research, available via a MSc or PhD degree. Clinician
– teachers (our star clinical teachers) benefit from advanced clinical training in a specialized area and requires training as a teacher. Clinician-QI practitioners are trained in scholarly QI research. Training in clinical research, i.e. to become a Clinical-investigator , may be obtained through advanced studies in epidemiology or postdoctoral training in clinical investigations.
Community endocrinology:
Many of our trainees become community endocrinologists at the end of their PGY-5 year. Some of these positions are also teaching positions, with university affiliations. Dr Ray Fung is the community representative on the RPC and can help trainees liaise with endocrinologists in the community. We let our trainees know whenever we hear of available positions, and interested PGY-5s are encouraged to attend community-based clinics and to do community-based electives to experience first-hand what the positions are like and to network.
Where to go from here:
With this background in mind, your first step is to contact Drs Lewis and Goguen to review your interests.
They can direct you to others in the division who will guide you in your career planning. You may wish to attend a meeting, e.g. Endocrine Society (U.S.), American Diabetes Association, combined Canadian
Diabetes Association/Canadian Society of Endocrinology and Metabolism or an Introduction to Research
Course sponsored by the Endocrine Society to increase your knowledge about possible areas of interest. In addition, investigating fields of endocrinology by library searches/literature reviews and by meeting with faculty members is encouraged.
If you are thinking of becoming an academic endocrinologist, it is important to initiate this process as early as possible, as soon as you begin your endocrine residency ( or even earlier). Applications for research fellowships, (e.g. Canadian Institutes for Health Research, Canadian Diabetes Association, Juvenile
Diabetes Research Foundations International), the University of Toronto Clinician-Scientist and Clinician-
Educator programs and the Master Teacher Program all have deadlines well before the start dates of these programs.
It is strongly encouraged that you begin your advanced training at the end of the first year of endocrine fellowship, after you have completed the essentials of clinical training. The second year of endocrine training does not absolutely require ambulatory clinics, but you will continue with your ½ day/week longitudinal clinic. Thus, you will save a year by planning ahead. If you decide that you wish to pursue advanced training outside the U of T, e.g. in the U.S., you must plan early and discuss this with Drs Lewis and Goguen so that they can help you with applications, letters, etc.
33

What if I don’t know what I want to do?
Some people are born knowing what they want to become while others seem to forever exploring different options. Most are somewhat in between. You may be surprised to discover that many of the leaders and senior faculty in the Division of Endocrinology at the University of Toronto did not have a clear cut vision of their ultimate job description when they chose to train in Endocrinology and have made one or more major changes in the direction of their academic interest along the way. If you are not certain about your choice because either you find everything interesting, the commitment seems overwhelming or you are secure in the clinical arena but somewhat anxious about lack of research or formal teaching experience, feel free to discuss this. Remember your choice is not “engraved in stone”. Advanced training in research or education will be of value regardless of where you end up 10 years from today. Often career paths develop over time so don’t be afraid to take a chance or even possibly, to make an error. Remember, step one is to contact
Drs. Goguen and Lewis for a frank, exploratory to discussion about the many exciting options that are open to you.
If you want a community position:
Practice Ontario at U of T is a joint initiative between U of T Postgraduate Medicine and Health Force
Ontario. To get one-on-one career guidance, contact: practiceontario@healthforceontario.ca
For a full list of services: www.HealthForceOntario.ca/practiceontario
As well, PARO offers the following services in order to assist residents with career planning:
1. Resident Placement Program
– After a confidential interview with PARO and community
Development Officers (CDOs), the resident will be provided with a list of potential communities that will suit the resident’s needs and goals, along with the appropriate contact information.
Spouses/partners are also invited to attend.
2. PARO Job Registry – Communities develop their own unique website which outlines their health and non-health resources. The full community listing for this online physician recruitment tool is available at ( www.myparo.ca
)
Health Professionals Recruitment Tour – Residents are provided the opportunity to network with other health professionals and community contacts from across Ontario.
Residents will also be given the opportunity to meet with community staff and discuss community positions.
34

Holidays should be planned with at least 3 months advance notice. You are permitted 2 weeks of vacation leave every 6 months. For the PGY 4s, under no circumstances are holidays to be taken during the 1 month
Pediatric Endocrine rotation or during the one week “Facilitating Diabetes Self Management Course” in July, the Endo week in September or CSEM in the fall. Holidays cannot be taken on endocrine practice exam days (Friday, Jan 29 and Friday May 20, 2015, to be confirmed). PGY-5s must also be present for DOM QI days and Endocrine Faculty Development days at the end of May (QI and Advocacy group presentations are then) and the first Friday of June, when you will present your research projects. Please notify the Program
Director, the Rotations Supervisor and Felomena Teixeira to request leave of any type. This facilitates planning for each rotation, including the granting of vacation to other trainees. During the core rotations at each of the four teaching hospitals, only 10 days can be taken off at each site for any reason (exams, conference, and holidays).
Conferences : You are all expected to attend the Canadian CSEM resident review course and the
CDA/CSEM meeting November 30 – December 4 th 2015 in Vancouver and you are strongly encouraged to participate in the oral or poster session for endocrine residents during the CSEM. You may wish to attend another major endocrine conference such as the ADA, Endocrine Society or similar subspecialty meeting to increase your exposure to current issues in clinical and research endocrinology.
Funding: Up to $1000 ($1,500 if you present a paper) is provided by the Division for travel refund for attending conferences per academic year. You MUST provide original receipts, VISA statements, conference ID badges and flight boarding passes. Funding is provided only if no other source of funding is available to you (ie, if you have $1,000 from another source, no funds will be given from the division, but you can use divisional funding towards another conference that academic Year. There is NO carry over to the next academic year.) These rules can change without notice. Residents are expected to attend the conference full-time, log their hours (Royal College mandated) and each will discuss something new they have learned at a debriefing meeting afterwards.
35

1. The ITER – the ITER or In-Training Evaluation Report will be completed and discussed with you at the end of each rotation. Interim feedback should be given to you at the mid-point of each base hospital rotation but you should also seek out formative feedback on your performance. Each resident must sign off the evaluation on the POWER System to document that you have received it. The program director will meet with each of you individually 6-7 months into your rotation as well as meet to complete the 12-month FITER.
2. Written examinations: Residents will need to formally demonstrate adequate knowledge in endocrinology prior to the end of their PGY-5 year. This must be done in at least 1 of 3 ways: a. Attain 60% or more on the January exam (if PGY
–5 gets less than 60% or PGY-4 less than 50%, they will be given remedial help, as that mark has been associated with difficulty passing the Royal College exam).
This is meant to identify candidates who are not able to demonstrate an acceptable knowledge base, and they will need to demonstrate that they have achieved adequate knowledge as outlined below. b. PGY-5s who do not obtain at least 60% on the January exam must attain 70% or more on the U of T May exam. It is composed of 30 short answer questions and is meant to be very practical, to make sure resident is safe to graduate. c. If b) not achieved, resident will do a pass/fail oral exam before the end of June. If c) not passed, the PGY-5 resident will be required to continue their residency beyond June, as a serious deficit in their knowledge base will have been demonstrated (this is anticipated to be a very rare event).
3. Mini-CEX: The mini-CEX is a method of assessing skills essential to the provision of good clinical care and to facilitate feedback. It assesses the trainees’ clinical and professional skills in outpatient clinics. The assessment involves observing the trainee interact with a patient in a clinical encounter. The areas of competence covered include: history taking, physical examination, professionalism, clinical judgment, communication skills, organization/efficiency and overall clinical care.
The assessor’s evaluation is recorded on a structured checklist that enables the assessor to provide developmental verbal feedback to the trainee immediately after the encounter. Feedback would normally take about 3-5 minutes. The mini-CEX tool is used in the ambulatory setting, esp longitudinal clinic, but at the resident’s discretion could be used in any teaching setting. There is a list or required topics to be covered with mini-CEX forms in your DOCOMP diary. You are expected to obtain evaluations in all of the topics and to obtain at least 24 Mini-CEX evaluations by the end of PGY-4 year and to get at least 24
PGY-5 clinic evaluations during each of your clinics that year (or further Mini – CEXs if required). This will be done on an electronic database: to set up your account, go to:
<ceep.med.utoronto.ca>, select “E-Dot”, “Endocrinology” and “Sign up”.
4. POWER-based procedural log: see page 11.
5. PORTFOLIO: The portfolio is a purposeful collection of the trainees’ work. Its purpose is to document activities done by the trainee and to promote reflection and development as a competent independent physician. It is handed in at the end of each training year and includes the following:
Docomp, MiniCEX (if done on paper)
Personal Learning Projects
Workshops attended
Teaching (date, topic, who taught)
Presentations: Hospital rounds, Journal club, Case reports for the PGY - 5s
Research posters, oral presentations, grants and awards
Summary (or slides from the presentation of): QA, Research and Advocacy projects
Professionalism write-up
Teacher and Rotation Evaluation:
We will also request of you ongoing feedback as to the strengths and weaknesses of your Endocrine training program. At the end of each rotation you will be asked to complete a Clinical Teacher Evaluation as well as a Rotation evaluation form. Completing these evaluations is a Department of Medicine requirement for successfully completing your year.
36

If the RPC recommends that the Resident should enter a remedial period, the Program Director, in consultation with the RPC, must develop a remedial plan. The Plan includes:
1. Resident background information
2.
Aspects of the Resident’s performance or behaviour that require remedial attention, organized around specific CanMEDS Roles
3. A detailed account of the proposed remedial education and resources available.
4. A time period for remediation
5. Expected outcomes of remediation, including details of the evaluation processes
6. Consequences of a successful or unsuccessful outcome of the remedial period
The PGME Education and Research Unit provides teaching and assessment resources to assist Program
Directors to develop a tailored remedial program.
The Program Director must consult the Resident about the Plan, and the Resident may appear before the
RPC in person (or in writing) regarding the Plan before the RPC makes a final decision regarding its recommendation. After approval by the RPC, the Plan will be submitted to the BOE-PG for one of its scheduled meetings.
The BOE-PG reviews the cases of Residents to approve:
1. the appropriate Remedial Period: remediation, remediation with probation, probation, or suspension and dismissal,
2. the appropriate length of the Remedial Period, and
3. the details of the Remedial Plan.
The Resident does not appear in person before the Board, but may make a written submission to the Board through the Vice-Dean, Postgraduate Medical Education. Decisions of the Board are final and binding on the
Faculty, the Residency Program Committees and Directors. Decisions of the Board may be appealed to the
Faculty of Medicine Appeals Committee.
The Appeals Committee is a Faculty Council committee with membership from all departments and undergraduate and postgraduate representatives. The Committee will hear appeals on the grounds that
(1) faculty policies and procedures were not followed;
(2) relevant evidence was not taken into consideration when the decision was made; or
(3) the decision could not be supported by the evidence that was considered when the decision was made.
Any resident wishing to appeal a decision of a Board of Examiners must notify the
Faculty Affairs Officer in writing of her/his intention to do so (“the Notice of Appeal”) within a maximum of two weeks (10 working days) after receiving written notice of a decision by the Board.
The Resident and the Program Director will present their arguments to the Appeals Committee, and the Vice
Dean may also be asked to present. Both sides may be represented by legal counsel. A decision of the
Faculty Appeals Committee is binding on the Faculty but the Resident may, if the appeal is not upheld, appeal to the Academic Appeals Board of the University Governing Council.
A decision of this Board is again binding on the Faculty, but, if the appeal is not upheld, the Resident may still appeal through the court system.
37

See also the U of T Endocrine Safety Policy on the divisional website www.endocrinology.utoronto.ca
The day-to-day responsibilities of being a Resident in a medical Subspecialty Program can at times be physically strenuous and emotionally draining. The coincident development of a problem in your personal life will only add to the emotional strain and challenge your ability to cope.
The two wellness advisors in our program are:
Dr. Diane Donat 416-340-3592
Dr. Baiju Shah 416-480-4250
Always remember that there are resources available to assist you. Please also feel free to talk to your assigned mentor for assistance and, as well, Dr Goguen is always available for you. In addition, professional counseling services by referral through PARO are available to all postgraduate trainees at the University of Toronto. PARO also provides a ½ day Workshop on Stress Management during the course of the year which you are strongly encouraged to attend.
The Physician Health Program of the Ontario Medical Association provides initial triage by highly trained case managers for mental health and substances use issues during normal work-day hours.
Assessment, treatment, and monitoring of the issues are provided by carefully screened mental health professionals who are able to see the resident within a two-week window.
Telephone: 1-800-851-6606 http://www.phpoma.org
The PARO Helpline is a 24 hours confidential service provided by the Professional Association of
Interns and Residents jointly with the Distress Centres of Toronto. This line offers crisis intervention as well as advice and resources. The Residents Well Being Committee of PARO keeps a log of family physicians and health professionals willing to see residents on a fairly urgent basis. Employee
Assistance Programs existing within each hospital are another option for residents seeking help who are working in partially or fully affiliated teaching hospitals. Other community resources for residents seeking counseling include the GP psychotherapy Network of Toronto and the Women’s Counseling
Referral and Education Centre. If the issue relates to intimidation or harassment, residents can seek advice from Paddy Stamp, the University Sexual Harassment officer, or from the University’s Anti-
Racism and Cultural Diversity Office at <http://www.hrandequity.utoronto.ca/about-hrequity/diversity/anti-racism.htm>.
PARO Helpline: 1-866-HELPDOC (1-866-435-7362) http://www.pairo.org
or ( www.myparo.ca
)
At the Postgraduate Dean’s Office, Dr. Susan Edwards provides back-up for our Residents Wellness
Advisors.
Telephone: (416) 946-4015
Fax: (416) 978-7144
Email: susan.edwards@utoronto.ca
Address: 500 University Ave., 6 th , Floor, Suite #602
38

The U of T Endocrine Safety Policy can be found on the divisional website www.endocrinology.utoronto.ca
“BARRIER PROTECTION” AND THE ENDOCRINE RESIDENT
Endocrinology, by its nature, is not considered to be a high-risk specialty. However, there will be times when you will be at potential risk of exposure to blood and blood products.
Such circumstances may include:
1. Fine needle aspiration biopsy of the thyroid
2. Performance of triple bolus tests
3. Performance of capillary glucose monitoring
4. Random venipuncture’s for other purpose
5. Administration of insulin or IV fluids to patients with diabetes
6. In the context of a research protocol, participation in an insulin-glucose clamp study
Under all of these circumstances, appropriate “barrier protection” precautions must be taken including:
1. Wear disposable latex gloves
2. Do not recap needles
3. Dispose of all biomedical waste including needles and syringes into an appropriate containers
Remember: The key towards providing maximum safety to yourself, your patients and those around you is to use common sense and consistently follow these practices.
39

Every resident needs to read and become familiar with the University of Toronto Privacy Policies found at
Website: www.pgme.utoronto.ca/content/policies-guidelines
40

ORIENTATION TO THE
BASE HOSPITALS
41

25.
St Michael’s Hospital
CORE HOSPITAL ROTATION OBJECTIVES
St. Michael’s Hospital
SITE-SPECIFIC OBJECTIVES
1. Medical Expert

Thyroid disease: o Manage autoimmune disease and nodules o Administer RAI (radioactive iodine)

Peri-operative management of Pituitary tumours, o Manage the perioperative care for the pituitary surgery patient, including knowing the indications for transphenoidal surgery and knowing how to address deficiencies of cortisol and ADH,

Parathyroid disease o Manage parathyroid disease, including secondary hyperparathyroidism due to
Vitamin D deficiency o Manage hypocalcemia after thyroid or parathyroid surgery

Metabolic bone disease: o Describe the physical examination, investigations and management of osteoporosis

Diabetes (T1DM, T2DM, Gestational DM, etc.): o Manage patients in the inpatient (including perioperatively) and out-patient settings
(Diabetes Clinic, Diabetes in Pregnancy Clinic)

Emergency management of DKA: o Manage DKA at a consultant level

Lipid disorders: o Describe 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: o Manage adrenal hyper function

Administer radioactive iodine for benign and malignant thyroid disease

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 implications regarding driving

Obtain informed consent for Radioactive Iodine (RAI)

Counsel patients regarding the safety of RAI

Write a well-constructed specialist-level consultation letter
3. Collaborator:
By the end of the rotation, the resident will be 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.
4. Manager:
By the end of the rotation, the resident will be able to:
42


Run the In-patient consultation team, including the supervision junior house staff.

There is an emphasis on perioperative glycemic control, and management of patients following pituitary, thyroid or parathyroid surgery, and an emphasis on the safe discharge of patients, with appropriate follow-up.
5. Advocate:

By the end of the rotation, the resident will be able to: Identify patients at high risk (e.g., homelessness, mental health issues) and ensure they have adequate social supports.

Access social workers and demonstrate knowledge of what financial resources are available to assist patients with diabetes mellitus.
6. Scholar:
By the end of the rotation, the resident will be able to:

Participate at the PGY-4 level at 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.

Demonstrate the ability to evaluate the medical literature and apply it critically to the ambulatory endocrine patients, particularly those with lipid disorders.

Research and present 1 Endocrinology round, demonstrating teaching and communication skills
7. Professional:
By the end of the rotation, the resident will be able to:

Show honestly, integrity, commitment, compassion and respect when working with patients, families and colleagues.

Demonstrate appropriate self-awareness and insights into their abilities (strengths and areas needing improvement)

Demonstrate reliability and responsibility.
ORIENTATION
Orientation package will be sent 1 week prior to rotation by Dr. Maria Wolfs wolfsm@smh.ca
. On the first
Monday of the rotation, meet at 8am with Dr. Wolfs in the 7 th floor conference room Queen Street East.
Call Responsibilites:

Endocrine team follows known endocrine patients during the day

New consults after 5pm and weekends are usually done by SCR on call.

Call responsibilities for Endocrine residents for 2 month rotation
– three weekends (resident’s choses dates) of “staff” call for endocrinology. This includes rounding on all endocrine inpatients and reviewing all new consults with the SCR (in-house senior consulting resident). Email Dr. Wolfs prior to your rotation with chosen dates.
Weekly Schedule:
61 Queen Street East 7 th Floor and SMH Main Hospital (1CC PAF clinic only)
MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY
08:00hrs
09:00hrs
12:00
13:00
In-Patient
Metabolic Bone
Clinic Rounds
Metabolic Bone
Clinic (Josse,
Derzko, Wolfs)
Lipid Clinic
(Leiter, Wolever,
Cheng, Ng)
Resident
Teaching
Endocrine
Rounds
Diabetes Clinic
(Advani, Yu,Wolfs,
Goguen, Hanna,
Josse, Booth)
CWER MSH
Academic half-day
11 th Floor Class
Room MSH
12:30 PAF Clinic
1CC
11:30 Lipid Clinic
Rounds
GDM Clinic 4th
Floor Women’s
Health
(Ray, Hanna,
Cheng, Wolfs)
Medical Grand
Rounds Queen
Wing Auditorium
11:30 Diabetes
Clinic Rounds
12:30 Resident teaching
Endocrine Clinic
(Yu, Wolfs, Gilbert,
Hanna, Josse,
Goguen)
In-Patient In-Patient
2:30 PAF Clinic
1CC
43

26. Sunnybrook Hospital
SITE-SPECIFIC OBJECTIVES
Sunnybrook Health Sciences Centre Site-Specific Objectives
By the end of the rotation, the resident will be functioning at the PGY4 level.
1. Medical Expert
By the end of the rotation the resident will be able to
Endocrine Disorders

Diabetes mellitus: o Manage insulin and non-insulin requiring diabetes in patients who are inpatients and out-patients, including peri-operative management of glycemic control

Thyroid disease: o Demonstrate an understanding of the effective use of thyroid function tests and thyroid imaging o 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 o Diagnose and manage patients with thyroid cancer, including counsel patients with thyroid cancer; develop treatment plans for these patients, including radioactive iodine; and provide appropriate decision making in long-term management

Emergency management of hyper- and hypocalcemia: o Appropriately manage calcium disorders at a consultant level

Female reproductive endocrinology: including hyperandrogenism, especially in the context of PCOS; infertility o Assess women with infertility and estrogen deficiency

Endocrinology of pregnancy: o Manage pregnant women with type 1 diabetes, type 2 diabetes or gestational diabetes as inpatients and outpatients o Manage pregnant women with endocrine conditions (other than diabetes), including thyroid, pituitary, and adrenal calcium abnormalities

Pituitary disorders: o Manage new or follow up patients with pituitary abnormalities

Describe the dietary principles for diabetes, hyperlipidemia and obesity
2. Communicator:
By the end of the rotation, the resident will be able to:

Effectively counsel patients on the treatment of hyper- and hypothyroidism
3. Collaborator:
By the end of the rotation, the resident will be able to:

Work effectively with members of the diabetes care team
4. Manager:
By the end of the rotation, the resident will be able to:

Run the In-patient consultation team, including supervision of 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.
44

5. Health Advocate:

Recognize important social determinants of health and preventative measures

Advocate effectively on behalf of patients, particularly involving access to endocrine medications and supplies
6. Scholar:
By the end of the rotation, the resident will be able to:

Demonstrate the ability to evaluate the medical literature and apply it critically to the ambulatory endocrine patients, particularly those with diabetes mellitus.

Participate at the PGY-4 level at teaching rounds, including staff rounds (Gab with Gilbert, etc.), pathology rounds, tumor board case rounds)

Present at Wednesday morning rounds once during the rotation, demonstrating teaching skills and communication skills.
7. Professional:
By the end of the rotation, the resident will be able to:

Show honestly, integrity, commitment, compassion and respect when working with patients, families and colleagues.

Demonstrate appropriate self-awareness and insights into their abilities (strengths and areas needing improvement)
Demonstrate reliability and responsibility.
45

Sunnybrook Hospital
ORIENTATION INFORMATION
NB: Please contact Dr. Jeremy Gilbert , 416-480-6717 jeremy.gilbert@sunnybrook.ca
2 weeks prior to the start of the rotation for orientation information
During the Endocrinology rotation at Sunnybrook you will be scheduled to spend a half of each day from
Monday to Thursday in an Endocrine Ambulatory Clinic, and the other half day seeing in-patient consultations and follow-ups.
We offer general endocrine clinics with Dr. Gilbert, Dr. Lowe, Dr. Silverberg, Dr. Werb and Dr. Shah, and clinics in PCOS, thyroid, and pituitary disease with Dr. Fettes. We also have occasions to attend the diabetes in pregnancy clinic. You will have the opportunity of work with our diabetes education team including nurse educators and dieticians.
Endocrine Rounds are held every Wednesday morning from 8 to 9, and there is a teaching session for residents on Thursday mornings from 8 to 9. City-wide Rounds are held every Friday morning followed by at least two hours of endocrine lectures. Friday afternoons are spent looking after in-patients with the staff endocrinologist on call.
You will not have any responsibilities during your half-day back. We will try to accommodate any special interests in Endocrinology that you may have. You will be responsible for presenting rounds on one
Wednesday morning during your rotation.
Teaching Sessions on Wednesday mornings (July and August)
Weekly Endocrine Rounds on Wednesday mornings (starting September) until June
Monday Mornings Teaching Session on Thyroid Disease with Dr. Silverberg
Monday Noon Teaching Session with Dr. Gilbert on General Endocrinology (Gab with Gilbert)
Tuesday Noon Teaching Session with Dr. Halperin on General Endocrinology (Hormones with Halperin)
Thursday Morning Teaching rounds with Staff on Consults that week
Thursday, Noon Teaching Session with Dr. Julia Lowe on General Endocrinology (Learn with Lowe)
46

27. University Health Network/Mount Sinai Hospital
SITE-SPECIFIC OBJECTIVES
By the end of the rotation, the resident will be able to manage at the PGY-4 level
1. Medical Expert
By the end of the rotation the resident will be able to
Endocrine Disorders

Diabetes mellitus: o Manage/Counsel patients with Type 1 and Type 2 Diabetes in the outpatient setting and in the peri-operative setting o Manage acute and chronic complications of diabetes o Manage diabetes in pregnancy, including pre-pregnancy counseling

Lipids: o Demonstrate an approach to, and management of, patients with dyslipidemia

Thyroid: o Demonstrate an approach to, and management of, patients with hyperthyroidism/hypothyroidism/thyroid nodules and thyroid cancer

Bone disease: o Diagnose and manage patients with hypercalcemia and/or osteoporosis o Use clinical tools to assess fracture risk and apply this in clinical practice

Endocrine oncology: o Diagnose and manage endocrine oncology disorders, including the
Clinical/Pathological correlation in endocrine oncology

Male sexuality and reproductive disorders o Manage male infertility/erectile dysfunction/andropause

Emergency management of Adrenal insufficiency: o Provide appropriate management of acute adrenal insufficiency at a consultant level

Endocrine dynamic testing: o Administer and interpret the results of endocrine dynamic testing

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 effectively on andrology disorders

Obtain informed consent for dynamic endocrine testing
3. Collaborator:
By the end of the rotation, the resident will be 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.
4. Manager:
By the end of the rotation, the resident will be able to:

Run the In-patient consultation team including the junior house staff.

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. Health Advocate:
By the end of the rotation, the resident will be able to:
47


Recognize important social determinants of health and preventative measures.

Advocate effectively on behalf of patients, particularly involving access to endocrine medications and supplies
6. Scholar:
By the end of the rotation, 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.

Demonstrate the ability to evaluate the medical literature and apply it critically to the ambulatory endocrine patients, particularly those with endocrine disorders in pregnancy and thyroid cancer disorders.

Research and present one Endocrinology round, demonstrating teaching and communication skills
7. Professionalism:
By the end of the rotation, the resident will be able to:

Show honestly, integrity, commitment, compassion and respect when working with patients, families and colleagues.

Demonstrate appropriate self-awareness and insights into their abilities (strengths and areas needing improvement)

Demonstrate reliability and responsibility.
.
University Health Network/Mount Sinai Hospital
ORIENTATION FOR ENDOCRINE RESIDENTS
The UHN-Mt. Sinai Hospital Division of Endocrinology is structured to provide both education and clinical care to three geographic sites:
1. University Health Network/ Toronto General Hospital
2. University Health Network /Toronto Western Hospital
3. University Health Network/ Mount Sinai Hospital
There are two concurrent and independent consultation services; one at the Toronto General Hospital and the Mount Sinai Hospital, and the other at the Toronto Western Hospital
You will spend approximately 1/3 of your time rotating through ambulatory clinics of your choice. The remainder of your time will be in a supervisory role to the rotating house staff on the Mount Sinai-Toronto
General Consultation Service. There is a rotating attending system every two weeks for the consultation services. You will be responsible for making rounds with the attending about 3 times per week at predesignated times which should not conflict with your ambulatory clinic schedule. There will also be additional half-days to provide time to you for additional reading. It is hoped that in the context of your supervisory role on the consultation service, that you will schedule allotted time towards the teaching of the rotating house staff.
The endocrine trainees together with the rotating house staff will participate in the presentation of the
Tuesday noon endocrine divisional rounds. These begin in early September and are completed in early
June, with a recess over the summer months. Dr. Phil Segal is responsible for the scheduling of these rounds which will periodically include outside guest speakers. You will be approached by Dr. Segal for ideas regarding topics with further assistance provided to you by Dr. Segal in the preparation of these rounds.
ENDOCRINE ROUNDS
Throughout the week, there will be a variety of formal divisional endocrine rounds.
Monday Lipid Clinic Conference
12 th Floor, Norman Urquhart Wing, Toronto General Division Conference Room
Between 12 – 1 pm. Lunch is provided (Sept – June)
Tuesday Noon Endocrine Division Rounds
PMH
– Rm. 7-605, between 12-1 pm. Lunches is provided. (Sept – June)
48

Thursday
Friday
Professor’s Rounds
1 – 2 p.m., Divisional Staff on a rotating basis
These occur in Rm. 7
– 605 PMH, throughout the entire year. The assigned
“professor” for the day will present either a topic or bring cases from his or hers practice for further discussion among the house staff.
Osteoporosis Rds. 12
– 1 PM. TGH Eaton Bldg. Rm. 7 – 316
City-Wide Endocrine Rounds 8
– 9 am. , Joseph and Wolfe Lebovic Building, 60 Murray
St.
– 3 floor conference room. (Sept -May)
Academic Half Day
9
– 12am., 11 th floor Classroom, Mount Sinai
Coffee, Crumpets and Questions
2:30 – 4:00 Toronto General Site, hosted by
Dr. R. Silver. The meeting place is in the Toronto General Hospital Food Court
49

28. 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 disorders:
Diabetes: o Management of acute and chronic complications of diabetes o Management of patients on insulin pumps and understand their unique problems
Thyroid and parathyroid: o Understand the effective use and interpretation of thyroid function tests and thyroid imaging o Diagnose and manage patients with thyroid diseases, including hyperthyroidism, hypothyroidism and thyroid nodules o To assess and manage thyroid disease in pregnancy and post-partum o To do fine needle aspiration biopsies of thyroid nodules o To manage patients with thyroid cancer: participate in counseling, planning of treatment, peri-operative follow-up
Reproductive life stages o Become familiar with how to accurately diagnose and appropriately manage reproductive disorders including prolactinoma and PCOS o To assess and manage patients with menopause and other estrogen deficiency stats, including counseling for HRT o To perform an appropriate history and investigations for women referred to a multi disciplinary program for premature ovarian failure (POF) o To counsel regarding options, as well as risk/benefits of ovarian replacement therapy in women with POF
Metabolic bone disease o Assess and manage complex patients referred to a multidisciplinary osteoporosis and metabolic bone disease program o To know how to interpret BMD testing and define its limitations o To observe how BMD results are obtained (ie. Observe a BMD test)
Emergency management of thyroid storm and myxedema coma o 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
3. Scholar: eproductive problem(s) (e.g. metabolic issues in PCOS) and the use of OCP/HRT
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: o Manage complex patients in a time efficient manner o Meet current standards for charting (CPSO: Peer Review) o 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 non-insulin requiring diabetes and its acute and chronic complications
6. Advocate
By the end of the rotation, the resident will be able to: o Practice a patience empowerment model of diabetes self management
50

o 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
WOMEN’S COLLEGE HOSPITAL
ORIENTATION INFORMATION:
Please contact Dr. Shoba Sujana-Kumar Phone: 416-323-6373 Email: shoba.sujanakumar@wchospital.ca
.
Endocrine Admin Assist: Maria Almeida Phone: 416-323-7501 Email: maria.almeida@wchospital.ca.
CLINIC SCHEDULES
A clinic schedule is e-mailed to each resident about 2 weeks prior to the start of the rotation indicating time and location of the different clinics and educational activities as well as instructions for registration and orientation session.
EDUCATIONAL ROUNDS
At Women’s College there are several weekly educational rounds. The residents are expected to attend these rounds as per schedule. Endocrine fellow are asked to present one Thursday noon endocrine round.
A schedule of these rounds is enclosed.

City Wide Endocrine Rounds at Mount Sinai Hospital, 60 Murray St., Lebowitsz Building at 0800 on Friday mornings from September to June. Topics include basic sciences and ground breaking clinical issues presented by invited international experts

Academic Half Day on Friday mornings 0900 to noon in the 11 th Floor classroom of the Mount
Sinai Hospital. These seminars cover a variety of clinical and basic science topics in
Endocrinology. Ethical issues are integrated throughout the program.

Weekly Endocrine Rounds on Thursday at 12:00. 6 th floor, Medical Education Classroom Rm
3324.. Literature reviews and case based discussions on multiple topics of clinical interest

Medical Grand Rounds/City Wide Medical Grand Rounds : Wednesdays at 12:00, Women’s
College Cummings Auditorium. Presentations by local and invited experts on a broad range of topics of clinical interest

Morning teaching sessions :
Morning report: Tuesday mornings with Chief Medical Resident, from *:00
– 9:00am.
Morning teaching sessions: with rotating endocrinology staff physicians, 8:00 – 8:30am
Wednesday and Thursday mornings, Rm 3106. Practical discussions on a variety of endocrine topics.

Osteoporosis Journal Club : Last Friday each month 12:00 – 1:00 (lunch provided) Endocrine
Program 4 th floor classroom, dates will be included in your schedule

Bone Density Observation and Interpretation sessions: one Friday each month 1:00 – 2:00,
Osteoporosis and Bone Densitometry Program 8 th floor, dates will be included in your schedule

Diabetes Teaching: separate learning sessions with the CIDC social worker, nurse educator, dietician, and dietician to review aspects of diabetes care. Dates and location will be included in your schedule.

Triage rounds and urgent consults: Friday afternoons, 1:00pm, in the Endocrine Team Room,
Rm 3124, with the endocrinologist on-call to review referrals and see urgent consultations
51

AM noon
PM
MONDAY TUESDAY
Morning report with
CMR
WEDNESDAY
Morning teaching
Medical Grand
Rounds
THURSDAY
Morning teaching
Endocrine
Rounds
FRIDAY
City-wide
Rounds
Academic
Half Day
Osteoporosis
Journal Club
(last Friday of month)
BMD Sessions
(dates included in your schedule)
Diabetes Teaching with CIDC team and Staff
(dates included in your schedule)
ENDOCRINE ON CALL
DAYTIME COVERAGE:
On Call coverage at Women’s College Hospital consists of responding to calls from the internist/hospitalist, surgical services including ENT (thyroid and parathyroid); responding to urgent ambulatory calls from family medicine, and triaging referrals to the Endocrine Program. Your schedule will indicate when you need to cover those services.
OVERNIGHT/WEEKEND CALL:
Endocrine residents or fellows will provide 1 week of call/month. Date will be assigned at the beginning of your rotation
52

29. Pediatric Rotation: Sick Kids
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 demonstrate knowledge of 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 the 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, and contraception

Hereditary endocrinopathy, including polyglandular autoimmune syndromes and MEN

Obesity

Delayed growth

Endocrine disorders in systemic disease

Endocrine emergency: Acute management of DKA in the pediatric population
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:

Communicate with and counsel patients & families effectively

Provide clear and concise oral communication & dictated letters

Effectively counsel pediatric patients & families on the use of insulin pump therapy
3. Collaborator:
By the end of the rotation, the resident will be able to:
Work effectively with the interprofessional healthcare team to develop shared management plans.
4. Manager:
By the end of the rotation, the resident will be able to:

Work effectively to manage outpatient practice to provide efficient and appropriate care.

Demonstrate an understanding of the principles of successful transition of care from pediatric to adult endocrinology
5. Advocate:
By the end of the rotation, 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.

Demonstrate knowledge of how to access social workers and what financial resources are available to assist patients pediatric with diabetes mellitus.
6. Scholar:
By the end of the rotation, 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 .
53


Research and present one Pediatric Endocrinology round, demonstrating teaching and communication skills
7. Professional:
By the end of the rotation, the resident will be able to:

Show honestly, integrity, commitment, compassion and respect when working with patients, families and colleagues.

Demonstrate appropriate self-awareness and insights into their abilities (strengths and areas needing improvement)

Demonstrate reliability and responsibility
54

Sick Children’s Hospital
ORIENTATION FOR ENDOCRINE RESIDENTS
Please contact Minet Smith at minet.smith@sickkids.ca
or (416)813-5991 during the week prior to the start of your rotation to arrange for ID badge, clinical computer systems training etc. Meet the on service team on
Ward 6A at 7:50 on the first day of your rotation.
Teaching/rounds schedule:
AM
MONDAY
Diabetes
Clinic
TUESDAY
Endocrine
Clinic or
Diabetes
Referral
12:15 –
1:15pm
Diabetes
Lunch /
WEDNESDAY
Endocrine
Teaching
Session
10:30
– 12:00
THURSDAY
Diabetes
Clinic
FRIDAY
City-wide
Rounds
Academic
Half Day
PM Ward
Teaching
Rounds
4
– 5:00pm
Fellows
Rounds
Journal Club
1:30 –
5:00pm
General
Endocrine
Clinic or
Calcium
Clinic
1:00 – 2: 00pm
Endocrine
Rounds
Ward
Teaching
Rounds
1:30 – 5:00pm
General
Endocrine
Clinic or
Bone Health
Clinic
1:00 – 2:00pm
Endocrine/
Rounds
Ward Teaching
Rounds
DIABETES CLINIC:
Approximately 20
– 40 patients are seen at each of the Monday and Thursday clinic each week. Patients are assessed by the trainees and reviewed with their respective staff physician (3 in attendance).
Other members of the multidisciplinary team (dietician, teaching nurses, and social worker) are present during both the Monday and Thursday clinics and interact both separately from and together with the physicians and with the patients. .
ENDOCRINE CLINICS:
The make-up and function of the Tuesday and Thursday clinics are similar. Approximately 20-25 general endocrine patients are seen at each clinic (2-4 new patients) with two-three staff in attendance. Patients are seen by the trainees and then reviewed with their respective staff physician.
CALCIUM AND BONE HEALTH CLINIC
Calcium Clinic takes place on Tuesday afternoons and is run by Dr. E. Sochett. Children with, various forms of rickets and other disorders of calcium and phosphate metabolism attend. A multidisciplinary Bone Health
Clinic takes place on Thursday mornings. Children with osteoporosis, osteopenia and other bone fragility disorders are seen.
55

T eaching/ROUNDS:
Monday 4:00
– 5:00 PM
A mixture of case based discussions and supplementary pediatric specific sessions to complement academic half day topics. These sessions are for fellows exclusively.
Wednesday 10:30 – 12:00noon: A problem based format is used to cover common pediatric endocrine problems. Trainees are given a folder containing these problems and are asked to prepare in advance of the rounds.
1:00 – 2:00pm Pediatric Endocrine Rounds (Wednesday and Friday): Trainees are asked to present interesting patients seen either on the wards or in the clinics. The emphasis is on unusual clinical features of the problem and /or advances in the basic sciences.
Friday 8:00- 9:00: City-Wide Rounds followed by the Academic Half Day at Mount Sinai
B) WARD SERVICE
The ward service team comprises a staff physician, pediatric endocrine fellow, 1-2 pediatric residents and 1 medical student. The adult fellow will join this team and share in its responsibilities.
These are comprised of:

Care of patients admitted to the service Consultation to other services (approximately 5 -10 weekly)

Supervision of the endocrine testing room
C) CALL:
There are no call requirements for this service.
56

STAFF CONTACT INFORMATION
RSIDENCY PROGRAM COMMITTEE & DIVISION CHIEFS
SMH
SUNNYBROOK
UHN
WCH
SICK KIDS
RESIDENTS AND FELLOWS
57

TRAINING PROGRAM COMMITTEE MEMBERS AND DIVISION CHIEFS
Training program
Dr. Jeannette Goguen (SMH) Program Director
Phone
867-3714 goguenj@smh.ca
Dr. Robert Silver (MSH-UHN site co-ordinator) robert.silver@uhn.on.ca
603-6453
Dr. Shoba Sujana-Kumar (WCH site co-ordinator) 323-6373 shoba.sujanakumar@wchospital.ca
867-3711 Dr. Maria Wolfs (SMH site co-ordinator)
Wolfsm@smh.ca
480-6717 Dr Jeremy Gilbert (Sunnybrook site co-ordinator)
Jeremy.gilbert@sunnybrook.ca
Dr. Diane Wherrett, (Peds Prog Dir) diane.wherrett@sickkids.ca
Dr. Denice Feig (UHN-MSH) (Research) dfeig@mtsinai.on.ca
Dr. Rene Wong (Education Expert) rene.wong@uhn.on.ca
Dr Ray Fung (Community) rfung@tegh.on.ca
Division Directors:
813-8159
340-4053
915-5460
Fax
867-3724
603-7378
323-7522
867-3696
480-4744
586-8590 361-2657
813-6304
340-3314
Dr. G. Lewis (DD U of T; Director BBDC) 340-4270 gary.lewis@uhn.on.ca
Dr Minna Woo
– (Head UHN)
Minna.woo@uhn.ca
Dr. Sophie Jamal, Division Head sophie.jamal@utoronto.ca
Dr Julia Lowe (Head SHSC) julia.lowe@sunnybrook.ca
Dr. Richard Gilbert, (Head, SMH)
Richard.gilbert@utoronto.ca
Dr. Mark R. Palmert (Head HSC) mark.palmert@sickkids.ca
340-3314
946-2000X3971 (OCI office)
323-6400 x4462 323-6484
480-6948 480-4250
864-6060 x6016 867-3681
813-5118 813-6304
58

ENDOCRINE DIVISION BY HOSPITAL
SMH
Dr. Richard Gilbert, Divisional Director
Richard.gilbert@utoronto.ca
Dr. Andrew Advani advania@smh.ca
Dr. Gillian Booth boothg@smh.ca
Dr. Alice Cheng chenga@smh.ca
Dr. Jeannette Goguen, Program Director goguenj@smh.ca
St Michael’s Hospital
Phone
864-6060 x6016
864-6060 x8413
867-3719
905-828-7622
867-3714
Dr. Amir Hanna hannaa@smh.ca
Dr. Robert Josse josser@smh.c
Dr. Larry Leiter leiter@smh.ca
Dr. Domenic Ng ngd@smh.ca
Dr. Maria Wolfs, SMH Education Coordinator
Wolfsm@smh.ca
867-3721
867-7455
867-7441
864-5197
867-3711
Dr. Catherine Yu catherine.yu@alumni.utoronto.ca
SMH Research Scientists:
Dr. Phil Connelly connellyp@smh.ca
Dr. Qinghua Wang qinghua.wang@utoronto.ca
Researchers in Nutrition:
Dr. David Jenkins david.jenkins@utoronto.ca
Dr. Vlad Vuksan v.vuksan@utoronto.ca
Dr. Tom Wolever thomas.wolever@utoronto.ca
Affiliated Staff:
Dr. Christine Derzko derzkoc@smh.ca
416-867-3701
Phone
864-6023
867-7474
867-7450
978-5556
867-7447
864-6060 X6767 8
Fax
867-3681
867-7497
867-3724
828-7769
867-3724
867-3724
867-3696
867-3696
864-5584
867-3696
416-363-9338
Fax
864-5870
64-6043
867-7495
867-7495
978-5882
867-3693
59

ENDOCRINE DIVISION BY HOSPITAL
Sunnybrook
Dr. Julia Lowe, Head
Julia.lowe@sunnybrook.ca
Dr. Ivy Fettes ivy.fettes@sunnybrook.ca
Dr Jeremy Gilbert (Site co-ordinator)
Jeremy.gilbert@sunnybrook.ca
Phone
480-6948
480-4760
480-6717
Dr Ilana Halperin
Ilana.halperin@sunnybrook.ca
Dr. Baiju Shah
480-6056
480-5914 baiju.shah@ices.on.ca
Dr. Jay Silverberg jay.silverberg@utoronto.ca
480-4761
Dr. Marsha Werb 322-3198 mrwerb@total.net
Associated Faculty :
Dr. Simon Raphael
Endocrine Pathology simon.raphael@sunnybrook.ca
Dr. Lisa Ehrlich
Nuclear Medicine lisa.ehrlich@sunnybrook.ca
Dr. Janet Hux jan@ices.on.ca
Dr. Philippe Poussier ppoussie@swri.ca
Dr. Michael Schwartz
Neurosurgery,
Pituitary Clinic michael.schwartz@sunnybrook.ca
SUNDEC
Carolyn Lawton, Nurse Practioner
Carolyn.Lawton@sunnybrook.ca
480-6100 X 2124
480-5731
480-4055 X3849
480-6136
480-4738
480-5890
Fax
480-4250
480-6875
480-4744
480-5122
480-4250
480-5258
322-3725
480-4271
480-5218
480-6048
480-4375
480-6085
60

UHN-TGH
Dr. Minna Woo, Head UHN mwoo@oci.utoronto.ca
Dr. Angela Cheung
Angela.cheung@uhn.ca
Dr. Diane Donat dianne.donat@uhn.ca
Dr. Susan George s.george@utoronto.ca
Dr. Gary Lewis, Division Director gary.lewis@uhn.ca
Dr. Annie Sawka annie.sawka@uhn.ca
Dr. Phillip Segal phillip.segal@uhn.ca
ENDOCRINE DIVISION BY HOSPITAL
UHN-MSH
Phone Fax
340 5214 (TGH Clinical Office) 340 3314
581 7531 (TGRI Research Office)
340-4301 340-4105
340-3592
340-4360
340-4270
340-3678
340-5329
340-3314
340-3314
340-3314
340-3314
340-3314
Dr. Rene Wong
Rene.wong@uhn.ca
MSH
340-4053
Phone
340-3314
Fax
361-2661 361-2669 Dr. Dan Drucker
Drucker@lunenfeld.ca
Dr. Shereen Ezzat sezzat@mtsinai.on.ca
Dr. George Fantus gfantus@mtsinai.on.ca
Dr. Denice Feig dfeig@mtsinai.on.ca
Dr. Jacqueline James jjames@mtsinai.on.ca
Dr. Adam Millar amillar@mtsinai.on.ca
586-8505
586-8665
586-8590
586-8369
586-4800X3939
586-8834
361-2657
361-2657
361-2662
619-5523
Dr. Bruce Perkins
Bruce.perkins@mtsinai.on.ca
Dr. Ravi Retnakaran rretnakaran@mtsinai.on.ca
586-8763
586-4800X3941
647 826-1528
586-4740
61

Dr. Paul Walfish walfish@mshri.on.ca
Dr. Bernard Zinman zinman@mshri.on.ca
UHN-TW H
Dr. Rowena Ridout
586-4437
586-8747
Phone
603-6454 rowena.ridout@uhn.ca
Dr. Robert Silver UHN-MSH Site coordinator robert.silver@uhn.ca
603-6453
586-8861
586-4740
Fax
603-7378
603-7378
62

ENDOCRINE DIVISION BY HOSPITAL
Women’s College Hospital
WCH
Dr. Sophie Jamal, Division Head
Phone
323-6400 x4462 sophie.jamal@utoronto.ca
Dr. Rosario Briones-Urbina rosario.briones@wchospital.ca
323-6088
Dr. Catherine Kelly, Division Head catherine.kelly@wchospital.ca
323-7510
Dr. Sandra Kim (Site co-ordinator) sandra.kim@wchospital.ca
323-6373
Dr Shoba Sujana Kumar 323-6013 shoba.sujanakumar@wchospital.ca
Dr. Sheila Laredo sheila.laredo@wchospital.ca
323-6373
Dr. Lorraine Lipscombe lorraine.lipscombe@wchospital.ca
Dr Geetha Mukerji
Geetha.mukerji@wchospital.ca
Dr. Afshan Zahedi afshan.zahedi@wchospital.ca
Dr. Iliana Lega iliana.lega@wchospital.ca
Associated Faculty :
Dr. Wendy Wolfman
Gynecology, POF Clinic
Dr. Lisa Allen
Gynecology, POI/Turner’s Clinic lisa.allen@wchospital.ca
Dr.Tara O’Brien
323-6373
323- 7340
323-6400 X4874
323-6400 x2532
586-4753
323-6400 x4310
323-6118
GIM, CDU Director tara.obrien@wchospital.ca
Dr. Robyn Evans 323-6215
Multidisciplinary Diabetes Foot Ulcer Program
TRIDEC/Diabetes Staff:
Nicola Donovan, NP, CDE nicola.donovan@wchospital.ca
323-6400 x4069
Fax
323-6484
323-6093
323-6360
323-7522
323-6534
323-7522
323-7522
323-6360
323-2669
323-6534
586-4699
323-7739
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Leah Drazek, APN, CDE leah.drazek@wchospital.ca
Carolyn Christo RD, CDE carolyn.christo@wchospital.ca
Cheryl Harris-Taylor, MSW cheryl.harris-taylor@wchospital.ca
323-6400 x4070
323-6400 x4071
323-6400 x4046
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ENDOCRINE DIVISION BY HOSPITAL
Sick Kids
Phone
Dr. Mark R. Palmert (Head HSC) mark.palmert@sickkids.ca
Dr. Jacqueline Curtis jacqueline.curtis@sickkids.ca
813-6217
813-7763
Dr. Denis Daneman denis.daneman@sickkids.ca
Dr. Jill Hamilton jill.hamilton@sickkids.ca
Dr. Kusiel Perlman kusiel.perlman@sickkids.ca
Dr. Etienne Sochett ebs@sickkids.ca
Dr. Stacey Urbach s tacey.urbach@sickkids.ca
813-6122
813-7595
813-5991
813-7041
813-7763
Dr. Diane Wherrett diane.wherrett@sickkids.ca
Dr. Jonathan Wasserman jonathan.wasserman@sickkids.ca
813-8159
813-8159
Fax
813-6304
813-6304
813-6304
813-6304
813-6304
813-6304
813-6304
813-6304
813-6304
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RESIDENT CONTACT INFORMATION:
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Current R4 to incoming R4 Orientation and Pearls
Written by : Dina Reiss, prior PGY-5. Updated by Nashwa Taha (June 2014), Sharon Sadry (June 2015)
Welcome to the University of Toronto Endocrinology Residency. This section contains supplemental information to what you have just read from the orientation manual. This information is created by current
R4’s and R5’s who have gone through the year. The following is meant to give you an ‘inside’ perspective from us of what to expect in the coming rotations + pearls on survival/how to best manage your time during this exciting and challenging year. This section will start with 9 tips and then go into our advice/experiences with the core rotations.
Tip #1: Before any rotation starts, email the coordinator + administrator (at least 2 weeks in advance) to make sure that they are expecting you, making/have made your schedule, what is expected in terms of talks
(and the dates if you have been pre-slotted in).
Tip #2 : If you drive, I recommend getting a UHN parking pass ASAP. It will be the cheapest parking you will find downtown. It is currently $9.00/day and allows you to easily walk to the hospitals of your UHN rotation
(Mt. Sinai, TGH, PMH), WCH rotation, Sick kids, Repro as well as park on academic half day.
Tip #3: a) With regards to parking, when you are on home call for UHN (TGH + TWH + PMH), TRI and
MSH. If you get called in (rare but may happen) you can actually park for free on Murray street (behind the hospital after 9pm), or Murray street (after 6pm) (also behind PMH/Mt. Sinai). b) Another parking tip! For St. Michael’s hospital, there is free parking on Shuter street EAST of Sherborne
(between Parliament and Sherborne). Otherwise, you are looking at anything from $12 + for the day.
Tip #4: When you are the fellow on the 3 inpatient core-rotations (UHN, sunnybrook, St. Michaels) be proactive in signing off patients that no longer need to be followed (ie: DM2 with pristine sugars/a1c of 6.5% just diet controlled). Always have the blessing of staff before signing off and make sure the patient has good outpatient follow up.
Tip #5: PRESENTATIONS! You will do lots of these as a PGY-4, whether at your site rotations or journal club. These can be quite nerve racking unless you have done a ton before. The best advice I can give you is: take a deep breath, talk slowly and present with confidence. I found the best way to prepare was to practice before hand. I brought my actual laptop to the conference room and presented to an empty room the night before or the morning of. Ensure you attend the AHD session on how to prepare/deliver a strong presentation. Technical glitches are the worst way to waste valuable presentation time and increase your stress. A general rule of thumb is to have your presentation in 3 places: save it on a USB stick, email it to yourself, and bring your laptop. If you have a Mac, bring your own converter cable (you can buy one from
Apple for $45.00)
During the presentation  If you do not know an answer to a question being asked IT’S OK to say “I don’t know” or “I will look that up” followed by: “An excellent question, does anyone else in the audience know” or
“Lets open that up to the audience”. REMEMBER: you are an R4 not a world class expert in
Endocrinology….. YET!  . Try to ensure your talks are interactive and provide opportunities for discussion throughout.
For your core rotation talks, try to get them done as early as possible in the year (two in the first two core rotations, one in each of the following core rotations, when you will be busier studying for exams).
Ask in advance your presentation date and around the time of your Royal College try to slot it in a time convenient for you. E.g., if you have a talk to give during your May and June block
– ask well in advance if you can arrange to do after the last potential oral examination date.
Tip #6: Read as much Endocrinology as you can in July and August because you will not have time once you start studying for Royal College in September/October. You can start with core articles (DCCT, UKPDS) or guidelines. I found that printing out the CDA 2013 guidelines was a good place to start.
Tip #7:
Before CWER/academic half day, double check the schedule (will be printed on U of Toronto’s
Endocrinology website) to make sure that there is a lecture. I can count on two hands the times myself or my colleagues shown up to CWER at 8 am without checking the schedule only to have realized that there was no lecture or another event was going on concurrently. AHD lectures may also be shuffled as well.
Tip #8: After you find out where your longitudinal clinic is, get computer access + ID badge + dictation # to that site ASAP.
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Tip #9: do NOT forget to fill out your call re-imbursement on the online POWER system online. If it is significantly late you may not qualify for PARO re-imbursement.
Sunnybrook:
Main Contact: Dr. Gilbert is the main contact attending that will be organizing your schedule/presentation dates.
Day #1: (follow these steps) a)
Introduce yourself to Dr. Jeremy Gilbert, who is the director of education during your rotation. You can find his room in the H-wing, 1st floor, down the hall on the left (room H1 66). Obtain your key
(which opens the door to the resident's room and all the other doors in the H-wing/Endo department). b)
You'll register with Sinthujah in room E324 (E Wing). You will be getting your computer ID, and they will tell you where to go for your badge and pager (if you have a pager from elsewhere you will
NOT need a Sunnybrook pager, this only applies if it is your FIRST rotation). I warn you there is a deposit on the pager (I think around 50 or 75 dollars) and for the fob key (comes with your badge to let you in and out of different departments).
Sunnybrook EMR is Sunnycare and can be accessed from home at www.sunnycare.ca
or on your mobile device. Give yourself at least half a day to get everything set up. For your pagers, you will have to pay the deposit at a different location
(they will direct you to the accounts office) and then you will provide them the slip that you paid.
Another point to consider: if you are starting at Sunnybrook and do NOT want to carry a bulky pager + a long lengthy number with an extension for the rest of the year consider getting one from
UHN before you start. c)
Now you're ready to see patients. Go back to the resident's room (on the H-wing), and print out a list of patients. How to print the list:
1) go to www.sunnynet.ca
2) click on patient sign out system v2.1
3) put in your ID/password
4) click on the physician's tab on the list
Nuts & bolts: The rotation is divided into clinics and in-patient/consults. Your schedule will usually be divided into either a morning or afternoon clinic and the other slot will be for seeing inpatients. The number or residents you have on your team will make a huge difference to the overall workload (obviously). That being said even if you only have 1 or 2 residents with you, the more volume you personally see the more you will learn. Coverage is of the entire hospital, including the veterans nursing facility across the street. You function in a managerial role: you are the one paged for consults and divvy up among residents. If the team is small, or you get swamped you take consults as well.
Most patients are either on the B/C/D wings or the M5 high-risk units. Under location in the list, look at the first letter that will tell you what wing to go to (ie: B30801) on the B wing. The first number indicates the floor
(so third floor in this case). And the rest is the room/bed number

room 8 bed 1. The CRCU/CVCI are on M2. Note there is a nurse practitioner who manages the D3 cardiovascular surgery patients. Please keep these patients on the signout list for her to keep track. When she is away however, the Endocrine service manages these patients.
To find the blood sugars you need to find the MARs (what nurses use to record sugars/write medications in).
Every floor had a different place where the MARs are placed. Ask the nurse 'where is the MAR' to easily locate it. Yes the MARs are PAPER charts . On the OB floor on M5 they use a different electronic system called OBTV – contact Fiona Hutchison (Pregnancy Diabetes RN) who will go through the program with you and grant you access in advance. Consult notes are written in Sunnycare everywhere but M5 where they are done in OBTV. Progress notes are in the paper chart, except for M5 where they should be done in
OBTV.
Your job as the R4 is to manage the team; you will all get there around 8 am and there is teaching on most mornings. You divvy up the list. Most patients need to be seen every day, with the exception of the diet controlled GDM patients who we tended to see 1-2/week (but remember this is staff dependent).
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All progress notes are written in charts EXEPT for the L-Wing (they are now on-line) and we don't have access to their system, so an RN has to log you on and you just sign your name. (The L-wing is across the street at the veteran's retirement home). Sunnybrook is a large hospital; to be efficient it is important that you map out your route for seeing follow ups and consults carefully in the day. There are standardized insulin orders that you will learn to use (printed out forms that you fill out and sign that go in the patient's chart). I would walk around with a stack of these for efficiency as they are in a different location on every floor.
To page someone, you go to www.sunnynet.ca
and under directories and schedules go to SMART paging. It takes a day or two to get used to this system. You can also page regularly through the phone system.
Clinic Notes: Most staff in clinic use Accuro (you will learn how to use it the first clinic and get the hang of it) and specific staff type their letters without an EMR. For Accuro the login varies for each staff but the password is the same and will be shared with you at the time.
Presentations: You will have 1 presentation here on a Thursday 8-9 am.
Food: Several incredible cafeterias (main floor near the entrance, M floor). A larger one on E wing 1 st floor.
In the summer they have barbeques outdoors (look outside the residents room: right outside in the garden. If all else fails there is a Tim Horton’s on the ground floor near the E wing and one around E wing floor 1.
Finally, if you cook for yourself there is a kitchen with a fridge across the resident’s room.
Transport : the Shuttle takes you directly from downtown (In front of WCH) to Sunnybrook, an efficient painless experience. You can download the shuttle service schedule on the Sunnybrook website. Note it can be delayed particularly on the way home from Sunnybrook back downtown. If you drive, you will want a parking pass. The lot that residents are permitted to park in is P3 and is approximately a one minute walk to the hospital and is behind the hospital. You will pay a $10 deposit fee for the electronic key that lets you in, but they will return it upon completion of your rotation. To get this parking key you go to the parking dept on the ground floor of the hospital. Note: Parking is around $100/month. Note you can also take the subway and subsequent bus from Lawrence or Davisville station.
Repro:
Main Contact : Dr. Cruickshank and administrator: Debbie Yorke. Important to email at least two weeks before your rotation to set up your schedule.
Day #1: Go to the Repro clinic and introduce yourself to Dr. Cruickshank and whomever you are starting clinics with that day (you should have your schedule before you start). Hopefully someone will give you a tour of the facility and show you where the locker room is (where you put you bag/belongings). Make sure to let them know of any scheduling conflicts (ie: academic half day on Friday and your longitudinal clinic) prior to the rotation start. Make sure you are NOT scheduled for any clinics on these days and if you are speak to
Dr. Cruickshank, Debbie Yorke to let them know that you will not be able to attend.
Nuts & Bolts: The rotation is composed of working with the repro attendees, 2-3 half days in the embryology lab and 2-3 clinics with an urologist (specializing in male infertility). You will have opportunities to shadow the repro folks and see infertility patients yourself. You will also have opportunities to see how
IVF transfers and oocyte retrievals are done. Note for the embryo lab days and procedure days you will need to dress in scrubs. Scrubs will be provided for you (in the locker room) free of charge.
Dictation : You will need at Mt. Sinai dictation number.
Each staff will have their own “work-type” number.
Presentations: You will have 1 presentation during this rotation, at noon. Make SURE to run your talk by
Dr. Greenblatt or Dr. Cruickshank before giving it . They will want you to present on a topic ‘relevant to repro’ and one that has not been presented recently.
Food: Plenty of restaurants in the area, includin g Avenue Bistro (on University) and Café Plenty downstairs on Dundas (although expensive). Bring your own: Fridge in lounge. If you have time you can walk to TGH or sick kids which have wonderful food courts.
Parking/transport: underground, expensive about $15 dollars for the day. As per Tip #3 park at UHN and walk about 3 minutes. The other option is to take the subway, which is quite convenient as the subway is right on University avenue (get off at the St. Patrick station).
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UHN/MSH:
Main Contact : Dr. Silver, he will page you or call you the week before you start and give you an orientation package to pick up prior to the rotation.
Day #1 : You will need to get your computer password/access. Note: the access system for TGH/TWH/PMH is distinct from Mt. Sinai. You will likely spend the day getting access to both. If at all possible try to set up access before you start your rotation. The UHN EPR training alone will take 4 hours to complete. The Mt
Sinai EPR training will take ~2-3 hours.
Nuts and Bolts: You will usually be covering three hospitals during this rotation: PMH, Mt. Sinai and TGH.
You are usually on the wards, but occasionally have half-day clinics. Additionally, during the 2 month block, you will have 1-2 weeks dedicated to clinics (off the consult service). You may also be designated an additional block at the TWH where you will be the only housestaff as it is generally a lighter site.
You meet your team on the 12 th floor, Endo conference room usually at 8 a.m. There is also a Fellows Room
12E211. This requires a special key that you will have to obtain via Fel. In the Fellow’s room is a desk and printer. Divvy up the list, work load is very dependent on the amount of residents on your team. I would also have residents follow patients they consulted on. The workload at UHN is quite variable, usually being on the heavy side. It was very common for me, as the fellow, to help the residents with the consults. Early on in th e year I would recommend checking up on most patients daily. It’s important to make sure that junior residents write adequate notes and adjust insulin doses appropriately. Note there are new pre-printed peripartum order sets at MSH as of 2015 for the large obstetrical population we see on the consults service at UHN. Ensure that the signout list is updated ideally by 5 p.m. (as you would for all sites) so that the oncall resident covering the UHN is aware of the patient’s plan and insulin adjustments.
Fridays are academic half days, in which the pager goes to one of the residents. Friday PM, there are no clinics and you help the residents with finishing up in-patient duties/consults. You will need to finish up before 2:30pm, which are crumpet rounds with Dr. Silver. Crumpet rounds consist of teaching sessions at the food court of TGH, Dr. Silver pays for a snack (hence the name CRUMPET rounds). Crumpet rounds typically end around 4-4:30 p.m. You will need to ensure that things are ready for the weekend resident on call.
Presentations: 1 presentations at noon. Go over your topic with Dr. Phil Segal. The presentations at UHN are formal, with an audience of approximately 30-40 (might be less in the summer). See Tip #7 (you will find it helpful for presentations here).
Food: there is an INCREDIBLE selection of food at the food court at TGH, ground floor. There is also a food court in the adjacent MARS building.
Parking/Transportation: UHN parking $9/day $16/day starting September 1 st 2014. Getting to TGH is easy on the subway; get off on the Queen’s park station.
WCH:
Main Contact: Dr. Shoba Sujana Kumar is the coordinator; Maria is the administrator who will give you your schedule.
First day: You will meet with Dr. Kumar in clinic, on the 3 rd floor at WCH at 8 or 8:30am (she will email you with specifics). After the initial orientation, you will need to register with Jennifer Alexander on the 9 th floor at
790 Bay Street. She will direct you to get your ID badge. The registration/ID process will take up to 1 hour at the most, if you can get it done earlier, its better as you will likely have clinic on the first day in the morning.
WCH has a new EPR as of Jan 2015 called EPIC. The training for this can be quite time consuming therefore it is best to have this done well in advance of starting your rotation.
Nuts & Bolts: This rotation is strictly outpatient. Your day is divided into AM and/or PM clinics with various staff. All clinics are on the 3rd floor of WCH, except for the osteoporosis clinics (on the 4 th floor). There is teaching on certain days of the week starting at 8 a.m. You typically come in for clinic between 8:30-9:00am
(depending on who’s clinic you are in) and see the patients after the nurses have taken vitals. All notes are typed in EPIC, there are no dictations.
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The clinics run from Monday to Thursday, Friday am is academic half day. In the afternoon, you will have triage rounds with one of the staff where you will learn how to triage referrals into the clinic. Subsequently there may be 1-2 patients booked that need to be seen on an urgent basis. There are osteoporosis rounds once a month at noon. There are general endocrine rounds Thursdays noon-1, it is important you attend these and try to finish your Thursday morning clinic in a timely fashion to do so.
Presentations: you will have 1 presentation on Thursday at noon.
Food: There is a fridge and microwave on the 3 rd floor. There is a
Tim Horton’s at the entrance and a
Nandos and sandwich deli across the street. If you like eating out, I recommend going to TGH or the Mars food court across the street.
Transportation/Parking: Park at UHN parking lot.
St. Michael’s Hospital:
Main Contact: Dr. Maria Wolfs
First day : You will meet the site coordinator, Dr. Maria Wolfs, who will give you a short orientation. After your orientation, you should go to the medical education office at the Li Ka Shing building (just north/behind the main hospital on the 5 th floor). They will direct you to get your badge and where you should go for your dictation number. You will need computer training and access to "Soarian Clinicals" for patient charting and labs and for entering orders. Try to get this done as soon as possible, the training center has several set times for training. Try to coordinate BEFORE your first day a time/date to train.
Nuts & Bolts: The structure of this rotation is a mix of clinics and inpatient consults. Roughly works out to
1/2 day clinic, 1/2 day consults every day. Clinics may be in the morning or afternoon depending on the day.
Most days run from 8 or 9am to 5 or 5:30pm. The clinic Schedule runs as follows Metabolic Bone Clinic
(Monday PM), Lipid Clinic (Tuesday AM), GDM Clinic (Tuesday PM), General Endocrine Clinic (Wednesday
PM), Diabetes Clinic (Thurs AM). Each of these days has an associated rounds at lunch: Monday bone rounds, Tues lipid rounds, Wed Grand Rounds, Thursday Diabetes rounds and subsequent resident teaching. No clinic on Fridays. There is also regularly scheduled "PAF" clinics for preoperative patients with endocrine issues (eg. DM2 on insulin going for CABG, thyroidectomy, pit adenoma resection, etc). These have 1-3 patients on Monday at 9:30am, Tues 2:30pm and Fri 12:30pm (although these clinics may be in flux for the 2015-2016 year. CALL PAF Clinic (Monday, Tues and Friday) mornings to gage the number of patients waiting for Endocrinology  and divvy up among residents early.
Workload of inpatients is fairly reasonable. It is a consulting service only. I estimate 1-2 new consults per day but it can be variable (0 to 6 while I was here). Your responsibility is to manage the team of about 3 residents who will see the consults; on the rare occasion, they are away and you see the consult yourself.
All consults are reviewed with staff same day or next day and don't need to be reviewed twice necessarily
(ie. once with you and then again with staff). There is an online patient "edischarge" list that needs to be updated daily on inpatient follow-ups. There is a medical resident on call who will cover these patients overnight and review with the staff if any issues arise. If for example you suspect there may be a concern with the patient overnight (e.g., likely to go into DI) have clear instructions on the signout list and verbally handover to the medical re sident who will be on call starting at 5 p.m. (usually the SCR “senior consultant resident”).
There is also a way to access the Soarian and edischarge system FROM HOME. It is super-helpful for following labs and glucose values from home. All you need is to contact the Help desk to get a "token" (long access no.) by email with instructions. You also need to download "RSA access" (free app) to your iphone/laptop for security clearance via a passcode that changes every 60 seconds. You can also update the signout list from home.
Presentations: You are expected to give 1 talks on a Wed morning (8:00am) on any topic of your choice
(except you have to run this "choice" by Dr. Wolfs or Dr. Yu to see if it's ok). Most staff are present and duration is approx 45 minutes with 10-15 min after for discussion. Both Drs. Wolfs and Yu are open to suggesting topics if you cannot come up with one. Don’t make slides too busy and remember to put the reference at the bottom of each slide. The staff are happy to review your slides as well.
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Food:
Breakfast is provided with Wednesday am rounds. There is a Subway down the street has a free drink with your sub for hospital staff. The Starbucks at Li Ka Shing has a small discount for hospital staff. Down the street (near 61
Queen st) there is a small café and a Druxys with good food at lunch.
Transportation: if you take the subway, Queen subway station is closest. If you drive, there is free parking on Shuter between Parliament and Sherborne. It will take you about 5 minutes to walk to the hospital from here, and I would NOT recommend parking here if you are staying late at night (rarely the case) or in the winter. There are various garages that offer monthly rates. You can also enquire with the medical education office at Li Ka Shing (5 th floor).
Call: You are expected to do 3 weekends during your 2 month block there - where you are rounding on the inpatients over the weekend and then acting as “junior attending” for any new consults seen over the weekend (ie. in-house resident the senior consultant resident (SCR) or junior consultant resident (JCR) sees the patient and reviews over the phone with you). The weekends are your choice, run them by Dr. Maria
Wolfs. When you are at St Michael’s hospital, you do call for St. Mikes and this is the only time you are not in the UHN call pool system. All other rotations (except away electives) you are in the UHN call pool system.
Foot:
Main Contact: Ann Marie Mclaren (Chiropodist):
Prior to the First day: contact Ann Marie Mclaren to obtain your schedule + and find out what clinic you are starting off at. You will need to register with medical education office at Li Ka Shing building just behind St.
Mike’s 
5 th floor. They will direct you to obtain your badge at the main hospital.
Nuts & Bolts: Usually you will be on the first floor of St. Michael’s hospital/Martin Arthritis center (Queen
Wing) working with the chiropodists. There is often a day scheduled for you at the WCH wound clinic as well. You will see a ton of patients with foot ulcers secondary to diabetic nephropathy. You will get to debride feet! It is up to you how much ‘hands on work’ you would like to do. You will also have opportunities to work with the wound care team treating inpatients at St. Mic hael’s hospital (not necessarily diabetes related).
Consider wearing scrubs to work.
There are no notes to dictate here, although you might help write the progress notes.
Presentations : N/A (none)
Food: cafeteria at on 6 th floor at St. Michael’s hospital, actually pretty good food. There is a second cup on
Queen St entrance. A Tim Horton’s is on the 1 st floor at the Cardinal Carter center. Several restaurants across the street (Druxy’s, Mcdonalds, a good café near 61 Queen st. east).
Transportation/Parking: BEST way to get here is the subway, Queen Subway stop. You can get street parking, which is expensive. Alternatively, I have found several ‘free’ streets on Shuter between parliament and sherborne (about a 5 minutes walk from the main hospital).
Community Rotation: Either at TEGH or Credit Valley (Mississauga)
TEGH:
Main Contact: Dr. Raymond Fung
– you will contact him well in advance to get your schedule for the month.
You will be working with different endocrinologists there.
First day: you will need to register at the medical education office, get your dictation # and get your ID badge. Dr. Fung and Dr. Fine use their own EMR where as Dr. Nicholas does the oral dictations himself.
Nuts & Bolts : The elective is 95% outpatient clinics, you might occasionally be asked to do an inpatient consult. You may spend 1-2 weeks with each of the staff depending on their availability.
Dictating: The only dictating you will do is for the GDM clinics, Dr. Fung/Fine have an outstanding online medical record system and you will type your note (very quickly thanks to templates) during office clinics.
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Presentations: N/A
Food: Cafeteria is in the main hospital. Alternatively, you can bring your own food.
Parking: you can try to park on the surrounding streets; however, parking meters are literally lurking at every corner. If you drive further, eg Virginia Ave or Holbourne Ave (5 minute walk from hospital) you can park there for free but move your car at lunch because there is a by-law that states a 4 hour limit. There is parking at the hospital for around $70-100 per month. An alternative is to take the subway to TEGH (just north of Coxwell subway). There is a bus from Coxwell station or you can walk ~10 minutes from there.
Credit Valley:
Main Contact: Dr. Alice Cheng
First day: Meet Dr. Alice Cheng/introduce yourself. You will need to go to the medical education office/credentialing dept at the hospital and register + get your ID badge.
Nuts & Bolts: The elective is 100% outpatient, in the professional building across from the main hospital.
You will rotate with the staff at credit valley. You usually don’t dictate notes as you will not have access. With
Dr. Longlois, you might type the note into the electronic medical record. There is usually no afternoon clinic on Friday.
Presentations: N/A
Food: Across the street, at the hospital or downstairs on the 1 st floor of the professional building. There is more selection in the hospital, namely a food court on the first floor.
Parking/Transportation: Approximately $45-50 for the time you are there. Difficult to get there without a car. It takes approximately 40 minutes to get from downtown Toronto to Mississauga (with no traffic) on the
Gardiner, or 40 minutes from Thornhill on the 407. Plan to leave early on your half day (if in the afternoon).
Sick Kids Rotation
Main Contact: Dr. Diane Wherrett
First Day: you will need to register, get your computer login (this WILL take at least ½ the day if not longer)
+ obtain a dictation number.
Nuts & Bolts:
You essentially function as an ‘elective resident’ on this rotation. The peds folks know that you are an adult endocrinology trainee and appreciate the fact that you have (likely) never treated children during residency. You will see a wide variety of pathology at sick kids that is not seen in the adult world
(growth hormone deficiency + learning to dose GH injections), the rare congenital diseases (such as
Turners, Noonans). Your month at Sick kids is divided into inpatient/outpatient experience. The day typically starts at 7:45 a.m. where you round on the ‘old’ ward patients (you will need to pre-round before rounds start). Most residents (including yourself) typically cover 1-3 patients (quite variable depending on work load/# of residents on service with you). After rounds, the team typically has clinic (diabetes or gen endo) most clinics are in the same location on the 1 st floor. The peds fellow covers ward issues. Afternoon is either devoted to clinic/inpatient or teaching.
Note, that over the first few days you might have limited computer access. Ask the peds fellow to help you gain access for the first few days. You will need to be able to login for 2 purposes: get lab values/data + review/sign your dictated notes. In terms of dictation, you will have your own number and dictate over the phone. I found a good system for follow ups: dictate while the computer is open so you can see how the previous note was done/formatted + see where the note is going to (referring/family MD). Since it might take a few days for your dictation number to arrive, SAVE your charts in one of the drawers in the clinic (RN’s will show you where) but remember to dictate them! You must review your dictated notes and will receive training around this.
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You can put your bag/stuff in the peds resident room (5 th floor of Sick Kids), the peds fellow will tell you the combo code to the room. There is a kitchen on the same floor as the peds room (ask to be shown the kitchen if you have food to store).
Presentations: you are expected to do 1 presentation during noon rounds. You are pre-slotted for this talk so email the chief resident 2 weeks before the rotation starts to determine your date.
Food : Sick kids has two great locations for food: an awesome food court, on the first floor (Elizabeth St side) and a smaller food court (also on the first floor) on the University avenue side. Tim Horton’s is at the smaller food court. You can also go to UHN or the Mars building nearby.
Parking: Park at UHN parking lot (cheapest) or take the subway. The closest stop is St. Patricks
Miscellaneous:
Internal Medicine Exam: This exam WILL take up the majority of free time you have as a PGY-4 from
September to May (or June). The first piece of advice I have to give you is to FIND A STUDY GROUP . This is CRUCIAL! It is very difficult to pass this exam studying alone. Your study group functions as your eyes and ears over your blind spot. Form the study group in June-August if you have NOT already done so.
All of us universally felt that one of the hardest parts of preparing for the exam, was balancing our
‘Endocrinology learning’ with internal medicine review. At times, you might feel like a ‘bad fellow’ or that you simply don’t have time to read the Endo articles you should have read because you are reviewing
Cardiology. My advice is to review and learn as much Endocrinology as you can over the summer. Know that your learning curve might temporarily be tapered off in the setting of studying for the royal college. Take the articles that you ‘should have read’ and put them in a pile called ‘after the RC’ or try to read here and there during breaks.
Another pearl is to try and schedule your presentations well in advance of the ‘crunch time’ for the RC. If not possible, finish the presentation in advance.
Know that studying/writing this exam is time consuming and we all appreciate your stress . Feel free to approach your PGY-5 colleagues next year for advice.
Call/Coverage Summary : UHN call all year round. The St Michael hospital resident is not in the UHN call pool because they do calls at St. Mikes. Christmas/New year is usually divided amongst the residents i.e. 10 days of coverage divided by the number of residents. You end up doing 1-2 days over the holidays.
Electives: Plan these early. Talk to Dr. Goguen to decide where your interests lie. Eg. If you eventually want to work in the community set up electives in the community where they may be hiring. If you want to do a thyroid cancer fellowship then do your elective in thyroid cancer. The earlier you plan this with Dr. Goguen the more likely you will be satisfied with your elective block.
Conferences: You are expected to go to CSEM/CDA but there are other excellent conferences annually.
Eg. Endo Society, AACE, ASBMR, ATA, etc.. You might be too busy with Royal College exam in 4 th year to go to any conferences, but definitely try to go to at least 2 in PGY5. As a trainee you are eligible for many travel awards if you present, so keep your ears peeled for submission deadlines. Conferences are a great way to network, learn new information, visit a new city, and look great on your CV if you present. Remember you are training in Toronto where there is a lot of the “weird and wonderful” so stay alert for interesting cases that can be written up and presented.
FINALLY, ENJOY YOUR 2 YEARS IN TORONTO! GO OUT, EXPLORE THE CITY, MAKE FRIENDS,
MEET PEOPLE, AND STUDY/WORK HARD! YOU LIVE IN A VIBRANT MULTICULTURAL CITY THAT
NEVER SLEEPS AND YOU ARE SURROUNDED BY GREAT MENTORS AND INVLUABLE
RESOURCES. EVERYONE HERE IS WILLING TO HELP YOU ADVANCE YOUR CAREER AND YOU
WILL RARELY RECEIVE A “NO” FOR ANYTHING YOU WANT TO DO DURING YOUR TRAINING, SO
MAKE THE MOST OF IT!
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