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Endocrine Elective Learning Objectives
Medical students who participate in the 4th year Endocrine Elective will achieve the following learning objectives:
- Diabetes mellitus. Differences between Type 1 and Type 2 diabetes. Natural course of diabetes and its complications. Appropriate monitoring methodologies to include home glucose monitoring, glycated proteins and microalbumin. Dietary management and pharmacological therapy to include intensive insulin programs. Patient recommendations for "sick days" and hypoglycemia. Management of commonly associated disorders (hyperlipidemia and hypertension) and their interaction with diabetic therapy. Appropriate and timely referrals to ophthalmology, podiatry, dietary and the diabetes education program.
- Thyroid disease. Diagnostic evaluation and management of the functional thyroid disorders (hypothyroidism and hyperthyroidism). Treatment options for hyperthyroidism. Evaluation of anatomic thyroid abnormalities (simple goiter, multinodular goiter and solitary thyroid nodule) to include use of nuclear medicine procedures, ultrasound studies and fine needle aspiration. Evaluation of thyroid function tests in the intensive care setting.
- Lipid disorders. NCEP guidelines. Secondary hyperlipidemia, Dietary and pharmacologic management of dyslipidemias.
- Metabolic bone diseases. Diagnostic evaluation and treatment options of osteoporosis. Risk factors for osteoporosis. The use of bone densitometry. Osteomalacia. Paget's disease.
- Calcium disorders. Diagnosis and management of hypercalcemia and hypocalcemia. Management of hyperparathyroidism (medical vs. surgical). Management of critical hypocalcemia and hypercalcemia. Diagnosis and management of vitamin D deficiency.
- Adrenal disease. Diagnosis and management of Cushing's syndromes, adrenal failure and pheochromocytoma. Diagnosis and management of adrenal emergencies (Addisonian or pheochromocytoma crisis). Evaluations of the incidental adrenal mass.
- Pituitary disease. Diagnostic evaluation of pituitary tumors to include the incidental pituitary mass. The role of surgery, radiation therapy and medical management. Diagnosis and management of pituitary apoplexy. Empty sella syndrome. Diagnosis and evaluation of posterior pituitary dysfunction (SIADH and diabetes insipidus).
- Gonadal dysfunction. Diagnostic evaluation of gynecomastia, hirsutism, amenorrhea and impotence. Androgen and estrogen replacement therapy.
4th Year Medical Student Endocrine Elective
In their 4th year, medical students can choose to participate in the Endocrine Elective. The educational goals of the Endocrine Elective for 4th year medical students are:
- to develop the ability to independently evaluate, treat and monitor common endocrine disorders (diabetes, thyroid dysfunction, lipid abnormalities, metabolic bone disease, and calcium disorders)
- to be familiar enough with the less common endocrinopathies (adrenal disease, pituitary disease and gonadal dysfunction) to recognize the abnormality and initiate evaluation prior to sub-specialty consultation.
Organization of the Elective
The following is an overview of the organization of the 4th year Medical School Endocrine Elective.
- Orientation: Dr. Cantley will meet with the students the week prior to/the first day of the rotation.
- Endocrine Clinic: Students will attend an Endocrine clinic on all occasions that do not conflict with their other responsibilities of this rotation. This is a fundamental component of the rotation. Failure to attend clinic is equivalent to failure to attend rounds on an inpatient service.
During clinics, you will see patients WITH the attending. This structure will allow you to have numerous exposures to Endocrine patients in a short time frame and will give you the opportunity to augment your skills (thyroid palpation, adjusting insulin regimes, etc.) efficiently through the many one-on-one interactions shared with the attending.
- Inpatient consultations: It is the resident's responsibility to ensure that the appropriate history and physical examination is obtained on each consult, and to follow the patient's progress during the hospitalization. The medical students will be assigned to follow consults along with the resident, but the resident remains primarily responsible. Residents are not to offer suggestions to the housestaff or make recommendations in the chart until the patient has been presented to the attending. The times for consult rounds will be set by the attending of the month, but SHALL NOT interfere with clinic obligations.
Conferences: Students will attend each of the following conferences:
- Endocrine Conference: Wednesdays, 1:00-2:00 p.m., Endocrine conference room, E floor, Nutrition Bldg
- Internal Medicine Grand Rounds: Thursdays, 8:00-9:00 a.m., Commons area
- Thyroid Conference is held every other Friday at 7:30 a.m.. This conference is optional
- Reading list: Completion of the reading list is an essential part of the Endocrine Elective. It consists of review articles from the general medicine literature concerning important endocrine and metabolic issues.
- Final Exam: At the conclusion of the elective, there will be a written test for the residents (but not for students) covering material primarily from the reading list.
- Diabetes Education: You are required to spend one session with the "Senior Adult Learning About Diabetes" ("SALAD") course. This is held 9:00 a.m.-11:00 a.m. at the Diabetes Care Center at Piedmont Plaza (5th floor) on every Wednesday throughout the year. Contact the Diabetes Nurse Educator at 6-8234 to let her know you are coming.
- Department of Internal Medicine Activities: You are expected to attend the regularly scheduled conferences for the Department of Internal Medicine.
The faculty of the Section on Endocrinology is committed to provide a valuable educational experience during your rotation. Please let me know if you have any questions or concerns regarding this elective.
K. Patrick Ober, MD.
Endocrinology And Metabolism Clinic Schedule