School of Medicine Course Syllabus Example Endocrinology Curriculum
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1 School of Medicine Course Syllabus Example Endocrinology Curriculum Description of Rotation This is a one month rotation in Endocrinology where third year medical students will gain experience in the evaluation and treatment of the most common endocrine and metabolic problems encountered in a general medicine practice setting. In this rotation, the third year medical student will join the residents, fellow and attending on service each month and participate in outpatient clinics as well as the inpatient consultations. Through regular close working with the team the student will be allowed to synthesize their own diagnostic and therapeutic plans for patients and discuss these with attending staff. Throughout the month the student will receive active teaching sessions with the fellow and attending as well as less structured learning on teaching rounds. Through the month it is hoped that students will become familiar with the appropriate directed history and physical examination, choosing and interpreting adequately the pertinent diagnostic studies and prescribing a plan of treatment and follow-up for most, if not all, of the following: 1. Diabetes Mellitus 2. Dyslipidemia 3. Thyroid disorders including hypothyroidism, hyperthyroidism, thyroid nodules and thyroid cancer 4. Parathyroid and calcium metabolism disorders 5. Anterior pituitary disorders: Pituitary tumors, pituitary incidentalomas, hypopituitarism, acromegaly, hyperprolactinemia. 6. Posterior pituitary disorders: Diabetes Insipidus, Stalk phenomena 7. Adrenal disorders: Adrenal insufficiency, Cushing s syndrome, pheochromocytoma, hyperaldosteronism and other causes of endocrine hypertension. Schedule Monday Tuesday Wednesday Thursday Friday Morning VA General Endo Pavilion Fellows VA Diabetes VA General Endo VA Lipid Clinic Afternoon Consults Consults Consults Consults Consults Students will attend their mandatory lectures and then join the endocrine group in clinic at the VA on every day except Tuesday (Fellows Pavilion clinic day) where students will instead see patients in the hospital in the morning. The schedule may change slightly and so the student is asked to contact the fellow on duty for that month when they begin the rotation. There are no weekend duties on this rotation.
2 Patient Care Students must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. 1. Obtain an accurate and pertinent Endocrine Medical history a. Obtain a complete and relevant endocrine medical history b. Recognize the classic presenting complaints, nuances and physical findings associated with endocrine diseases. c. Recognize the importance of family and medication history in endocrine disorders. 2. Learn, review or improve the following skills during physical examination: a. Examination and description of findings in patients with thyroid eye disease. b. Thyroid gland examination by inspection, palpation, auscultation and adequate description of the findings. c. Identify other common systemic manifestations of thyroid disease (heart, skin, nails, deep tendon reflexes, etc) d. Identify ocular and dermatologic manifestations of dyslipidemias e. Evaluation of gynecomastia f. Foot examination of diabetic patients including monofilament and vibratory sensation test identifying patients at high risk for diabetic ulcers. g. Gross visual field examination in patients with a suspected or known pituitary mass. h. Chvostek and Trousseau signs in patients with hypocalcemia i. Recognize the particular hand exam (short 4th-metacarpal) in patients with pseudohypoparathyroidism. j. Recognize and describe the physical findings of patients with acromegaly k. Recognize and describe the physical findings of patients with adrenal insufficiency l. Recognize and describe the physical findings of patients with Cushing s syndrome. m. Evaluate clinically patients with diabetic neuropathy (peripheral and autonomic) 3. Recognize the indications and limitations of the following diagnostic tests: a. Thyroid scan and thyroid uptake b. Thyroid Ultrasound c. Fine Needle Aspiration of the thyroid gland d. Bone density study e. Sestamibi parathyroid gland scan f. Pituitary imaging (CT, MRI) g. Cortrosyn (ACTH) stimulation test h. Dexamethasone suppression test i. Adrenal imaging j. Adrenal venous sampling k. Inferior petrosal sinus sampling
3 Medical Knowledge Students must demonstrate knowledge of established and evolving endocrine and metabolic disorders as well as the application of this knowledge to patient care. At the end of the rotation is expected that the student will be able to know and describe the pathophysiology, natural history, physical findings, diagnostic procedures, appropriate treatment and follow-up for the most common endocrine and metabolic disorders as follows: 1. Diabetes Mellitus, carbohydrate metabolism. a. Describe the classification and diagnosis of diabetes mellitus b. Understand the epidemiology and pathophysiology of diabetes mellitus, the current epidemic and how diabetes is affecting the state of Mississippi. c. Understand the importance of lifestyle modification and education in diabetes as a first line of therapy in the management of DM d. Learn and apply the ADA guidelines for diabetes care including goals for HbA1c, lipids, blood pressure control, use of aspirin, recommended immunizations, frequency of ophthalmologic exam, monofilament testing, microalbuminuria. e. Choose the most appropriate pharmacological agent for management of diabetes, individualized for each patient according to history and physical (weight, age, lifestyle, renal function, liver function, history of severe hypoglycemia or hypoglycemia unawareness, CHF, etc.). f. Initiate and/or adjust insulin regimen, choosing from the multiple types of insulin available 2. Dyslipidemia. a. Diagnose dyslipidemia b. Recognize when to initiate pharmacological therapy in patients with dyslipidemia and choose the most appropriate one. c. Describe the side effects associated with those drugs used for treatment of dyslipidemia; how to recognize and treat them as well as how to educate the patient of those risks. 3. Thyroid disorders a. Understand and describe the indications and limitations of the different thyroid function tests including TSH, FT4, TT3, antithyroid antibodies, TSI, uptake and scan of the thyroid gland, thyroid ultrasound. b. Describe the most common manifestations of hypothyroidism, causes, appropriate diagnosis and management. c. Describe the most common symptoms of hyperthyroidism, causes, differential diagnosis and treatment (Graves, subacute thyroiditis). d. Describe the appropriate management of hyperthyroidism according to the etiology. e. Understand the pros and cons of the different options for management of hyperthyroidism (antithyroid medications vs. ablation with 131 iodine), and explain it clearly to the patient so he/she can make an informed decision. f. Describe the evaluation of a thyroid nodule. g. Describe the indications and limitations of Fine Needle Aspiration of the thyroid gland.
4 h. Describe the risk factors for thyroid cancer, the natural history and the appropriate treatment and follow up. i. Recognize euthyroid sick syndrome 4. Parathyroid and calcium metabolism disorders a. Understand the mechanisms involved in the homeostatic control of calcium levels including magnesium, ph, albumin, PTH, and vitamin D b. Describe the most common manifestations, diagnosis and treatment of hyperparathyroidism including indications for surgery. c. Recognize the pathophysiology of osteoporosis, diagnosis and treatment. How to interpret a bone density scan enumerating the limitations and indications. d. Describe when to suspect vitamin D deficiency and the manifestations of osteomalacia and rickets. e. Understand pseudohypoparathyroidism and other PTH resistance states. f. Describe the various mechanisms associated with hypercalcemia of malignancy. 5. Anterior pituitary disorders: a. Describe the normal function and feedback of the pituitary gland and the interpretation of pituitary function tests. b. Recognize hypopituitarism: manifestations, diagnosis and treatment. c. Describe the evaluation and follow up of non-functional pituitary tumors. d. Describe the appropriate evaluation, management and follow-up of prolactinoma and acromegaly e. Describe the adequate evaluation of pituitary incidentalomas f. Explain the diagnostic algorithm for hyperprolactinemia and how to treat it. 6. Posterior Pituitary disorders: a. Describe the role of vasopressin in normal salt and water handling b. Recognize the clinical signs associated with diabetes insipidus and an appropriate diagnostic strategy to prove it. c. Understand how to discriminate central from nephrogenic diabetes insipidus and know of some agents that may cause this. Understand treatment regiments for both. d. Recognize the normal regulation of prolactin secretion and how this can be impacted by a pituitary lesion 7. Adrenal disorders: a. Describe the normal function and feedback regulation of the adrenal gland b. Recognize adrenal insufficiency and describe the different manifestations, diagnosis and treatment. c. Understand Cushing s syndrome including Cushing s disease, describing its manifestations, diagnosis and treatment. d. Know the manifestations, evaluation and treatment of pheochromocytoma e. Describe the appropriate evaluation of adrenal incidentalomas. f. Enumerate the different types of congenital adrenal hyperplasia, presentation, diagnosis and treatment g. Explain the appropriate evaluation, differential diagnosis and treatment of primary hyperaldosteronism.
5 Practice-Based Learning and Improvement Students must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant selfevaluation and lifelong learning. Competencies 1. Systematically analyze practice, using quality improvement methods, and implement changes with the goal of practice improvement. 2. Locate, appraise and assimilate evidence from scientific studies related to their patients health problems 1. Review the literature to find original studies and meta-analyses to support decisions on patient care. Systems Based Practice Students must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Students are expected to: Competencies 1. Work effectively in various health care delivery settings and systems relevant to their clinical specialty. 2. Work in inter-professional teams to enhance patient safety and improve patient care quality 1. Work effectively in different health care delivery settings: VA, University hospital, Inpatient, outpatient. 2. Participate actively in the multidisciplinary conferences involving ENT, general surgery, Neurosurgery, pathology Professionalism Students must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Students are expected to demonstrate:
6 Competencies 1. Compassion, integrity, and respect for others 2. Respect for patient privacy and autonomy 1. Arrive on time at the office or hospital 2. Demonstrate responsibility for patient privacy following the HIPPA regulations Interpersonal and Communication Skills Students must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. Students are expected to: Competencies 1. Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds 2. Communicate effectively with physicians, other health professionals, and health related agencies 1. Discuss with patients their management plans. 2. Order adequately patients for nuclear medicine tests or referral to other specialties 3. Provide feedback to referring physicians after a consult Teaching Methods A significant proportion of the teaching in this course will be through teaching at the patient bedside and through direct consultations. However, there will be a list of articles through which each student will be guided and they will also receive dedicated lectures with the clinical fellows and attendings. Students perform the history and physical examination and present the case to the attending endocrinologist. A plan for patient care is developed together, teaching points reviewed. Students will discuss their findings, impressions and plans of action with the fellow and attending who will provide constructive feedback and teaching. Learning will also occur in conferences. 1. The weekly endocrine conferences (Wednesday p.m.) will include lectures and case presentations. Bimonthly thyroid conference is held during this time where cases are presented by the endocrinology fellow for review with surgery or ENT, radiology and pathology. 2. Pituitary Conference is held every six weeks. Cases are presented by the endocrine fellow and reviewed with neurosurgery and pathology.
7 Assessment Method Evaluations of the student s clinical skills and overall performance in the core elements will be performed by the attending physician at the end of the month using the E-Value system. The student will also receive regular feedback from the fellow and attending throughout the month. At the end of the rotation, the fellow and/or attending will meet with the student to discuss their experience and look for ways to improve the rotation for future rotators. Level of Supervision Every encounter of a student with a patient (clinic or inpatient consult) is followed by a presentation of the case to the attending physician who will see the patient as well and perform a physical exam and confirm or acquire new information as needed, to have a supervised assessment and plan for every patient. Educational Resources 1. The endocrinology division has copies of over 100 papers in the different areas of endocrinology that cover all the specific objectives mentioned above. Students will get selected copies of these papers during their rotation as needed and according to the curriculum. 2. The university hospital library has copies of the most important journals in the field of endocrinology, diabetes and metabolism and a good number of them are available on-line as well 3. Students have free and permanent access to Up-To-Date. Revised July, 2012
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