A. Introduction

The Subspecialty Training Program in Endocrinology, Metabolism and Diabetes is designed to provide advanced training and experience at a level for the trainee to acquire the knowledge, skills, attitudes and experience required for all of the competencies needed by a consultant in this field. This program is designed to fulfill the needs of trainees who anticipate careers in the clinical practice of this specialty, those who expect to function as clinician-educators, and those who intend to pursue a career in clinical and/or basic research. The program recognizes that some trainees may evolve into specialists whose activities encompass more than one career path. The teaching environment and educational experiences for trainees, detailed below, will equip them to become strong clinicians, educators, and investigators.

Overall Goals

The ultimate goal of the Endocrinology and Metabolism Subspecialty Program is to educate fellows toward Board certification through excellence in educational instruction and achievement of required performance skills through implementation of The ACGME Six Core Competencies.

Major Goals for year 1 of the fellowship

1. To learn the basic and advanced endocrine biochemistry, physiology and pathophysiology which provide the basis for understanding endocrine disorders.

2. To accumulate a critical mass of fundamental information and practical approaches for the diagnosis, management and prevention of endocrine disorders including endocrine disorders in children.

3. To acquire knowledge and skills necessary for the critical analysis of the endocrine literature

Major Goals for year 2 of the fellowship

1. To gain skills as a medical educator by supervising fellows, residents and students.

2. To conduct scholarly research in Endocrinology, Metabolism and Diabetes

3. To gain hands on experience in order to acquire the knowledge necessary for the critical analysis of the results of endocrine laboratory tests.

4. To gain exposure to the Endocrinology of Reproduction

The ACGME Six Core Competencies:

I. Patient Care

a) Communicate effectively and demonstrate caring and respectful behavior

b) Gather essential and accurate information about their patients

c) Make informed decisions about diagnostic and therapeutic interventions

d) Develop and carry out patient management plans

e) Counsel and educate patients and their families

f) Use information technology to support patient care decisions and patient education

g) Perform competently all medical and invasive procedures

h) Provide healthcare services aimed at preventing and maintaining health

i) Work with healthcare professionals to provide patient-focused care

II.Medical Knowledge

a) Demonstrate knowledge about establishing and evolving biomedical, clinical and cognate sciences and how to apply them

b) Demonstrate an investigative and analytic thinking approach to clinical situations

c) Know and apply the basic and clinically supportive sciences

III. Practice-Based Learning and Improvement

a) Analyze practice experience and perform practice-based improvement activities using a systematic methodology

b) Locate, appraise and assimilate evidence from scientific studies

c) Obtain and use information about their own population of patients and the larger population of patients in the University

d) Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness

e) Use information technology to manage information, access online medical information and support their own education

f) Facilitate the learning of students and other healthcare professionals

IV. Interpersonal and Communication Skills

a) Create and sustain a therapeutic and ethically sound relationship with patients

b) Use effective listening skills as well as nonverbal clues

c) Work effectively with others

V. Professionalism

a) Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society; and a commitment to excellence

b) Develop a commitment to ethical principles

c) Demonstrate sensitivity and responsiveness to patients’ culture, age, gender and disabilities

VI.Systems-Based Practice

a) Understand the greater effects of patient care and other professional practices

b) Know how types of medical practice and delivery systems differ from one another

c) Practice cost-effective healthcare and resource allocation that does not compromise quality of care

d) Advocate for quality patient care and assist patients in dealing with system complexities

e) Know how to partner with healthcare managers and healthcare providers to assess, coordinate, and improve healthcare and know how these activities can affect system performance

B. Goals

The process of training fellows in endocrinology is that of graded responsibility and development. That is, while the types of rotations as well as clinical and research experiences are similar through the training program, the expectations and allotment of time varies significantly. This progress is detailed in the subsequent section, training milestones.

The following is a summary of the goals and objectives that pertain to the entire training program. The table that follows the listing of goals and objectives summarizes the specific goals and objectives for each training experience. These descriptions of goals and objectives and their specific applications to various training experiences are distributed to the trainees and to the faculty responsible for each training experience. Both trainees and faculty are required to understand these goals and objectives and to discuss the relevant ones before the beginning of each rotation.

1. To learn basic and advanced endocrine biochemistry, physiology and pathophysiology, which provide the basis for understanding endocrine diseases.

2. To accumulate a critical mass of fundamental information and practical approaches for the diagnosis, management and prevention of endocrine disorders.

3. To acquire the technical and practical skills required by a consultant in endocrinology, diabetes and metabolism.

4. To acquire clinical skills in a progressive fashion and with increasing responsibility appropriate for a consultant in endocrinology, diabetes and metabolism.

5. To acquire knowledge and skills necessary for providing cost-effective, ethical and humanistic care of patients with diabetes and disorders of endocrinology and metabolism.

6. To acquire knowledge and skills necessary for critical analysis of the laboratory testing and the endocrine literature.

7. To acquire skills in design and performance of hypothesis-driven endocrine research, and to participate in such research or equivalent scholarly activity. This may include gaining extensive experience in grant writing and scientific presentation.

C. Objective

The program will provide training in:

1. Endocrine biochemistry, physiology and pathophysiology
2. Hormone action and inter-relationships
3. Diagnosis and management of endocrine diseases including:
4. (3.1) History and physical examination with emphasis on the examination of the fundus of the eye, thyroid, breasts, penis, testes and female reproductive organs.
5. (3.2) Selection and interpretation of endocrine biochemical tests.
6. (3.3) Selection and interpretation of imaging procedures such as sonograms, radionuclide scans, computerized axial tomography, magnetic resonance imaging, positron emission tomography, etc.
7. (3.4) Fine needle aspiration of the thyroid, and interpretation of cytology and pathology.
8. (3.5) Understanding pharmacotherapy for endocrine disorders and appropriate use of surgery, radiation therapy, treatment with radioisotopes, etc.
9. Procedural and technical skills required by the endocrine subspecialist.
10. Professionalism, including peer interaction, communication with patients, their families and other health care providers, confidentiality and avoidance of conflict of interest.
11. Endocrine clinical and basic research.
12. Understanding of existing and emerging endocrine literature.
13. Personal scholarship and self-instruction.

A summary of specific learning objectives as they apply to the major learning experiences of this program is indicated below, and is detailed in the following sections.

D. Patient Care Experience

1. General

Trainees will be directly supervised and continually evaluated by attending physicians assigned to the inpatient and ambulatory settings. Inpatients are reviewed on a daily basis with the attending physician. Attending physicians who are physically in the ambulatory setting review the ambulatory care experience of the trainee on a case-by-case and real time basis. The continuing interaction between trainee and attending physician is the heart of the educational experience. The integration of endocrine disorders with other diseases of the patient is part of the interaction between attending physician and trainee. When relevant, health promotion and identification of risk factors for disease are emphasized. All patient interactions take into account cultural, socioeconomic, ethical occupational, environmental and behavioral issues.

Our program provides a progressive learning experience. Trainees are given increasing responsibility as they progress through the program and demonstrate their expanding knowledge base and expertise in diagnosis and management of endocrine disease. They serve as leaders of the endocrine ‘team’, which is constituted by trainee, Internal Medicine and Psychiatry residents and medical students, always under the supervision of the attending physician. Our program emphasizes a scholarly approach to diagnosis and management. Self-instruction is expected of the trainee along with critical analysis of the patient’s problems and appropriate decision analysis regarding further evaluation and/or management.

Professionalism and ethical behavior are hallmarks of the training program. Our faculty serves both as mentors and role model clinicians for the values of professionalism. These include placing the needs of the patient first, a commitment to scholarship, helping other colleagues, continuous quality improvement and humanistic behavior both in patient interactions and interactions with other health care providers. Issues concerning professional ethics and physician impairment are discussed as they relate to specific interactions with patients. When applicable, these issues will be discussed as part of the evaluation of specific patients. Attributes of professionalism may also be the subject of conferences using examples in Project Professionalism, published by the American Board of Internal Medicine (www.ABIM.org). Each trainee will be provided a copy of Project Professionalism and will be expected to read and understand its contents and behave according to the highest professional standards.

2. Ambulatory Care

Since most endocrine care is delivered in an ambulatory setting, the ambulatory experience is emphasized throughout the entire duration of the program.

Educational Purpose: To learn about a variety of diseases of endocrinology, metabolism and diabetes through consultation and provision of continuing care.

Goals and Objectives:

The General Goals and Objectives for the ambulatory experience are competency-based:

- Patient Care: Prioritize the daily “work” of the clinic; recognize the relative significance of a patients’ list of medical conditions; recognize the acuity and/or chronicity levels of illness; understand the indications, contraindications and risks of common procedures; work with all providers to provide patient-focused care.

- Medical Knowledge: Use literature and reference sources to increase knowledge base; demonstrate basic knowledge in the areas of underlying pathophysiology and the clinical aspects of basic disease states; apply knowledge in the treatment of patients.

- Professionalism: Establish trust with patients, their families, and staff; exhibit honesty, reliability and responsibility in patient care; demonstrate respect for patients and staff; work to fulfill the needs of patients; accept assignments graciously; attend conferences.

- Interpersonal Skills: Write understandable and legible notes; develop ability to listen to patients, their families, mentors and staff and communicate verbally and nonverbally in a productive manner; work effectively as a member of the health care team.

- Practice Based Learning and Improvement: Understand limitation of knowledge; use references and literature to improve practice patterns; accept feedback and change behavior; asks for help when needed.

- Systems Based Practice: Advocate for patients; learn about the health care system/structure and begin to develop mechanisms to utilize ancillary services to benefit patients.

Specific Goals for the ambulatory experiences:

During the ambulatory experiences, the trainee will gain the following:

1. Basic and advanced endocrine biochemistry, physiology and pathophysiology which provide the basis for understanding endocrine diseases and their management.

2. Fundamental information and practical approaches for the diagnosis, management and prevention of endocrine disorders.

3. The technical and practical skills that are required by a consultant in endocrinology, diabetes and metabolism.

4. Clinical skills in a progressive fashion and with increasing responsibility appropriate for a consultant in endocrinology, diabetes and metabolism.

5. Knowledge and skills necessary for providing cost-effective, ethical and humanistic care of patients with diabetes and disorders of endocrinology and metabolism.

6. Knowledge and skills necessary for critical analysis of the laboratory testing and the endocrine literature.

Specific Objectives for the ambulatory experiences:

During the ambulatory experience, the trainee will learn:

1. Endocrine biochemistry, physiology and pathophysiology.

2. Hormone action and inter-relationships.

3. Diagnosis and management of endocrine diseases including:

(3.1) History and physical examination with emphasis on examination of the

fundus of the eye, thyroid, breasts, penis, testes and female reproductive organs.

(3.2) Selection and interpretation of endocrine biochemical tests.

(3.3) Selection and interpretation of imaging procedures such as sonography,

radionuclide scans, computerized axial tomography, magnetic resonance

imaging, positron emission tomography, etc.

(3.4) Fine needle aspiration of the thyroid and interpretation of cytology and

pathology; us of thyroid ultrasound and ultrasound-guided biopsy

(3.5) Understanding pharmacotherapy for endocrine disorders and appropriate use

of surgery, radiation therapy, treatment with radioisotopes, etc.

4. Procedural and technical skills required by the endocrine subspecialist.

5. Aspects of professionalism, including peer interactions, communication with patients, their families and other health care providers, confidentiality and avoidance of conflict of interest.

6. Understanding of existing and emerging endocrine literature.

7. Advanced aspects of personal scholarship and self-instruction.

Teaching Methods: Ambulatory care is both consultative and continuing. For each interaction, the trainee will spend sufficient time with the patient to carry out an appropriate history and physical examination and then to interact with and be directly supervised by the endocrine faculty assigned to that ambulatory activity. The learning experience surrounding a patient interaction evolves from review, of history, physical examination and laboratory results with ‘the faculty, taking direction from the faculty and being provided with references or other learning materials that can be used for self-instruction and subsequent review with the faculty.

Disease Mix and Patient Characteristics: Patients are 18 years of age or older including adequate representation of geriatric patients. The distribution of age and sex in our clinics approximates their distribution among the general population with endocrine disease. Trainees care for patients with a wide range of clinical problems in stages of illness appropriate to the ambulatory setting.

In addition to clinics in which the trainee encounters the broad range of endocrine pathology, rotations through disease-specific clinics are an integral part of the training program. These clinical opportunities are either required or strongly encouraged. They include:

Procedures and Services; Dynamic endocrine studies and fine needle aspiration biopsy of the thyroid will be taught and performed by the trainees in the ambulatory setting. Appropriate laboratory testing, including imaging, will be ordered and results reviewed as part of the doctor/patient/attending interaction. Cytological and pathological material will be reviewed and analyzed when appropriate.

Reading Lists and Educational Resources: These are listed in an accompanying sections and in a binder according to the disease specific sections of the curriculum.

Evaluation: See section on evaluation, below.

Trainees are provided the opportunity to follow their ambulatory patients for the duration of the program. By means of the ambulatory experience provided in this program, the trainee has the opportunity to observe and learn the course of endocrine diseases and their treatments.

3. In-patient Care

Since endocrine specialists are frequently required to consult on and manage endocrine aspects of care in hospitalized patients, the training program also emphasizes training in the inpatient setting.

Educational Purpose: To learn about a variety of diseases of endocrinology and metabolism as they occur in the hospitalized patient.

Teaching Methods: Hospital care is both consultative and continuing. For each interaction, the trainee will spend sufficient time with the patient to carry out an appropriate history and physical examination and then to interact with and be directly supervised by the endocrine faculty assigned to that activity. The learning experience surrounding a patient interaction evolves from review of history, physical examination and laboratory results with the faculty, taking direction from the faculty and being provided with references or other learning materials that can be used for self-instruction and subsequent review with the faculty. Consultation is frequently requested to determine the impact of endocrine disease on coexisting illnesses that necessitated hospitalization. The trainee will also learn, under supervision, how to interact not only with the patient and family, but also with other physicians caring for the patient.

Specific Goals for the in-patient consultative service:

The resident will gain an understanding of:

1. Basic and advanced endocrine biochemistry, physiology and pathophysiology, which provide the basis for understanding endocrine diseases and their management.

2. Fundamental information and practical approaches for the diagnosis, management and prevention of endocrine disorders.

3. The technical and practical skills that are required by a consultant in endocrinology, diabetes and metabolism.

4. Clinical skills developed in a progressive fashion and with increasing responsibility appropriate for a consultant in endocrinology, diabetes and metabolism.

5. Knowledge and skills necessary for providing cost-effective, ethical and humanistic care of patients with diabetes and disorders of endocrinology and metabolism.

6. Knowledge and skills necessary for critical analysis of the laboratory testing and the endocrine literature.

Specific Objectives for the in-patient consultative services:

During this training experience, the trainee will learn:

Diagnosis and management of endocrine diseases including:

(1) History and physical examination with emphasis on examination of the fundus of the eye, thyroid, breasts, penis, testes and female reproductive organs.

(.2) Selection and interpretation of endocrine biochemical tests.

(.3) Selection and interpretation of imaging procedures such as sonography, radionuclide scans, computerized axial tomography, magnetic resonance imaging, positron emission tomography, etc.

(.4) Fine needle aspiration of the thyroid and interpretation of cytology and pathology.

(5) Understanding pharmacotherapy for endocrine disorders and appropriate use of surgery, radiation therapy, treatment with radioisotopes, etc.

(6) The interaction of the endocrine disorders with complex other medical illnesses.

Disease Mix and Patient Characteristics:

On request, trainees provide consultation to the Internal Medicine service and other departments such as Surgery, Obstetrics and Gynecology, Psychiatry, Neurosurgery, etc. Patients will have a variety of diseases that impact on the endocrine system, diseases of other systems with coexisting endocrine disease, or manifestations of primary endocrine disease such as diabetes mellitus, thyroid or parathyroid disease that warrant hospitalization. Patients will be adults of all ages, including the geriatric age group and both sexes. Sex and age of patients will parallel their distribution among the variety of endocrine disease that occurs in hospitalized patients. The severity of illness will be much greater than in the ambulatory setting.

Procedures and Services:

When the trainee receives a request for consultation, she/he generally assigns a resident or student to first see the patient. After the resident has seen the patient, the trainee reviews the resident’s findings at the bedside. The trainee will, with the resident, then present and discuss the patient with the attending physician who has ultimate responsibility for the consultative care of the patient. If for some reason the attending physician is not available in a timely manner, the trainee and resident will present the patient to the Chief of the Division.

The standard hospital day is between 8:00 AM and 5:00 PM from Monday through Friday. Fellows will respond to requests for consultations according to these written guidelines of responsibility for all rotations and clinics. The senior trainee develops an on-call schedule that falls within the rules for trainees’ working hours. The Program Director and the Director of the House Staff Office regularly review these schedules. When on call during nights and weekends, they must be available for emergency and non-emergency consultations. This can be done from home or by cell phone. Trainees may respond to requests for information on emergency and non-emergency situations by telephone. They must make a judgment about whether to come in to see the patient immediately themselves.

If they do the latter, they will then communicate with an attending physician who will review the problem and make suggestions, which the fellow will take to the bedside of the patient and interact with the medical residents caring for the patient. The trainee, in all cases, is not responsible for the direct care of the patient, only offering consultative service.

Trainees coordinate the evaluation and management of the endocrine aspects of the patient’s illness. After interaction with the endocrine attending physician, the trainee will order appropriate laboratory tests, biopsies, imaging and infusion studies, as dictated by the patient’s problem. Data will be reviewed and treatment recommended.

Reading Lists and Educational Resources: These are listed in the accompanying binder under the disease specific sections of the curriculum.

Evaluation: See section on evaluation, below.

Trainees evaluate patients by history, physical examination, and review of available laboratory and other data. The trainee is encouraged to formulate a differential diagnosis, plan for further evaluation and management. These are reviewed with faculty assigned to teaching rounds. Learning occurs by an iterative process through continuing interaction with faculty, review of pertinent literature and further discussion as new data emerges or changes in the patient’s condition occurs as a consequence of recommended treatment.

Experience in the inpatient setting will include preparation of appropriate patients with endocrine disease for surgery as well as postoperative management, radiation therapy and/or treatment with iodine-I- 131. Interaction with professionals from other departments is reviewed and evaluated. In-patients who have surgery or biopsy, pathology and cytology are reviewed with appropriate specialists in those departments.

E. Resources

1, Rotation Schedules (Year 1-2). Tabular Overview Of Activities

PATIENT CARE EXPERIENCE: YEAR 1

1) Ambulatory Care

In the ambulatory care setting, fellows provide the initial encounter with the patient. They take a medical history and perform a physical examination. They review medications and all diagnoses. Fellows then formulate diagnostic and treatment plans, and present them to the Attending Physician who then interviews and examines the patient together with the trainee, and a final plan is agreed upon.

2) Inpatient Care

Consults are requested by other Divisions and Departments by calling the Division Administrative Office or the Department Group Practice Office. Fellows may designate residents or students to provide the initial consultation, but they follow-up that encounter with their own thorough medical history and physical examination which is entered into the patient chart. New patients are seen together with the Attending Physician of the month within 24 hours.

PATIENT CARE EXPERIENCE: YEAR 2

1) Ambulatory Care

In year 2, the ambulatory care experience is reduced to allow protected time for research and other scholarly activities. Fellows also rotate through Ophthalmology Clinic for 1 month to gain experience in this discipline.

2) Inpatient Care

The program has full-time secretarial support, which facilitates scheduling, arranging consultations, preparing conference schedules and referrals. Fellows have office space in a room within the Division Suite that contains a computer for email and internet services, including literature searches, and basic texts. The faculty members receive a number of journals and books, all of which are available to the trainee. Trainees are encouraged to participate in local and national endocrine meetings. In general, each trainee attends one national meeting per year.

1.9.1 Teaching Site(s)
See Attached.

1.9.2 Rotations
See Attached.

1.9.3 Additional Facilities and Resources

Our hospital has modern facilities and services, including in-patient, ambulatory care and laboratory resources and these are readily available to all trainees. In addition, complete biochemistry laboratories and hormone assays are available 24 hours per day. The hospital has facilities for karyotyping. The Department of Radiology provides MRI, CT, ultrasound, DEXA and radiologic imaging services that can conduct studies for all types of endocrine diseases including petrosal sinus and adrenal vein sampling. The hospital supports a dietary/nutritional service. There is a fully staffed surgical pathology laboratory for the interpretation of surgical and cytologic specimens, including immunohistologic studies. Cytologic interpretation of thyroid aspirations is available and fellows review these specimens with the Department of Pathology staff and in a monthly Thyroid Conference. Nuclear Medicine provides all routine radionuclide imaging methods including radio-iodine thyroid scanning and ablation, adrenal and parathyroid scanning as well as MIBG and technicium pyrophosphate bone scans. Podiatric Medicine provides care to all patients at University Hospital on an as-needed basis.

2. Conferences

Specific Goals:

The resident will gain an understanding of:

1. Basic and advanced endocrine biochemistry, physiology and pathophysiology, which provide the basis for understanding endocrine diseases and their management.

2. Fundamental information and practical approaches for the diagnosis, management and prevention of endocrine disorders.

3. Knowledge necessary for providing cost-effective, ethical and humanistic care of patients with diabetes and disorders of endocrinology and metabolism.

4. Knowledge necessary for critical analysis of the laboratory testing and the endocrine literature.

5. Skills in design and performance of hypothesis-drivenendocrine research, and to participate in such research or equivalent scholarly activity. This may include gaining extensive experience in grant writing and scientific presentation.

Specific Objectives

During this activity, the trainee will learn:

1. Endocrine biochemistry, physiology and pathophysiology.

2. Hormone action and inter-relationships.

3. Diagnosis and management of endocrine diseases including:

(a) Selection and interpretation of endocrine biochemical tests.

(b) Selection and interpretation of imaging procedures such as sonography, radionuclide scans, computerized axial tomography, magnetic resonance imaging, positron emission tomography, etc.

(c) Understanding pharmacotherapy for endocrine disorders and appropriate use of surgery, radiation therapy, treatment with radioisotopes, etc.

4. Procedural and technical skills required by the endocrine subspecialist.

5. Aspects of Professionalism, including ethics, confidentiality and avoidance of conflict of interest.

6. Endocrine clinical and basic research.

7. Understanding of existing and emerging endocrine literature.

8. Advanced aspects of personal scholarship and self-instruction.

Clinical Conferences

Multidisciplinary Endocrine Grand Rounds

This weekly conference is attended by faculty, trainees and students from many
Departments within the University of Louisville Medical School including Medicine, Obstetrics-Gynecology, Surgery, Urology, Laboratory Medicine, Nuclear Medicine, Pharmacology, Clinical Pharmacology and Biochemistry/Molecular Biology.

Educational Purpose: To discuss a variety of diseases of endocrinology and metabolism in greater depth than at the bedside or the ambulatory care setting. Correlation with endocrine biochemistry, physiology and pathophysiology is expected.

Teaching Method: Case discussions or lectures by University of Louisville faculty, or visiting faculty from other institutions.

Disease Mix: All endocrine diseases are discussed. Less common disorders that might not be encountered by a trainee during the program are also discussed.

Procedures and Services: Appropriate use of biochemical testing, imaging and biopsy as well as review of above studies, cytology and pathology may be the subject of the conference.

Reading Lists and Educational Resources: May be prepared for selected conferences. More detailed lists and resources are provided below in the sections on specific groups of endocrine diseases.

Fellows Conference:

The purpose of the fellows’ conference and methods are similar to those used in Endocrine Grand Rounds except that fellows prepare the conference. The fellows’ conference is monthly. This approach allows fellows to review in depth a topic of interest to them, and to learn to be a lecturer. The conference also helps the first year fellow select an area of research concentration.

Evaluation: Trainees who give conferences will be evaluated by attending physicians. Their performance in this venue is part of their overall evaluation by attending physicians and the program director. See section on evaluation, below.

Basic Science Conference

Educational Purpose: To instruct trainees in the basic biochemistry, physiology and pathophysiology of the endocrine system. At a minimum, subject areas will include molecular biology and immunology as they relate to endocrinology and metabolism, signal transduction pathways, biology of hormone receptors and principles of hormone action, biology of sexual development, reproductive endocrinology, endocrine aspects of sexual dysfunction, and feedback systems.

Teaching Method: Trainees will be given materials for self-instruction in the subject area of the Basic Science Conference. Faculty will lead the conference, which will usually be a seminar format with as much interaction between trainees and faculty as possible.

Evaluation: The faculty will evaluate trainee preparedness and interaction. In turn, trainees will evaluate the effectiveness of the faculty.
Basic Science Conferences are held monthly or twice monthly. It is organized by the Endocrine Research Group in the Department of Biochemistry/Molecular Biology. Endocrine Scientists from that Department, Obstetrics-Gynecology and Women’s Health, and the School of Dental Medicine participate regularly. In addition, many other basic science conferences take place within our institutions both in basic science and clinical departments. Their schedules are posted and trainees are encouraged to attend, as their time allows.

Journal Club

Journal Club is scheduled twice or three times monthly. Faculty, trainees in Endocrinology, and Residents and students electing the Endocrine rotation attend and present to the group. Handouts of Abstracts and data from the manuscripts are provided for detailed review.

Educational Purpose: To expose trainees, on a continuing basis, to critical reading of the emerging endocrine literature. Participation in Journal Club also provides instruction in clinical epidemiology, in biostatistics and in clinical decision theory.

Teaching Method: Trainees will be expected to present analyses of papers of their own selection. Their presentation will include analysis of experimental groups and design, methodology of measurements, and of statistical analysis. Others, including faculty, will interact with the trainee.

Disease Mix: Literature relating to all endocrine disease will be discussed during the training program.

Procedures and Services: As research concerning endocrine procedures or services is published, those papers may come under discussion in Journal Club.

Evaluation: Trainee’s performance in this venue will be part of their evaluation by the faculty. In turn, trainees will evaluate faculty as facilitators of the Journal Club and as participants.

Research Conferences

Educational Purpose: To acquaint trainees with the status of current research carried out by the faculty, other trainees, members of other Divisions within the Department of Medicine, or other Departments in the institution. Trainees will participate in the critique of the presentation and be exposed to the interactive discussions of the participants.

Teaching Method: Interactive discussion of presented research among experts on topics of basic and clinical science of endocrinology and metabolism, including experimental design, methodology, statistical analysis and interpretation of data. In addition, those fellows actively participating in either basic or clinical research will present their research project to the division at least annually.

Disease Mix: Research may be presented that relates to any and all endocrine disease.

Procedures and Services: Not applicable.

Research and Basic Science Conferences are scheduled at monthly or twice monthly intervals, and occur at least weekly intervals for other Divisions and Departments within the institution. Those schedules are posted and trainees are encouraged to attend, as their time allows. They must attend Research Conferences at least monthly intervals.

Endocrine Tumor Conference

Educational Purpose: To discuss interesting and challenging cases referred for surgical management. The conference teaches fellows to interact with colleagues in other disciplines who share interest in Endocrine diseases.

Teaching Method. This conference is organized by the Division of Surgical Oncology. In attendance are surgical and medical oncologists, radiologists, and pathologists. Interesting and challenging patients are presented for discussion. Radiographs, scans and pathological specimens are viewed and discussed. Articles from the medical literature relating to these cases are reviewed.

Disease Mix. Thyroid cancer as well as other endocrine tumors including parathyroid tumors, pancreatic tumors, and ectopic tumors.

Procedures and Services: NA

Conferences are scheduled monthly,

3. Procedures

Trainees will obtain a comprehensive understanding of indications, contraindications, limitations, techniques, complications and interpretations of procedures that are required for diagnosis and management of patients with disorders of endocrinology and metabolism. This understanding includes informing the patient about the above aspects of specific procedures and obtaining informed consent. Procedures will be taught and then supervised by faculty in various patient care settings, described above. Trainees will maintain logbooks that list each procedure and copies will be maintained in the program director’s files. Each entry includes name of patients, identifying numbers, clinical problem, procedure, indication of complications, results of test. The program director will determine, on the basis of faculty input and analysis of logbook entrees, when the trainee has achieved proficiency in a specific procedure. For fine needle aspiration biopsy of the thyroid, a minimum of 10 aspirations must be done before a trainee can be considered to be proficient or require further training and experience.

All procedures are carried out in accord with universal precautions and protection of health-care workers, as defined by Occupational Safety and Health Administration (OSHA). Trainees, along with all other health care personnel at this institution, must participate in annual training sessions(s) on precautions for health-care workers, as detailed by OSHA.

The specific procedures that will be learned in this training program will be detailed in the disease-specific sections of this curriculum.

4. Other Competencies

Trainees who do not have appropriate computer skills to enable them to search the literature electronically, participate in computer-assisted instruction and use electronic information networks will be taught those skills.

Issues concerning quality assessment, quality improvement, risk management and cost-effectiveness are discussed in all clinical and laboratory settings throughout this program.

Similarly, ethics and professionalism are considered in all patient interactions and may be supplemented by exercises in Project Professionalism, published by the American Board of Internal Medicine. As indicated above, each trainee will be given a copy of this publication and expected to carry out their daily activities in accord with the highest professional standards.

Additional training experiences are encouraged in clinical pathology. For those trainees who may, in future activities, direct a clinical laboratory, twenty hours of supervised training in the indications, performance, and evaluation of results of endocrine testing are suggested.

Patient education, counseling and end-of-life care will be taught by example when appropriate in specific interactions with patients and their families. Other issues that concern palliative care for terminally ill patients are discussed when appropriate. Two available resources may be used as supplementary teaching materials, if deemed necessary by the program director. These are the publications: (1) Care of the Dying and Promotion of Physician Competency- Educational Resource and Personal Narratives, published by the American Board of Internal Medicine (www.ABIM.org), and (2) EPEC (Education for Physicians on End-of-life Care), published jointly by the Robert Wood Johnson Foundation and the American Medical Association (www.amaassn.org/ethic/epec) .

F. Research and Other Scholarly Activities

Trainees in this program are expected to conduct research and to participate in other scholarly activities. During the first year, trainees are expected to learn about the research interests of the faculty members by attending Research Seminars, Journal Clubs, or by direct interaction initiated by the faculty, trainee or program director. In general, trainees should reach an agreement to carry out research with a specific faculty member by the middle of the first year of the program. This allows the trainee to learn the literature concerning the research area and begin, by repeated interaction with the faculty mentor, to formulate an experimental design. Thus, by year 2 of the fellowship, the trainee is ready to move into the research arena without delay. In our program, the allotment of time dedicated to research varies over the course of a training year as well as between years of training. In general, the annualized percentage effort for research is:

Year l 5%
Year 2 50 %

The research experience in our training program is based on a mentor:trainee relationship that is meaningful, interactive at frequent intervals, and that leads to formulation of the research problem, determination of appropriate experimental design, use of appropriate research methodology, analysis of data, interpretation of results and, eventually, publication in peer-reviewed journals. In our program, trainees publish in peer-reviewed journals and present their work at national endocrine meetings.

In addition to basic and clinical research, trainees will present at Clinical Conferences, Journal Club, and, possibly, Research Seminars. They are encouraged to write up and publish interesting cases that they encounter during their training. Finally, faculty is encouraged to ask trainees to participate in writing of invited Chapters or Reviews, with appropriate authorship designation.

Specific Goals:

The resident will gain an understanding of:

1. Basic and advanced endocrine biochemistry, physiology and pathophysiology, which provide the basis for understanding endocrine diseases and their management.

2. Knowledge and skills necessary for providing cost-effective, ethical and humanistic care of patients with diabetes and disorders of endocrinology and metabolism.

3. Knowledge and skills necessary for critical analysis of the laboratory testing and the endocrine literature.

4. Skills in design and performance of hypothesis-drivenendocrine research, and to participate in such research or equivalent scholarly activity. This may include gaining extensive experience in grant writing and scientific presentation.

Specific Objectives

During this activity, the trainee will learn:

1. Endocrine biochemistry, physiology and pathophysiology.

2. Hormone action and inter-relationships.

3. Aspects of professionalism, including peer interactions, ethics, confidentiality and

avoidance of conflict of interest.

4. Endocrine clinical and basic research.

5. Understanding of existing and emerging endocrine literature.

6. Advanced aspects of personal scholarship and self-instruction.