Rotation & Elective

Curriculum: Goals and Objectives
Department of Medicine
Harbor-UCLA Medical Center

ENDOCRINOLOGY AND METABOLISM (R2, R3)

A. The PURPOSE of this rotation is to provide clinical experience with patients having endocrine and metabolic problems in both the outpatient and inpatient settings. At the conclusion of this rotation, residents will have gained insight into the pathophysiology, diagnosis, natural history and management of many common endocrine and metabolic diseases. Aside from the general rotation described below, the elective may be modified to accommodate: 1) residents who choose to have a focused interest in one area of endocrinology; 2) wish to have a tailored or individualized rotation content; and 3) with to have clinical or basic research experiences. Specific areas of clinical research and basic research in the Division include:

1) study of male infertility and contraception;
2) study of reproductive aging;
3) androgen replacement therapy;
4) GH replacement therapy;
5) inborn errors of metabolism;
6) blood glucose regulation;
7) lipid disorders;
8) immune basis of Grave’s ophthalopathy;
9) studies of insulin secretory dysfunction;
10) genetics of type II diabetes;
11) studies of non diabetic hypoglycemia;
12) genetic basis of diabetic nephropathy;
13) Pituitary dysfunction after head trauma;
14) Kleinfelter syndrome;
15) regulations of Spermatogenesis;
16) adult stem cell transplantation into the testis.

This can be done through discussion of specific goals with the Chief of Endocrinology or one of the members of the Education Committee (Drs. Gianoukakis or Mao).

Both R2 and R3 residents may be assigned to the rotation. The Department of Medicine does not distinguish R2 and R3 resident assignments on this rotation; both have identical levels of responsibility for patient care, teaching, and medical record documentation. There are no differences in patient assignment.

However, R3 residents are expected to display a greater degree of independence in decision-making (under the supervision of the Attending Physician) than R2 residents.

B. GOALS AND OBJECTIVES
1. Increased understanding of common endocrine, reproductive, and metabolic disorders, including recent advances at the molecular level.
2. Ability to plan a comprehensive evaluation of an endocrine problems in a rapid, cost efficient manner.
3. Ability to accurately examine and describe normal and abnormal thyroid glands.
4. Increased experience in the diagnosis and management of endocrine emergencies including myxedema coma, thyroid storm, adrenal crisis, hyper- and hypocalcemia, and DKA.

C. The CLINICAL EXPERIENCE may include patients having:
1. Thyrotoxicosis
2. Thyroid nodules, thyroid cancer
3. Hypothyroidism
4. Diabetes mellitus
5. Hypocalcemia and hypercalcemia
6. Hypoglycemia
7. Management of morbid obesity
8. Differential diagnosis of Cushing’s
9. Pituitary tumors
10. Post menopausal management including osteoporosis
11. Endocrine causes of hypertension
12. Abnormalities of salt and water metabolism
13. Reproductive disorders: amennorhea, hypogonadism, erectile dysfunction, male factor infertility, hirsutism, gynecomastia

D. The CLINICAL SKILLS to be developed include:
1. Systematic approach to thinking about endocrine problems. 2. Ability to interpret the results of measurements of hormones in the blood and urine and the responses to stimulation and suppression of the glands.
3. Appropriate format for writing subspecialty consultations.

Curriculum: Goals and Objectives Department of Medicine Harbor-UCLA Medical Center

E. Exposure to the following endocrine PROCEDURES:
1. Interpretation of thyroid function tests
2. Fine needle thyroid aspiration and interpetation of the cytology
3. Nuclear medicine diagnostic and therapeutic modalities as related to endocrine disorders
4. Appropriate use of intravenous insulin (insulin drip), rational use of the newer oral antidiabetic agents
5. Performance and interpretation of common endocrine tests including cotrosyn stimulation, glucagon stimulation, and pituitary stimulation testing

F. EDUCATIONAL RESOURCES available during this rotation include:
1. Daily work rounds with fellow
2. Attending rounds 4x/week
3. Weekly core endocrine curriulum sessions
4. Weekly general endocrinology clinic
5. Weekly diabetes clinic which includes interaction with diabetes nurses educators, ophthalmology, psychiatry, nephrology, and nutrition staff part of the multidisciplinary approach to the management of diabetes in weekly diabetes clinic
6. Bi-monthly interdisciplinary pituitary clinic. Here, patients with pituitary/hypothlamic tumors are evaluated from both the medical (endocrine) and surgical perspectives

G. SUPERVISION will be provided by:
1. Endocrinology Fellow
2. Attending physician of consult service
3. Full time endocrine faculty in all clinics. Volunteer endocrine clinical faculty in endocrine and diabetes clinics (Endocrine and neurosurgical faculty in pituitary clinic).

H. EVALUATION of performance will be provided by written evaluation by the Attending Physician of the consult service. This evaluation takes into account feedback from fellows and nursing staff. Residents in turn evaluate the experience as a whole and the individual physicians they interact with in both the consult service and outpatient clinics.

I. WHO might ELECT this rotation
1. Residents who appreciate an intellectual challenge and have an appreciation for the importance of mechanism of disease.
2. Residents who are interested in pursuing a career in primary care and who would like to have a better handle on the intricacies of managing diabetes and thyroid diseases (two very common endocrine diseases).
3. Residents who want to explore the possibility of a career in this exciting, intellectually gratifying yet undersubscribed field of Endocrinology and Metabolism.