Endocrinology Curriculum

Department: Internal Medicine

            Faculty Coordinator: Richard Sachson, M.D.

            Hospital: Texas Health Presbyterian Hospital Dallas

            Periods offered: All

            Length: 4 weeks

            Max no. of residents: 2

            First Day Contact: Dr. Sachson - (214) 363-5535

            First DayTime: 9:00 a.m.

            First Day Place: 10260 N. Central Expressway, Suite 100, Dallas, TX 75231

            Requirements: Monday through Friday 9:00 am to 5:00 pm

            Weekends: None

I. Course Description:

Residents will be working with an Endocrinologist. They will participate in seeing inpatient consults. However, the primary focus of this rotation is an outpatient clinic where the resident will gain skills in the recognition, evaluation, and management of metabolic disease states.

II. Course Goals and Objectives: (based on ACGME competencies for resident education)

Patient Care:

Residents are expected to provide care that is compassionate, appropriate and effective for the promotion of health, prevention of illness, treatment of disease and at the end of life.

Objectives:

• Gather accurate, essential information from all sources, including medical interviews, physical examinations, medical records and diagnostic/therapeutic procedures. Examples: Resident will learn the skills of taking a complete, system-focused history and physical exam in the patient with an endocrine related illness; Resident will learn cost effective, evidence-based diagnostic evaluation of the patient with endocrine disease.
  
  
• Make informed recommendations about preventives, diagnostic and therapeutic options and interventions that are based on clinical judgement, scientific evidence, and patient preference. Examples: Resident will be able to inform the patient with diabetes mellitus or a thyroid nodule about the appropriate interventions for their disease state; Resident will educate the at-risk patient about evidence-based interventions to prevent diabetes mellitus and osteoporosis.
  
  
• Develop, negotiate and implement effective patient management plans and integration of patient care. Examples: Resident will learn the skill of working with a multidisciplinary team in the education, evaluation, and management of the patient with diabetes mellitus, obesity, and infertility.
  
  
• Perform competently the diagnostic and therapeutic procedures considered essential to the practice of internal medicine. Examples: Resident will observe the technique of a thyroid nodule biopsy.

Medical Knowledge:

Residents are expected to demonstrate knowledge of established and evolving biomedical, clinical and social sciences, and the application of their knowledge to patient care and the education of others.

Objectives:

• Apply an open-minded, analytical approach to acquiring new knowledge. Examples: Resident will demonstrate a desire to pursue knowledge by reading about patients seen in the office, bringing literature pertaining to the area of interest in Endocrinology to the attending, actively listening and asking appropriate questions of the attending.
  
  
• Access and critically evaluate current medical information and scientific evidence. Examples: By participating in journal club, the resident will learn the art and science of evaluating medical literature. He/she will apply this to the field of Endocrinology.
  
  
• Develop clinically applicable knowledge of the basic and clinical sciences that underlie the practice of internal medicine. Examples: Resident will read, understand and apply the biochemistry and physiology of the endocrine system to the common metabolic diseases such as diabetes mellitus, hyperlipidemia, Cushing's syndrome, and hypertension.
  
  
• Apply this knowledge to clinical problem-solving, clinical decision-making, and critical thinking. Examples: See above. 

Practice-Based Learning and Improvement:

Residents are expected to be able to use scientific evidence and methods to investigate, evaluate, and improve patient care practices.

Objectives:

• Identify areas for improvement and implement strategies to enhance knowledge, skills, attitudes and processes of care. Examples: Resident will, with the help of the attending, recognize his/her knowledge deficits and read text books, review articles and original research to improve the deficits.
  
  
• Analyze and evaluate practice experiences and implement strategies to continually improve the quality of patient practice. Examples: Gaining experience in a well-run Endocrine Clinic, the resident will develop skills to improve the care of his/her Internal Medicine Clinic patients with diabetes mellitus, osteoporosis, hyperlipidemia, etc.
  
  
• Develop and maintain a willingness to learn from errors and use errors to improve the system or processes of care. Examples: Resident will have an open-minded approach to realizing his/her errors and working with the attending to correct those errors.
  
  
• Use information technology or other available methodologies to access and manage information, support patient care decisions and enhance both patient and physician education. Example: Resident will be skilled at accessing current literature through the Internet. 

Interpersonal and Communication Skills:

Residents are expected to demonstrate interpersonal and communication skills that enable them to establish and maintain professional relationships with patients, families and other members of health care teams.

Objectives:

• Provide effective and professional consultation to other physicians and health care professionals and sustain therapeutic and ethically sound professional relationships with patients, their families, and colleagues. Examples: Resident will be skilled in his/her role as consulting endocrinologist and work with the referring physician to manage and educate the patient. He/she will demonstrate professional behavior when interacting with patients and staff.
  
  
• Use effective listening, nonverbal, questioning, and narrative skills to communicate the patients. Examples: Resident will be able to obtain an accurate history by using the above skills. He/she will also demonstrate the skill of informing and educating the patient.
  
  
• Interact with consultants in a respectful, appropriate manner. Examples: See above.
  
  
• Maintain comprehensive, timely, and legible medical records. Examples: Resident will be responsible for entering timely, written or dictated consultations and progress notes in the inpatient and outpatient setting.

Professionalism:

Residents are expected to demonstrate behaviors that reflect a commitment to continuous professional development, ethical practice, an understanding and sensitivity to diversity and a responsible attitude toward their patients, their profession, and society.

Objectives:

• Demonstrate respect, compassion, integrity, and altruism in relationships with patients, families, and colleagues.
  
  
• Demonstrate sensitivity and responsiveness to the gender, age, culture, religion, sexual preference, socioeconomic status, beliefs, behaviors and disabilities of patients and professional colleagues.
  
  
• Adhere to principles of confidentiality, scientific/academic integrity, and informed consent.
  
  
• Recognize and identify deficiencies in peer performance.

Systems-Based Practice:

Residents are expected to demonstrate both an understanding of the contexts and systems in which health care is provided, and the ability to apply this knowledge to improve and optimize health care.

Objectives:

• Understand, access and utilize the resources, providers and systems necessary to provide optimal care. Examples: Resident will work with the dietician, nurse, and diabetic educator in managing the patient with diabetes mellitus. He/she wil learn how to access the governmental resources available to patients with diabetes.
  
  
• Understand the limitations and opportunities inherent in various practice types and delivery systems, and develop strategies to optimize care for the individual patient. Examples: While working in a private practice setting, the resident will work to optimize the care of the patient with limited financial resources by utilizing services offered by the hospital, county, and state such as diabetic education, cholesterol screening and education, osteoporosis screening.
  
  
• Apply evidence-based, cost-conscious strategies to prevention, diagnosis, and disease management. Examples: See above.
  
  
• Collaborate with other members of the health care team to assist patients in dealing effectively with complex systems and to improve systematic processes of care. Examples: See above.

III. Methods of instruction:

1. Didactic (schedule, topic, faculty)

Daily residents conference 12:00-1:00 p.m. - IM Training Room
Wednesday mornings 7:30-8:00 a.m. - Clinical Ground Rounds - IM Training Room
Wednesday afternoons 12:15-1:00 p.m. - Internal Medicine Update - Haggar Hall
Friday mornings 7:30 - 8:00 a.m. - Coffee with Cardiology - IM Training Room

2. Clinical

Attend clinic from 9:00 a.m. to 5:00 p.m., seeing and assessing patients, writing notes in the charts, discussing cases one on one with the attending. See inpatient consults.