UC COM :: M3/M4 Course Syllabi

M3/M4 Course Offerings

2017-2018 M3/M4 Course Syllabi

Internal Medicine

COURSE NUMBER:

07 11 01

TITLE:

ENDOCRINOLOGY/METABOLISM -IM -ICE
This elective provides a broad exposure to inpatients and outpatients with endocrine diseases. The student will see patients at both the VA Medical Center and the University Hospital. There will be exposure to the care of diabetes mellitus, pituitary disorders, thyroid disorders and thyroid cancer, parathyroid disorders, and endocrine disorders of the reproductive system.

PREREQUISITES:

26931373 (INTERNAL MEDICINE CORE CLKSP)

Must be a fourth year student and must complete the internal medicine clerkship.

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GENERAL INFORMATION

COURSE YEAR:

CREDIT HOURS:

CREDIT WEEKS:

DOMESTIC VISITING:

YES

INTERNATIONAL VISITING:

GRADED:

Honors/High Pass/Pass/Fail

COURSE QUALIFICATIONS:

ICE

COURSE TYPE:

Clinical

STATUS:

Full-Time
OFFERED AS FULL-TIME AND PART-TIME: NO
ALLOWS OVERLAP: YES

COURSE LENGTH:

4 wks

DIRECTOR:

Abid Yaqub, MD
yaqubad@ucmail.uc.edu

ADMINISTRATIVE SUPPORT PERSON:

Julie Karpe
Julie.Karpe@uc.edu
558-2426
MSB, 3504

INSTRUCTOR:

MikeCanos, MD

SITE(S):

University Hospital
VAMC

MAX ENROLL:

ROTATIONS:

Rotation	Dates	Max
1	07/03/2017 - 07/28/2017	2
2	07/31/2017 - 08/25/2017	2
3	08/28/2017 - 09/22/2017	2
4	09/25/2017 - 10/20/2017	2
5	10/23/2017 - 11/17/2017	2
6	11/27/2017 - 12/22/2017	2
7	01/02/2018 - 01/26/2018	2
8	01/29/2018 - 02/23/2018	2
9	02/26/2018 - 03/23/2018	2
10	03/26/2018 - 04/20/2018	2
11	04/23/2018 - 05/18/2018	2
12	05/21/2018 - 06/22/2018	2

NOTE: If a rotation is offered in both 2 and 4 week slots, the max capacity is limited to the actual spots offered for the 4 weeks. (ie: the 2 week rotations listed share the max of the 4 week rotation)

WORKING HOURS:

8:00 am - 5:00 pm, Monday - Friday

REPORT 1^ST DAY:

Page fellow 249-0848 TBD 8:00 am

INSTRUCTION

LEARNING ACTIVITIES:

Case-Based Instruction/Learning
Clinical Experience - Inpatient
Conference
Patient Presentation--Faculty
Patient Presentation--Learner
Research

LEARNING ENVIRONMENT POLICIES:

UCCOM strives to provide medical students with a learning environment that is conducive to their professional growth. All UCCOM and visiting medical students are encouraged to review the Student Handbook.

The Office of Student Affairs and Admissions is available to all UCCOM and visiting medical students to discuss any concerns/questions related to the learning environment. Please call 558-6796 to access faculty/staff that can assist you.

ORIENTATION:

Attending physician or Fellow

TEACHING:

50%	Attending Physician
50%	Senior Resident

FEEDBACK:

Faculty

ASSESSMENT:

FINAL GRADE:

55%	Clinical work performance evaluations
15%	Attitude, e.g., professionalism, motivation etc
15%	Journal club, critical review of literature
15%	Topic presentation

GRADE ASSIGNED BY: Elective director

OBJECTIVES

Attitudes :

1. Appreciate the physician’s role and responsibility in ambulatory management of chronic disease.

2. Appreciate the importance of tight control in diabetes: Need for individualization of diabetes care based on patient interest and ability, other intercurrent diseases, and impact of social factors (e.g., home, employment, food, availability of medicines and home glucose testing materials.) Involvement of patient in development of plan of management by process of negotiation. Importance of multidisciplinary team approaches in diabetes management. Role of extensive physician contact and attitude conveyed by physician.

3. Develop consideration for and apply pathophysiologic knowledge and systematic approaches to cost-effective and efficient evaluation of endocrine hyper- and hypo-function and endocrine neoplasms, and effective communication of plan, results and implications to patients and referring physicians.

4. Appreciate and display proper use of subspecialty consultation in the management of endocrine disease.

Curricular Resources :

Interpretation of thyroid function tests. Lancet 2001; 357: 619-24

Medical Progress. N Engl J Med 2000; 343:1236-1248

Clinical Practice. N Engl J Med 2001; 345:512-516

Oral Antihyperglycemic Therapy for Type 2 Diabetes. JAMA 2002; 287:360-372

Intensive Insulin Therapy in Critically Ill Patients. N Engl J Med 2001; 345:1359-1367

Oral Antithyperglycemic Therapy for type 2 Diabetes. JAMA 2002; 287:373-376

Graves' ophthalmopathy: a rational approach to treatment. Trends in Endocrinology & Metabolism 2002; 13:280-287

Medical Progress. N Engl J Med 2000; 343:1863-1875

Current Concepts. N Engl J Med 1996; 335:1206-1212

The students will receive a textbook, Endocrine Secretes (McDermott)

The students will also be referred to the major Endocrinology texts, Endocrinology/Metabolism section of general medicine texts and a bibliography of major papers maintained in this Division as their primary sources of reference material.

The major endocrine textbooks are as follows:

a. Williams' Textbook of Endocrinology (Wilson and Foster, editors);

b. Endocrinology and Metabolism (Felig, Baxter, Frohman, editors);

c. Endocrinology (DeGroot et al, editors);

d. Ellenberg and Rifkin's Diabetes Mellitus: Theory and Practice (Rifkin and Porte, editors);

e. Werner and Ingbar's The Thyroid (Braverman and Utiger, editors);

f. Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism (Favus, editor).

Knowledge/Skills:

1. Perform a critical history and physical examination on patients with endocrine/metabolic problems.

2. Develop a concise differential diagnosis.

3. Select and interpret diagnostic tests for common endocrine conditions including thyroid, adrenal, pituitary, gonadal, bone, lipid disorders, and diabetes.

4. Describe the relevant pathophysiology of the more common endocrine/metabolic diseases including diabetes mellitus, thyroid hypo- and hyperfunction, disorders of calcium metabolism and pituitary and adrenal disease, and explain clinical presentation of patients in terms of the pathophysiology.

5. Display knowledge of systematic approaches to conditions encountered less frequently but applicable across the spectrum of endocrine disease and organ systems which depend upon negative feedback regulation. These may include such conditions as multiple endocrine neoplasia and polyendocrine failure syndromes, pheochromocytoma, peptide or steroid hormone producing tumors or congenital adrenal hyperplasias.

6. Be familiar with preventive strategies in management of other chronic endocrine/metabolic diseases.

Main Course Topics :

1. Endocrine hyper- and hypo-function and endocrine neoplasms, pathophysiology and workup, affecting: pituitary, thyroid, parathyroids, endocrine pancreas, adrenals, testes, ovaries.

2. Diabetes Mellitus: Theory and practical management of glycemic control, hypoglycemia, chronic complications of diabetes

3. Thyroid Disease: Thyroid function testing, hypothyroidism, hyperthyroidism, euthyroid sick syndrome, thyroid nodules, thyroid cancer

4. Mineral Metabolism and Metabolic Bone Disease: Hypercalcemia, hypocalcemia, osteopenia, calcium nephrolithiasis

5. Hirsutism

Objectives:

The student's experience in Endocrinology/Metabolism will revolve around patient contact in both hospital, clinic and private outpatient settings. Residents and fellows will act as their primary source of information. Patients will be assigned by staff and fellows in such a way that the students have a broad exposure to problems in endocrinology and metabolism. The student's primary objective, however, is not to serve as primary or secondary provider of patient care, but to further their own education. It is expected that the students will read extensively on the specific problems which their patients present.

Other Resources - Audiovisuals:

Slides of unusual endocrine findings, e.g., fundus photographs of diabetic retinopathy.

Other Resources - Computer resources:

Diabetes and Endocrinology-related sites for patients & physicians on the World Wide Web.

Other Resources - Other :

Access to Radiology Teaching files for Endocrine & Metabolic Diseases.

Procedures:

1. Perform home blood glucose monitoring, to see the variety of methods and equipment available to patients.

2. Perform endocrine dynamic tests as the opportunity arises on their patients. These may include such tests as ACTH, gonadotropin releasing hormone, thyrotropin releasing hormone or corticotrophin releasing hormone stimulation tests or dexamethasone or clonidine suppression tests.

SAMPLE WEEK

Monday:

8:00AM	12:00PM	Inpatient follow-up rounds and new patient evaluations UH/VAMC
1:00PM	5:00PM	New inpatients and attending rounds UH and VAMC *

Tuesday:

7:30AM	8:30AM	Combined Endocrinology/Nuclear Medicine Conference ***
8:30AM	12:00PM	Inpatient follow-up rounds and new patient evaluations UH/VAMC
12:00PM	1:00PM	Clinical conference/Endocrine Grand Rounds and lunch
1:00PM	5:00PM	New inpatients and attending rounds, UH and VAMC *

Wednesday:

8:00AM	12:00PM	Diabetes Clinic, Hoxworth Center, 2nd Floor
12:00PM	1:00PM	Medical Grand Rounds and Lunch
1:00PM	5:00PM	Independent reading and preparation of topical presentation **

Thursday:

8:00AM	1:00PM	Endocrine Clinic, VAMC
2:00PM	5:00PM	Clinical Case Discussion/Inpatient Rounds UH/VAMC

Friday:

8:00AM	12:00PM	Endocrine Clinic, Hoxworth Center, 2nd Floor
12:00PM	1:00PM	Lunch
1:00PM	3:00PM	Endocrine Grand Rounds/Clinical Case Conference
3:00PM	5:00PM	New inpatients and attending rounds UH/VAMC

SCHEDULE NOTE:

* Rounds begin in the MSB Endocrinology/Metabolism Conference Room, Room 7701 MSB. The times will be mutually agreed upon by the house staff and attendings. During times without formal scheduled activities, students may be seeing consults, preparing conference presentations, reading from textbooks or the syllabus of papers provided. Based on individual interest, additional sessions with diabetes patient educators can be scheduled.

**One additional half-day outpatient session will be held one to two times monthly with the dietician/nurse practitioner in the diabetes clinic.

***Held 1st week of every month.

ATTENDANCE AND ABSENCE POLICY

Session Attendance for M4 Students

Students may miss no more than two days of planned excused absences on a four week rotation without being required to make-up the work, at the discretion of the clerkship/elective/course director or his/her designee.
Non-AI Rotations - Per the Student Duty Hours Policy, an average of one day (24 hours) in every seven must be free of clinical responsibilities (including seminars, clinic, rounds, lectures) averaged over a four week period. These days off are assigned by the clerkship director to best align with the site schedule. Students may request to schedule 1 or more of these 4 days for planned absences that fall under 1 of the categories listed below for excused absences during non-AI rotations, in consultation with the course/elective director, who may or may not approve such planned absences.
AI Rotations - Per the Student Duty Hours Policy, an average of one day (24 hours) in every seven must be free of clinical responsibilities (including seminars, clinic, rounds, lectures) averaged over a four week period. These days off are assigned by the course director to best align with the site schedule. Students may request to schedule 1 or 2 of these days for planned absences that fall under 1 of the categories listed below for excused absences during AI rotations, in consultation with the course director, who may or may not approve such planned absences. Students must avoid scheduling Step 2 examinations during an Acting Internship.
Excused Absences - The following will be considered excused absences:
- Diagnostic, preventative, and therapeutic health services (e.g. doctor appointments, physical therapy, counselling, etc).
- Personal illness, accident or a major catastrophic event
- Death or serious illness of immediate family members. Immediate family members, as defined by UC, are Grandparents, Brother, Sister, Brother-in law, Sister-in-law, Daughter-in-law, Son-in-law, Father, Mother, Mother-in-law, Father-in-law, Step-sister, Step-brother, Step-mother, Step-father, Spouse or domestic partner, Child, Grandchild, legal Guardian or other person who stands in place of parent (in Loco Parentis)
Whenever possible, planned absences should be requested a minimum of six weeks in advance of the start of the clerkship/elective/course in which the absence will occur; this enables the clerkship/course/elective to help plan for educational event scheduling (e.g. a known appointment could be scheduled around with enough notice and the student might not have any required coursework to make up). Absences requested less than 1 week prior to the planned absence may not be considered for a possible excused absence unless extenuating circumstances prevented the student from providing timely notification per the policy. Students should first submit their request for a planned absence to the clerkship/elective/course director using the online MSSF. All planned/excused absences for any reason should be documented on the MSSF.
The COM abides by the UC Religious Observance Policy that respects the religious diversity of its students by providing opportunities, where possible, for accommodation in cases where conflicts exist between students’ religious beliefs/practices and educational activities. In clinical settings, such accommodations must honor the primacy of a commitment to patient care and avoid unduly burdening faculty, staff and the general student population involved in the affected educational and/or patient care activity.
The following items are explained in detail in the Medical Student Handbook:
- Excused/unexcused/unplanned absence, religious holidays, jury duty, and make-up work

See Attendance and Absences Policy, Religious Observance Policy, Medical Student Handbook.