2018-2019 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 the MAB, VA Medical Center, and the University of Cincinnati Medical Center. Students will see patients with Type 1 and Type 2 diabetes mellitus, pituitary disorders, thyroid and parathyroid disorders and disorders of calcium metabolism, adrenal disease as well as other disorders of the endocrine system.
PREREQUISITES:
26931373 (INTERNAL MEDICINE CORE CLKSP)

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

expand all

GENERAL INFORMATION

COURSE YEAR:
M4
CREDIT HOURS:
8
CREDIT WEEKS:
4
DOMESTIC VISITING:
YES
INTERNATIONAL VISITING:
NO
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:
2 
ROTATIONS:
Rotation Dates Max
1 07/02/2018 - 07/27/2018 2
2 07/30/2018 - 08/24/2018 2
3 08/27/2018 - 09/21/2018 2
4 09/24/2018 - 10/19/2018 2
5 10/22/2018 - 11/16/2018 2
6 11/26/2018 - 12/21/2018 2
7 01/02/2019 - 01/25/2019 2
8 01/28/2019 - 02/22/2019 2
9 02/25/2019 - 03/22/2019 2
10 03/25/2019 - 04/19/2019 2
11 04/22/2019 - 05/17/2019 2
12 05/20/2019 - 06/30/2019 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 1ST DAY:
Page fellow 249-0848 TBD 7:45 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
30% Attitude, e.g., professionalism, motivation etc
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.

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 :
Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 13th ed. Philadelphia, PA: Saunders; 2015.

Jameson JL, De Groot LJ, de Kretser DM, Giudice LC, Grossman AB, Melmed S, Potts JT Jr, Weir GC, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2010.

Rosen CJ, Bouillon R, Compston JE, Rosen V, eds. Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 8th ed. Washington, DC: Wiley-Blackwell; 2013.

Braverman LE, Cooper D, eds. Werner & Ingbar’s The Thyroid: A Fundamental and Clinical Text. 10th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2013.

Reading List:

Nieman LK, Biller BM, Findling JW, et al. The diagnosis of Cushing’s syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2008;93(5):1526-1540.

Bancos I, Hahner S, Tomlinson J, Arlt W. Diagnosis and management of adrenal insufficiency. Lancet Diabetes Endocrinol. 2015;3(3):216-226

Funder JW, Carey RM, Fardella C, et al; Endocrine Society. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2008;93(9):3266-3281.

Silverberg SJ. Primary hyperparathyroidism. In: Rosen CJ, Bouillon R, Compston JE, Rosen V, eds. Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 8th ed. Washington, DC: Wiley-Blackwell; 2013.

Verbalis JG, Goldsmith SR, Greenberg A, et al. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med. 2013;126(10 Suppl 1):S1-S42.

Nieman LK. Approach to the patient with an adrenal incidentaloma. J Clin Endocrinol Metab.2010;95(9):4106-4113


Cosman F, de Beur SJ, LeBoff MS, et al; National Osteoporosis Foundation. Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int. 2014;25(10):2359-2381.

American Diabetes Association. Diagnosis and classification of diabetes mellitus [published correction appears in Diabetes Care. 2010;33(4):e57]. Diabetes Care. 2010;33(Suppl 1):S62-S69.

Standards of Medical Care in Diabetes-2017.  Diabetes Care; January 2017; volume 40, suppliment 1

Duckworth W, Abraira C, Moritz T, et al; VADT Investigators. Glucose control and vascular complications in veterans with type 2 diabetes [published correction appears in N Engl J Med. 2009;361(10):1028]. N Engl J Med. 2009;360(2):129-139.

Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, etal. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358(24):2545-2559.

ADVANCE Collaborative Group, Patel A, MacMahon S, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358(24):2560-2572.

NICE-SUGAR Study Investigators, Finfer S, Chittock DR, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283-1297.

Melmed S, Casanueva FF, Hoffman AR, et al; Endocrine Society. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(2):273-288.

McCartney CR, Marshall JC. Clinical practice. Polycystic ovary syndrome. N Engl J Med. 2016;375(1):54-64.

Speiser PW, Azziz R, Baskin LS, et al; Endocrine Society. Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an Endocrine Society clinical practice guideline [published correction appears in J Clin Endocrinol Metab. 201;95(11)5137]. J Clin Endocrinol Metab. 2010;95(9):4133-4160.

Bhasin S, Cunningham GR, Hayes FJ, et al; Endocrine Society. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010;95(6):2536-2559.

Katznelson L, Laws ER Jr, Melmed S. Acromegaly: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2014;99(11):3933-3951.

Vance ML. Hypopituitarism [published correction appears in N Engl J Med. 1994;331(7):487]. N Engl J Med. 1994;330(23):1651-1662.

Oiso Y, Robertson GL, Norgaard JP, Juul KV. Clinical review: treatment of neurohypophyseal diabetes insipidus. J Clin Endocrinol Metab. 2013;98(10):3958-3967.

American Diabetes Association. (8) Cardiovascular disease and risk management. Diabetes Care. 2015;38(Suppl):S49-S57.

Bahn Chair RS, Burch HB, Cooper DS, et al; American Thyroid Association; American Association of Clinical Endocrinologists. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists [published corrections appear in Thyroid. 2011;21(10):1169 and Thyroid. 2012;22(11):1195]. Thyroid. 2011;21(6):593-646.

Jonklaas J, Bianco AC, Bauer AJ, et al; American Thyroid Association Task Force on Thyroid Hormone Replacement. Guidelines for the treatment of hypothyroidism: prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement. Thyroid. 2014;24(12):1670-1751.

Interpretation of thyroid function tests.  Lancet 2001; 357: 619-624
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 and outpatient settings. Residents, fellows, and consult attending physician will act as their teachers and professional role models.  Endocrinology consult fellow and/or attending physician will assign patients to medical students with the am of providing a broad exposure to the field of endocrinology, diabetes, 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.  Become familiar with finger stick blood glucose testing, continuous glucose monitoring systems (CGMS) and insulin pump, insulin pens and other insulin delivery devices.  

2.  Participate in endocrine dynamic tests as the opportunity arises on their patients. These may include such tests as ACTH stimulation testing, Glucagon stimulation testing, metyrapore tests, dexamethasone suppression testing, oral glucose tolerance testing (OGTT) and 72 hour fast for hypoglycemia.

3. Observe and/or participate in thyroid ultrasound exams and fine needle aspiration (FNA)biopsy of thyroid nodules.

SAMPLE WEEK

Monday:
8:00AM 12:00PM Endocrine Clinic - VAMC
1:00PM 5:00PM Inpatient Rounds UCMC and VA/Independent Study
Tuesday:
7:30AM 8:30AM Combined Endocrinology/Nuclear Medicine Conference ***
8:30AM 12:00PM Inpatient Rounds UCMC and VA/Independent Study
1:00PM 5:00PM Inpatient Rounds UCMC and VA/Independent Study
Wednesday:
8:00AM 12:00PM Endocrine Clinic - MAB, 6th Floor
12:00PM 1:00PM Medical Grand Rounds and Lunch
1:00PM 5:00PM Inpatient Rounds UCMC and VA/Independent Study
Thursday:
8:00AM 1:00PM Endocrine Clinic, VAMC
1:00PM 5:00PM Endocrine Academic Half Day - Clinical Case Conference
Friday:
8:00AM 12:00PM Inpatient Rounds UCMC and VA/Independent Study
1:00PM 5:00PM Inpatient Rounds UCMC and VA/Independent Study
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.




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