Department of Medicine
1. Rotation Sites and Supervision
Rotation
Name: ENDOCRINOLOGY
CONSULTS
|
Site |
Faculty Supervisor |
Administrator |
Phone |
|
UCIMC |
Ping Wang, M.D. |
Gail Meltebarger |
949-824-6887 |
|
LBVAMC |
Ellis Levin, M.D. |
Noah Wagner |
562-826-5748 |
2. The educational rationale for this rotation:
Learn the diagnosis and treatment of common endocrine disorders including diabetes mellitus, thyroid disorders, osteoporosis, hyperlipidemia, pituitary and adrenal disorders. Hypogonadism, hypertension, polycystic ovarian disease, diabetes insipidus, gynecomestia, hypoglycemia.
3. The principal teaching methods for this rotation:
Inpatient and outpatient consultations and weekly and monthly conferences
4. The responsibilities for medical students, PGY1 residents (interns), PGY2 & PGY3 residents, fellows and attending on this rotation:
* Medical Student: Participate in patient evaluations and assist with consultations.
* Medical Resident: Each resident will see inpatient consultations as assigned by the service
* Fellow. The fellow, resident and consult attending will meet daily to discuss new and follow-up patients. All consults need to be signed by the attending staff. Weekly diabetes inpatient reaching rounds with the fellow and house staff occur on Wednesday at 8:30 am.
* The resident will attend the following four clinics weekly. The practice of endocrinology is largely in the outpatient area.
* UCIMC
* Diabetes Clinic: 8:30 am – 12 noon, Tuesday.
* Endocrine Clinic: 1 pm – 5 pm, Wednesday.
VA
* Diabetes Clinic: 8:45 am – 12 noon, Thursday.
* Endocrine Clinic: 8:45 am – 12 noon, Friday.
A weekly grand rounds/journal club occurs on Thursday afternoon at 1 pm at the VA. Monthly clinical conferences in which the fellows present interesting management cases to the faculty occur on the UCI Campus, usually on the third Tuesday of each month at 4 pm.
Guest speakers present at the Endocrine Grand Rounds every other month at UCIMC.
The schedule should be obtained from the fellow and section secretary at UCIMC (Gail, 949-824-6887) or section secretary at the VA (Noah, x5748 at the VA). There is ample opportunity for reading during the endocrine section rotation. The residents should review at least the previous year’s worth of clinical reviews in the Journal of Clinical Endocrinology and Metabolism (available in our library). Additional reading in endocrine texts and articles (provided by the fellows and staff) are required. A suggested reading syllabus of 30 key articles in the field will also be provided to the resident on the first day of the rotation.
Fellow:
The clinical endocrine fellow has a variety of responsibilities that focus on Supervising resident and students on the teaching service, arranging for the various conferences and attending clinics. He or she is the direct link between the inpatient wards and the consultation service. Listed below is an outline of the major duties of the clinical fellow and what exactly the fellow role entails.
1. The fellow should see all of the consult cases, including those primarily staffed by the resident on the endocrine rotation. At UCIMC, the consult fellow will round daily on the patient followed by the consult service. Rounds with the attending physician are usually on Monday, Wednesday, and Friday, but may occur more frequently as the need arises. At LBVAMC, the fellow will meet with one general medicine ward (two housestaff teams) every week, Monday at 8:30 am, to go over the detailed management of one or two diabetes patients under the care of the housestaff. Therefore, all ward teams will have met with the fellow over a month’s time.
2. Cases should be assigned by the fellow to the housestaff on the consult service to evaluate and follow. The fellow will assist the resident in making sure the proper tests are ordered, carried out and evaluated, and that the discharge planning links the in-house and outpatient management.
3. The fellow should discuss each consult with the general medicine housestaff, provide them with articles and be sure that they do adequate follow-up. This will be overseen by the faculty attending.
4. The fellow should discuss each case with the attending on service for the month at formal attending rounds. Follow-up discussions are dictated by the ongoing nature of the care provided.
5. The fellow on the consult service should find cases to present at the clinical conferences. If no cases are in the hospital, out patient cases can be used. The fellow should also prepare and assign to the resident, responsibility for journal club articles, when at the VA.
6.
Monthly case management
conferences are held on the Monday of each mouth on the UCI Campus in the
Clinics:
1. Every Tuesday morning, the medical center and "elective" fellow need to be in the Diabetes Clinic at UCIMC. These clinics are primarily the responsibility of the fellows.
2. The fellow on elective covers the clinics mentioned and rotates through the Gyn-Endocrine Clinic and Pediatric Endocrine Clinics at the medical center. He/she also engages in a research project during this time.
3. The medical center fellow attends the Endocrine Clinic at UCIMC on Wednesday afternoons, as well as the Diabetes Clinic.
4. The VA-based fellow attends the Thursday morning Diabetes and Friday morning Endocrine Clinics, while the "elective" fellow should also attend Endocrine Clinic at the VA.
5.
The fellow assigned to UCIMC is
required to attend Dr. Wang's clinic at the
6. Attendance at the Lipid Clinic at the VA is optional, but suggested.
7. The senior fellow has responsibility for making out the year-long rotations and weekend schedules with concurrence by the junior fellows and Dr. Levin and Dr. Wang. The on-call schedule must be prepared monthly and provided to the hospital operators two days prior to the beginning of each month.
Research:
A research project with any of the faculty must be selected and initiated in the first year, with the selected faculty member as the mentor. The plan for the proposed research should be submitted to the Division Chief and the Fellowship Program Director. Research activity is mandatory for the first and second years, and is monitored by publication of scholarly work which includes basic or clinical research, as well as case reports.
Beepers:
1. All of the fellows share endocrine call. The on-call beeper needs to be carried 24 hours per day, 7 days per week, by a fellow. Most questions can be answered over the phone, although occasionally, the fellow needs to come in to see a DKA or to round on ill inpatients on the weekends.
2. The attending-of-the-month on the endocrine consult service should be available for back-up. However, if they are not available, feel free to call any attending you can find. Everyone is very willing to help.
Ellis Levin, M.D. 562/826-5748, pager 7388
Bogi Andersen, M.D. 949-824-9093, pager 714-506-9007
Lawrence Parker, M.D. 562/826-5175, pager 7472
Alan Elias, M.D. 714/456-5125, pager 714-506-6893
Ping Wang, M.D. 949/824-6981, pager 714-506-6107
Attending:
Supervise fellow, resident and students. Direct rounds and conferences
5. Core primary
resource readings
Noah has a reading syllabus for distribution to residents (and new fellows) that is regularly updated. Please check with him at the VA.
Endocrinology Section Reading List:
ADH
Adrogue, HJ, Madias, NE. Hyponatremia. N Engl J Med 342:1581, 2000.
Bonlni P: Central diabetes insipidus. Endocrinologist 1:180, 1991.
Holtzman et al: a molecular defect in the vasopressin V2-receptor gene causing nephrogenic diabetes insipidus. New Engl J Med 328 (21): 1534-36, 1562-63, 1993.
Cushing’s Syndrome
Newell-Price, J, Trainer, P, Besser, M, Grossman, A. The diagnosis and differential diagnosis of Cushing's syndrome and pseudo-Cushing's states. Endocr Rev 19:647, 1998.
Oldfield EH, Doppman JL, Chrousos GP, Miller DL Katz DA, Cutler GB Jr and Loriaux DL: Petrosal sinus sampling with and without corticotropin-releasing hormone for the differential diagnosis of Cushing’s syndrome. New Engl J Med 325 (13): 897-905, 1991.
Dichek, HL, Nieman, LK, Oldfield, EH, et al. A comparison of the standard high dose dexamethasone suppression test and the overnight 8-mg dexamethasone suppression test for the differential diagnosis of adrenocorticotropin-dependent Cushing's syndrome. J Clin Endocrinol Metab 78:418, 1994.
Other Adrenal Diseases
Peacey, SR, Guo, CY, Robinson, AM, et al. Glucocorticoid replacement therapy: are patients overtreated and does it matter? Clin Endocrinol 46:255, 1997.
Glowniak, JV, Loriaux, DL. A double-blind study of perioperative steroid requirements in secondary adrenal insufficiency. Surgery 121:123, 1997.
Betterle C, Greggio NA, Volpato M: Autoimmune polyglandular syndrome type 1. J Clin Endocrinol & Metab 83 (4): 1049-55, 1998.
Cutler GB and Love L: Congenital adrenal hyperplasia due to 21-Hydroxylose deficiency. New Engl J Med 343 (26): 1806-13, 1990.
Cook, DM, Loriaux, DL. The incidental adrenal mass [see comments]. Am J Med 101:88, 1996.
Ganguly, A. Primary aldosteronism. N Engl J Med 339:1828, 1998.
Aging
Lamberts SWJ, van den Beld Aw, van der Lely A-J: The Endocrinology of Aging. Science 278:419-24, 1997.
Calcium Metabolism
Pearce HS and Brown EM: The genetic basis of endocrine disease: Disorders of calcium ion sensing. J Clin Endocrinol Metab 81 (6): 2030-35, 1996.
Silverberg SJ and Bilezikian JP: Extensive personal experience: Evaluation and management of primary hyperparathyroidism. J Clin Endocrinol Metab 81(6): 2036-40, 1996.
Silverberg, S, Shane, E, Jacobs, T, et al. A 10 year prospective study of primary hyperparathyroidism with and without parathyroid surgery. N Engl J Med 341:1249, 1999.
Bilezikian, JP. Drug therapy: Management of acute hypercalcemia. N Engl J Med 326:1196, 1992.
Delmas, PD, Meunier, PJ. The management of Paget's disease of bone. N Engl J Med 336:558, 1997.
Osteoporosis
Osteoporosis prevention, diagnosis, and therapy. JAMA 2001; 285:785.
Sambrook P, et al. Prevention of corticosteroid osteoporosis. New Engl J Med 328 (24): 1747-52, 1781-82, 1993.
Eastell R: Treatment of postmenopausal osteoporosis. New Engl J Med 338 (11): 736-46, 1998.
Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA 288:321, 2002.
Crandall, C. Parathyroid hormone for treatment of osteoporosis. Arch Intern Med 2002; 162:2297.
Diabetes
Epstein FH: The pathogenesis of insulin-dependent diabetes mellitus. New Engl J Med 331 (21):1428-36, 1994.
The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329:977, 1993.
Rosenstock, J, Park, G, Zimmerman,
J. Basal insulin glargine (HOE 901) versus NPH
insulin in patients with type 1 diabetes on multiple daily insulin regimens.
Kahn CR: Insulin action, diabetogenes, and the cause of Type II diabetes. Diabetes 43:1066-84, 1994.
Knowler, WC, Barrett-Connor, E, Fowler, SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346:393, 2002.
Inzucchi, SE. Oral antihyperglycemic therapy for type 2 diabetes: Scientific Review. JAMA 287:360, 2002.
Siperstein M: DKA and hyperosmolar coma. Endo/Metab Clin NA 21:415, 1992.
Hypoglycemia
Service FJ: Hypoglycemic disorders. New Engl J Med 332 (17): 1144-52, 1995.
Obesity
Rosenbaum M, Leibel RL, Hirsch J: Obesity. New Engl J Med 337 (6): 396-407, 1997.
Mokdad, AH, Ford, ES, Bowman, BA, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 289:76, 2003.
Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults--The Evidence Report. National Institutes of Health. Obes Res 6 Suppl 2:51S, 1998.
Rohner-Jeanrenaud F, Jeanrenaud B: Obesity, leptin and the brain. New Engl J Med 334 (5): 324-35, 1996.
Considine RV, Sinha MK, Heiman ML, et al. Serum immunoreactive–leptin concentrations in normal-weight and obese humans, New Engl J Med 334 (5):292-95, 1996.
Lipids
Ballantyne, CM, Grundy, SM, Oberman, A, et al. Hyperlipidemia: diagnostic and therapeutic perspectives. J Clin Endocrinol Metab 85:2089, 2000.
Third report of the National Cholesterol Education Program
(NCEP) Expert Panel on detection, evaluation, and treatment of high blood
cholesterol in adults (Adult Treatment Panel III): Final report.
Ginsberg, HN. Hypertriglyceridemia: New insights and new approaches to pharmacologic therapy. Am J Cardiol 87:1174, 2001.
Gynecomastia
Braunstein GD: Gynecomastia, New Engl J Med 328 (7): 490-95, 1993.
Hypothalamus/Pituitary
Casanueva G: Physiology of GH
secretion and action. Endo/Metab
Clin
Melmed, S, Ho, K, Klibanski, A, et al. Clinical Review 75: Recent advances in pathogenesis, diagnosis and management of acromegaly. J Clin Endocrinol Metab 80:3395, 1995.
Reyes-Fuentes A: Neuroendocrine physiology of normal male gonadal axis. Endo/Metab Clin NA 22:93, 1993.
Kleinberg, DL, Noel, GL, Frantz, AG. Galactorrhea: A study of 235 cases, including 48 with pituitary tumors. N Engl J Med 296:589, 1977.
Carter, JN, Tyson, JE, Tolis, G, et al. Prolactin-screening tumors and hypogonadism in 22 men. N Engl J Med 299:847, 1978.
Webster, J, Piscitelli, MD, Polli, A, et al. A comparison of cabergoline and bromocriptine in the treatment of hyperprolactinemic amenorrhea. N Engl J Med 331:904, 1994.
Vance ML: Hypopituitarism. New Engl J Med 330 (23): 1651-62, 1994.
Growth Hormone treatment in adults
De Boer, H, Blok, GJ, Van der Veen, EA. Clinical aspects of growth hormone deficiency in adults. Endocr Rev 16:63, 1995.
Carroll PV, Christ ER, Members of the Growth Hormone Research Society Scientific Committee: Growth hormone deficiency in adulthood and the effects of growth hormone replacement: A review. J Clin Endo and Metab 83 (2): 382-95, 1998.
Testosterone treatment in men
Harman, SM, Metter, EJ, Tobin, JD, Pearson, J. Longitudinal
effects of aging on serum total and free testosterone levels in healthy men.
Snyder, PJ, Peachey, H,
Menopause
Wise PM, Krajnak KM, Kashon ML: Menopause: The aging of multiple pacemakers. Science 273:67-70, 1996.
Risks and benefits of estrogen and progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA 288:321, 2002.
Grady, D, Herrington, D, Bittner, V, et al. Cardiovascular disease outcomes during 6.8 years of hormone therapy: Heart and Estrogen/progestin Replacement Study follow-up (HERS II). JAMA 288:49, 2002.
Nelson, HD, Humphrey, LL, Nygren, P, et al. Postmenopausal hormone replacement therapy: scientific review. JAMA 288:872, 2002.
Pancreas
Perry RR, Vinik Al: Diagnosis and Management of functioning islet cell tumors, J Clin Endoc & Metab 80 (8): 2273-78, 1995.
Thyroid
Paschke R, Ludgate M: The thyrotropin receptor in thyroid diseases. Mechanisms of Disease 337 (23): 1675-81, 1997.
Franklyn, JA. Drug therapy: The management of hyperthyroidism. N Engl J Med 330:1731, 1994.
Burch HB, Wartofsky L: Grave’s opthalmopathy: Current concepts regarding pathogenesis and management. Endocrine Reviews 14:747-93, 1993.
Roth E, Leibel RL: Postpartum thyroiditis. J Clin Endocrinol Metab 74:3-5, 1992.
Arafah BM. Increased need for thyroxine in women with hypothyroidism during estrogen therapy. New Engl J Med 344:1743-1749, 2001.
Chopra IJ. Euthyroid sick syndrome: is it a misnomer? J Clin End Metab 82:329-334, 1997.
Cooper DS. Subclinical thyroid disease: a clinician’s perspective. Ann Int Med 129:135-138, 1998.
Cooper DS. Suclinical hypothyroidism. New Engl J Med 345:260-265, 2001.
Dayan CM, and Daniels GH. Chronic autoimmune thyroiditis. New Engl J Med 335:99-107, 1996.
Hak EA, Pols
HAP, Visser T et al. Subclinical
hypothyroidism is an independent risk factor for atherosclerosis and myocardial
infarction in elderly women: the
Langton JE, and Brent GA. Nonthyroidal illness syndrome: evaluation of thyroid function in sick patients. Endocrinol Metab Clin N Am 31:159-172, 2002.
Surks MI, and Sievert R. Drugs and thyroid function. New Engl J Med 333:1688-1694, 1995.
Toft AD. Thyroxine therapy. New Engl J Med 331:174-180, 1994.
Hay I: Papillary thyroid carcinoma, Endo/Metab Clin NA 19:545, 1990.
Nicoloff JT, Spencer CA: The use and misuse of the sensitive thyrotropin assays. J Clin Endocrinol Metab 71:553-58, 1990.
Retetoff S, Weiss RE, Usala SJ: The syndromes of resistance to thyroid hormone. Endocrine Review 14:348-99, 1993.
Ridgeway EC: Clinician’s evaluation of a Solitary thyroid nodule. J Clin Endocrinol Metab 74: 231-35, 1992.
Tan, GH, Gharib, H. Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann Intern Med 126:226, 1997.
Robbins J: Thyroid cancer: A lethal endocrine neoplasm. Annals of Int Med 115:133-47, 1991.
Vulsma T, Gons MH, de Vijlder JJM: Maternal-fetal transfer of thyroxine in congenital hypothyroidism due to a total organification defect of thyroid agenesis. N Engl J Med 321:13, 1998.
6. Key physical diagnosis skills:
Routine HSP, thyroid examination, breast examination in men and women, gonadal examination in men
7. Key procedures that the resident should be able to perform
None for the residents. Thyroid FNA for fellows
8. Key procedures
that the resident should be able to understand the indications for and to
interpret
Thyroid pituitary, adrenal, and glucose homeostasis tests
9. Key topics (no
more than 10 topics)
Diabetes Mellitus
Hyperthyroidism
Hypothyroidism
Pituitary Tumors
Osteoporosis
Hyperlipidemia
10. Evaluation Methods
Faculty will evaluate each resident’s performance using the standard "Internal Medicine Resident Evaluation Form" at the end of each block rotation. Evaluation forms will be submitted to the Residency Program for review by the Program Director and by the Residency Oversight Committee.
Residents will complete evaluations of their attending faculty, their supervising residents, and the rotation itself. These evaluations will be submitted to the Residency Program for Review by the Program Directors and the Curriculum Committee. Copies of evaluations will be submitted to the Division Chiefs for their review.
a. Professional
competencies will be evaluated by (check all that apply)
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Evaluation Method |
Direct Observation & Feedback |
Journal Club |
Written Exam |
Report or Presentation |
Other (specify) |
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Competency |
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Patient Care
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x |
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Medical Knowledge
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x |
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Practice-based Learning |
x |
x |
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Communication Skills |
x |
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Professionalism
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x |
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Systems-based Practice |
x |
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b. Evaluation Methods
Faculty will evaluate each resident’s performance using the Competencies Evaluation Form and any special documents developed for the rotation. Faculty will provide formative, face-to-face feedback at the midpoint and end of each rotation.
Evaluation forms will be submitted to the Program Director for review by the Residency Oversight Committee (ROC; competency committee).
Residents will evaluate the rotation, their faculty attending and their peers on the rotation. Rotation Evaluations will be reviewed by the ROC and transmitted to the Division Chiefs.
Updated 11/06