Endocrinology - Hellerman TeacherWeb Update *Curriculum*

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Curriculum for outcomes-based<A href="http://www.users.cloud9.net/~jgh841/OLCon9/welcome.htm"> Endocrinology</A>:<o:p></o:p>
           (updated <?xml:namespace prefix = st1 ns = "urn:schemas-microsoft-com:office:smarttags" /><st1:date Year="2004" Day="1" Month="1">1/1/04</st1:date> by James Hellerman, MD)<o:p></o:p>
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              Outline<o:p></o:p>
<o:p> </o:p>
       I.     Nuts and Bolts (or Introduction)<o:p></o:p>
       II.    Measurable Goals & Objectives ("Outcomes")<o:p></o:p>
       III.   Teaching Methods ("How you will learn")<o:p></o:p>
       IV.    Outcome Assessment and Feedback<o:p></o:p>
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<o:p> </o:p>
<o:p> </o:p>
I.     Nuts and Bolts  (or Introduction)<o:p></o:p>
       <o:p></o:p>
       A.  Key Faculty and how to reach: <o:p></o:p>
           Name       Office Number    Answering Serv.<o:p></o:p>
          J.Hellerman  x6202           914-366-5205           <o:p></o:p>
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<o:p> </o:p>
       B.     Weekly Schedule Outline:<o:p></o:p>
              Mon      Tue      Wed      Thu      Fri<o:p></o:p>
          am:                           Grand  <o:p></o:p>
                                        Rounds<o:p></o:p>
        <o:p></o:p>
          pm: <st1:place>Bronx</st1:place>             Office  Endo      Office<o:p></o:p>
              Park                      Clinic  <o:p></o:p>
       <o:p></o:p>
       C.  Responsibilities of the resident and the Chain<o:p></o:p>
           of Command:   <o:p></o:p>
            1- Make certain that the Endocrine Office has<o:p></o:p>
               your beeper and/or cell phone number and <o:p></o:p>
               that you keep the office informed of how to<o:p></o:p>
               reach you at all times.<o:p></o:p>
            2- Periodically check in with the office to <o:p></o:p>
               see if there are any consultations.<o:p></o:p>
            3- If possible, you should see the patients <o:p></o:p>
               before your preceptor, and write up the<o:p></o:p>
               consultation on a formal consultation <o:p></o:p>
               sheet, based on information you have <o:p></o:p>
               obtained from the patient, family, old<o:p></o:p>
               record, and primary physician.   Then <o:p></o:p>
               present the case to Dr. Hellerman, who<o:p></o:p>
               will see the patient with you to review<o:p></o:p>
               your findings and to discuss your <o:p></o:p>
               assessment and recommendations.  All cases<o:p></o:p>
               must be discussed with Dr. Hellerman.<o:p></o:p>
            4- You should follow up on all patients daily, <o:p></o:p>
               including any passed on to you from the<o:p></o:p>
               previous rotation.   Similarly, you should<o:p></o:p>
               prepare a list of patients you have been<o:p></o:p>
               following to pass on to the next resident<o:p></o:p>
               who joins the Endocrine service.<o:p></o:p>
               When needed, your assistance in <o:p></o:p>
               transitioning patients into the <o:p></o:p>
               community will be greatly appreciated<o:p></o:p>
               by all (for example, calling patients<o:p></o:p>
               after discharge to discuss their blood sugar<o:p></o:p>
               results and adjustment of insulin).<o:p></o:p>
<o:p> </o:p>
            5- You should continue to attend your Continuity<o:p></o:p>
               Clinic during this rotation.  Please let us<o:p></o:p>
               know as soon as possible regarding any <o:p></o:p>
               proposed absences (e.g., for an interview).<o:p></o:p>
               <o:p></o:p>
                      <o:p></o:p>
<o:p> </o:p>
       D.  Formative/Summative Feedback:<o:p></o:p>
<o:p> </o:p>
               Residents on this rotation must schedule<o:p></o:p>
               a personal meeting  midway through, for<o:p></o:p>
               verbal formative assessment by <o:p></o:p>
               Dr. Hellerman, and then again before the<o:p></o:p>
               end of the rotation, for a written summative<o:p></o:p>
               assessment.<o:p></o:p>
<o:p> </o:p>
               Residents must also provide anonymous<o:p></o:p>
               evaluation and feedback of the rotation by<o:p></o:p>
               clicking on the following link: 
<o:p> </o:p>
     <A href="http://www.freesurveysonline.com/fso/AskSurvey.fso?Survey=3667&CheckID=19">www.freesurveysonline.com/fso/AskSurvey.fso?Survey=3667&CheckID=19</A>
<o:p> </o:p>
  II.  Measurable Goals and Objectives for Endocrinology<o:p></o:p>
<o:p> </o:p>
       A.  Outcomes required to document competency<o:p></o:p>
            <o:p></o:p>
           The following paragraphs list the six major
           domains (medical knowledge, interpersonal and
           communication skills, patient care, 
           professionalism, practice-based learning and
           improvement, and systems-based practice) for 
           which residents must demonstrate knowledge, 
           skills, attitudes, and habits that demonstrate<o:p></o:p>
           competency at each level of training.  Such<o:p></o:p>
           competency progresses from "knowing" to "knowing<o:p></o:p>
           how" to "can teach"  the following:<o:p></o:p>
<o:p> </o:p>
       B.  Demonstrate the following:<o:p></o:p>
           Knowledge
               PGY-1<o:p></o:p>
               Management of DKA and hyperosmolar states<o:p></o:p>
               Practice Guidelines for outpatient diabetes<o:p></o:p>
               Cultural issues & Dietary management of diabetes<o:p></o:p>
               Medicines to treat diabetes<o:p></o:p>
               Interpretation of thyroid function tests<o:p></o:p>
               Principles of treatment of hypothyroidism<o:p></o:p>
               Differential diagnosis of hyperthyroidism <o:p></o:p>
               Initial evaluation and treatment of <o:p></o:p>
                   Hypercalcemia
               PGY-2
               Whom to screen for diabetes<o:p></o:p>
               Evaluation of hypoglycemia<o:p></o:p>
               Management of myxedema coma<o:p></o:p>
               Options to treat hyperthyroidism <o:p></o:p>
               Evaluation of hypercalcemia<o:p></o:p>
               Evaluation and treatment of <o:p></o:p>
                    adrenal insufficiency
               PGY-3
               Consulting for DM management on Surgery,<o:p></o:p>
                   Psychiatry, and Ob-GYN<o:p></o:p>
               Consulting for hypothyroidism on Surgery,<o:p></o:p>
                   Psychiatry, and Ob-GYN<o:p></o:p>
               Recognition and treatment of thyroid storm<o:p></o:p>
               Consultation for hyperthyroidism on the<o:p></o:p>
                   Surgery, Psychiatry, and Ob-Gyn services<o:p></o:p>
               Evaluation of amenorrhea, hirsutism, and <o:p></o:p>
                    PCOS<o:p></o:p>
               Evaluation of Cushing�s Syndrome, <o:p></o:p>
                    Pseudo-Cushing�s and CAH<o:p></o:p>
               Glucocorticoid remediable hyperaldosteronism<o:p></o:p>
               Evaluation for endocrine causes of hypertension<o:p></o:p>
               The incidentaloma of the pituitary or adrenal<o:p></o:p>
               Evaluation of the thyroid nodule<o:p></o:p>
               Principles of thyroid cancer management<o:p></o:p>
<o:p> </o:p>
                         <o:p></o:p>
           Interpersonal & Communication Skills<o:p></o:p>
               PGY-1
               Legible notes<o:p></o:p>
               Open-ended, non-directive, empathetic,<o:p></o:p>
               culturally sensitive interviews<o:p></o:p>
               appropriate to this rotation<o:p></o:p>
               Function as effective consultant who <o:p></o:p>
                 facilitates collaboration among members<o:p></o:p>
                 of the healthcare team
               PGY-2
               Include communication with families,<o:p></o:p>
               liaison with attending, consult effectively 
               PGY-3
               Communicates with healthcare providers<o:p></o:p>
                outside of the hospital
<o:p> </o:p>
           Patient Care
               PGY-1<o:p></o:p>
               Physical examination skills include <o:p></o:p>
                 careful palpation of the thyroid<o:p></o:p>
                 observation of signs of hyperlipidemia<o:p></o:p>
                 evaluation for changes of diabetes<o:p></o:p>
                Informed consent regarding potential side<o:p></o:p>
                  effects of treatment, especially when<o:p></o:p>
                  propylthiouricil, methimazole, or radio-<o:p></o:p>
                  iodine are involved in therapy<o:p></o:p>
                Clinical judgment is the synthetic skill you <o:p></o:p>
                  should demonstrate based upon all available<o:p></o:p>
                  evidence specific to a particular patient
                PGY-3
                Clinical judgment should approach that of<o:p></o:p>
                   a new attending
       
           Professionalism
                PGY-1<o:p></o:p>
                This includes accountability, altruism, <o:p></o:p>
                excellence, and compassion.<o:p></o:p>
                Ethical behavior should be demonstrated<o:p></o:p>
                  particularly as it applies to<o:p></o:p>
                  pharmaceuticals 
<o:p> </o:p>
           Practice-based learning improvement
                PGY-1<o:p></o:p>
                Use information technology to track<o:p></o:p>
                patients, reduce errors, improve quality,<o:p></o:p>
                teach others, maintain confidentiality,<o:p></o:p>
                participate in clinical research.<o:p></o:p>
                Utilize practice guidelines for DM
<o:p> </o:p>
           Systems-based practice
                PGY-1 <o:p></o:p>
                Transition care from one setting to<o:p></o:p>
                another (e.g., from hospital to the<o:p></o:p>
                clinic), advocate for patient, reduce<o:p></o:p>
                risk, practice cost-effective care,<o:p></o:p>
                appreciate different delivery systems and<o:p></o:p>
                regulatory agencies.<o:p></o:p>
<o:p> </o:p>
       <o:p></o:p>
  III.  Teaching Methods and How You Will Learn<o:p></o:p>
<o:p> </o:p>
        Residents will acquire the above knowledge, skills,<o:p></o:p>
        attitudes and habits by utilizing the following:<o:p></o:p>
<o:p> </o:p>
        Required videos: none<o:p></o:p>
                 Books:  <st1:place>Harrison</st1:place>�s Principles of Medicine
                         all endocrine chapters and
                         MKSAP, all endocrine chapters<o:p></o:p>
                 articles: all at:
                 www.teacherweb.com/ny/stbarnabas/endocrine
                 conferences:  GR and NT core endocrine<o:p></o:p>
                 experiences:  Endocrine Clinic and/or
                               Endocrine Elective<o:p></o:p>
                 vignettes : none<o:p></o:p>
<o:p> </o:p>
  IV.   Outcome Assessment and Feedback<o:p></o:p>
<o:p> </o:p>
        Competency at each level of training in this<o:p></o:p>
        discipline will be documented by the resident by<o:p></o:p>
        means of the following:<o:p></o:p>
<o:p> </o:p>
<o:p> </o:p>
        Knowledge:        On-line quizzes: 
                           at <A href="http://coursesites.blackboard.com/">http://coursesites.blackboard.com</A>
                              <A href="http://www.hopkinsilc.org/">http://www.hopkinsilc.org</A>     <o:p></o:p>
                          Chart-stimulated recall<o:p></o:p>
                          ABIM Global Rating Scale<o:p></o:p>
<o:p> </o:p>
        Communication:    mini-CEX<o:p></o:p>
                          Standardized Resident<o:p></o:p>
                          Nursing, NF, CMR evals<o:p></o:p>
                          ABIM Global Rating Scale<o:p></o:p>
                          Portfolio � paper on empathy<o:p></o:p>
        Patient Care:     mini-CEX<o:p></o:p>
                          ABIM Global Rating Scale<o:p></o:p>
<o:p> </o:p>
        Professionalism:  Portfolio - reflective practice<o:p></o:p>
                                     - community service<o:p></o:p>
                          Nursing, NF, peer, CMR, &<o:p></o:p>
                                      patient evaluations<o:p></o:p>
                          ABIM Global Rating Scale<o:p></o:p>
<o:p> </o:p>
        PBLI:             Chart audit for qual.indicators<o:p></o:p>
                          Portfolio - reflective Error<o:p></o:p>
                                      Reduction-Safety<o:p></o:p>
                                      commitment to change<o:p></o:p>
                                    - use of Information<o:p></o:p>
                                      Technology (and<o:p></o:p>
                                      Confidentiality)<o:p></o:p>
                                    - Teaching activities<o:p></o:p>
                          ABIM Global Rating Scale<o:p></o:p>
<o:p> </o:p>
        SBP:              Chart audit for discharge summary<o:p></o:p>
                                  and transition of care<o:p></o:p>
                          Portfolio on Delivery Systems<o:p></o:p>
                                    on Regulatory Agencies<o:p></o:p>
<o:p> </o:p>
        As noted above, residents on this rotation must<o:p></o:p>
        schedule a personal meeting  midway through, for<o:p></o:p>
        verbal formative assessment by the faculty<o:p></o:p>
        preceptor, and then again before the end of the<o:p></o:p>
        rotation, for a written summative assessment.<o:p></o:p>
<o:p> </o:p>
        Residents must also provide anonymous evaluation<o:p></o:p>
        and feedback of the rotation by clicking on the<o:p></o:p>
        following link: 
<o:p> </o:p>
<A href="http://www.freesurveysonline.com/fso/AskSurvey.fso?Survey=3667&CheckID=19">www.freesurveysonline.com/fso/AskSurvey.fso?Survey=3667&CheckID=19</A>
<o:p> </o:p>
<o:p> </o:p>
<o:p> </o:p>

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