Endocrinology and Metabolism

Credits: 4.00 CREDITS (Clinical Elective)
Sites: BWH
Directors: Hamnvik, Ole-Petter Riksfjord
Prerequisites: HMS Principal Clinical Experience (Core Clinical Clerkships) or equivalent
Offered: Full time for one month. Not offered July, August.
Open to Exclerks: US/Canadian
This training provides an intensive exposure to clinical endocrinology and metabolism, including diabetes, hypertension, neuroendocrine and thyroid diseases; as well as other disorders such as, calcium and bone metabolism, thyroid and adrenal glands, pituitary dysfunction, hypertensive disorders, and other disorders of fuel homeostasis. Residents and students will perform endocrine consultations and participate in the diagnostic and therapeutic management of a broad variety of patients with these disorders, including work-up, background reading and presentation/discussion of cases at rounds. Teaching rounds will be held four to five times weekly and will focus on new and follow-up consultations. Students will also attend clinics in one or more of these same areas on a weekly basis. Interhospital Endocrine Grand Rounds and clinical/teaching conferences will be held weekly, in conjunction with the Children’s Hospital. Evidence-based medicine is the expected standard for the student's learning related to the cases evaluated and discussed in teaching rounds and clinics. Students are expected to perform literature searches to identify original articles, review articles and meta-analyses related to their case load, read relevant sections of endocrinology textbooks and utilize electronic resources, such as Up-to-Date, as appropriate. Basic science, as it is relevant to the team's consultations and to clinic patients, is an integral component of the student's reading, principally in textbooks, and is also presented as part of teaching rounds and/or in clinics by attendings and fellows.
Learning Goals:
To have students master the basic elements of endocrinology/metabolism and related disorders as they are encountered in a busy hospital consultation service and in general endcorine and specialty clinics. It is expected that students will be versed in the common disorders of calcium and bone metabolism, such as hypercalcemia and osteoporosis, adrenal disease, including adrenal hyper- and hypofunction, as well as diseases of the thyroid and the anterior and posterior pituitary and diabetes, among others.
To have students become facile in carrying out in-hospital consultations on patients with endocrine/metabolic diseases as well as participating in the evaluation and work-up of such patients in the clinic setting. Relevant skills include obtaining histories and performing physical examinations--with an emphasis on the aspects of these skills relevant to endocrine and metabolic diseases--and writing up and presenting these work-ups in a clear and coherent manner, including assessments and recommended diagnostic and therapeutic interventions.
To have the students become facile in evidence-based endocrinology/metabolism by reading in depth about endocrine/metabolic disorders related to patients they work up with an emphasis on learning the relevant underlying basic science as well as identifying clinical literature through searches. The students should be competent in use of electronic media for such searches, for the purpose of identifying original articles, review articles, meta-analyses and electronic resources, such as Up-to-Date, relevant to their case load.
Incorporation of Basic Science Content and Evidence-Based Medicine:
Evidence-based medicine, based on readings from original articles, review articles, meta-analyses, textbooks of endocrinology, and electronic resources (e.g., Up-to-Date) are the expected standard for the students' work-ups and their presentations of their cases in teaching rounds and clinics. Basic science, as it is relevant to patients seen in consultations and in clinics, is presented as part of teaching rounds and/or in clinics by attendings and fellows. Both evidence-based medicine and related basic science are emphasized in the weekly teaching conference attended by the entire Endocrine Division, in which two cases are discussed in detail by the first year clinical fellows.
Students will be evaluated based on their ability to take a history and perform a physical examination, prepare written work-ups of their patients and present and discuss those patients at rounds or in clinics. Students are expected to be conversant with the medical literature relevant to their cases based on their reading of original and review articles, textbooks, and online resources, such as Up-To-Date. The evaluations will be carried out by the endocrinology fellows and the endocrine attending. The latter will synthesize this information for transmittal to the Course Director and preparation of the HMS evaluation forms or other forms for students from other medical schools.
Grade Criteria:
High Honors:
A student who performs at an exceptionally high level in terms of oral and written presentations and knowledge of the literature. About 10% of students fall into this category, and their performance approaches that of a medical graduate, such as an intern or resident. Punctuality and professional behavior toward staff, fellows, and other medical personal as well as patients and their families is expected of all students.
A student who shows clearly above average performance in terms of oral and written presentations and knowledge of the literature. Such students display initiative and growth in their acquisition of new knowledge and mastery of new endocrine/metabolic conditions with each patient they work-up but perform at a level below that of students with High Honors. 50-60% of students generally fall in this category. It is the grade achieved by the majority of HMS students.
Students who display below average to average, but satisfactory performance in terms of oral and written presentations and knowledge of the literature based on historical observations of the students taking this course. These students, while satisfactorily working up and presenting their patients, show less growth and initiative than those getting honor grades. 20-30% of students fall in this category.
Students who display a lack of interest and/or professional behavior and/or exhibit a lack of competence in their work-ups and presentations. Generally less than 10% of students fall in this category.
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