University of Rochester School of Medicine & Dentistry Electives

GOAL:
To understand the diagnostic approaches and management methods used in evaluation and treatment of common endocrine disorders.

LEARNING OBJECTIVES: By the end of the rotation the student should be able to:

• Use a pathophysiologic approach to the diagnosis and management of endocrine disease. Demonstrate understanding of mechanisms of hormone secretion and action, and of operation of negative feedback systems; apply that understanding to the diagnosis and treatment of endocrine disorders.
• Assess and manage glycemic status of patients with Type I and Type II diabetes mellitus.
• Evaluate and treat complications in patients with diabetes mellitus.
• Appreciate the contributions to patient care made by the members of a diabetes treatment team (physician, nurse-educator, dietitian, and social worker).
• Assess by physical exam accurately the size and texture of the thyroid, and the presence, size, and character of nodules.
• Diagnose and treat hyperthyroidism: use a Hertel exophthalmometer properly.
• Discuss the differential diagnosis and management of patients with thyroid nodules.
• Recommend diagnostic and management plans for post-menopausal women or men with osteoporosis.
• Discuss the differential diagnosis of hypopituitarism in youth and adulthood.
• Discuss the differential diagnosis, evaluation, and complications of the patient with hypercalcemia.
• Understand the methods to diagnose Cushing’s Syndrome; differentiate among its etiologies.
• Discuss the diagnosis and management of adrenocortical insufficiency; in childhood and adulthood. Demonstrate knowledge of commonly associated disorders.
• Evaluate and treat hypogonadism and reproductive failure in men and women.
• Discuss the diagnosis and management of diabetes insipidus.
• Describe the various forms of multiple endocrine neoplasia and of autoimmune polyendocrinopathies.
• Discuss the differential diagnosis and management of hyponatremia.

SCHEDULE OF ACTIVITIES:
Students will attend outpatient office hours and be included in the inpatient rounding team’s activities. They will work from ~8AM to~5-6PM weekdays, and on occasion will also make weekend rounds. In the office, they will see new and follow-up patients as assigned by the Attending.

DIDACTIC ACTIVITIES:
Endocrine grand rounds, a city-wide conference, is held every Friday at 7:45AM in the Gibbs Library of the Endocrine Unit (3-6416). A multidisciplinary (ENT, Nuclear Medicine, Surgery, Endocrinology, Cytology/Pathology) thyroid conference is held on the first Monday of each month. An Endocrinology seminar series, including clinical topics, is scheduled on the 2nd and 3rd Monday of each month. Students are expected to attend these conferences as well as Medical Grand Rounds. Monthly journal club is held in the evening at the home of a faculty member. Student may also attend; weekly didactic sessions for the Fellows; occasional research seminars; and other related talks and seminars sponsored by other units. Students are expected to prepare a case for Endocrine grand rounds once during their rotation. The Attending of the month will advise and consult with the student regarding the presentation.

REQUIRED READING:
Endocrine Pathophysiology, Hershman et al. The larger endocrine texts (Williams’ Textbook, the DeGroot or the Baxter, Frohman et al texts) should be used for focused patient-centered or problem oriented reading. Primary literature is also to be consulted when appropriate. Students are expected to consult the learning objectives and make specific attempts to cover each of them during the rotation.

STUDENT EVALUATIONS:
Students will be evaluated by the Attending with whom they work. Evaluations will also be sought from Fellows and Residents as appropriate. The Endocrine Unit will make available to each student a copy of the Medical Knowledge Self-Assessment Program’s (MKSAP) Endocrinology and Metabolism self-assessment test, for personal self-evaluation, and for discussion with the faculty.