mcgill endocrinology and metabolism training program ... · reproductive endocrinology and...

McGill Endocrinology and Metabolism Training Program

Rotation Specific Goals and Objectives

1. General Objectives 2. General Endocrinology Objectives – CanMeds Format 3. Longitudinal Clinic Objectives 4. In-Patient Consultation Objectives 5. General Endocrinology Clinic Objectives 6. Diabetes Clinic Objectives 7. Lipid Clinic Objectives 8. Neuroendocrine Clinic Objectives 9. Gestational Diabetes Clinic Objectives 10. Calcium and Bone Metabolism Clinic Objectives 11. Thyroid Clinic Objectives 12. Montreal Children’s Hospital Endocrinology Rotation Objectives 13. Reproductive Endocrinology and Infertility Rotation Objectives 14. Endocrinology Clinical Laboratory Rotation Objectives 15. Research Block Objectives 16. Insulin Pump Rotation Objectives

Revised – September 2013

McGill Endocrinology & Metabolism

Training Program General Objectives Medical Expert As Medical Experts, Endocrinologists integrate all of the CanMEDS roles, applying medical knowledge, clinical skills, and professional attitudes in their provision of patient-centered care. Medical Expert is the central physician role in the CanMEDS framework. Key and Enabling Competencies: Endocrinologists are able to: 1. Funct ion e f f e c t ive ly as consul tants , integrat ing al l o f the CanMEDS roles to

provide opt imal , e thi cal and pat ient - centered medical care . 1.1 Perform a consultation effectively, including the presentation of well-

documented assessments and recommendations in written and/or verbal form in response to a request from another health care professional.

1.2 Demonstrate effective use of all CanMEDS competencies relevant to their practice.

1.3 Identify and appropriately respond to relevant ethical issues arising in patient care.

1.4 Demonstrate ability to effectively and appropriately prioritize professional duties when faced with multiple patients and problems.

1.5 Demonstrate compassionate and patient-centered care. 1.6 Recognize and respond to the ethical dimensions in medical decision-making. 1.7 Demonstrate medical expertise in situations other than patient care.

2. Establ ish and maintain c l ini cal knowledge , ski l l s and at t i tudes appropriate to

Endocr inology and Metabol i sm. 2.1 Apply knowledge of the clinical, socio-behavioural, and fundamental

biomedical sciences (including genetics, physiology, biochemistry and histopathology) relevant to Endocrinology and Metabolism including:

2.1.1 Normal linear growth and development.

2.1.2 Alterations in the endocrine system in persons with systemic disease. 2.1.3 Alterations in the endocrine system in persons with critical illness.

2.1.4 Alterations in the endocrine system in pregnant women. 2.1.5 Disorders of glucose metabolism including hypoglycaemia and

hyperglycemia. 2.1.6 Disorders of lipid metabolism. 2.1.7 Disorders of obesity.

2.1.8 Type 1 and Type 2 diabetes mellitus including the role of nutrition, exercise, pharmacological management including but not limited to insulin pump therapy and complications.

2.1.9 Metabolic bone disease and disorders of calcium metabolism including but not limited to disorders of the parathyroid glands and the Vitamin D system.

2.1.10 Disorders of the thyroid gland. 2.1.11 Disorders of reproduction in females, including disordered sexual

development and gender identity, abnormalities of puberty, menstrual disorders, hypogonadism, infertility and hyperandrogenic states.

2.1.12 Disorders of protein metabolism. 2.1.13 Disorders of growth in children and adolescents (limited to pediatric

Endocrinology and Metabolism). 2.1.14 Disorders of the adrenal cortex and the adrenal medulla. 2.1.15 Disorders of the pituitary gland (anterior and posterior). 2.1.16 Hypertension related to endocrine disorders. 2.1.17 Fluid, electrolyte and acid-base disorders to the endocrine system. 2.1.18 Screening for endocrine disorders and autoimmunity as it relates to

the endocrine system. 2.1.19 Nutrition as it applies to endocrine disorders. 2.1.20 Genetics as it relates to endocrine disorders. 2.1.21 Endocrine tumors and cancers. 2.1.22 Radiation safety in the use of radioactive isotopes in endocrine

disorders.

2.2 Describe the CanMEDS framework of competencies relevant to Endocrinology and Metabolism.

2.3 Apply lifelong learning skills of the Scholar Roles to implement a personal program to keep up-to-date and enhance areas of professional competence.

2.4 Contribute to the enhancement of quality care and patient safety in their practice, integrating the available best evidence and best practices.

3. Perform a complete and appropriate assessment o f a pat ient

3.1 Identify and explore issues to be addressed in a patient encounter effectively, including the patient’s context and preferences.

3.2 For the purposes of prevention and health promotion, diagnosis and/or management, elicit a history that is relevant, clear, concise and accurate to context and preferences.

3.3 For the purposes of prevention and health promotion, diagnosis and/or management, perform a focused physical examination that is relevant and accurate.

3.4 Select medically appropriate investigations in a resource-effective and ethical manner.

3.5 Demonstrate effective clinical problem solving and judgment to address patient problems, including interpreting available data and integrating information to generate differential diagnoses and management plans including but not limited to:

3.5.1 Interpret diagnostic imaging in the diagnosis of endocrine disorders. 3.5.2 Interpret results of hormonal assays in basal states. 3.5.3 Interpreting results of dynamic endocrine testing. 3.5.4 Interpreting pathology reports in the diagnosis of endocrine disorders. 3.5.5 Interpreting and providing advice on glucose monitoring results. 3.5.6 Interpreting bone density reports.

4. Use prevent ive and therapeut i c intervent ions e f f e c t ive ly 4.1 Implement an effective management plan in collaboration with a patient and

their family.

4.1.1 Provide intensive diabetes care and management including insulin pump therapy.

4.2 Demonstrate effective, appropriate and timely application of preventive and therapeutic interventions relevant to Endocrinology and Metabolism including but not limited to:

4.2.1 Counselling patients on preventative behaviour.

4.2.2 Smoking cessation. 4.2.3 Dietary modifications. 4.2.4 Exercise. 4.2.5 Weight loss. 4.3 Ensure appropriate informed consent is obtained for therapies. 4.4 Use radioisotopes in the diagnosis of endocrine disorders. 4.5 Provide referral and transfer to appropriate end-of-life care.

5. Demonstrate pro f i c i ent and appropriate use o f procedural ski l l s , both diagnost i c

and therapeut i c 5.1 Demonstrate effective, appropriate and timely performance of diagnostic

procedures relevant to Endocrinology and Metabolism, including the ability to perform the following: 5.1.1 Fine needle thyroid biopsy (Limited to adult Endocrinology and

Metabolism). 5.1.2 Dynamic endocrine testing.

5.2 Ensure informed consent is obtained for procedures. 5.3 Document and disseminate information related to procedures performed and

their outcomes. 5.4 Ensure adequate follow-up is arranged for procedures performed.

6. Seek appropriate consul tat ion from other heal th profess ionals , recognizing the

l imits o f the ir expert i se 6.1 Demonstrate insight into their own limitations of expertise.

6.2 Demonstrate effective, appropriate and timely consultation of another health professional as needed for optimal patient care.

6.3 Arrange appropriate follow-up care services for a patient and their family. Communicator As Communicators, Endocrinologists effectively facilitate the doctor-patient relationship and the dynamic exchanges that occur before, during and after the medical encounter. Key and Enabling Competencies: Endocrinologists are able to: 1. Develop rapport , t rust and ethical therapeut i c re lat ionships with pat ients and

famil i es 1.1 Recognize that being a good communicator is a core clinical skill for

physicians and that effective physician-patient communication can foster patient satisfaction, physician satisfaction, adherence and improved clinical outcomes.

1.2 Establish positive therapeutic relationships with patients and their families that are characterized by understanding, trust, respect, honesty and empathy.

1.3 Respect patient confidentiality, privacy and autonomy. 1.4 Listen effectively. 1.5 Use patient appropriate language. 1.6 Recognize and respond to non-verbal cues. 1.7 Facilitate a structured clinical encounter effectively.

2. Accurate ly e l i c i t and synthes ize re l evant information and perspec t ives o f pat ients

and famil i es , co l l eagues and other pro fess ionals 2.1 Gather information about a disease, but also about a patient’s beliefs,

concerns expectations and illness experience. 2.2 Seek out and synthesize relevant information from other sources, such as a

patient’s family, caregivers and other professionals. 3. Convey re l evant information and explanat ions accurate ly to pat ients and

famil i es , co l l eagues and other profess ionals 3.1 Deliver information to a patient and family, colleagues and other

professionals in a empathetic manner and in such a way that it is understandable, encourages discussion and participation in decision-making.

3.2 Counsels patients and/or families in an empathetic, accurate and supportive manner with attention to age, disability, gender, gender identity, sexual orientation, ethnicity, religion, level of education and cultural beliefs.

4. Develop a common understanding on issues , problems and plans with pat ients ,

famil i es and other profess ionals to deve lop a shared plan of care 4.1 Identify and explore problems to be addressed from a patient encounter

effectively, including the patient’s context, responses, concerns and preferences.

4.1.1 Engage in dialogue with respect to patient’s use of alternative health care practices in the treatment of endocrine diseases.

4.2 Respect diversity and difference, including but not limited to the impact of

age, gender, gender identity, sexual orientation, religion and cultural beliefs. 4.3 Encourage discussion, questions and interaction in the encounter. 4.4 Engage patients, families and relevant health professionals in shared

decision-making to develop a plan of care. 4.5 Address challenging communication issues effectively, such as obtaining

informed consent, delivering bad news and addressing anger, confusion and misunderstanding.

5. Convey e f f e c t ive oral and wri t t en information about a medical encounter

5.1 Maintain clear, accurate and appropriate written or electronic records of clinical encounters and plans.

5.2 Present verbal reports of clinical encounters and plans effectively. 5.3 Develops and communicates a management plan for patients being

discharged from his/her care. 5.4 Present medical information effectively to the public or media.

Collaborator As Collaborators, Endocrinologists effectively work within a healthcare team to achieve optimal patient care. Key and Enabling Competencies: Endocrinologists are able to: 1. Part i c ipate e f f e c t ive ly and appropriate ly in an interprofess ional heal thcare t eam

1.1 Describe the Endocrinologist’s roles and responsibilities to other professionals.

1.2 Describe the roles and responsibilities of other professionals within the health care team including but not limited to: diabetes educators, dietician, endocrine testing nurse, genetic counselor, mental health professional, pharmacist, physiotherapist, registered nurse and social worker.

1.3 Recognize and respect the diversity of roles, responsibilities and competencies of other professionals in relation to their own.

1.4 Work with others to assess, plan, provide and integrate care for individual patients or groups of patients.

1.5 Work with others to assess, plan, provide and review other tasks, such as research problems, educational work, program review or administrative responsibilities.

1.6 Participate effectively in inter-professional teams respecting confidentiality, resource allocation and professionalism.

1.7 Consult effectively with other professionals particularly those most often associated with Endocrinology and Metabolism including but not limited to: diagnostic imaging specialists, obstetricians-gynecologists, oncologists, ophthalmologists, pathologists, primary health care providers and surgeons.

1.8 Describe the principles of team dynamics. 1.9 Respect tram ethics, including confidentiality, resource allocation and

professionalism. 1.10 Demonstrate leadership in a health care team, as appropriate.

2. Work e f f e c t ive ly with other heal th profess ionals to prevent , negot iate and reso lve

inter -pro fess ional conf l i c t 2.1 Demonstrate a respectful attitude towards other colleagues and members of

an inter-professional team. 2.2 Work with other professionals to prevent conflicts. 2.3 Employ collaborative negotiation to resolve conflicts. 2.4 Respect differences and address misunderstandings and limitations in other

professionals. 2.5 Recognize one’s own differences, misunderstanding and ;imitations that may

contribute to inter-professional tension. 2.6 Reflect on inter-professional team function.

Manager As Managers, Endocrinologists are integral participants in healthcare organizations, organizing sustainable practices, making decisions about allocating resources and contributing to the effectiveness of the healthcare system. Key and Enabling Competencies: Endocrinologists are able to: 1. Part i c ipate in act iv i t i es that contr ibute to the e f f e c t iveness o f the ir heal thcare

organizat ions and systems 1.1 Work collaboratively with others in their organizations including diabetes

education centres. 1.2 Participate in systemic quality process evaluation and improvement, such as

patient safety initiatives.

1.2.1 Recognize the role of audits, budget reviews, quality improvement, risk management, incident reporting and complaint management in various settings including diabetes centres, endocrine testing units, the laboratories and ambulatory care settings.

1.3 Describe the structure and function of the healthcare system as it relates to

Endocrinology and Metabolism, including the roles of physicians. 1.4 Describe principles of healthcare financing, including physician remuneration,

budgeting and organizational funding. 2. Manage the ir pract i ce and career e f f e c t ive l y

2.1 Set priorities and manage time to balance patient care, practice requirements, outside activities and personal life.

2.2 Manage clinical practice effectively and efficiently by:

2.2.1 Avoiding duplication of services. 2.2.2 Involving other caregivers when appropriate. 2.2.3 Using appropriate information technology. 2.2.4 Delegating responsibility effectively and appropriately as a team

leader to optimize patient care. 2.2.5 Prioritizing patient visits appropriately.

2.3 Implement processes to ensure personal practice improvement. 2.4 Employ information technology appropriately for patient care. 2.5 Manage a practice including finances and human resources. 3. Allocate f ini t e heal thcare resources appropriate ly

3.1 Recognize the importance of just allocation of healthcare resources, balancing effectiveness, efficiency and access with optimal patient care. 3.1.1 Demonstrate the use of cost/benefit ratios of diagnostic and

therapeutic interventions for endocrine disorders as well as cost containment, efficacy and efficiency as they relate to decision making and quality assurance.

3.2 Apply evidence and management processes for cost-appropriate care. 4. Serve in administrat ion and leadership ro les , as appropriate 4.1 Chair or participate effectively in committees and meetings. 4.2 Lead or implement change in health care.

4.3 Plan relevant elements of health care delivery not limited to work schedules and participation in on-going monitoring of clinical care in Endocrinology and Metabolism.

Health Advocate As Health Advocate, Endocrinologists responsibly use their expertise and influence to advance the health and well-being of individual patients, communities and populations. Key and Enabling Competencies: Endocrinologists are able to: 1. Respond to indiv idual pat ient heal th needs and issues as part o f pat ient care 1.1 Identify the health needs of an individual patient.

1.2 Identify opportunities for advocacy, health promotion and disease prevention with individuals to whom they provide care including the –

1.2.1 Hypoglycemia in diabetes.

1.2.2 Driving and diabetes. 1.2.3 Diabetes sick day management. 1.2.4 Adrenal insufficiency. 1.2.5 Medication and supply reimbursement for endocrine conditions.

2. Respond to the heal th needs o f the communit i es that they serve

2.1 Describe the practice communities that they serve including ethnicity and socioeconomic status.

2.2 Identify opportunities for advocacy, health promotion and disease prevention in the communities that they serve and respond appropriately.

2.3 Appreciate the possibility of competing interests between the communities served and other populations.

3. Ident i fy the determinants o f heal th for the populat ions with endocr ine disease

that they serve 3.1 Identify the determinants of health of the populations, including barriers to

access to care and resources. 3.1.1 The high burden of illness from common endocrine disorders such

as diabetes mellitus, thyroid disorders, obesity, hypertension, metabolic bone disease and lipid disorders that may strongly contribute to inadequate access to care and resources.

3.2 Identify and respond appropriately to vulnerable or marginalized populations

including: 3.2.1 Aboriginal communities. 3.2.2 Patient with language, cultural or social barriers. 3.2.3 Patients with mental health concerns. 3.2.4 Patients with orphan diseases with significant endocrine involvement.

4. Promote the heal th o f indiv idual pat ients , communit i es and populat ions at r i sk

for endocr ine disease 4.1 Describe an approach to implementing a change in a determinant of health

of the populations they serve. 4.2 Describe how public policy impacts on the health of the populations served. 4.3 Identify points of influence in the healthcare system and its structure. 4.4 Describe the ethical and professional issues inherent in health advocacy,

including altruism, social justice, autonomy, integrity and idealism. 4.5 Appreciate the possibility of conflict inherent in their role as a health

advocate for a patient or community with that of manager or gatekeeper. 4.6 Describe the role of the medical profession in advocating collectively for

health and patient safety. Scholar As Scholar, Endocrinologists demonstrate a lifelong commitment to reflective learning, as well as the creation, dissemination, application and translation of medical knowledge. Key and Enabling Competencies: Endocrinologists are able to:

1. Maintain and enhance profess ional act iv i t i es through ongoing l earning 1.1 Describe the principles of maintenance of competence.

1.2 Describe the principles and strategies for implementing a personal knowledge management system.

1.3 Recognize and reflect learning issues in practice. 1.4 Conduct a personal practice audit. 1.5 Pose an appropriate learning question. 1.6 Access and interpret the relevant evidence. 1.7 Integrate new learning into practice. 1.8 Evaluate the impact of any change in practice. 1.9 Document the learning process.

2. Evaluate medical in formation and i t s sources cr i t i ca l ly and apply this

appropriate ly to pract i c e dec i s ions 2.1 Describe the principles of critical appraisal. 2.2 Critically appraise retrieved evidence in order to address a clinical question. 2.3 Integrate critical appraisal conclusions into clinical care. 3. Faci l i tate the l earning o f pat ients , famil i es , s tudents , res idents , o ther heal th

profess ionals , the publ i c and others , as appropriate 3.1 Describe principles of learning relevant to medical education.

3.2 Identify collaboratively the learning needs and desired learning outcomes of others.

3.3 Select effective teaching strategies and content to facilitate others’ learning. 3.4 Deliver an effective lecture or presentation. 3.5 Assess and reflect on a teaching encounter. 3.6 Provide effective feedback. 3.7 Describe the principles of ethics with respect to teaching.

4. Contribute to the deve lopment , disseminat ion and translat ion o f new knowledge

and pract i c es . This requires the complet ion or s igni f i cant part i c ipat ion in a scholar ly pro jec t re lated to any aspec t (research, educat ion, or creat ive pro fess ional ac t iv i ty) o f Endocr inology and Metabol i sm

4.1 Describe the principles of research and scholarly inquiry. 4.2 Describe the principles of research ethics. 4.3 Pose a scholarly question. 4.4 Conduct a systematic search for evidence. 4.5 Select and apply appropriate methods to address the question. 4.6 Disseminate the findings of a study appropriately. Professional As Professionals, Endocrinologists are committed to the health and well-being of individuals and society through ethical practice, profession-led regulation and high personal standards of behaviour.

Key and Enabling Competencies: Endocrinologists are able to: 1. Demonstrate a commitment to the ir pat ients , pro fess ion and soc ie ty through

ethi cal pract i c e 1.1 Exhibit appropriate professional behaviours in practice, including honesty,

integrity, commitment, compassion, respect and altruism. 1.2 Demonstrate a commitment to delivering the highest quality care and

maintenance of competence. 1.3 Recognize and appropriately respond to ethical issues encountered in

practice. 1.4 Manage conflicts of interest appropriately. 1.5 Recognize the principles and limits of patient confidentiality as defined by

professional practice standards and the law. 1.6 Maintain appropriate relations with patients.

2. Demonstrate a commitment to the ir pat ients , pro fess ion and soc ie ty through

part i c ipat ion in profess ion- led regulat ion 2.1 Demonstrate knowledge and an understanding of the professional, legal and

ethical codes of practice. 2.1.1 Abide by the RCPSC-endorsed guidelines of ethical interactions with

industry (especially the pharmaceutical industry) with respect to research, education and clinical care.

2.2 Fulfill the regulatory and legal obligations required of current practice. 2.3 Demonstrate accountability to professional regulatory bodies. 2.4 Recognize and respond to others’ unprofessional behaviours in practice. 2.5 Participate in peer review. 3. Demonstrate a commitment to physi c ian heal th and sustainable pract i c e

3.1 Balance personal and professional priorities to ensure personal health and a sustainable practice.

3.2 Strive to heighten personal and professional awareness and insight. 3.3 Recognize other professionals in need and respond appropriately.

The practice of endocrinology and metabolism involves the evaluation, diagnosis and treatment of patients with diseases of the endocrine glands, disorders of hormone systems and their target organs, and disorders of metabolism. During the course of residency in endocrinology and metabolism, the candidate must acquire clinical competence in management of endocrine disease and related problems, together with a sound background in the relevant basic sciences. During the residency training, in addition to knowledge base, several areas of clinical competence recognized to be of importance for a consultant endocrinologist are promoted and evaluated:

- The resident must demonstrate that he/she is able to perform a medical history that is relevant, concise, accurate and appropriate.

- The resident must demonstrate the ability to perform a comprehensive physical examination relevant to the endocrine problem.

- The resident should demonstrate the capability of developing effective therapeutic relationships with patients and their families in order that appropriate information and counsel may be given concerning chronic endocrine or metabolic diseases.

Residents must learn to serve as consultants to general medicine, medical specialties and others specialty services (e.g. surgery, obstetrics, psychiatry). Considering this, communication skills should be improved during the fellowship training in order that the resident:

- Be able to write a thorough, clear note, communicating all of the important elements of a consultation in an effective, focused manner relating to endocrinology patients.

- Be able to present verbally the case of a patient with an endocrine disorder, including all the pertinent clinical and laboratory information, as well as the diagnostic impressions, investigative strategy, and therapeutic recommendations.

Several areas of knowledge and clinical skills are recognized with which the resident must become familiar, experienced and comfortable over the course of the 2 year Fellowship in Endocrinology and Metabolism. The following specific objectives of training are meant to guide but not restrict the resident in the acquisition of this knowledge and of these clinical skills and attitudes. These objectives are also meant to reflect the training requirements and objective standards found at the national level. The evaluation of performance throughout residency is based on the achievement of these clinical skills and the knowledge base demonstrated during rotations, presentations, and during the in-training examination.

General Endocrinology Objectives

CanMeds Format

DISEASE-SPECIFIC OBJECTIVES

CanMeds Role

Objective At the end of training, the Endocrine resident will be able

to MEDICAL EXPERT General Requirements

a) Knowledge •Demonstrate diagnostic and therapeutic skills for ethical and effective patient care. •Access and apply relevant information to clinical practice. •Demonstrate effective consultation services with respect to patient care, education and legal opinions. b) Skills •Perform a medical history that is relevant, concise, accurate and appropriate to the endocrine problem. •Perform a comprehensive physical examination relevant to the endocrine problem. •Interpret the results of hormonal assays in basal, stimulated and suppressed states. •Understand the use of radioisotopes in diagnosis and management of endocrine disorders. •Understand standard endocrine clinical laboratory assays. •Understand the basic concepts of the genetics of endocrine disorders and some of the diagnostic tests used to evaluate these. •Interpret neuroradiographic, nuclear medicine, and ultrasound tests in the diagnosis of endocrine disorders. •Interpret bone mineral density measurements and plain x-rays in the evaluation of metabolic bone disease. •Demonstrate effective consultation skills and services in presenting timely assessments and recommendations for patients with endocrine disorders in response to a request from another health care provider with respect to patient care, education of provider and legal opinions.

MEDICAL EXPERT Disease Specific Requirements a) Knowledge

Diabetes •Describe the anatomy and histology of the pancreas.

b) Skills c) Attitudes

Describe the structure of insulin, draw the insulin receptor and describe the mechanism of action at the cellular level. •Describe the diagnostic criteria for diabetes mellitus. Compare Type 1 and Type 2 diabetes with respect to epidemiology, etiology, pathogenesis, pathological changes in the pancreas, natural history, treatment and complications. •Describe other conditions – heritable or acquired that can give rise to diabetes mellitus. •Describe the epidemiology, pathophysiology, clinical presentation, screening and treatment of microvascular and macrovascular complications of diabetes. •Outline the risks of mother and fetus in a pregnancy complicated by Type 1, Type 2 or gestational diabetes and strategies to reduce these risks. •Demonstrate an awareness of new developments in the prevention and treatment of Type 1 and Type 2 diabetes. •Perform a focused medical interview and physical examination of a person with diabetes. •Counsel a patient effectively on the basic principles of diabetes mellitus self care including importance of glycemic control with particular emphasis on the prevention of diabetes complications. •Explain the basic principles of a diabetic diet including carbohydrate counting, and understand how dietary modification affects glycemic control. •Interpret home blood glucose readings and adjust insulin and hypoglycaemic therapy appropriately based on their results. •Manage a patient with diabetes with diabetic ketoacidosis, hyperosmolar coma, severe hypoglycaemia, during sick days, prolonged exercise or fasting and perioperatively. •Select laboratory tests to effectively assess risk factors and screen for microvascular complications. •Outline appropriate treatment strategies for acute and chronic complications such as ophthalmopathy, painful neuropathy, incipient nephropathy, overt nephropathy, hypertension, and hyperlipidemia in a person with diabetes. •Effectively counsel and manage the adolescent with poor metabolic control due to lack of compliance with diabetes regimens. •Collaborate effectively with the multidisciplinary team. •Appreciate the impact of diabetes on the child/adolescent, their family and society. •Recognize that diabetes is a self-care disease requiring education, and accept and encourage the role of the patient and family in decision making and goal setting.

•Appreciate the different needs and developmental stages in the infant, child, adolescent, and young adult with diabetes. •Recognize the impact the patient’s and families own health beliefs and support system will have on the goals of therapy.

a) Knowledge b) Skills c) Attitudes

Hypoglycemia •Explain normal glucose metabolism in the fed and fasting state including glycolysis, gluconeogenesis, glycogenesis and glycogenolysis. Understand the interactions between glucose, protein and fat metabolism in the body. •Understand the different genetic conditions that can give rise to hypoglycaemia and be able to describe the molecular defects giving rise to these conditions. •Describe an approach to the diagnosis and management of hypoglycaemia in infants, children, adolescents, and adults. •Perform a focused history and examination in a patient referred for hypoglycaemia. •Select and interpret critical blood samples in the diagnosis of hypoglycaemia. •Effectively manage an infant, child or adult with hypoglycaemia. •Recognize the concerns of parents of children with hypoglycaemia with respect to the investigation and treatment of hypoglycaemia and the risk of neurologic consequences.

a) Knowledge

Hypothalamic/Pituitary Disorders •Explain and diagram the general anatomy, histology and embryology of the hypothalamus and pituitary gland. •Understand the role of various genes involved in pituitary –hypothalamic development and how mutations in these impact on normal hormone synthesis and release. •Describe in detail the control mechanisms and physiology including target organ response for the six anterior pituitary hormones. •Describe the etiology, clinical presentation, differential diagnosis, investigation and management of hypopituitarism with particular emphasis on acquired conditions. •Discuss water homeostasis including the role of thirst, antidiuretic hormone, renin-angiotensin system, plasma volume and plasma tonicity. Outline the etiology, clinical presentation, differential diagnosis, investigation and management of SIADH and diabetes insipidus (central and nephrogenic). •Discuss pituitary tumors by describing their histology, clinical presentatiom, differential diagnosis, investigation (laboratory


and radiographic) and specific treatment modalities including their success rates. •Perform a focused history and examination in a patient referred for possible disorders of the pituitary gland including: growth failure, delayed or precocious puberty, hypopituitarism, diabetes insipidus, SIADH, brain tumor, particularly involving the hypothalamus/pituitary, incidental pituitary lesion, empty sella, Cushing’s syndrome, hyperprolactinemia and acromegaly. •Interpret common investigation tools including blood tests of basal pituitary function, stimulatory and suppressive tests of pituitary function and water deprivation tests. •Select appropriate imaging modalities and recognize features consistent with congenital hypopituitarism (SON, classic triad of ectopic posterior pituitary), empty sella syndrome, pituitary adenomas (including micro vs. macro and extension outside sella) and craniopharyngioma. •Effectively msnage a child with hypo- or hyper-pituitarism. •Recognize the long-term effects of pituitary disease including changes in physical appearance, fertility and the necessity of therapeutic compliance.


Growth •Discuss the approach to disorders of growth in children, including epidemiology, pathophysiology, investigation and management. •Demonstrate the ability to perform an appropriate history and physical examination of a patient referred for short stature or overgrowth. •Select and interpret appropriate investigations of a patient with short stature or overgrowth. •Recognize the potential psychosocial impact on children and adolescents with short stature or extreme tall stature.

a) Knowledge

Sexual Development/Fertility •Explain and diagram the anatomy, histology and embryology of the ovaries and testes. •Discuss the biosynthesis, transport, peripheral actions and control of secretion of the gonadal hormones and how this can impact on embryology and development. •Describe the etiology, clinical presentation, differential diagnosis, investigation and management of ambiguous genitalia.

b) Skills c) Attitudes a) Knowledge b) Skills

•Describe the clinical manifestations, differential diagnosis, investigation and management of precocious puberty, delayed puberty, incomplete puberty, menstrual disorders, infertility and hyperandrogenic states in females and estrogenization of males. •Perform a focused history and physical examination in a patient referred for suspected ambiguous genitalia or aberrant pubertal development. •Interpret basal and stimulatory tests used in the diagnosis of these disorders including gonadal dysgenesis, androgen insensitivity, premature thelarche, premature adrenarche, hypogonadotropin hypogonadism, hirsutism, amenorrhea and gynescomastia. •Recognize the psychosocial impact and the concerns of the parents of children with ambiguous genitalia with respect to the diagnosis and treatments. •Recognize the impact on the children and adolescent with disorders of puberty especially related to investigations and treatment. Adrenal •Explain and diagram the anastomy, histology and ambryology of the adrenal cortex and medulla. •Discuss the biosynthesis, transport, peripheral actions via their receptors and control of secretion of adrencortical hormones. •Discuss how these hormones impact on fluid, electrolyte and acid-base disorders. •Describe the etiology, clinical presentation, differential diagnosis, investigation and management of primary and secondary adrenal insufficiency. •Describe the clinical manifestations, differential diagnosis, investigation and management of congenital adrenal hyperplasis, hyperandrogenism, Cushing’s syndrome, hypoaldosteronism, hyperaldosteronism, pheochromocytoma and adrenal masses. •Outline the etiology and investigation of endocrine causes of hypertension. •Perform a focused history and physical examination in a patient referred for suspected adrenal insufficiency, congenital adrenal hyperplasia, hyperandrogenism, Cushing’s syndrome, hyperaldosteronism, pheochromocytoma or adrenal mass. •Interpret basal, stimulatory and suppressive tests used to diagnose adrenal insufficiency, congenital adrenal hyperplasia,

c) Attitudes a) Knowledge b) Skills c) Attitudes

hypergonadgenism, Cushing’s syndrome, hypoaldosteronism, hyperaldosteronism, hyperandrogenism, and pheochromocytoma. •Select appropriate imaging modalities for adrenal lesions. •Effectively manage emergency situations such as adrenal crisis and hypertensive crisis secondary to a pheochromocytoma. •Recognize the importance of education in the adjustment of glucocorticoid medication and the necessity for good compliance. •Recognize the impact of potential surgery, repeated examinations and the importance of compliance in children and adolescents with congenital adrenal hyperplasia. Thyroid •Explain and diagram the general anatomy histology and embryology of the thyroid gland. •Discuss physiology of the normal thyroid including: thyroid hormone synthesis, mechanism of action and signal transduction at the level of the thyroid hormone receptor. •Outline the etiology, clinical presentation, investigation and treatment of thyroid disease including: hypothyroidism, hyperthyroidism, thyroid nodules and thyroid cancer. •Demonstrate an understanding of the biochemical and nuclear medicine laboratory tests used in the investigation of thyroid disease. •Demonstrate the ability to take a focused history in a patient referred for thyroid disease. •Demonstrate appropriate technique in examination of the thyroid and examination of the eyes for evidence of thyroid disease. •Describe, select and interpret thyroid function tests in addition to thyroid scans and ultrasounds. •Demonstrate an understanding of the impact of the diagnosis of congenital hypothyroidism on the parents of a newborn infant. •Demonstrate an understanding of patients’ concerns regarding lifelong treatment with thyroid hormone, radiation therapy for both Graves’ disease and thyroid cancer, and prognosis of thyroid cancer.

a) Knowledge

Calcium and Bone •Discuss the normal physiology of calcium and bone metabolism including the control and action of parathyroid


hormone, calcitonin and vitamin D, mechanisms of bone growth and development. •Outline the histology of bone development, formation / destruction and factors controlling bone modeling and remodelling. •Discuss the differential diagnosis, investigation and treatment of hypercalcemia, hypocalcemia, hypo and hyperphosphatemia and hypo and hyermagnesemia in both the acute and chronic setting. •Outline the etiology, investigation and treatment of disorders of bone and mineral metabolism, primary and secondary osteoporosis, and skeletal dysplasias. •Perform a focused history and examination in patients referred for disorders of mineral disturbances, bone mineral metabolism, osteoporosis or skeletal dysplasia. •Describe, select and interpret the appropriate laboratory and radiological investigation of patients with metabolic bone disease and mineral disturbances. •Effectively manage a pediatric patient with osteoporosis or disorders of bone mineral metabolism. •Demonstrate an understanding and respect for a patient’s concerns with regard to treatment for skeletal disorders.


Obesity •Discuss the physiology and pathophysiology of energy balance and the implications for the development of obesity. •To understand the genetic and environmental factors contributing to obesity. •To understand the short- and long-term health implications of childhood obesity. •To perform a focused history and physical examination in patients referred for obesity including the detection of signs and symptoms indicating an endocrine cause and/or secondary effects of obesity. •To identify those patients requiring further diagnostic work-up an, in such cases, describe, select and interpret the appropriate laboratory and radiological investigations. •Demonstrate sensitivity, understanding and respect for a patient’s concerns around the psychosocial and health implications of obesity.

a) Knowledge

Lipids •Discuss lipid metabolism including metabolic pathways


involved and the important receptors, enzymes and control hormones. •Outline the etiology, clinical significance, investigation and management of the dyslipidemias. •Discuss the available evidence for benefit from lipid reduction in childhood in primary and secondary prevention of coronary artery disease later in life. •Discuss the genetics of the inherited dyslipidemias. •Perform a focused history and physical examination in a patient referred for suspected dyslipidemia. •Recognize the important physical findings in dyslipidemia including the various types of xanthomas, xanthelasma and retinal lipemia. •Describe, select and interpret laboratory tests to determine etiology and classification of the dyslipidemias. •Select, educate patients about and follow effectiveness of pharmacological and non-pharmacological interventions for dyslipidemias. •Demonstrate an understanding and be able to counsel patients and families with concerns regarding the effects of their dyslipidemia and its management on diet and daily living, long-term complications, family life and inheritance of the disorder within the family.

a) Knowledge

Other Endocrine Topics •Discuss the alterations in the endocrine system in persons with systemic disease and in pregnant women. •Discuss nutrition as it applies to endocrine disorders. •Discuss screening for endocrine disorders and autoimmunity as it relates to the endocrine system. •Discuss cytogenetics and molecular genetics as they relate to disorders of sexual differentiation, infertility and other inherited endocrine disorders.

COMMUNICATOR General Requirements Specific Requirements

•Establish therapeutic relationship with patient and families. •Obtain and synthesize relevant history from patients, families and communities. •Listen effectively. •Discuss appropriate information with patients and families and the health care team. •Establish therapeutic relationships with patients and their families and other caregivers that are characterized by understanding, trust, respect, empathy and confidentiality. •Listen effectively to patient, families and members of the

health care team. •Present clinical problems clearly, concisely and correctly in verbal reports or written letters. •Demonstrate an ability to provide appropriate support and counselling to a patient and family with chronic endocrine or metabolic disease. •Demonstrate an appreciation of the patient’s perception of health, concerns and expectations and the impact of the endocrine disease on the patient and the family while considering factors such as the patient’s age, gender, cultural and socioeconomic background and spiritual values. •Demonstrate open mindedness to consideration of alternative health care practices in the treatment of endocrine diseases. •Demonstrate an understanding of the importance of communication among health care professionals involved in the care of individual patients such that the roles of these professionals are delineated and consistent messages are delivered to patients and their families. •Demonstrate effective communication with children and adolescents of varying ages, and with their families.

COLLABORATOR General Requirements Specific Requirements

•Consult effectively with other physicians and health care professionals. •Contribute effectively to other interdisciplinary team activities. •Consult effectively with other physicians particularly those most often associated with endocrinology such as neurosurgery, neuroradiology, ophthalmology, nephrology, urology, genetics, obstetrics, paediatrics and psychiatry. •Contribute effectively to other interdisciplinary team activities, particularly those most often associated with endocrinology such as diabetes mellitus, metabolic bone disease, gastroenterology, neurology, urology, community general paediatrics and newborn screening.

MANAGER General Requirements Specific Requirements

•Utilize resources effectively to balance patient care, learning needs and outside activities. •Allocate finite health care resources wisely. •Work effectively and efficiently in a health care organization. •Utilize information technology to optimize patient care, life-long learning and other activities. •Allocate finite health care resources wisely in the context of the health care system for individual patient care, the institution and the community.

•Work effectively and efficiently in health care organizations such as inpatient wards, outpatient clinics, metabolic day treatment centres, acute and chronic care institutions and regional or provincial health systems. •Recognize the role of audits, budget reviews, quality improvement, risk management, incident reporting, and complaint management in various settings including metabolic day treatment centres, clinical investigation units, the laboratory and the ambulatory care setting. •Demonstrate the use of cost/benefit ratios of diagnostic and therapeutic interventions for endocrine disorders as well as cost confinement, efficacy and efficiency as they relate to decision making and quality assurance.

HEALTH ADVOCATE General Requirements Specific Requirements

•Identify the important determinants of health affecting children and adolescents. •Contribute effectively to improved health of patients, families and communities. •Recognize and respond to those issues where advocacy is appropriate. •Identify the important determinants of health affecting patients, particularly those contributing to the burden of illness from endocrine disorders such as diabetes mellitus, hypertension, metabolic bone disease, lipid disorders and obesity. •Contribute effectively to improved health of all patients and communities including education on aspects of prevention of endocrine disorders, specifically environmental, genetic and lifestyle risk factors.

SCHOLAR General Requirements Specific Requirements

•Develop, implement and monitor personal continuing education strategy. •Critically appraise sources of medical information. •Facilitate learning of patients, housestaff/students, and other health care professionals. •Contribute to the development of new knowledge. •Critically appraise sources of medical information particularly as it pertains to endocrinology and metabolism. •Educate patients, housestaff, students and other health care professionals in formal and informal education settings regarding endocrine disorders and the impact of chronic disease on the endocrine system. •Demonstrate an understanding of preferred learning methods in dealing with students, residents and colleagues. •Contribute to the development of new knowledge in

endocrinology and metabolism. PROFESSIONAL General Requirements Specific Requirements

•Deliver highest quality health care with integrity, honesty and compassion. •Exhibit appropriate personal and interpersonal professional behaviours. •Practice medicine ethically consistent with the obligations of a physician. •Demonstrate an understanding of the principles of medical ethics as they relate to patient care and clinical research including autonomy, beneficence/nonmalificence, confidentiality, truth telling, justice, and respect for persons, conflict of interest and resource allocation. •Demonstrate a willingness to accept peer and supervisor reviews of professional competence. •Demonstrate recognition of personal limitation of professional competence and demonstrate a willingness to call upon others with special expertise. •Demonstrate flexibility and willingness to adjust to changing circumstances.

Longitudinal Clinic Objectives At Six Months Medical Expert To obtain/demonstrate diagnostic and therapeutic skilld

effectively and ethically, manage a spectrum of endocrinology out-patient problems.

Communicator To establish a therapeutic relationship with patients. To elicit and synthesize relevant information from the patient and discuss the appropriate information with the patient. To ensure proper follow up of patients.

Collaborator To effectively consult with other physicians. To effectively interface with allied health professionals (pathology, radiology, laboratory). To ensure follow up in the out- or in-patient setting (discharge planning and clinic appointments).

Health Advocate To identify the determinants of health that affect a patient, such as for obesity, diabetes mellitus, hyperlipidemic patients and to contribute to improving their health.

Manager To work efficiently and effectively in an out-patient clinic setting. To organize time and work management. To be able to triage consults. To utilize health care resources in a cost effective manner.

Scholar To continue developing a personal continuing education program.

Professional To deliver the highest quality care with integrity and to practice medicine in an ethically responsible manner. To reorganize one’s own limitations. To answer pages promptly and vet the issues with the staff.

At Twelve Months Medical Expert To master the knowledge and the skills to deal with most

everyday endocrine/diabetic situations. Communicator To feel comfortable communicating with families / patients

and to synthesize relevant information for the conditions listed below.

Collaborator To have integrated into our multidisciplinary teams- diabetes

mellitus, laboratory, pathology, radiology, antenatal clinic and reproductive endocrinology.

Health Advocate To be fairly comfortable advocating independently for some routine conditions DKA, dm illness and hospitalization, new onset dm and teaching and endocrine disorders such as short stature, hypo and hyperthyroidism, pubertal disorders, hyperlipidemia, obesity, calcium disorders, hypopituitarism.

Manager To manage housestaff teams and to delegate appropriately. Scholar To have acquired the skill for literature searches, analysis of

articles and appraisal. Professional To have modified previously acquired professional behaviour

to the Endocrinology environment. One Year Medical Expert To have mastered the knowledge base and skills to function

independently regarding conditions such as calcium, lipid, pituitary, thyroid disorders, diabetes early and long term complications, metabolic bone disease, growth, fluid and electrolyte disorders. As well as understanding how genetic, radiology, nuclear medicine and pathology complement the care of our patients.

Communicator To feel comfortable communicating with families / patients and to synthesize relevant information for the conditions listed below.

Collaborator To have integrated into our multidisciplinary teams- diabetes mellitus, antenatal clinic, laboratory, pathology, radiology and reproductive endocrinology.

Health Advocate To be fairly comfortable advocating independently for some routine conditions DKA, dm illness and hospitalization, new onset dm and teaching and endocrine disorders such as short stature, hypo and hyperthyroidism, pubertal disorders, hyperlipidemia, obesity, calcium disorders, hypopituitarism.

Manager To manage housestaff teams and to delegate appropriately. Scholar To have acquired the skill for literature searches, analysis of

articles and appraisal. Professional To have modified previously acquired professional behaviour

to the Endocrinology environment. Twenty-four Months Medical Expert To have further refined the knowledge base but most

importantly refined scholarly skills to be able to tackle any new health care issue for their patients even if they have had no previous exposure.

Communicator Collaborator Health Advocate To not only be able to advocate for an individual or family but

to see how healthcare physicians can impact health at a

community if not at a national or international level. Manager Scholar To have asked at least one clinically important question and

researched this. Usually most trainees will have presented and/or published this if not more than one over the period of 2 years.

Professional To have polished their skills.

In-Patient Consultation Objectives Curriculum – Attend in-patient consultation service concurrently with out-patient clinics in assigned hospital. Medical Expert To obtain/demonstrate diagnostic and therapeutic skills

effectively and ethically manage a spectrum of endocrinology in-patient problems. To access and apply relevant information for such said patient care. To aid in the learning of the trainees on the team.

Communicator To establish a therapeutic relationship with patients. To elicit and synthesize relevant information from the patient and discuss the appropriate information with the said patient. To ensure appropriate sign-out to the next team member for patients.

Collaborator To effectively consult with other physicians. To effectively interface with allied health professionals (pathology, radiology, laboratory). To ensure follow-up in the out- or in-patient setting (discharge planning and clinic appointments).


Manager To work effectively and efficiently in health care setting. To delegate appropriately within the team. To ensure that clinics and protected teaching are not interrupted with pages. To implement accepted preventative measures. To organize time and work management. To be capable of triaging consultations. To utilize health care resources in a cost effective manner.

Scholar To continue developing a personal continuing education program.

Professional To deliver the highest quality care with integrity and to practice medicine in an ethically responsible manner. To recognize one’s own limitations. To answer pages promptly and vet the issues with the staff.

General Endocrinology Clinic Objectives Medical Expert To obtain/demonstrate diagnostic and therapeutic skills

effectively and ethically managed a spectrum of endocrinology out-patient problems. To access and apply relevant information for such said patient care.

Communicator To establish a therapeutic relationship with patients. To elicit and synthesize relevant information from the patient and discuss the appropriate information with the said patient. To master composing a consultant’s letter. To be cognizant of providing follow-up/letters to referring physicians.

Collaborator To effectively consult with other physicians. To effectively interface with allied health professionals (pathology, radiology, laboratory).


Manager To work effectively and efficiently in health care setting. To implement accepted preventative measures. To organize time and work management. To be capable of triaging consultations. To utilize health care resources in a cost effective manner.

Scholar To continue developing their personal continuing education program.

Professional To deliver the highest quality care with integrity and to practice medicine in an ethically responsible manner. To recognize one’s own limitations.

Diabetes Clinic Objectives Medical Expert Establish and maintain clinical knowledge of:

Disorder of glucose metabolism including hypoglycaemia and hyperglycemia. Type 1 and Type 2 diabetes including the role of nutrition, exercise, pharmacologic management including insulin pump therapy and complications.







Lipid Clinic Objectives

Medical Expert Establish and maintain clinical knowledge of disorder of lipid metabolism.







Neuroendocrine Clinic Objectives

Medical Expert Establish and maintain clinical knowledge of: Normal growth and development and its variations. Disorders of the anterior and posterior pituitary gland.







Gestational Diabetes Clinic Objectives

Medical Expert Establish and maintain clinical knowledge of: Gestational diabetes and pregestational diabetes. Treatment of gestational diabetes and pregestational diabetes. Risks to mother and fetus and prevention of these risks.







Calcium and Bone Metabolism Clinic Objectives

Medical Expert Establish and maintain clinical knowledge of: Metabolic bone disease and disorders of calcium metabolism including disorders of the parathyroid glands and the vitamin D system.







Thyroid Clinic Objectives

Medical Expert Establish and maintain clinical knowledge of disorders of the thyroid gland and metabolism. Acquire skill in FNA +/- ultrasound guidance.







Pediatric Endocrinology and Metabolism

Objectives for Adult Endocrinology Residents GENERAL OBJECTIVES Residents and students performing a rotation in our division will work primarily in the outpatient setting assessing and managing patients with common endocrine disorders (growth issues, delayed or precocious puberty and thyroid gland dysfunction) as well as the diagnosis and management of diabetes mellitus. 1) MEDICAL EXPERT

The resident is expected to achieve medical competence in these domains/topics of endocrinology. This will be accomplished by direct patient care, clinical case presentations, teaching sessions and self directed teaching.

Glucose homeos tas i s

The resident will be able to: • Diagnose Type 1, Type 2 and glucose intolerance and to provide a differential

diagnosis for these disorders • Describe the pathophysiology and natural history of these disorders • Select appropriate therapy and follow up for such said patients • Provide guidance for illness, exercise or ketosis • Diagnose hypoglycaemia, to initiate investigations and to be able to interpret

them • Provide a differential diagnosis • Understand the various therapeutic modalities available

Pitu i tary g land dys func t ion The resident will be able to • Describe the clinical manifestations of congenital or acquired hypopituitarism,

including diabetes insipidus • Delineate the investigations required to diagnosis hypopituitarism and those

required for follow up monitoring • Describe the pathophysiology and natural history with special emphasis on

children post chemotherapy and/or radiotherapy • Understand the concepts related to hormone replacement strategies and potential

side effects • Understand how exogenous glucocorticoids can cause adrenal suppression, its

manifestations and its treatment

Growth The resident will be able to • Describe typical linear height patterns and be able to discuss the use of BMI and

wt : ht curves

• Understand how chronic illness or medications may impact on growth • Discuss appropriate investigations for children with abnormal growth patterns • Understand the current usage of growth hormone and its side effects Thyro id

The resident will be able to • Be able to examine the thyroid gland • Understand the symptoms of hypo- and hyperthyroidism and be able to select

and interpret the appropriate laboratory tests • Describe the pathophysiology and natural history of these disorders • Prescribe the appropriate medications

Puber ty The resident will be able to • Expertly perform puberty Tanner staging and to understand the typical ages for

the onset of puberty • Describe the pathophysiology of several benign pubertal variants (premature

thelarche, premature adrenarche and gynecomastia) and to outline the differential • Discuss the differential diagnosis of precocious or delayed puberty, galactorrhea,

hirsuitism, primary and secondary amenorrhea and to outline the required investigations

• Prescribe the appropriate medications

Adrenal The resident will be able to understand the cortisol/aldosterone synthetic pathway and to be able to discuss the clinical manifestations of 21-hydroxylase CAH and its treatment

Ambiguous g en i ta l ia and normal g en i ta l deve lopment The resident will be able to review how normal genital development occurs. She/he will be able to understand how ambiguous genitalia may arise because of an underlying genetic disorder, related to an endocrinopathy or as an idiopathic event. She/he will appreciate the urgent need for assessment by a variety of health care professionals.

Obes i ty The resident will be able to review the causes of endogenous obesity and to outline strategies to prevent as well as treat exogenous obesity. She/he will be able to discuss the kinds of sequelae- short and long term that can arise from obesity.

Bone and minera l homeos tas i s The resident will understand the hormones that assist in mineral homeostasis and how defects in their function can give rise to clinical manifestations. She/he will be able to counsel families about the correct dietary recommended intakes of calcium and vitamin D across childhood.

Lipid abnormali t i es- pr imary and secondary The resident will acquire knowledge about causes of primary and secondary lipid disorders and ways to apply screening methods and follow up for high risk individuals. She/he will be able to counsel families about sound dietary advice to prevent and treat hyperlipidemia.

2) COMMUNICATOR

The resident will be observed and assisted to ensure that he/she demonstrates appropriate communications skills. Specifically, he/she will establish therapeutic relationships with the patients and the families and provide them with anticipatory guidance. Additionally, he/she will communicate findings of the consultation to the referring physician in an organized letter and/or by telephone. Clear documentation of care will be written in the medical chart.

3) SCHOLAR

The resident will participate in all academic activities of the division including attending weekly rounds, participating in post-clinic conferences, participate in clinical case discussions and in twice-weekly resident teaching sessions. The resident will wish to use the ‘log book’ provided to document the cases seen and the material that was researched to augment her/his database. Analysis of at least one journal article and or other presentation will foster critical appraisal.

4) COLLABORATOR

The resident will understand the role of the physician as a member of a multidisciplinary health care team and recognize and understand the roles and expertise of the other allied health professionals. The resident must demonstrate appropriate interactions with other health care professionals throughout the rotation.

5) PROFESSIONAL

The resident will demonstrate appropriate personal and interpersonal behaviours, which include honesty, integrity, responsibility, self-discipline, sensitivity to diversity and a sense of ethics. He/she will demonstrate a willingness to respond to constructive feedback.

6) ADVOCATE

The resident will identify the important determinates of health affecting patients and recognize and respond to those issues where advocacy is appropriate. The resident will encourage families to see support from all team members, from reliable information sources and families who are available for advice. The resident will also ensure that issues such as timely investigation, prompt communication of results to patients, families and other health care providers and initiation of care are addressed.

7) MANAGER

The resident will serve as the primary health care coordinator for children with dm and as the front line consultant for children with endocrinologic disorders. She/he will be able to manage and integrate the care of patients with multi-system medical problems. As well, he /she will utilize health care resources appropriately and implement accepted preventative measures.

Reproductive Endocrinology Rotation Objectives

By the completion of the six (6) week rotation in reproductive endocrinology, the resident should have acquired knowledge of the following:

Medical Expert Normal steroid pathway and interpretation of steroid pathway

anomalies. The diagnosis of reproductive endocrine disorders including polycystic ovarian syndrome (PCOS), weight-related and other menstrual dysfunction, prolactinomas, hypogonadotropic hypogonadism, premature ovarian failure and hirsutism.

The diagnmostic testing of the above disorders, their indications and contraindications, their limitations, sources of errors and interpretation.

For PCOS:

- The resident should be able to assess the metabolic risk factors including insulin resistance.

- They should be able to induce ovulation using weight modification, insulin resistance, modification, adrenal suppression, clomiphene citrate and gonadptropins.

- They should have an understanding of the principles of ovulation induction with pulsatile LHRH therapy.

- They should be able to treat androgen excess with anti-androgen therapies.

For prolactinemia:

- The fellows should be able to examine patients with pituitary disease.

- The appropriate use and interpretation of endocrine tests.

- The use and interpretation of radiological studies of the sella tursica.

- The resident should be able to appropriately diagnose a prolactinoma.

- The institution and monitoring of treatment. - The indication for surgical therapy.

For hypogonadotropic-hypogonadism: - The fellows should know the differential diagnosis of

the underlying pathology. - They should be able to administer hormonal

replacement therapy.

- They should have an understanding of the principles of LHRH substitution or gonadotropin treatment.

For premature ovarian failure (POF):

- The fellows should know how to define and to diagnose POF.

- They should know the differential diagnosis of the underlying pathology.

- They should be able to manage this condition. - They should know the related endocrinopathies.

For menstrual dysfunction: - The fellows should be able to investigate

oligomenorrhea and amenorrhea. - They should be able to manage menstrual dysfunction.

For hirsutism and acne: - The fellows should be able to conduct investigations

and treatment of the condition. - They should be able to understand their relevance to

PCOS and the associated risks. Communicator Consult patients and their families on a routine basis medically

and psychologically. Obtain and synthesize relevant history from patients, families and communities. Gain respect and trust from the patients and families. Be culturally sensitive.

Collaborator Consult effectively with other physicians, allied health professionals, non-medical experts and other institutions or departments. Contribute and collaborate with others.

Health Advocate Identify important determinants affecting a patient’s health. Contribute to improved health of patients and communities. Recognize and respond to issues where advocacy is appropriate. Be aware of regulations and changes in Health Care and Reproductive Technologies.

Manager Utilize resources effectively and efficiently to balance patient care.

Allocate resources wisely. Work effectively and efficiently in health care organization. Utilize information technology to optimize patient care and lifelong education. Manage clinical practice.

Scholar Develop, implement and monitor personal continuing education strategy. Critically appraise medical literature. Facilitate learning of patients, students and allied health professionals. Contribute to development of new knowledge by presentations.

Professional Deliver highest quality of care with integrity, honesty, compassion and ethics. Exhibit appropriate personal and interpersonal professionalism.

Endocrinology Clinical Laboratory Rotation Objectives

Curriculum – Attend a two (2) week block in laboratory medicine at three (3) different hospital sites (RVH, MGH, JGH). Medical Expert To obtain knowledge of molecular diagnosis, functional

endocrine testing, endocrine assays. To understand the steps required in testing/tests, their caveats and to understand the need for adequate reference ranges/protocols To gain knowledge in the use of radioisotopes in the diagnosis and management of endocrine disorders, including knowledge about radiation safety and the regulatory requirements pertaining to the use of radioactive isotopes.

Communicator To encourage communication with nuclear medicine consultants, pathologists, and laboratory technicians


Health Advocate To observe how healthcare professionals contact allied healthcare workers to negotiate timely care To understand how ancillary laboratories function to ensure appropriate panels of tests and reference ranges for a specific age group To observe how specialized testing can be mandated/arranged and carried out within current fiscal and hospital limits

Manager To work effectively and efficiently in health care setting. To implement accepted preventative measures. To utilize health care resources in a cost effective manner. To understand the costs and turnaround time involved in routine and STAT testing To understand how to prioritize sample testing and analyses scheduling To appreciate QA/QI issues and how they impact on

laboratory results Scholar To continue developing their personal continuing education

program. To use exposure to laboratory medicine to address a QA/QI question about laboratory function/results


Research Block Objectives Medical Expert To assess and apply relevant information to research or

research clinical practice. To demonstrate medical expertise in situations other than direct patient care.

Communicator To document research ideas as a protocol, manuscript or lecture To develop good comunication skills with research subjects, supervisor, trainees or team members

Collaborator Possibly – to contribute to other interdisciplinary teams. Health Advocate To identify determinants of health that affect a patient

To use research as a tool to advocate for health changes/ dissemination of health information

Manager To manage time wisely to address the research question and any other professional commitments. To utilize resources effectively when designing and implementing research project To manage a research operating budget

Scholar To formulate a clinical/research question and to formulate a plan to fill this gap in knowledge. To contribute to the development of new knowledge.

Professional To exhibit appropriate personal and interpersonal professional behaviours.

Insulin Pump Objectives In the second year of training attend insulin pump information sessions organized by the Montreal Children’s Hospital, and attend carbohydrate counting sessions. Follow 2-3 insulin pump starts and follow up of these patients. Medical Expert Understands the mechanics of insulin delivery by a pump

Understands how to prescribe and to adjust insulin pump therapy Understands how to deal with pump malfunctions and abnormal blood sugars Understands the limitations of pump therapy Understands the advantages and burdens of pump therapy

Communicator To establish a therapeutic relationship with patients and families

Collaborator Effectively consults with pump centre diabetic educators Works with the pump centre team and the families to optimize diabetes control

Health Advocate Identifies situations that may be considered high risk for DKA or hypoglycemia Works with patients and their families to prevent these situations Identifies and practices effective ways of helping patients with insurance coverage of pump and supplies. Identify ways of promoting change in the policy of government and private insurers that will lessen the financial burden of using the insulin pump. Understands the role of the physician in advocating for pump options vis a vis insurance companies and the government

Scholar To continue developing their personal continuing education program

Updated – July 2013

mcgill endocrinology and metabolism training program ... · reproductive endocrinology and...

Documents