Subspecialty Training Program in Endocrinology and Metabolism
Program Goals and Objectives
Contents:
- Preamble
- Didactic lecture series
- Journal club
- In-patient clinical training
- Core ambulatory clinical training
- Special ambulatory rotations
- Research training
- Teacher training
- Assumption of increasing independence and responsibility
The overall goals and objectives of the training program are to meet the six general competencies common to all ACGME clinical training programs, as they apply to this subspecialty and to attain these incrementally, while simultaneously reducing the amount of supervision required, such that upon completion of the training program, the resident is fully competent to serve as an independent subspecialist.
2-A) Core Didactic Lecture Series:
This lecture series comprises a program of 96 hours of didactic lectures, discussion and CME-type evaluation, held over the 2-year training period. The program consists of 48 two-hour educational encounters, held twice monthly, 24 in year A and 24 in year B on a cyclical basis. These are held on Monday evenings from 5-7 p.m. in the dedicated conference room (200 Medical Plaza, Suite 510). Since both PGY-4 and PGY-5 residents attend these lectures together, there is no specific “first” and “second” year series, but all residents will be offered all lectures over the course of their 24 months of training.
Goals and Objectives:
1. To provide didactic information on the pathogenesis, clinical features, evaluation and management of the major classes of adult and pediatric endocrine disorders;
2. To provide a forum for discussion and feedback from the information provided in order to ensure that comprehension and the ability to use the information in practice have been achieved;
3. To perform self-assessment based on the theme of the didactic presentation as a tool to evaluate comprehension and knowledge acquisition;
The specific goals of the didactic lecture series are to achieve the 3 overall objectives described above in the following specific areas:
YEAR A:
1. Posterior pituitary and related hypothalamic disorders;
2. Anterior pituitary and related hypothalamic disorders;
3. Ethical responsibilities of the investigator;
4. Psychosocial aspects of diabetes mellitus, including counseling and education;
5. Nutrition and dietary planning for diabetes mellitus;
6. Practice-based diagnostic services (dual x-ray absorptiometry, ambulatory blood pressure monitoring, continuous glucose monitoring system, thyroid ultrasound with and without fine needle aspiration biopsy, nerve conduction studies, carotid intimal medial thickness analysis, digital retinal imaging and body composition analysis);
7. The metabolic syndrome and its relationship to macrovascular disease;
8. Type 1 diabetes mellitus – acute and chronic metabolic management;
9. Type 2 diabetes mellitus – acute and chronic metabolic management;
10. Atypical forms of diabetes mellitus (MODY, LADA, surgical, calcific, toxic etc);
11. Microvascular complications of diabetes mellitus;
12. Disorders of bone metabolism, with emphasis on osteoporosis;
13. Endocrine hypertension;
14. Adrenal cortical disorders;
15. Amenorrhea and infertility, inc. polycystic ovarian syndrome and hyperandrogenism;
16. Biostatistics in study design and data management;
17. Disorders of thyroid function;
18. Evaluation of goiter and thyroid nodules;
19. Testicular tumors and male reproductive disorders;
20. Principles of parenteral nutrition;
21. Disorders of sexual differentiation;
22. Parathyroid disorders
23. Syndromes of multiple endocrine neoplasia;
24. Impotence and hypogonadism;
YEAR B:
25. Management of endocrine disorders in pregnancy;
26. Adrenal medullary disorders;
27. Hypoglycemia;
28. Dynamic functional testing in endocrinology;
29. Isotope and radiologic imaging techniques in endocrinology;
30. Disorders of growth and development;
31. Obesity;
32. The dyslipidemias;
33. Diabetes in pregnancy;
34. Endocrine autoimmunity and polyglandular endocrine failure;
35. Inborn errors of metabolism;
36. Management of endocrine cancers;
37. Endocrinology of puberty and pubertal disorders;
38. Genetics in endocrinology;
39. Management of hyperglycemia in hospitalized patients;
40. Endocrine disorders and end of life issues;
41. Gastrointestinal hormonal disorders;
42. Ectopic hormone syndromes;
43. Endocrine aspects of athletic training, sports medicine and substance abuse;
44. Coding, billing and documentation compliance;
45. Endocrinology of aging and aging related disorders;
46. Fluid and electrolyte disorders, inc. calcium and magnesium balance;
47. Psychiatric disease & endocrine disorders, including anorexia nervosa & bulimia;
48. Pancreas and pancreatic islet transplantation;
2-B) Endocrine Grand Rounds Lecture Series:
In this weekly lecture series a wide variety of clinical and research topics relevant to the endocrine, paracrine and autocrine dysfunction of endocrine and metabolic tissues are presented. In addition disorders of all endocrine glands, including the parathyroids, pituitary, thyroid, pancreas, adrenal, and gonads, and endocrine function of brain, kidney, skin and other “nonendocrine” tissues are discussed. The Endocrine Grand Rounds consists of formally presented topics. Once per month, these rounds address a topic relevant to pediatric endocrinology. It should be noted that this lecture series is a core divisional, rather than a training program, activity. Therefore the goals and objectives are those to be achieved by attendance and participation, rather than from the course content.
Goals and Objectives:
1. To increase understanding of the pathophysiology of diverse endocrine and
metabolic disorders at a biochemical, molecular and physiologic level;
2. To enhance understanding of new biochemical and image based investigations of
endocrine and metabolic disorders;
3. To increase knowledge of the epidemiology and societal impact of common
endocrine and metabolic disorders;
4. To understand the use of cellular and animal models as a basis for the study of
endocrine and metabolic disorders.
2-C) Gonda Diabetes Center Educational Lunch Meetings:
This activity is held monthly on the first Friday of each month, with periodic additional meetings on an ad-hoc basis. Although the topics in this series are not set or recurrent, in contrast to the Didactic Lecture Series, these lectures are arranged exclusively by the Program Director and/or Program Co-Director in with the specific objective of bringing
additional information that will broaden the scope of the core didactic series in various areas. They are designed to be dynamic and topical, with the flexibility to provide new information on topics of immediate relevance.
Goals and objectives:
1. To provide information on newly available medications and technologies relevant to
the practice of clinical endocrinology;
2. To compare and contrast new medications and technologies with currently
available therapies;
3. To critically evaluate the investigative and therapeutic options for common
endocrine disorders;
2-D) UCLA Diabetes Symposium:
The UCLA Diabetes Symposium is held annually, occasionally bi-annually, and is a one-day educational program of the UCLA Division of Endocrinology, Diabetes and Hypertension. The target audience is diverse and includes physicians and other professional practitioners. Attendance is mandatory for both divisional faculty and subspecialty training program residents. The usual format consists of eight 45-minute didactic lectures divided into a morning and afternoon program of four lectures each. The morning program focuses on epidemiology and pathophysiology, while the afternoon program focuses on evaluation and management. At the conclusion of both the morning and afternoon sessions, a panel discussion is convened. This program is run under the auspices of the Continuing Medical Education Office of the David Geffen School of Medicine at UCLA and fulfils the criteria for Category 1 CME credit for physicians. Each program has its own stated learning objectives unique to the particular topic.
For our subspecialty training program attendees the goals and objectives are:
1. To increase understanding of the pathophysiology and epidemiology of the specific
disorder under consideration;
2. To learn state-of-the-art approaches to diagnosis, evaluation and management
of the disorder under consideration.
3. To engage in interactive discussion to enhance the experience of participation in a focused large group (i.e. over 100 attendees) educational setting.
2-E) Endocrine Pathophysiology Lecture Series:
The residents are advised to attend selected lectures in this series given to the first year medical students at the David Geffen School of Medicine at UCLA annually in January and February. The third block of this series includes lectures themed on diabetes mellitus, osteoporosis, pituitary disorders and infertility. The following topics are covered in this series of one-hour lectures:
1. Glycogen metabolism and response to fasting/starvation;
2. Fatty acid biosynthesis and its regulation;
3. The pentose phosphate pathway and hormonal regulation of diet;
4. Adipocyte cell biology;
5. The LDL receptor and lysosomal disorders;
6. Cholesterol and bile acid synthesis and statins;
7. Steroid hormones;
8. Glucose and lipid measurement;
9. Disorders of calcium metabolism and calcium signaling;
10. The pituitary and growth problems in children;
11. Female reproductive physiology;
12. Female reproductive physiology (pregnancy);
13. Male reproductive physiology;
14. Thyroid hormone synthesis;
15. Reproductive physiology and contraception;
16. Effects of thyroid hormones;
17. Disorders of amino acid and protein metabolism;
18. Ambiguous genitalia.
The Journal Club is held biweekly throughout the academic year. An original investigative article (reviews, commentaries and editorials are not permitted) is chosen by the resident. The resident presents the article in an interactive semi-formal setting with active discussion and feedback by other residents and program faculty. The resident specifically comments on the validity of the experimental design and on the statistical analytic methods used and provides his/her opinion of the validity and importance of the findings and any apparent flaws.
Goals and objectives:
1. To develop residents’ ability to critically appraise original investigative published
reports in the field of endocrinology and metabolism;
2. To enable residents to develop the necessary organizational skills to concisely
summarize the major points of a published report;
3. To enable residents to present scientific information in a semi-formal setting and
address constructive comments and criticism;
4. To enable residents to effectively use audiovisual media to improve communication;
5. To emphasize the importance of use of biostatistics in study design and data
analysis;
6. To enable residents to further develop the skills and self-discipline necessary for scholarship and self-study;
4. Inpatient Endocrine Consultation Service:
Goals and objectives
1) To learn how to be an effective consultant in Endocrinologic disorders (this includes understanding what question is being asked by the referring physician, providing prompt evaluation of patients when consulted, providing effective and timely communication with the referring physician)
2) To be competent in the diagnosis and management of a broad range of endocrine and metabolic disorders. This experience specifically stresses those aspects that are most commonly encountered in the inpatient setting such as:
-Endocrine emergencies, including:
1) Hypercalcemia and hypocalcemia
2) Thyroid storm
3) Myxedema coma
4) Acute adrenal insufficiency
5) Pituitary apoplexy
-Disorders of fluid, electrolyte, and acid-base metabolism including:
1) Hypernatremia and hyponatremia
2) Hyperkalemia and hypokalemia
3) Metabolic acidosis
4) Metabolic alkalosis
5) Disorders of magnesium metabolism
6) Diabetes insipidus, central and nephrogenic
-Disorders of lipid, carbohydrate, and protein metabolism including principles of enteral and parenteral nutritional support
-Hormone-producing neoplasms
-Endocrine adaptations and maladaptations to systemic diseases
-The surgical patient with diabetes mellitus
-The neurosurgical patient during and after transphenoidal pituitary surgery;
-Differential diagnosis and management of disorders of primary and secondary hypertension
-Neuroendocrinology and endocrine aspects of psychiatric diseases
-The interpretation of laboratory tests; immunoassays; and radionuclide, ultrasound radiologic and other imaging studies for the diagnosis and treatment of endocrine and metabolic disease including the effects of a variety of unrelated disorders and performance and interpretation of stimulation and suppression tests.
In addition, the Division now operates an in-patient hyperglycemia service for the intensive management of hyperglycemia in hospitalized patients. This service is staffed by a full-time hospitalist, who is board-certified in Endocrinology and Metabolism and is a full-time member of the teaching faculty. Rotation through this service occurs separately from rotation through the in-patient endocrine consultation service.
The goals and objectives of the In-patient Hyperglycemia Service rotation are:
1. To understand the contribution of hyperglycemia to mortality and multiple morbidities in hospitalized patients;
2. To achieve proficiency in the management of hyperglycemia using intravenous insulin protocols;
3. To be able to transition patients from intravenous insulin protocols to subcutaneous insulin;
4. To communicate with the patient and the patient’s physician(s) and other caregivers in regard to post-discharge planning for education and ongoing treatment, when previously unrecognized diabetes mellitus is diagnosed during admission;
5A) Core Ambulatory Endocrine Training Program:
The ambulatory training program is conducted at 2 sites: On the UCLA campus in Westwood in The Gonda (Goldschmied) Diabetes Center at 200 UCLA Medical Plaza; and in the UCLA Community Practices in Santa Monica at 1801 W. Wilshire Boulevard.
All components of the core ambulatory program are integrated within these two settings. Although the campus site is a Diabetes Center in name, all endocrine and metabolic disorders are seen there. The Pituitary Program is also located in this center. The diabetes teaching programs of the Gonda Diabetes Center are certified by the American Diabetes Association and diabetes education classes are held there each month. The Diagnostic Services Unit resides in immediate proximity to the Gonda Diabetes Center. In addition to core teaching physician faculty, the following professional personnel practice within the ambulatory suite and provide clinical and didactic teaching to the residents:
1. Nurse Practitioner/Certified Diabetes Educator;
2. Registered Dietitian/Certified Diabetes Educator;
3. Pharmacists (2);
4. Exercise Physiologist;
5. Certified X-ray technologist;
6. Podiatrist;
7. Cardiologist;
8. Nephrologist.
A Dietitian/Certified Diabetes Educator is located in the Santa Monica Community Practice.
Goals and objectives
1) To learn how to be an effective consultant in Endocrinologic disorders (this includes understanding what question is being asked by the referring physician and providing effective and timely communication with the referring physician)
2) To learn skills related to history, examination, assessment, and management of ambulatory patients with the following endocrine problems in the context of referral to a subspecialty endocrine clinic:
-Thyroid disorders including:
1) Hyperthyroidism and hypothyroidism
2) Nodular thyroid diseases
3) Thyroid cancer
4) Goiter
-All varieties of thyroiditis
-Disorders of calcium and skeletal metabolism including:
1) Hyperparathyroidism and other causes of hypercalcemia
2) Hypoparathyroidism and other causes of hypocalcemia
3) Metabolic bone diseases
4) Evaluation and treatment of kidney stones
-Disorders of blood pressure
-Endocrine aspects of aging, including menopause
-Nutritional disorders and obesity
-Male and female reproductive endocrinology
-Routine management of patients with pituitary disease
-Diabetes mellitus and related disorders, including:
-Patient monitoring and treatment objectives in children and adults
-Acute and chronic complications including:
-Diabetic ketoacidosis
-Hyperosmolar coma
-Hypoglycemia
-Microvascular and macrovascular disease including:
-Diabetic retinopathy
-Diabetic nephropathy
-Diabetic neuropathy
-Diabetic dermopathy
-Coronary heart disease
-Peripheral vascular disease
-Cerebral vascular disease
-Infections
-Patient education
-Psychosocial issues
-Genetic counseling
-Hypoglycemic syndromes
-Dietary principles
In addition residents gain skills in the management of patients of all ages with diabetes mellitus, including but not limited to the following aspects of the disease:
a. The rationale, indications, performance and interpretation of
glucose tolerance tests
b. The utilization and interpretation of glycosylated hemoglobin levels, islet cell and insulin antibody levels in patient management and counseling
c. Rational for and calculation of diabetic diets
d. Prescription of exercise programs.
e. Oral antidiabetic therapy
f. Chronic insulin administration including the use of all varieties of insulin delivery systems
g. Glucose monitoring devices
h. Funduscopic examination, recognition, and appropriate referral of patients with diabetic retinopathy
i. Foot care
j. Psychosocial effects of diabetes mellitus on patients and their families
k. Patient and community education
l. Preconception and contraceptive counseling
5B) Thyroid Screening and Fine Needle Aspiration Clinic:
-Goals and Objectives:
To learn skills related to history taking, examination, assessment, and plan, including imaging and fine needle aspiration biopsy for ambulatory patients with thyroid nodules. Patients seen in this venue are screened for the presence of nodule and if necessary a fine needle aspiration is performed within the context of that clinic. Subspecialty residents become confident in the detection of thyroid nodules and the performance and cytologic interpretation of the fine needle aspiration of the thyroid with and without ultrasound guidance.
5C) Pituitary and Neuroendocrine Disorders Program:
-Goals and Objectives:
To learn the skills related to history taking, examination, assessment and plan for the management of ambulatory patients with symptoms suggestive of a midline tumor that might involve the pituitary gland, hypothalamus or related structures, or the management of the patient with established pituitary pathology. Subspecialty residents are familiarized with the diagnosis and management of the following hypothalamic and pituitary tumors and disorders:
1) Prolactinoma
2) Alpha-subunit-secreting pituitary tumors
3) Acromegaly
4) Cushing’s disease
5) Gonadotropin-secreting pituitary tumors
6) Thyrotropin producing pituitary tumors
7) Nonfunctioning tumors
8) Metabolically active lesions
9) Craniopharyngioma
10) Hypophysitis
11) Granulomatous disease (sarcoidosis, histiocytosis-X,
Wegener’s granulomatosis etc)
6) Special Ambulatory Rotations:
In addition to the core ambulatory and in-patient training programs, the training program provides special ambulatory rotations, generally of one half-day per week over a one month period. Some rotations repeat in the second year of training. The purpose of these special rotations is to provide special training and experience that is not obtainable either in the physical location where core training occurs, or when these rotations are supervised provided by teachers other than the core physician faculty. The following are attended by all residents.
6-A) Pediatric growth and development: Location: UCLA Div. of Pediatric Endocrinology
-Goals and Objectives:
1. To learn skills related to history taking, examination, assessment, and management of pediatric endocrinology ambulatory patients;
2. To learn to evaluate and manage growth disorders in children, including the various indications for growth hormone therapy;
3. To acquire the knowledge required to manage Turner’s Syndrome (diagnosis, evaluation, specific therapies);
4. To learn to evaluate and manage pubertal disorders (delayed and advanced; benign vs. true precocious puberty);
5. To learn the work-up and chronic management of congenital adrenal hyperplasia;
6. To master the evaluation and management of hypopituitarism (congenital and iatrogenic) in children;
7. To learn to evaluate and manage congenital hypothyroidism and common thyroid disorders in children.
6-B) Female reproductive endocrinology and dysfunctional uterine bleeding: Location: UCLA Dept of ObGyn
-Goals and Objectives:
1. To acquire the skills necessary to the careful and thorough evaluation of the female patient with a possible reproductive endocrine disorder or dysfunctional bleeding.
2. To understand the human menstrual cycle and its neuroendocrine regulation;
3. To understand the endocrine regulation of the breast and its disorders;
4. To understand and be able to evaluate the role of the thyroid gland in reproductive function;
5. To be able to evaluate and treat the woman with hirsutism and other manifestations of hyperandrogenism;
6. To understand the causes of primary and secondary amenorrhea and evaluate this problem;
7. To evaluate the woman with the complaint of infertility;
8. To understand the major methods of contraception, their effectiveness, risks and benefits.
6-C) Male reproductive endocrinology and testicular tumors:
Location: UCLA Division of Urology
Goals and Objectives:
To learn skills related to history, examination, assessment, and plan for ambulatory patients with male infertility, sexual dysfunction or hypogonadism. Patients seen in this venue include problems leading to male infertility. Residents are exposed during the reproductive endocrine clinic to the full spectrum of male reproductive pathology.
6-D) Obesity and nutrition: Location: UCLA Dept of Clinical Nutrition
Goals and Objectives:
1. To learn the definition, epidemiology and health risks of obesity;
2. To understand pathogenic mechanisms leading to obesity including genetic, psychosocial, endocrine and neuroendocrine, dietary and drug-related;
3. To understand the significance of visceral versus subcutaneous and android versus gynecoid obesity; and the evaluation of patients with anorexia & bulimia.
4. To develop an approach to the evaluation and management of the obese patient including commonly used dietary and exercise prescriptions;
5. To understand the indications, benefits and risks of pharmacologic and surgical approaches to the treatment of obesity.
6-E) Pediatric Endocrinology: Location:UCLA Division of Pediatric Endocrinology
Goals and Objectives:
1. To understand aspects of the common endocrine disorders that are unique to children;
2. To acquire the ability to screen for, evaluate and treat the main forms of multiple endocrine neoplasia;
3. To understand the pathogenesis of congenital hypothyroidism and to be familiar
with the application of screening programs for its detection and treatment.
4. To understand the physiology of normal and abnormal puberty;
5. To gain practical knowledge of unique aspects of endocrine testing in children;
6. To become familiar with the commoner genetic pediatric endocrine disorders, e.g.
Prader-Willi Syndrome, Laurence-Moon-Biedl Syndrome, Frohlich’s Syndrome etc.
6-F) Diabetes in pregnancy: Location: UCLA Dept of ObGyn
Goals and Objectives:
1. To learn the definition of gestational diabetes and its epidemiology in
various ethnic groups;
2. To understand the risks to mother and fetus of the various forms of diabetes and
pregnancy;
3. To know the risk factors and standard approaches to screening for gestational diabetes;
4. To understand principles of nutritional counseling for diabetes in pregnancy that
are unique to the pregnant state;
5. To develop an approach to monitoring glycemic control in pregnancy;
6. To know the indications for initiation of insulin therapy in diabetes in pregnancy;
7. To understand the principles of management of diabetes in pregnancy during
labor, delivery and the postpartum period, including postpartum surveillance for the
development of frank type 2 diabetes.
8. To acquire the skills and knowledge necessary to counsel high-risk patients and
patients with existing diabetes on pre-conception care and pregnancy planning.
6-G) Diagnostic services: Location: Diagnostic Services Unit
Goals and Objectives:
1. To understand the various types of diagnostic services available for in-office use and their training and certification requirements;
2. To understand the principles of the techniques employed and their benefits and risks.
3. To become proficient in the use and/or interpretation of the following diagnostic techniques: DXA bone densitometry, DXA body composition analysis, thyroid ultrasound (diagnostic and biopsy guidance), ambulatory blood pressure monitoring, continuous glucose monitoring, nerve conduction studies, digital retinal imaging and carotid intimal medial analysis.
4. To understand coding and compliance requirements for the listed procedures.
6-H) Diabetes diet and nutrition planning: Location: Gonda Diabetes Center
Goals and Objectives:
1. Be able to state the 3 major carbohydrate containing food groups;
2. To be able to calculate insulin:carbohydrate ratios and insulin sensitivity ratios for carbohydrate counting;
3. To demonstrate knowledge of food labels;
4. To list 3 high fiber foods from the starch, fruit and vegetable groups;
5. To state the 5 major medical nutrition therapy recommendations (from ATP III ) for lowering LDL cholesterol;
6. To calculate body mass index, stages of obesity and appropriate weight loss guidelines;
7. To be able to state recommendations for treatment of hypoglycemia;
8. To distinguish between a “fad” diet and a medical nutrition therapeutic diet.
6-I) Psychosocial aspects of diabetes: Location: Gonda Diabetes Center
Goals and Objectives:
1. To understand the impact of stress on diabetes control and diabetes self-care
and to be able to identity stress as a causative factor;
2. To identify the common attitudes, beliefs and other psychosocial barriers to
optimal self-care;
3. To recognize patterns of medical problems that often indicate a psychosocial component to their development;
4. To understand simple interventions and resources that can help a patient to overcome some psychosocial barriers to optimal diabetes self care;
5. To understand the indications for specialist referral and the social and psychological resources available.
6-J: Diabetic foot care: Location: UCLA Dept of Podiatry
Goals and Objectives:
1. To learn the pathophysiology and clinical features of common disorders affecting the diabetic foot.
2. To develop a practical approach to the diagnosis and treatment of diabetic foot wounds and infections, including the indications for podiatric consultation and the principles antibiotic groups employed in treatment.
3. To acquire the knowledge necessary to be able to provide instruction to patients about good preventative diabetic foot care.
4. To learn how to perform a basic diabetic foot examination to assess neurovascular compromise and risk assessment.
6-K) Diabetes in Childhood: Location:UCLA Division of Pediatric Endocrinology
Goals and Objectives:
1. Learn the signs, symptoms and biochemical findings that distinguish type 1 diabetes from type 2 diabetes in children;
2. Appreciate the complex interplay between the affected child and their parents, family and developmental issues in relation to treatment of childhood type 1 and type 2 diabetes.
3. Learn the differing, pathophysiology-based treatment approaches to type 1 and type 2 diabetes in children, including protocols for the judicious use of oral agents and insulin in these disorders.
4. Learn standardized protocols for disease monitoring for childhood diabetes mellitus including differences between children and adults.
6-L) High Risk Obstetric Clinic (Elective): Location: UCLA Dept of ObGyn
Goals and Objectives:
To learn skills related to the evaluation and management of patients with gestational diabetes and of uncontrolled diabetes mellitus during pregnancy, as a supplement to the general goals and objectives defined for diabetes in pregnancy (see Item 6-F).
6-M) Nuclear Medicine Clinic: (Elective)\Location: UCLA Dept of Nuclear Medicine
Goals and Objectives:
To learn skills related to the treatment of ambulatory patients with thyroid pathology that requires radionuclide iodine treatment. Patients seen in this venue include the full range of thyroid diseases requiring radioiodine imaging or treatment.
6-N) Clinical Genetics Clinic: (elective)Location: UCLA Dept of Clinical Genetics
Goals and Objectives:
To learn skills related to the evaluation of patients with inherited metabolic and endocrine diseases. Methods of diagnosis and genetic counseling are emphasized.
7). Research Training Program:
Goals and Objectives:
All residents enrolled in the program must participate in a research project. During program faculty members and discuss their research interests with them. They must then choose a faculty mentor be their primary guide and resource for their chosen project. If none of the core faculty is able to precept in the resident’s particular area of research interest then he/she may request that a preceptor external to the Division (but almost always internal to the David Geffen School of Medicine at UCLA) be assigned as research mentor.
This request is evaluated by the Program Faculty and if compelling justification exists, this is granted. Residents must prepare periodic reports of their research progress, which must be reviewed and co-signed by the primary faculty mentor. There is protected time of a minimum of one day per week for research and protected blocks can be arranged if justification is made. Application for external funding (e.g. from the Endocrine Fellows Foundation) is encouraged. For the resident who is very interested in an investigative career the Department offers the STAR program, in which a M.S. or Ph.D. can be obtained, with appropriate research training based on the NIH K30 training program and an intensive multi-year experience. The Division also offers a 2-year program in translational research training in Endocrinology and Metabolism to residents who have completed the ACGME training requirements for subspecialty certification. This is offered to selected graduates who are particularly interested in pursuing formal research training but who are not seeking a higher professional degree. The didactic lecture series also offers lectures on ethical responsibilities of the investigator and biostatistics in study design and data management (see Item 2-A).
The goals and objectives of the core research training program are:
1. To teach residents the key elements of design of a hypothesis-driven research
proposal and the ability to develop specific aims and define quantifiable primary and secondary outcome measures;
2. To train residents in the practical aspects of preparation of submissions to the
Institutional Review Board and/or Animal Research Committee.
3. To ensure that residents understand their ethical responsibilities when engaged in
human or animal research;
4. To develop scientific rigor and the basic or clinical scientific skills necessary for
successful conduct of their project;
5. To provide residents with the resources and support to enable them to analyze,
disseminate and publish the results of their research endeavors;
6. To teach residents to critical evaluate and analyze research data, especially their
own.
8). Training of Residents as Teachers:
Goals and Objectives:
1. To help residents to acquire the communication and organizational skills necessary to become effective teachers;
2. To train residents in the use of audiovisual and other communication media in order to enhance the effectiveness of their teaching;
3. To encourage residents to function as role models to junior trainees by provision of high quality teaching;
4. For residents to provide community service and enhance the visibility of our subspecialty to the community by engaging in teaching activities in the lay community;
To help the residents to achieve these objectives, they are given gradually increasing responsibility to plan and conduct teaching rounds, both didactic and clinical, as well as Journal Clubs. They also mentor internal medicine residents and medical students in the ambulatory clinics and on the in-patient consultation services. Each resident also presents at least one community lecture during the course of his/her training to a community interest group (e.g. YMCA, local City Hall employees, university staff groups). The residents are also evaluated as teachers by the junior trainees that they mentor.
9). Assumption of Increasing Independence and Responsibility by Residents:
The specific components of the training program itself are not incremental in terms of the amount of responsibility integral to them. However, the following goals and objectives are designed to ensure that residents are provided with gradually increasing independence and responsibility in the following ways:
Goals and Objectives:
1. On the in-patient consultation services, the resident will initially review all patients with the faculty attending immediately. Over time however, the more latitude will be given to the resident to determine which cases require immediate attending input and which can be presented routinely at the next formal rounds;
2. In the residents’ continuity clinic gradually increasing autonomy is given to
residents to manage routine aspects of care as their expertise increases, although the attending faculty member is always physically present and sees and evaluates each patient;
3. The residents have increasing autonomy in planning the case presentations for rounds and the topics of journal clubs and in conducting these activities.