In our Endocrine Medicine Rotation program at Wake Forest School of Medicine, internal medicine residents are intimately involved in patient care and have significant autonomy in decision-making.
Although nearly all rotations occur at the medical school or medical center, the department also has a large community-based ambulatory health center. Residents may spend time in underserved areas of the Winston-Salem community, gaining insight into the challenges faced by patients and providers.
Wake Forest is a national leader in evidence-based medicine (EBM). Residents are taught to be leaders in EBM and learn to critically appraise and apply the best evidence from the medical literature at the bedside and in clinic. Upper-level residents assume an important role in teaching EBM to medical students and junior house officers. Residents also receive a solid foundation in medical systems.
Goals and Objectives
The educational goals of the Endocrine Medicine Rotation are to develop the ability to independently evaluate, treat and monitor common endocrine disorders (diabetes, thyroid dysfunction, lipid abnormalities, metabolic bone disease and calcium disorders) and to be familiar enough with the less common endocrinopathies (adrenal disease, pituitary disease and gonadal dysfunction) to recognize the abnormality and initiate evaluation prior to sub-specialty consultation.
Educational Objectives
- Differences between Type 1 and Type 2 diabetes
- Natural course of diabetes and its complication
- Appropriate monitoring methodologies to include home glucose monitoring, glycated proteins and urine protein excretion
- Dietary management and pharmacological therapy to include intensive insulin programs, non-insulin injectables and oral hypoglycemic medications
- Patient recommendations for "sick days" and treatment of hypoglycemia
- Management of commonly associated disorders (hyperlipidemia and hypertension) and their interaction with diabetes management
- Appropriate and timely referrals to ophthalmology, podiatry, dietary and the diabetes education program
- Diagnostic evaluation and management of the functional thyroid disorders (hypothyroidism and hyperthyroidism)
- Treatment options for hypothyroidism and hyperthyroidism
- Evaluation of anatomic thyroid abnormalities (simple goiter, multinodular goiter and solitary thyroid nodule) to include use of nuclear medicine procedures, ultrasound studies and fine needle aspiration
- Evaluation of thyroid function tests in the intensive care setting
- National Cholesterol Education Program (NCEP) guidelines
- Secondary hyperlipidemia, dietary and pharmalcologic management of dyslipidemias
- Diagnostic evaluation and treatment options of osteoporosis and osteopenia
- Risk factors for osteoporosis
- Use of bone densitometry
- Osteomalacia
- Paget's disease
- Diagnosis and management of hypercalcemia and hypocalcemia
- Management of hyperparathyroidism (medical or surgical)
- Management of critical hypocalcemia and hypercalcemia
- Diagnosis and management of vitamin D deficiency
- Diagnosis and management of Cushing's syndromes, adrenal failure and pheochromocytoma
- Diagnosis and management of adrenal emergencies (adrenal or pheochromocytoma crisis)
- Evaluations of the incidental adrenal mass
- Diagnostic evaluation of pituitary tumors to include the incidental pituitary mass
- The role of surgery, radiation therapy and medical management
- Diagnosis and management of pituitary apoplexy
- Empty sella syndrome
- Diagnosis and evaluation of posterior pituitary dysfunction such as central DI and SIADH
- Diagnostic evaluation of gynecomastia, hirsutism, amenorrhea and impotence
- Androgen and estrogen replacement therapy
Conferences
The department maintains an active schedule of didactic education for residents, students and fellows including grand rounds. All are invited to and included in the grand rounds offered by the department.
Residents will attend each of the following conferences:
Endocrine conference
Wednesdays, 1-2 pm
Endocrine conference room, E Floor, Nutrition Building
Internal Medicine Grand Rounds
Thursdays, 8-9 am
Commons area
