Thyroid disease, diabetes, short stature and many other conditions can affect GOAL: Diabetes Mellitus. for primary prevention of childhood diabetes. …
Goals Objectives
Pediatric Endocrinology
I Rationale: Pediatric Endocrinology represents the study of
communication; between distant glands and organs and from cell to
cell Complicated feedback loops are involved in intricate regulation
of virtually all body functions through the endocrine system Thyroid
disease, diabetes, short stature and many other conditions can affect
the quality of life of children; the general pediatrician needs a
working knowledge of pediatric endocrinology principles in order to
effectively function on a day-to-day basis By mastering the
principles involved in evaluating a child with a potential endocrine
condition and developing a sound knowledge base of endocrinology, the
pediatric resident will be prepared to perform well as a general
pediatrician in the community after graduation
II Goal: To acquire and demonstrate the fund of knowledge and practical
skills necessary to manage common and complex pediatric endocrine
conditions in infants, children, and adolescents
III Specific Objectives:
A Medical Knowledge
1 GOAL :
Normal Versus Abnormal Endocrine Demonstrate the ability
to differentiate
between normal and pathological states related to endocrinology,
with the following
objectives:
a Describe normal patterns of linear growth and weight gain, applying
this to evaluation of
variations in growth patterns
b Describe physiologic events in puberty and Tanner staging, and
differentiate normal from
early and delayed puberty
c Differentiate premature thelarche and
adrenarche from true precocious puberty
2 GOAL : Common Conditions Not Referred Endocrine Demonstrate the
ability to
diagnose and manage endocrine conditions generally not requiring
referral; with the
following objectives:
a Describe the pathophysiology of, recognize,
and manage these conditions:
i Abnormal newborn thyroid
screen initial evaluation
ii Benign premature
adrenarche
iii Benign premature
thelarche
iv Delayed puberty due to
chronic disease or anorexia nervosa
v Exogenous obesity
vi Familial short stature,
constitutional delay of growth or puberty
vii Gynecomastia in a
pubertal male
viii Infant of mother with
gestational diabetes
ix Transient hypocalcemia
in a newborn
x Transient hypoglycemia in a
newborn
3 GOAL: Conditions Generally Referred Endocrine Demonstrate the
ability to
recognize, initiate management of, and refer endocrine conditions
which require referral;
with the following objectives:
a Identify, provide initial management of, and
refer appropriately these conditions:
i Adrenal insufficiency
ii Ambiguous genitalia,
hypogonadism, and micropenis
iii Central and
nephrogenic
diabetes insipidus and psychogenic polydipsia
iv Congenital adrenal
hyperplasia
v Delayed or precocious
puberty
vi Diabetes mellitus
diabetic ketoacidosis DKA, long-term management
vii Endocrine and genetic
causes of obesity
viii Genetic syndromes and familial
inheritance patterns with endocrine abnormalities
ix Hirsutism
x Hypoglycemia in childhood and
adolescence
xi Metabolic bone disease
including rickets and skeletal dysplasias
xii Persistent abnormalities of
calcium, phosphorus, or magnesium homeostasis
xiii Polycystic ovaries and
hyperandrogenism in girls
xiv Short stature variants, with
selection of possible hormonal treatment
xv Tall stature and excessive
growth
syndromes
xvi Thyroid dysfunction and goiters
xvii Turner syndrome
xviii Undescended testes
xix Zinc deficiency
4 GOAL: Diabetes Mellitus Demonstrate understanding of the
diagnosis and management of diabetes mellitus; with the following
objectives:
a Recognize the initial presentation, perform confirmatory lab tests,
treat immediate life
threatening complications, and refer for education
b Order and accurately interpret laboratory tests for screening,
confirmation of diagnosis,
routine monitoring glucose and Hemoglobin A1C, and
identification of complications
c Recognize and treat DKA using appropriate IV and PO fluids,
insulin, and laboratory
parameters
d Demonstrate understanding of the correct use of home glucose
monitoring and
adjustment of insulin dosages
e Describe the use of insulin including initial dosages, adjustment
of dosages based on
serum glucose records or illness,
different preparations, and
pharmacokinetics
f Describe the principles behind preventative, anticipatory care for
children with diabetes
and their families; be aware of community resources available to
the family and diabetic
team camps, American Diabetes Association materials, etc; be
aware of future trends
for primary prevention of childhood diabetes
g Monitor patients routinely and review implications of diabetes
associated complications
retinopathy, nephropathy, neuropathy
h Identify the specialists role in long-term
management
i Counsel patients on the role of diet and
exercise
5 GOAL: Prevention Endocrine Demonstrate understanding of the
pediatricians role in preventing morbidity related to endocrine
dysfunction in children; with the following objectives:
a Counsel parents and children about changes
expected in puberty and normal variations
b Recognize need for influenza vaccination in children with certain
endocrine disorders
hypoadrenalism, diabetes mellitus,
hypopituitary, and Cushings
Syndrome
c Counsel asthmatics on steroids about risks
d Discuss Vitamin D supplements in breast fed infants and select
populations with low
vitamin D, calcium, or phosphorus intake
B Skills: Acquire and demonstrate the following skills required to
adequately evaluate and manage the common maladies in pediatric
endocrinology
1 Obtain a comprehensive pediatric endocrinology history to include a
clear definition of the chief complaint, a comprehensive history of
present illness, a thorough past medical history to include a
prenatal, perinatal and neonatal history to include birth weight
and length, medical history, developmental history, surgical
history, dietary history and current medicines expressed as
standard dose per Kg or per M2, system review to include symptoms
related to the CNS, thyroid and chronic systemic diseases, family
history to include age, heights, weights, age of puberty and any
medical conditions within the family and to specifically annotate
any endocrine maladies; diabetes, thyroid
disease, short stature,
abnormal puberty, infertility, menstrual irregularity, etc, and to
summarize relevant previous evaluations
2 Evaluate and interpret growth data available in the medical record
3 Perform a thorough physical examination with emphasis on the
endocrine system to include but not limited to, accurate
measurement of stature/length, assessment of body proportions
upper segment/lower segment ratio, arm span/height and plotting
in the appropriate place on the appropriate growth curve, palpation
of the thyroid gland, assessment of sexual maturity rating Tanner
Stage, and comprehensive physical examination related to the chief
complaint
4 Develop a differential diagnosis and plan for laboratory and
radiologic evaluation related to the history and physical
examination
5 Interpret laboratory results in the context of the particular
patient
6 Develop an appropriate plan for follow-up
B Patient Care: Demonstrate a family-centered consistent, compassionate,
effective, and age
appropriate approach toward the evaluation and management of
inpatients
and outpatients
referred to the pediatric endocrinology service through the above
activities
C Interpersonal Skills and communication: Demonstrate effective
communication skills with
families and patients referred to the pediatric endocrinology service
Demonstrated effective
communication skill during the interaction with nurses and other
doctors involved with the
referred patient Maintain comprehensive and concise written
consultations and notes on the
endocrine patients seen for the service
D Practiced based learning and improvement: Demonstrate the ability to
use the medical
literature to effectively and cogently evaluate pediatric endocrine
conditions or symptoms
and modify management plans appropriately based on the information
obtained from the
literature Demonstrate receptiveness to feedback provided during the
rotation with
appropriate modification of behavior to improve performance
E Professionalism: Demonstrate a commitment to patient care and
learning by timeliness, responsibility for patients seen on the
service, and sensitivity to cultural diversity
F Systems based
practice: Demonstrate understanding of cost issues
related to pediatric endocrinology lab tests, radiographic studies, and
medications Demonstrate understanding of health care prevention and
maintenance related to pediatric endocrinology
I LEARNING ACTIVITIES
A Supplement learning by regularly reading the Pediatric Endocrinology
articles provided in the binder loaned to the resident at the beginning
of the rotation This binder contains over 50 articles covering
endocrine topics important to the general pediatrician These topics
include:
1 Puberty- advanced and delayed
2 Thyroid disorders
3 Adrenal disorders
4 Growth disorders
5 Diabetes Mellitus
6 Other metabolic syndromes
7 Pituitary disorders
A Patient care experience:
1 Perform initial assessment and plan for consultations written on
inpatients referred to pediatric endocrinology
2 See outpatient endocrine clinic patients with Dr Newman and Dr
McClellan, writing the notes on each patient seen On a usual week
this consists of seven day clinics seeing endocrine patients
A Meet with Dr Newman and Dr McClellan
several times a week for informal
discussions and lectures on endocrinology topics The discussions will
focus on learning, in increased depth, about the patients seen on the
service
B At the end of the rotation participate in an oral examination in which
you demonstrate competence in evaluation and management of a patient in
two or more of the following scenarios:
1 A 16 year old girl with an enlarged thyroid gland
2 A 5 year old male with secondary sexual characteristics
3 A newborn with genital abnormalities
4 A 6 year old female with short stature
5 A 5 day old male with an abnormal newborn thyroid screen
6 A 14 year old female with recurrent diabetic ketoacidosis
7 A 15 year old diabetic with recurrent hypoglycemia
8 A 1 year old male with excessive growth
9 A 17 year old female with amenorrhea
10 A 2 year old male with bowed legs
V EVALUATION
A Throughout the rotation, residents will be evaluated on their ability
to gather data, analyze data, and generate differential diagnoses and
management plans based upon their reading and experience Residents
should be
able to discuss their initial approach, differential
diagnosis, evaluation, and management plan for each case encountered
during the rotation
B Mid-rotation evaluation feedback will be given A written evaluation
of the residents performance during the rotation will be completed at
the conclusion of the experience Discussion of performance and
feedback will be given at the conclusion of the oral examination
V SUPERVISING STAFF
COL Robert J Newman, MD
LTC Donald R McClellan, MD
