AHS Department of Medicine :: Calgary, Alberta :: Section of Endocrinology and Metabolism :: Education Program

Section of Endocrinology and Metabolism - Education Program

Program Overview

• 1. Introduction
• 2. Core Rotations
• 3. Elective Rotations
• 4. Academic Opportunities

1. Introduction

The specialty program in Endocrinology and Metabolism (E&M) at the University of Calgary enrolled its first resident in July 1981. In that era, two years of specialty education in E&M was recognized by conferring the designation "special competency" in this field. In 1985, when E&M became a specialty program accredited by the Royal College of Physicians and Surgeons of Canada (RCPSC), the post-graduate educational program in E&M at the University of Calgary was approved and officially certified.

The main principle of our educational program is to respect the educational needs and career aspirations of the individual resident. We have a longstanding and close linkage with pediatric endocrinology. We offer a variety of elective rotations to meet individual preferences. Reflecting the predominantly outpatient nature of the practice of E&M, emphasis is placed on experience in ambulatory care. Outpatient facilities at the Foothills Hospital include the Endocrine Metabolic Center, Tom Baker Cancer Clinic, educational and treatment outpatient programs in diabetes in pregnancy and osteoporosis. The Metabolic Testing Unit allows outpatient diagnostic testing of most problems in E&M. The Sheldon Chumir downtown facility houses our busy and active Diabetes Education Centre along with the Hypertension and Cholesterol program. The Alberta Children's Hospital, Rockyview General and Peter Lougheed Centre (PLC) Hospitals also have active outpatient programs including diabetes in pregnancy education and treatment clinics. We anticipate a move to the Richmond Road Diagnostic & Treatment Centre for many of our outpatient clinics in 2008 or 2009.

The inpatient hospital service is primarily at the Foothills Hospital and is almost entirely consultation-based. The majority of patients have tertiary and often challenging medical problems. The majority of classroom and bedside teaching for the University of Calgary undergraduate medical school takes place on the Foothills/Health Sciences Centre campus. The Endocrinology Fellow has the principal roles of consultant and supervisor/teacher for junior residents and medical students.

Structure of the Post-Graduate Training Program

Entry requires three core years in an Internal Medicine Program approved by the RCPSC. The usual program required to obtain certification by the RCPSC in E&M consists of two years. At least one year must be clinical, generally the first year. The second year may be comprised of various options, including combinations of further clinical investigation and basic research, and up to six months of more clinical training. Administration of the University of Calgary program is the responsibility of the Program Director who also chairs the Resident Training Committee; the RTC consists of appointed teaching faculty representing full time academic, major clinical and clinical appointments plus all the current fellowship trainees in E&M.

Research Opportunities

The Division of E&M is affiliated with the University of Calgary Diabetes and Endocrinology Research Group (DERG). This group is multi-disciplinary and thus brings together basic and clinical investigators from several departments. Researchers outside of the clinical section belong to this group who may be potential supervisors and co-supervisors. Thus, beyond clinical training, ample opportunities exist for research development. This can be initiated during the second year of the formal program. Selected trainees can extend their research through additional years and have the choice to combine this training with programs leading to MSc and PhD degrees, according to the requirements of the Faculty of Graduate Studies of the University of Calgary. One faculty member will be assigned to overview the trainee's research program. The RTC will review and evaluate the research in progress.

Travel to Conferences

Funds will be made available from the Division of E&M to attend one major specialty meeting a year. For any meeting at which the resident is presenting a paper, further funds may be made available. Important conferences include: the conjoint Canadian Diabetes Association/Canadian Society of Endocrinology & Metabolism annual meeting, the Endocrine Society Annual Scientific Meeting, the American Diabetes Association meeting and the Clinical Endocrinology Update organized by the Endocrine Society.

Evaluation of Residents and Faculty

Royal College In-Training Evaluation Reports (ITER) are discussed and completed every six months at a meeting of the Resident Training Committee. Rotation-specific evaluation forms for elective rotations are completed by the faculty and reported to the Resident Training Committee.

Appeals pertaining to evaluations should be addressed to the program director, except in the case where he or she is the object of complaint. In this case, the Division Head and the Graduate Training Committee should deal with the appeal. Higher appeals against aspects of the educational program should be directed to the Associate Dean of Postgraduate Medical Education, University of Calgary. We also have a program ombudsperson selected from our allied program, Pediatric Endocrinology.

Fellows are asked to complete an Evaluation Form for the Training Program and individual faculty participating in the Program. The Evaluation is discussed with and made available to the Program Director and Division Head. The regular meetings of the Resident Training Committee also provide a less formal mechanism for the Fellow to raise and discuss issues or problems regarding the training program. In addition, the Program Director and Division Head encourage "open door" access for the Fellow to discuss matters pertaining to the training experience.

2. Core Rotations

A: In-Patient Consultation & Teaching Rotation

Location: Calgary Health Region Hospitals principally Foothills Medical Centre

General description of the rotation:
The Division of E&M will consult on problems on medical, obstetric, psychiatric, and surgical wards throughout the hospital. All such patients are admitted to either general medical teaching units (there is no separate E&M unit) or to wards of other departments. The resident will act as a consultant, without primary care responsibilities, to residents and clinical clerks as well as to referring physicians who are taking care of these patients.

The resident will have the opportunity to select patients to provide longitudinal follow-up outpatient care under the supervision of a staff endocrinologist. The resident will have time on this rotation to arrange and lead teaching sessions for both rotating residents and clinical clerks.

On call duties of the residents: The resident will be on-call one in four evenings and weekends. He or she is encouraged to act as the initial contact for the discussion of patient problems with the consulting physicians. This will help the resident to develop communication skills, consultative expertise, and improved confidence.

Faculty supervisors: A member of the Division of E&M will serve as the attending staff for inpatient consultations.

B: Clinical Ambulatory Services

Locations:

• University of Calgary Medical Clinic (UCMC), Foothills Hospital & PLC Sites
• Foothills Hospital & PLC Diabetes and Pregnancy Clinics
• Osteoporosis Clinic, Foothills Medical Centre
• Osteoporosis Clinic, Foothills Medical Centre
• Tom Baker Cancer Center Outpatient Clinic
• Private Endocrinologists’ clinics

The resident will attend at least three outpatient consultation clinics per week. A representative of the Graduate Training Committee will assign each of these in a block of four weeks.

Endocrine Fellow's Clinic:
The resident will select patients with problems in E&M who require long-term investigation and therapy. This will enable the development of skills and knowledge in patient management regarding long-term patient care, and regarding the natural history of disease or of its therapeutic intervention. This will occur one-half day per week, at the UCMC outpatient clinic or the Diabetes Education Centre, under the supervision of a staff endocrinologist. This particular clinic will allow a graded level of responsibility beyond that offered by short term clinic rotations. Furthermore, the fellow’s clinic provides a unique learning experience, especially regarding the natural history of E&M disorders. This clinic has been a major success since the inception of our program in terms of guiding the transition from supervised trainee to independent consultant.

Adult Outpatient Programs:
An excellent opportunity exists to participate in multi-disciplinary patient care and education clinics. The health care team includes physicians, nurse-educators, dieticians, and students. Participating specialties include: obstetrics, surgery, medical and radiation oncology.

Foothills Hospital

• Endocrine Diagnostic Unit (metabolic tests)
• Diabetes and Pregnancy Clinic
• Osteoporosis Centre
• Sheldon Chumir Diabetes Hypertension & Cholesterol Centre
• Regional Diabetes Education and Care Centre
• Hypertension & Cholesterol Centre
• Peter Lougheed Centre Hospital
• Diabetes and Pregnancy Clinic
• Tom Baker Cancer Centre
• Thyroid Cancer Clinic (weekly)
• Neuroendocrine Tumor Clinic (monthly)
• Associate Clinic Endocrinology Office
• General Endocrinology Clinic

C: Pediatric Endocrinology and Metabolism

Location of rotation: Alberta Children's Hospital

This rotation includes three out -patient clinics per week under the supervision of pediatric endocrinologists. This is the major referral centre for pediatric disorders of E&M in Southern Alberta. In addition to providing inpatient services, there are comprehensive outpatient assessment facilities and a metabolic testing unit.

Duration of rotation: Eight (8) weeks

3. Elective Rotations

The elective options are individualized to the interests and needs of the fellow. A four week block of research planning will be arranged early in the first year.

A. Anatomic Pathology

Location of rotation: Pathology Department, Foothills Hospital

Duration of rotation: Two weeks

Supervisor: Dr. Moosa Khalil

B. Endocrine Surgery

Location: Foothills Hospital

Duration: Two weeks. Residents will spend time seeing patients with endocrine surgical problems both in the inpatient and outpatient settings. The resident will also have the opportunity to attend the operating room to observe surgery and gain a better appreciation for the anatomy and pathology of particularly thyroid, parathyroid and adrenal disease.

Supervisor: Dr. Janice Pasieka is an endocrine surgeon in the Division of General Surgery, Department of Surgery. She works closely with the Division of E&M.

C. Nuclear Medicine/Diagnostic Imaging

Location: Foothills Hospital

Duration of rotation: Two to four weeks.

This rotation will be focused on Nuclear Medicine, ultrasonography and pituitary imaging as relates to disorders of E&M. The teaching with the staff will be primarily evaluating images. The various sessions will be staggered so that the resident has the opportunity to see relevant cases in all areas each day.

D. Clinical Chemistry

Location: Foothills Hospital and Calgary Laboratory Services.

Duration of rotation: Two weeks.

Supervisor: Dr. Andrew Lyon.

E. Diabetes and Pregnancy

Location: Peter Lougheed Hospital and Foothills Hospital.

Duration of rotation: One or two blocks, or a six month horizontal block in conjunction with other rotations.

This elective will provide ambulatory education for the management of pregnancy patients with both Type 1 and Type 2 diabetes mellitus. It will involve pre-­pregnancy , antepartum, and labour & delivery management.

F. Diabetes Education Centre Rotation

Location: Diabetes Hypertension & Cholesterol Centre.

Duration of rotation: Four week block including an introduction to administration, supervision & teaching of diabetes educators, triage, and outpatient clinic including attending insulin pump clinics.

G. Endocrine Ophthalmology

This elective will provide outpatient training for ophthalmological diseases related to disorders of E&M; specifically, diabetes mellitus and Graves' disease.

I. Endocrine Oncology

Description:

• Thyroid Cancer Clinic. One half day per week for 3 blocks (12 weeks)
• Neuroendocrine Tumour Clinic. One half day per month. The resident is encouraged to attend these regularly throughout the program.

This rotation will provide outpatient experience in the broad field of oncology as it relates to disorders of E&M, with an emphasis on thyroid and neuroendocrine tumours. The resident will supervise the care of such patients. This clinic at TBCC provides facilities for the resident to provide follow-up management of patients assessed at the TBCC.

4. Academic Opportunities

Excellent opportunities for research in basic and clinical endocrinology are available. The predominant resources include the medical sciences graduate program of the University of Calgary and the affiliation of the Division of E&M with the Faculty of Medicine Diabetes and Endocrine Research Group.

Medical Sciences Graduate Program
The Faculty of Medicine, University of Calgary, offers MSc And PhD degree programs in Medical Research. Degrees in a number of disciplines are offered usually as part of the training program of research groups. We have close liaisons with the Department of Community Health Sciences. A booklet describing Graduate Studies in Medical Science at the University of Calgary is available on request.

Diabetes and Endocrinology Research Group
The Diabetes and Endocrinology Research Group comprises of an inter-disciplinary team of investigators working in the general area of E&M. Departmental affiliations include Medicine (Division of E&M), Medical Biochemistry, Medical Physiology, Pharmacology and Therapeutics, Pathology, and Biological Sciences (Faculty of Science). The administrative leadership of the group is the responsibility of the Chairman, elected by the membership. A weekly research seminar is held. The complex of laboratories of the Endocrine Research Group includes approximately 15,000 square feet including laboratories of individual investigators and a substantial amount of multiple-user space and major equipment.

1. Quality Improvement Project

Residents are expected to identify and start a quality improvement (assurance) project during their program.

2. Research Project

During the first year the resident will plan and complete a research proposal for the second and possibly subsequent years. The program director and Residency Training Committee will assist with generation of the proposal. An individual from the Division or allied Division will act as preceptor with regular reports to be given to the RTC.

3. Curricula for Independent Directed Studies

Printed material in a curriculum format is available for study in the following areas. These will support independent learning and will be guided by tutorial meetings with the program director and other faculty members.

• Basic Science as applied to endocrinology
• Evidence Based Medicine
• Quality Assurance and Improvement
• Bioethics
• Practice written short answer examinations

4. Learning to be a Clinical Teacher

Excellent opportunities are available to teach at the following levels:

• Undergraduate medical education in endocrinology (small group sessions and clinical skills, supervision of clinical clerks).
• Core Internal Medicine (small group and supervision of core residents on the endocrinology rotation).
• Other Residency Programs (small groups)

The objectives of these teaching opportunities are to learn and gain experience with the goal of becoming an excellent clinical teacher. This should lay the groundwork for a career-long interest and high competency in clinical teaching. Review and feedback on clinical teaching is available from the Undergraduate and Postgraduate Educational Programs. Many of our present faculty have been recognized with awards and acknowledgments for teaching excellence, including during their endocrine fellowship years. Career opportunities for clinical teachers are increasingly becoming available in Canada.

For more information on our program, please contact:

Dr. Chris Symonds, Program Director
Division of Endocrinology & Metabolism,
University of Calgary

c/o Tania Banzet
Richmond Road Diagnostic & Treatment Centre
Division of Endocrinology and Metabolism
1820 Richmond Rd. SW
Calgary AB T2T 5C7

Phone: (403) 955-8343
Fax: (403) 955-8248
E-mail: