PCP OBE-CBTP IN INTERNAL MEDICINE

LEARNING CONTRACT
Section of Endocrinology
City of General Trias Doctors Medical Center

Name of Resident:_________________________
Inclusive Dates of Rotation: _________________
Section Chief: _____________________________
Section Training Officer: ____________________

I. Expected general outcome of rotation: After the one month sub-specialty rotation in Endocrinology
during YL II, the medical resident is expected to acquire the competences for YL II in Endocrinology for
conditions listed under the Terminal Competencies of Internists (PCP OBE-CBTP Document #2) in
Endocrinology encountered in the Medical Ward, Emergency Room, OPD, ICU and referrals from other
department, as well as special issues related to Program Outcomes # 2 to 8 like
A. Complications from diabetes and other metabolic syndromes,
B. Screening and assessment for the acutely, chronically, critical and terminally-ill patients, and
C. Addressing the nutritional requirements of patients.
II. Expected specific outcomes of rotation or (intermediate competencies and corresponding contents):

1. Intended for Program Outcome # 1: Clinical competence in Endocrinology:

A. Diagnose and manage common medical conditions/diseases both in the out-patient and in-patient
settings in Endocrinology:

Medical Conditions Recommended (#) Actually Certified Correct by

Minimum Number encountered Section Chief
of Cases (X) Read Only (signed: initials)
Encountered for (O) No Idea
Clinical
Competence
1 Weight changes 5
2 Growth disturbances 5
3 Menstrual abnormalities 5
4 Galactorrhea 0-1
5 Loss of libido 5
6 Polyuria 5
7 Polydipsia 5
8 Energy loss 5
9 Hypercortisolism 3
10 Labile hypertension 5
11 Poor wound healing 5

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 B. Diagnose and manage common conditions/diseases both in the outpatient and inpatient setting in
Endocrinology

Medical Conditions/Disease Recommended (#) Actually Certified Correct

Minimum encountered by Section Chief
Number of (X) Read Only (signed: initials)
Cases (O) No Idea
Encountered for
Clinical
Competence
1 Hypoglycemia in Diabetics (Mild / moderate) 5
2 Hypoglycemia in Non-diabetics (Mild / moderate) 5
Disorders of Carbohydrate Metabolism
3 Type 2 diabetes mellitus 50
4 Gestational diabetes mellitus 20
Metabolic Syndrome and related disorders
5 Overweight and obesity 5
6 Metabolic syndrome 5
7 Hyperthyroidism - Mild 5
8 Hypothyroidism - Mild 5

C. Diagnose and initiate management common but complicated medical conditions/ diseases and
refer to appropriate subspecialists in Endocrinology:

Medical Conditions/Disease Recommended (#) Actually Certified Correct

Minimum Number encountered by Section Chief
of Cases (X) Read Only (signed: initials)
Encountered for (O) No Idea
Clinical
Competence
1 Hypoglycemia Diabetes (Severe) 5
2 Hypoglycemia in Non-diabetics (Moderate / 5
Severe)
3 Pancreatic and GIT tumors: Insulinoma / 1
Glucagonoma / Somastatinoma / Gastrinoma
/ Syndromic Pancreatic Tumors (MEN 1) /
Carcinoid Tumor
4 Type 1 diabetes mellitus 10
5 Gestational diabetes mellitus 5
6 Diabetes Complications (Nephropathy / 10
Retinopathy / Autonomic neuropathy / Foot
complications
7 Metabolic syndrome and related disorders 5
(Polycystic ovary syndrome / Obesity /
Lipoprotein abnormalities)
8 Hyperthyroidism (Moderate / Severe) 5
9 Hypothyroidism (Moderate / Severe) 5
10 Thyroid adenoma 1
Bone and Mineral Metabolism
11 PTH related: Destruction of the parathyroid 1
glands / Pseudohypoparathyroidism

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 12 Metabolic Bone Disease: Osteoporosis / 3
Osteomalacia and Rickets / Osteopetrosis
13 Kidney stones 5
14 Cushing syndrome 1
15 ACTH independent (adrenal glucocorticoid 1
overproduction): Adrenal Adenoma / Bilateral
Micronodular Hyperplasia / Bilateral
Macronodular Hyperplasia
16 Adrenal Incidentaloma 1
17 Disorders of Posterior Pituitary Lobe 1
Hormones (ADH insufficiency – Diabetes
insipidus / SIADH)
18 Disorders of the Testis and Male 1
Reproductive organs (Andropause /
Gynecomastia)
19 Disorders of the Ovaries and Female 1
Reproductive organs (Menopause / Infertility)
20 Disorders of Growth and Development 0-1
(Klinefelter’s / Turner’s)

D. Diagnose and manage common emergency conditions in Endocrinology:

Emergency Conditions Recommended (#) Actually Certified Correct by

Minimum Number encountered Section Chief
of Cases (X) Read Only (signed: initials)
Encountered for (O) No Idea
Clinical
Competence
1 Diabetic Ketoacidosis (mild and 10
moderate)
2 Hyperosmolar hyperglycemic state: 10
HHS (mild)
3 Hypoglycemia: Insulin or OAD 5
induced (mild-mod)

E. Diagnose and initiate management on common but complicated emergency conditions and refer to
appropriate subspecialists in Endocrinology

Emergency Conditions Recommended (#) Actually Certified Correct by

Minimum Number encountered Section Chief
of Cases (X) Read Only (signed: initials)
Encountered for (O) No Idea
Clinical
Competence
1 DKA (severe) 5
2 HHS (mod to severe) 5
3 Severe or persistent hypoglycemia 5
or hypoglycemia of insulinoma
4 Thyroid Emergencies (Thyroid 5
storm / Myxedema)
5 Hypercalcemic emergency 2
6 Hypocalcemia (severe)/tetany 5
7 Adrenal crisis (insufficiency) 2

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 8 Diabetes Insipidus 1
9 Necrotizing fasciitis and other 3
diabetic foot emergencies

F. Explain the indications and steps of common diagnostic tests, interpret and correlate results with
the patient’s condition in Endocrinology

Diagnostic Tests Recommended (#) Actually Certified Correct by

Minimum Number encountered Section Chief
of Cases (X) Read Only (signed: initials)
Encountered for (O) No Idea
Clinical
Competence
1 Thyroid scintigraphy (scan) 1
2 Fine needle aspiration biopsy, 5
thyroid
3 Intact PTH 1
4 Bone densitometry 3
5 25 (OH) Vit D3 Assay 1
6 1,25 (OH)2 Vit D3 Assay 1
7 Bone markers 1
8 1 mg dexa (overnight dexa supp 1
test)
9 CT Scan (Adrenal, Pituitary) 1
10 MRI (adrenals, pituitary) 1
11 8 am OR Random cortisol 1
12 Prolactin (PRL) 1
13 Plasma and urine osmolality 5

G. Perform common diagnostic and therapeutic procedures in Endocrinology

Procedures Recommended (#) Actually Certified Correct by

Minimum Number encountered Section Chief
of Cases (X) Read Only (signed:initials)
Encountered for (O) No Idea
Clinical
Competence
1 Direct ophthalmoscopy 3

2. Intended for Program Outcomes 2 to 8:

A. See all patients referred to the section of endocrinology and metabolism including
patients for nutrition support. Proper referral to consultants within 24hours should be
done. Rotating resident should follow up referred patients to the attending
endocrinologist.
B. Implement the proper Insulin Drip Protocol in the critically ill patients under strict
monitoring and guidance from respective consultants.
C. Teach all admitted insulin naive patients who need insulin therapy as maintenance
medication prior to discharge.
D. In charge of the patients seen in the Diabetes MellItus Clinic at the OPD every Friday.
E. Manage and/or refer to consultants patients seen at the following:

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 a. DM clinic
b. Endocrinology consultation
F. Screen nutritional status and provide consultation for pregnant patients with GDM.
G. Organize activities during Goiter Week Awareness (last week of January), Diabetes
Awareness Week (3rd week of July), Obesity Awareness Week (first week of Sept)
and Hypertension Month (May) to increase awareness regarding these diseases if
possible.
H. Conduct lay forum for common endocrine disorder at least twice a month.
I. Facilitate the work-up of patients with rare endocrine disorders especially if the tests
are not available in the hospital.
J. Discuss assigned topic during Endocrine Conference
K. Apply local and international guidelines.
L. Find solutions to clinical dilemma by reviewing and critically appraising related
literatures.
M. Encourage research and publication on common disorders like diabetes, thyroid,
dyslipidemia , obesity and nutrition.
N. Attend PSEDM, PASOO, PLAS and PTA convention.

3. Duration of rotation: 1 month

4. Schedule of teaching-learning activities and workplace assessment processes:

Mondays Tuesdays Wednesdays Thursdays Fridays

1st Week *Orientation *Rounds/Answer *Rounds/Answer *Rounds/Answer *Rounds/Answer
*Discussion on Referrals Referrals Referrals Referrals
how the * RCI with * RCI with * RCI with
‘Learning Endocrinologist Endocrinologist Endocrinologist DM clinic
Contract will be * Endo
accomplished consultation at
*Rounds/Answer OPD
Referrals
2nd Week *Rounds/Answer *Rounds/Answer *Rounds/Answer *Rounds/Answer *Rounds/Answer
Referrals Referrals Referrals Referrals Referrals
* RCI with * RCI with * RCI with
Endocrinologist Endocrinologist Endocrinologist DM clinic
* Endo
*Layman’s forum consultation at
on T2DM OPD
3rd Week *CbD and/or *Rounds/Answer *Rounds/Answer *Rounds/Answer *Rounds/Answer
Mini-CEX Referrals Referrals Referrals Referrals
* RCI with * RCI with * RCI with
**Rounds/Answer Endocrinologist Endocrinologist Endocrinologist DM clinic
Referrals * Endo
* RCI with consultation at
Endocrinologist OPD
4th Week *Rounds/Answer *Rounds/Answer *Rounds/Answer *Rounds/Answer *Rounds/Answer
Referrals Referrals Referrals Referrals Referrals
* RCI with * RCI with * RCI with * RCI with
Endocrinologist Endocrinologist Endocrinologist Endocrinologist DM clinic
* Endo
*Layman’s forum consultation at
on T2DM OPD

5. Additional cases, topics and procedures that the rotating resident is interested to acquire.

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 _________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
____________

Date of initial discussion of this learning contract: ______________

Signed:

__________________ __________________________ _________________________

Endocrinology Rotator Training Officer (Endocrinology) Section Chief (Endocrinology)

Date of final discussion/ assessment / feedback / completion of learning contract: ___________________

Signed:

__________________ __________________________ _________________________

Endocrinology Rotator Training Officer (Endocrinology) Section Chief (Endocrinology)