Pediatric Endocrinology and Metabolism

Sites: MGH
Director(s): Lynne Levitsky, Alberto Puig
Prerequisites: HMS Principal Clinical Experience (Core Clinical Clerkships) or equivalent
Offered: Full time for one month.
Location: MGH - Mass. General Hospital (3)
Open to Exclerks: US/Canadian
Description: The course offers a clinical overview, using the clerkship technique, of problems of somatic growth, development, chronic illness, and endocrine/metabolic dysfunction. This course will enable the student to recognize causes of disturbances in growth and development, design and carry out critical diagnostic evaluations, provide rational therapy, evaluate effectiveness, and communicate relevant information to the child, parents, and referring physician. Emphasis will be on utilizing evidence-based medical knowledge, tempered by a humanistic approach to patient care. Management of children with diabetes mellitus will provide an opportunity to master multidisciplinary management of chronic illness in childhood. The student will work with 5 attending faculty, fellows, and ancillary personnel. Patient care will be largely in an ambulatory setting and the student will work in a preceptored relationship with various attendings. Inpatient rounds and some inpatient consultations will be conducted in a similar manner. Formal didactic experiences include regularly scheduled conferences (7:45-8:45 AM) on Tuesdays and Thursdays encompassing clinical care and didactic discussions. A review of pediatric endocrine disorders (Tuesdays 9 AM- 10AM) is additionally available. The student will also be expected to attend Endocrine Grand Rounds (Tuesday 12 noon), and Endocrine Rounds offered in some of the internal medicine services can enrich the didactic experience. The student will be expected to review a subject of interest and present a conference on this subject toward the end of the clerkship. There is no assigned night or weekend call, but the student may be available for particularly interesting or critical patient care during these times.
Incorporation of Basic Science Content and Evidence-Based Medicine:
All patient-care interactions will involve discussions of the evidence-base for clinical decision making. Students will be encourage to review and interpret primary source documents related to understanding and management of their patients. All scheduled conferences will offer a didactic and evidence-based approach to aspects of endocrine clinical care or management. One didactic conference each week is specifically devoted to the basic science of aspects of endocrinology or treatment of endocrine disorders. An understanding of the biology of disorders of the endocrine system will be recognized as necessary for appropriate care and management.
Grade Criteria:
Honors with Distinction: Students at this level are in the top 10% of Harvard Medical Students and are functioning essentially at the level of senior residents taking elective experiences with us. They ask for feedback but rarely require it. They have initiative to review the literature and examine the evidence base for all clinical decisions. Honors: Students are in the top 25% of Harvard Medical Students and are competent, knowledgeable, and willing to learn but not functioning at the level of a pediatric resident in our program. They require some feedback for clinical care. They review the literature and let this review guide their clinical judgement, with help from fellows and attendings. Satisfactory: Students are in the mid range and clearly have room to increase knowledge and judgement, but are warm and caring, and are not perceived to be likely to cause harm to patients or make major misjudgments. They need some encouragement to perform full literature review and make supervised clinical care decisions. Unsatisfactory: These students are inattentive, do not complete their work, or are inappropriate in interactions with patients and families. They do not grow in knowledge during their time on elective and in the view of the faculty, might make dangerous clinical judgements without remediation.