Outpatient US Clinical Experience in Endocrinology in Washington D.C.

Information about this clinical experience:

This is an outpatient experience during which you will be under the supervision of a board-certified endocrinologist. During fellowship training in endocrinology at Georgetown University, this preceptor cared for patients at a number of affiliated institutions, including the NIH, Walter Reed National Military Medical Center, Medstar Georgetown University Hospital, and MedStar Washington Hospital Center, gaining exposure to a diverse range of patients and problems. Following this training, this physician joined a well-regarded endocrinology group in the Washington, D.C. area.

Learners who take part in this clinical experience will encounter endocrine problems that are commonly seen during internal medicine residency. Despite the prevalence of diabetes mellitus and thyroid disease, many graduating internal medicine residents do not feel fully prepared to manage these patients. In one survey assessing preparedness to manage diabetes, only one fourth of trainees reported feeling “very prepared” to use newer generation insulin analogs or the latest advances in technology such as insulin pumps or continuous glucose monitoring.

Since most patients with diabetes, thyroid disease, and other endocrine conditions are managed by primary care physicians and hospitalists rather than endocrinologists, gaps in knowledge can impact the quality of care delivered to these patients. This clinical experience will expose you to a wide depth and breadth of endocrine problems, deepening your knowledge and readying you to provide high-quality care to your patients during residency.

On a typical day, the physician sees approximately 15 patients, most of which are in-person visits. Approximately 1-3 patients per day are seen in virtual encounters. In the presence of the physician, you will have opportunities to ask the patient questions, examine patients with notable findings, and educate patients. This will allow the physician to observe and include details that are of interest to residency programs in your letter of recommendation, such as your communication and clinical skills. Please note that because this physician has only one exam room, it will not be possible to take independent histories.

Examples of clinical skills you will be able to refine through this experience include examination of the diabetic foot and assessment of the thyroid for nodules. Although foot screenings are widely recognized as an important preventive measure, one survey revealed that less than 50% of patients with diabetes reported ever having foot exams done by their primary care provider. Even when foot screenings are performed, the evidence indicates that not all elements of the exam are consistently done. Useful articles to read to prepare for the examination of endocrine patients include:

Improving the Detection of Foot Abnormalities in Patients with Diabetes

Thyroid Exam

As you will see many patients with diabetes during residency, learning how to evaluate and manage these patients is a top goal of this clinical experience. Every year, the American Diabetes Association releases evidence-based guidelines for diabetes care. Rotators are highly encouraged to read these articles:

Standards of Care In Diabetes

As a strong proponent of patient education, the preceptor makes teaching an important aspect of every patient encounter. You will observe how an endocrinologist can help patients understand the complexity of the endocrine system, the meaning of abnormal test results, and the pros and cons of the various pharmacologic agents. With time, you will be given the responsibility to educate patients under the preceptor’s supervision. The feedback you receive from the preceptor will ensure that the words you are using match the patient’s health literacy level.

At the end of some clinic days, you will be given the opportunity to deliver an oral case presentation on a patient that you saw with the preceptor. This will be your opportunity to practice your outpatient clinical presentation so that you will be ready to give these types of presentations for the patients you see in the future as a resident. Please note that you may be asked to periodically research topics and give brief topic presentations.

During your experience, you will learn the following U.S. medical practices under the preceptor’s supervision:

• Performing physical exams under the physician's supervision.

• Presenting patients.

• Interpreting endocrine tests.

• Have opportunities to research the literature to answer clinical questions at the point of care.

• Being involved in patient education.

• Teaching other team members.

• Spending time with other healthcare professionals to understand their roles and responsibilities.