Educational Purpose: To learn about a variety of diseases of endocrinology and metabolism as they occur in the hospitalized patient.

Teaching Methods: Hospital care is both consultative and continuing. For each interaction, the trainee will spend sufficient time with the patient to carry out an appropriate history and physical examination and then to interact with and be directly supervised by the endocrine faculty assigned to that activity. The learning experience surrounding a patient interaction evolves from review of the history, physical examination and laboratory results with the faculty, taking direction from the faculty and using references or other learning materials that can be used for self-instruction and subsequent review with the faculty. Consultation is frequently requested to determine the impact of endocrine disease on coexisting illnesses that necessitated hospitalization. The trainee will also learn, under supervision, how to interact not only with the patient and family, but also with other physicians caring for the patient. The trainee is encouraged to formulate a differential diagnosis, plan for further evaluation and management, which are reviewed with faculty assigned to teaching rounds. Learning is a continuing interactive process with faculty, review of pertinent literature and further discussion as new data emerge or changes in the patient's condition occur as a consequence of recommended treatment. The fellows develop the experience to give expert opinion on the day to day management of the patient.

Experience in the inpatient setting also includes preparation of appropriate patients with endocrine disease for surgery as well as postoperative management, radiation therapy and/or treatment with iodine-I-131. Interaction with professionals from the relevant department is reviewed and evaluated. In-patients who have surgery or biopsy, pathology and cytology are reviewed with appropriate specialist in those departments.

Practice Setting: The in-patient consultation-based teaching is conducted at the following hospitals, which are interconnected and form part of a large single-campus complex:

• Detroit Receiving Hospital
• Harper University Hospital
• Hutzel Women's Hospital
• Rehabilitation Institute of Michigan

The consult team typically consists of an attending endocrinologist, a fellow and 1-2 residents. When available, a medical student who may be taking an elective in endocrinology will also be part of the team. The consult team typically sees 10-15 new consults per week and provides follow-up evaluation and management of the problem(s) for which the consultation was requested. This is done under close interaction with the patients' primary physicians on the wards.

Disease Mix and Patient Characteristics: On request, trainees provide consultation to the Internal Medicine service and other departments such as surgery, vascular surgery, obstetrics and gynecology, psychiatry, ophthalmology, neurosurgery, orthopedic surgery, rehabilitation medicine, etc. Patients will have a variety of diseases that impact on the endocrine system, diseases, or manifestations of primary endocrine diseases such as diabetes mellitus, thyroid or parathyroid disease that warrant hospitalization. Patients will be adults of all ages, including the geriatric age group and both sexes. Sex and age of patients will parallel their distribution among the variety of endocrine diseases that occurs in hospitalized patients. The severity of illness will be much greater then in the ambulatory setting.

Procedures and Services: Trainees will coordinate the evaluation and management of the endocrine aspects of the patient's illness. After interaction with the endocrine-attending physician, the trainee will order appropriate laboratory tests, biopsies, imaging and infusion studies, as dictated by the patient's problem. Data will be reviewed and treatment recommended.