An elective rotation in Endocrinology was something I knew I always wanted to do during clinicals because as an aspiring primary care physician, I knew I would be seeing lots of patients with diabetes, hyperthyroidism, hypothyroidism, and other hormone diseases. After four weeks, I am so happy to have been able to finally do it, and with an excellent team of attendings and fellows as well. The endocrinology elective rotation at Nassau University Medical Center (NUMC) has been one of my favorite rotations that I have done.
NUMC is located in East Meadow, New York, on Long Island, about an hour away from New York City by car without traffic. Although I’ve only done this one rotation at NUMC, it has given me a really good impression of NUMC as a place to do clinical rotations. I felt my days were fulfilling and I did a lot of useful work, like seeing new consults and following patients on my own. I felt the attendings also give a lot of feedback and find every opportunity to teach as well, and I felt like I was constantly learning something. The hours were a little bit longer than most rotations that I’ve done (ranging from 8-4 on a short day to 7-7 on a busy day) , but I didn’t care, since I didn’t feel like I was wasting any time. Also, there are so many benefits of working in a team of attendings, residents, and fellows, something that I never got in Miami. As future practitioners in US hospitals, its important to understand this hierachy, power, and roles within the medical team, and to experience it at least once before residency.
During this rotation, we get a good balance between inpatient and outpatient, as well as the practical and the educational experiences. Every morning, I come in around 7am or 8am (depending on the day) to see the 3-4 patients that I am following (pre-rounding). I talk to them, see how they’ve been doing since I last saw them the day before, and do a physical exam. I then record my findings on a progress note. Afterwards around 8am or 9am (depending on the day), I head to the outpatient clinic on the 6th floor of the hospital. In the clinic, we focus on different things on different days:
On Monday mornings, the clinic is usually reserved for patients who have suspicious thyroid nodules and need Fine-Needle Biopsies. The fellow typically perform the biopsies, while I usually help press buttons to capture ultrasound images of the fine needles and nodules.
On Tuesday mornings at 9am, we have Diabetes Clinic, in which we see mostly diabetic patients. Typically the nurse would come into the residents’ room and start stacking up a pile of paperwork of the patients that are ready to be seen. The residents and students would then grab the patient files, find an empty room to see the patient, and call the patient in. I would see the patient, check his/her labs and documents on the computer, do a physical exam, and write my findings on the progress note. I would then ask the patient to wait in the room while I return to the resident’s room and present my findings to the attending. After discussing the case, we would then both go back into the examination room to see the patient together.
On Wednesday mornings at 8am, we typically have Journal Club in which students, residents, and fellows are assigned journal articles about endocrinology to present and discuss with the group. This weekly event keeps us up to date with the medical literature, helps us build critical reading skills, and educates us. Journal club is followed by “Nuclear Medicine” educational session in which the fellow presents and discusses a case, and we see the patient as well as the nuclear imaging of the case.
On Thursday mornings at 9am, we have Thyroid Clinic, in which we see mostly hyper and hypothyroid patients.
On Friday mornings, we have Endocrinology Grand Rounds at 8am, in which residents, fellows, or attendings would give a talk about a certain endocrine topic they have been researching. After Grand Rounds end at 9am, we start clinic, and see a mix of different endocrine patients.
Every afternoon, after clinic is over (around 1-2pm, depending on how busy it is), I usually take 30 minutes off to eat lunch in the hospital cafeteria, during which the fellow may or may not ask me to see a new consult before the afternoon inpatient rounds with the attending. Endocrine consults are ordered by other doctors for patients who may or may not have been admitted to the hospital for the endocrine problems (and often it’s not). For example, I’ve done consults on patients who were admitted to the hospital for fractured leg who also happened to have diabetes. I’ve also done consults on psych patients in the psych ward who happen to have found to have high parathyroid hormone levels, etc. If there is a new consult to see, I usually go by myself to wherever the patient is located at the hospital. I would then introduce myself, talk to them (if they are conscious), see why they were admitted to the hospital, and find out more about their endocrine conditions. I’d do a physical exam, and then write a detailed account of my findings on the consult (pink) sheets.
The last event of the day is usually rounds, which may begin at 3pm or so (it’s not a set time). With the attending, fellows, residents, and students, we first discuss all the patients we are following, including new consults. Usually, there’s 12-13 patients. After deciding who we need to go see, we go see the patients, assess their progress, and decide on the management of the patient. Always be prepared to answer what your assessment and plan for the patient is. We finish rounds at around 6 or 7pm.
Sometimes it’s not too busy and we get done early, and if the fellow is not as busy, he/she would often sit with me one-on-one and give me a lecture about different topics, like hypothyroidism, diabetes drugs, etc. The attending may also sometimes assign me certain topics to read up on in the library before going home, and ask me questions about them the next morning.
Monday: Pre-rounds –> Biopsy in the clinic –> Lunch/Consults –> Rounds
Tuesday: Pre-rounds –> Clinic –> Lunch/Consults –> Rounds
Wednesday: Pre-rounds –> Journal Club –> Nuclear Medicine –> Lunch/Consults –> Rounds
Thursday: Pre-rounds –> Clinic –> Lunch/Consults –> Rounds
Friday: Pre-rounds –> Grand rounds –> Clinic –> Lunch/Consults –> Rounds
Who Do We Work With?
There are usually 4 attendings during the morning clinics. However, usually only one of the attendings lead the afternoon rounds. There are two fellows we work with (the junior and senior fellows). We also occasionally work with one resident and/or another medical student. Besides other AUC students, Stony Brook University and NYCOM medical students also rotate there with us.
How Are We Graded?
As endocrinology is an elective, there is no Shelf Exam we have to pass in order to pass the rotation. Your grade is completely dependent on the faculty evaluation. Nassau uses electronic evaluation forms, and therefore it’s not necessary to print out an eval sheet to give your attendings, like it is at other clinical sites. And of course like all other rotations at AUC, make sure to fill out the case logs.
What Types of Cases Do We See?
Because it’s endocrinology, we see all sorts of hormonal diseases. By far the most common one we see is Diabetes mellitus type II. Following this, we also see lots of hypothyroidism and hyperthyroidism. By the end, we get a good sense of the management of Diabetes, which really just involves the same few drugs, tweaking the dose here and there, and doing trial and error to see what’s best for the patient. Here are some of the other types of conditions I have seen in the last 4 weeks: hypoparathyroidism, osteoporosis, VIPoma, amnorrhea secondary to methadone, hypogonadotropic hypogonadism, hypertrophic osteodystrophy, hypokalemic periodic paralysis.
Endocrinology at NUMC is a really good rotation, and I felt I learned a lot from it. My days felt busy, but productive, which is what I love. The attendings are nice, and put their time and effort into teaching. Although I’ve only done one rotation at NUMC, from what I see, I feel this hospital is a really good learning environment, and I’d definitely recommend it. Plus, there are lots of AUC students everywhere here… and that’s always a plus ;).