Specific Educational Goals and Education HO I Endocrine/Breast

Endocrine Surgery Rotation Objectives

These objectives outline the knowledge and skills that should be taught, learned, and demonstrated by the completion of general surgery residency. Although the field
of endocrine surgery encompasses many uncommon diseases and syndromes, the curriculum is based on common endocrine diseases where the practicing general surgeon is often involved in the care. Other, uncommon syndromes outlined are appropriate for review because of their underlying pathophysiology and presence on standardized examinations. A resident successfully demonstrating all of these objectives will have the appropriate background to perform common endocrine
surgical procedures commensurate with his/her skill and expertise.

PGY1

Thyroid Disease:

Knowledge objectives

By the completion of the first year, the general surgery resident should be able to:

  1. Demonstrate normal thyroid anatomy in the operating room, including the thyroid gland, its vascular supply and venous drainage, the parathyroid glands, recurrent laryngeal nerves, strap muscles, and platysma.
  2. Describe normal variants in recurrent laryngeal nerve anatomy including frequency.
  3. Describe normal thyroid embryogenesis and descent.
  4. Outline the normal thyroid hormone synthetic pathway including iodine metabolism and feedback mechanisms.
  5. Describe the impact of specific medications on the thyroid hormone synthetic pathway and thyroid function.
  6. Describe the impact of aging on the thyroid hormone synthetic pathway and thyroid function.
  7. Outline appropriate thyroid function testing for the following clinical scenarios, including interpretation of predicted test results:
    • Thyroid nodule
    • Goiter
    • Hyperthyroidism
    • Hypothyroidism
  8. Develop an algorithm that includes pertinent history, examination findings, and diagnostic evaluation of:
    • A palpable thyroid nodule
    • A nonpalpable nodule discovered on imaging performed for nonthyroid pathology
  9. Describe the recognition, evaluation, and management of the following early postoperative complications:
    • Hematoma
    • Hypocalcemia
  10. Describe the outpatient management of the following postoperative conditions
    • Thyroid hormone replacement, postoperative
    • Postoperative hypocalcemia
    • Postoperative voice changes

Skill objectives

By the completion of the first year, the general surgery resident should be able to:

  1. Obtain a focused history, perform an examination, and institute the diagnostic evaluation of a patient with the following conditions:
    • Thyroid nodule
    • Goiter
    • Hyperthyroidism
  2. Palpate and describe a thyroid nodule
  3. Palpate and describe a goiter
  4. Identify exophthalmos

Parathyroid disease:

Knowledge objectives

By the completion of the first year, the general surgery resident should be able to:

  1. Demonstrate normal parathyroid anatomy in the operating room, including typical gland locations, blood supply, and relationship to the recurrent laryngeal nerves and other adjacent structures.
  2. Describe normal parathyroid embryogenesis and descent. Describe how this affects ectopic gland location
  3. Outline the normal calcium metabolic pathway including vitamin D metabolism, parathyroid hormone production and regulation, and calcitonin production and regulation.
  4. Describe the impact of specific medications and medical conditions on serum calcium and calcium metabolism.
  5. Describe the impact of aging on calcium metabolism.
  6. Outline the evaluation and treatment of life-threatening hypercalcemia.
  7. Outline the appropriate evaluation for the following clinical scenarios, including interpretation of expected test results:
    • Primary hyperparathyroidism
    • Secondary hyperparathyroidism
    • Tertiary hyperparathyroidism
    • Hypercalcemia associated with malignancy
    • Hypercalcemia associated with medications
  8. Develop an algorithm that includes pertinent history, examination findings, and initial diagnostic evaluation of:
    • Asymptomatic primary hyperparathyroidism
    • Symptomatic primary hyperparathyroidism
  9. Describe the recognition, evaluation, and management of the following postoperative complications:
    • Hematoma
    • Hypocalcemia
    • Voice changes

Skill objectives

By the completion of the first year, the general surgery resident should be able to:

  1. Obtain a focused history, perform an examination, and institute the diagnostic evaluation of a patient with hypercalcemia

Adrenal disease:

Knowledge objectives

By the completion of the first year, the general surgery resident should be able to:

  1. Describe the embryology, histology, and physiology of the adrenal gland, distinguishing differences in the cortex and medulla.
  2. Describe the anatomy of the adrenal gland, including the arterial supply, venous drainage and relationship to adjacent structures.
  3. Outline the biosynthesis and physiologic effects of glucocorticoids, mineralocorticoids, and adrenal sex steroids.
  4. Outline the catecholamine synthetic pathway.
  5. Identify the etiologies, common signs and symptoms, and clinical presentations of Cushing’s syndrome.
  6. Outline the diagnostic evaluation of hypercortisolism.
  7. Describe the protocol for perioperative steroid use in a patient taking exogenous steroids.
  8. Outline the etiologies, clinical presentation, evaluation and management of adrenal insufficiency.
  9. Identify complications of adrenalectomy, including adrenal insufficiency and the diagnosis, treatment, and causes.
  10. Describe the signs, symptoms, and evaluation of primary hyperaldosteronism.
  11. Differentiate between primary and secondary hyperaldosteronism.
  12. Describe the general attributes of adrenocortical carcinoma.
  13. Describe the physiology, clinical presentation, treatment, and preoperative preparation of pheochromocytoma.
  14. Perform a thorough physical examination and be familiar with signs of hormone excess. (hirsuitism, striae, acne, facial changes, clitoral hypertrophy, etc)

Skill objectives

By the completion of the first year, the general surgery resident should be able to:

  1. Identify both adrenal glands in the operating room.
  2. Locate the adrenal glands on a CT scan