Internal medicine & family medicine residents
For IM and FM residents. The emphasis is on managing a full panel efficiently and knowing precisely where the boundary between primary care and referral sits.
Why this rotation is different
Most of your training happens in settings built around acute illness: a problem appears, gets treated, and resolves. Endocrinology is largely the opposite. Our patients have conditions they will live with for decades, managed through hundreds of small decisions made mostly by the patient, at home, between visits. The visit is a checkpoint in a long process, not the event where the treating happens.
That changes what good care looks like. Data becomes central — a CGM download is 2,000 data points about someone’s life. Adherence is a diagnosis, not a verdict: when a plan isn’t happening, the clinical question is why. Titration is the skill, not drug choice. And the system — prior authorization, formulary tiers, insulin pricing — determines outcomes as directly as pathophysiology does.
Your objectives
You will spend your career caring for people with diabetes, thyroid disease and osteoporosis. The purpose of this rotation is to make you good at that — not to recruit you.
- Manage a full panel of follow-up patients efficiently, with a defensible plan for each before precepting
- Adjust insulin regimens from CGM data: basal, bolus, correction factor, and carbohydrate ratio, with explicit reasoning
- Work up and stage a thyroid nodule: ultrasound risk stratification, appropriate FNA decision, and Bethesda category interpretation
- Evaluate osteoporosis including secondary causes, interpret DXA and FRAX, and select and sequence therapy
- Screen appropriately for adrenal and pituitary disease — and recognize how often incidental findings do not need chasing
- Identify which endocrine problems belong in primary care and which need referral, articulating the boundary
- Manage diabetes in the context of CKD, heart failure, ASCVD, and pregnancy, choosing agents by comorbidity rather than by A1c alone
- Practice deprescribing: recognize overtreatment in older adults and act on it
What you’ll see, and at what depth
| Area | What you’ll see | You |
|---|---|---|
| Diabetes — type 2 | Newly diagnosed, treatment intensification, comorbidity-driven agent selection, complication screening | M |
| Diabetes — type 1 | Multiple daily injections, pumps and AID systems, CGM interpretation, hypoglycemia unawareness, exercise and sick-day rules | M |
| Diabetes in special contexts | CKD, heart failure, pregnancy and gestational, post-transplant, steroid-induced, post-bariatric | W |
| Thyroid — function | Hypothyroidism, Graves' disease, thyroiditis, subclinical disease, pregnancy, amiodarone effects | M |
| Thyroid — structural | Nodules, ultrasound risk stratification, FNA and Bethesda categories, goiter, thyroid cancer surveillance | W |
| Bone & mineral | Osteoporosis, DXA and FRAX, secondary causes, hyper- and hypoparathyroidism, hypercalcemia, vitamin D | M |
| Adrenal | Adrenal insufficiency, Cushing's syndrome, incidentaloma, primary aldosteronism, pheochromocytoma | W |
| Pituitary | Prolactinoma, acromegaly, hypopituitarism, diabetes insipidus, incidental sellar lesions | W |
| Reproductive & gonadal | PCOS, hirsutism, hypogonadism, gender-affirming hormone therapy, menopause and hormone therapy | W |
| Obesity & metabolic | Pharmacotherapy, metabolic surgery evaluation and follow-up, MASLD, metabolic syndrome | M |
| Lipids & cardiometabolic risk | Statin intolerance, familial hypercholesterolemia, severe hypertriglyceridemia, risk-based prevention | M |
| Urgent presentations | Severe hypoglycemia, DKA and HHS recognition, adrenal crisis, thyroid storm, myxedema, severe hypercalcemia | W |
What you may do
| Activity | Resident |
|---|---|
| Observe visits (with consent) | Yes |
| Take a history independently | Yes |
| Perform physical exam | Yes |
| Sensitive / chaperoned exam | Preceptor present |
| Download / interpret CGM & pump data | Yes |
| Counsel or educate a patient | Yes |
| Draft a note in the EHR | Yes |
| Enter orders (pended, unsigned) | Yes, cosigned |
| Sign or release any order or result | No |
| In-office procedures (thyroid US, FNA) | Assist, then supervised |
| Call patients with results or advice | After preceptor review |
| Prescribe | No |
⚠ Absolute limits
No learner signs an order, releases a result, prescribes, dispenses or administers medication — including an insulin adjustment communicated directly to a patient.
How the rotation is paced
A four-week arc, compressed or extended proportionally for shorter or longer rotations.
| Before day one | Paperwork complete, EHR access requested, and two or three personal learning goals emailed to your supervising physician. |
| Week 1 — orient | Learn the clinic flow, the team and the EHR. Shadow, then begin seeing straightforward follow-ups. Expect heavy correction on presentations — that is the point of week one. |
| Week 2 — take ownership | Carry 3–5 patients per session. Draft your own notes, pend your own orders, commit to a plan before precepting. Midpoint feedback lands at the end of this week — ask for it if it isn’t scheduled. |
| Week 3 — add complexity | New patients and harder follow-ups. Work a full diagnostic arc on at least one case. Start the systems work: a prior authorization, a denial, a CGM coverage request. |
| Week 4 — consolidate | Near-full panel, efficient presentations, teaching presentation delivered, case log complete, notes closed, final evaluation. |
Before your first day
Two things are required of every learner, whatever your level.
1. Read the Rotation HandbookConduct, HIPAA, dress, supervision, documentation, assessment — the rules that apply to everyone. 2. Work through the Patient Education LibraryOur patient education library is the fastest way to get oriented to how this clinic actually practices. Download: HIPAA Confidentiality Agreement (PDF)Print, sign, and bring it with you on your first day. The clinic keeps the signed copy.Questions before you start?
Email the clinic with your name, program, and preferred dates.
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