Category: Other - Medical education; quality improvement; telephone medicine

Monitor: 7


Friday, Apr 26
12:00 PM – 12:30 PM

Objective : Although phone interactions with patients are an essential part of modern medicine, few formal curricula exist to ensure that trainees are educated in telephone medicine. We aimed to assess confidence and perceptions regarding after-hours call management amongst endocrinology fellows and faculty at a tertiary care academic center.

Methods : We designed a survey to assess fellows’ confidence in their decision making during telephone encounters. We designed a separate survey to assess faculty members’ satisfaction with fellows’ management of outpatient calls.

Results :

Thirteen faculty members completed the survey, and all reported agreeing with fellows’ management of their patients’ calls “almost always” or “usually.” Faculty reported highest levels of agreement with fellows’ management of hyperglycemia, hypoglycemia, patients taking wrong insulin dose/type, and adrenal insufficiency. Faculty reported lowest levels of agreement with fellows’ management of insulin pump problems, positive ketones, and hyperthyroid symptoms. Most faculty believed fellows have appropriate thresholds to send patients to the ER and to involve on-call attendings to assist with decision making.
Six fellows completed the survey. Self-rated confidence in managing various complaints ranged widely, with most fellows feeling confident “sometimes” or “usually.” Fellows reported feeling most confident managing hyperglycemia, hypoglycemia, and patients taking wrong insulin dose/type. Fellows felt least confident managing insulin pump problems. Second year fellows reported similar or higher confidence levels than first year fellows in all domains. All fellows reported “rarely” receiving feedback from outpatient attendings on their decision making.

Discussion : Survey results indicate faculty are generally satisfied with handling of after-hours outpatient calls by endocrine fellows, but fellows’ confidence in managing calls varies widely. Both faculty and fellows had highest confidence in fellows’ ability to manage common diabetes calls, and both groups had lowest ratings in insulin pump management. Fellows rarely receive feedback on decisions they make on after-hours outpatient calls. However, most fellows feel that taking outpatient after-hours calls has educational value and that they are able to impact patient care in a meaningful way through such calls.

Conclusion : After-hours telephone medicine is an important but often missed opportunity for education and feedback in endocrine fellowship training. Educational interventions should especially target challenging areas such as management of insulin pump problems.


Ramya Punati

Fellow in Endocrinology, Diabetes, and Metabolism
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania

Ramya Punati is a second year endocrinology fellow at Hospital of the University of Pennsylvania. She is interested in the full spectrum of clinical endocrinology, as well as in medical education.

Serena Cardillo

Associate Professor of Clinical Medicine
Hospital of the University of Pennsylvania

Dr. Cardillo joined the faculty in the Division of Endocrinology, Diabetes, & Metabolism at the University of Pennsylvania in 2006. She completed her undergraduate studies at Johns Hopkins University where she received a B.A. in Behavioral Biology. She received her M.D. from the University of Pennsylvania and completed both a residency in Internal Medicine and a fellowship in Endocrinology at the Hospital of the University of Pennsylvania. Her clinical interests include diabetes management, transplant associated diabetes, pre-diabetes and metabolic syndrome and diabetes in bariatric surgery patients. Her clinical practice is based at the Penn Rodebaugh Diabetes Center. Dr. Cardillo is also actively involved in medical education at the residency and fellowship levels. She is currently the Director of Ambulatory Training for the Internal Medicine Residency Program and the Director of Graduate Diabetes Education.

Jeffrey Kroopnick

Assistant Professor of Clinical Medicine
University of Pennsylvania

Dr. Kroopnick is an Assistant Professor of Clinical Medicine at the Hospital of the University of Pennsylvania. Dr. Kroopnick is interested in diabetes and metabolic bone disease, as well as medical education.

Susan Mandel

Professor of Medicine
Hospital of the University of Pennsylvania

Dr. Mandel is a Professor of Medicine and Radiology at the University of Pennsylvania School of Medicine, where she also directs the fellowship program in Endocrinology, Diabetes, and Metabolism. She serves as the Associate Chief of the Division of Endocrinology, Diabetes, and Metabolism at the Hospital of the University of Pennsylvania and is the Director of the Thyroid Nodule Clinic. She attended medical school at the College of Physicians and Surgeons, Columbia University and completed her medical residency at Columbia Presbyterian Medical Center in New York City. After finishing a fellowship in endocrinology at the Brigham and Women’s Hospital in Boston, she was a faculty member at the Brigham prior to moving to the University of Pennsylvania in 1997. She is a member of the Endocrine Society, the American Association of Clinical Endocrinologist, and the American Thyroid Association (ATA). She is the current President of the Endocrine Society. Her research interests include the use of sonography in the evaluation of patients with thyroid nodules, the novel introduction of I-123 imaging in differentiated thyroid cancer, and thyroid disease during pregnancy. She has served on task forces that authored the ATA Guidelines for the Treatment of Patients with Thyroid Nodules and Differentiated Thyroid Cancer (2006, 2009, 2015)and the ATA Guidelines for the Treatment of Thyroid Disorders During Pregnancy (2016). She has authored papers in the New England Journal of Medicine, the Annals of Internal Medicine, JAMA, and as well as publications in the endocrine and nuclear medicine journals.