Endocrinology during internal medicine residency: The dark side of the moon.

Sir,

We read with great interest “Arjuna's recollections” published in your journal.[1] We would like to give our perspective on a few points touched upon in the article and relevant to internal medicine residency.

It is safe to say that during internal medicine residency there is no structured exposure to endocrinology at most teaching colleges in India. The majority of medical colleges do not have separate Endocrinology Departments while very few have DM courses.[2] Hence beyond “diabetic” Out-patient Departments and a few isolated “interesting” cases admitted in the ward, many residents encounter endocrinology at close quarters in the pages of Harrison's toward the later part of their tenure. A lucky few choose endocrinology topics for their thesis and have an endocrinologist as a co-guide. What textbooks fail to convey is the rich variety of clinical features of a single endocrinologic diagnosis. The commonly encountered diagnosis can possibly be made as a spotter, but even then the full spectrum of clinical features is rarely fully appreciated.

Almost all endocrinologic diseases have complications affecting the nervous, cardiovascular, gastrointestinal, and renal systems. Whether it is a patient with hyperparathyroidism and pathological fractures, pituitary adenoma, and neurological deficits or hyperthyroidism and heart failure; many endocrine diseasesfirst present to other specialties. Plus endocrinology remains but one facet of this specialty. We must never forget to mention metabolism in the same breath. Moreover, understanding metabolism can improve outcomes and patient satisfaction in wards of all specialties of medicine. This is why we believe that beyond learning the primary skill of history taking and physical examination, a firm foundation in endocrinology and metabolism is the greatest asset that one can acquire during internal medicine residency, irrespective of what subspecialty one chooses for further study.

In spite of the above drawbacks, it is heartening to see the exponential growth in interest in endocrinology as a career. The ranks of DM aspirants have definitely swollen in the last few years. However, here, too work needs to be done. Most medical colleges with DM courses have no seats for non-DM senior residents. There are very few senior resident posts available for the pre-DM period. Moreover, Registrar posts in endocrinology in private or corporate hospitals rarely exist. Hence, there is a vacuum in the immediate post-MD period for many endocrinology enthusiasts looking for a mentor/apprenticeship.

The Endocrine Society of India can go a long way in redressing this balance. Most of the current activities are targeted solely at doctors already in endocrinology training and beyond.[2] Monthly or quarterly meets and updates organized beyond the major centers of endocrine training in close association with the departments of medicine in the respective places would be a good start. Not only would this give medicine residents the chance to present their cases but also bring residents from colleges without endocrine departments in contact with endocrinologists and endocrine DM trainees and broaden their horizons.

If endocrinology is a satellite moon to internal medicine's mother earth, most medicine residents only get to see one side of the moon even on full moon nights. Hopefully, changes in attitude and MD curriculum in the near future will help many to peer over the edge and have a glimpse of the dark side of the moon.

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