Clinical and Laboratory Training

Inpatient Consultation

Most of the fellows’ activity during the inpatient rotation is addressing consults from medicine, surgery, and OB/GYN services.  This activity provides a broad exposure to clinical endocrinology while allowing ample time for careful follow-up reading and teaching.  In particular, the fellow is routinely involved in the perioperative management of glucose control in diabetic patients who have undergone coronary artery bypass surgery and in the postoperative follow-up of patients who have undergone various endocrine surgeries such as transsphenoidal surgery, parathyroid exploration, adrenalectomy, etc.  A limited number of patients with specific endocrine diagnoses are admitted to the Endocrine Service; the vast majority are patients with thyroid cancer who are admitted for radioactive iodine therapy.  Rotations on the consultation service in pediatric endocrinology are also available for interested fellows. 

Outpatient Clinics

Experience in the outpatient setting is emphasized throughout the fellowship, since the majority of the endocrinology practice occurs in the ambulatory setting.  During the outpatient rotation, the fellows participate in five half-day general endocrinology clinics per week.  Although every patient is seen under the supervision of faculty attending physicians, the fellows are expected to assume a primary role in patient management and to follow individual patients until the next appointment.  A team approach to diabetes care is encouraged with a staff that includes diabetes educators, dietitians, nurse practitioner and physician assistant.  An active insulin pump program and the use of new technologies such as the Continuous Glucose Monitor Sensor (CGMS) are available.  In addition to the general endocrinology and diabetes clinics, fellows receive training in specialty clinics such as pediatric endocrinology, infertility, high-risk pregnancy, genetics, lipid disorders, and nuclear/medicine ultrasound.  Fellows are also trained in fine needle aspiration of thyroid nodules and in the interpretation of thyroid aspirate cytology. 

Clinical Laboratory Experience

Training in assay methodology and its pitfalls is a critical component of our training program since the correct interpretation of laboratory results is essential for a successful practice in endocrinology.  Such training occurs through the interaction of the fellows with the staff of the Core Endocrine Laboratory (CEL), a fully accredited reference laboratory that specializes in the quantitative analysis of hormones, hormone receptors, cytokines, and growth factors.  At a weekly CEL Conference, abnormal results are identified and discussed, focusing on the principles of hormone assays and their interpretation as well as quality control and quality assurance issues.  In addition to its commitment to supporting clinical care and education, the CEL plays a critical role in providing laboratory support for both clinical and basic investigators.