The Clinical Program, composed of the outpatient and inpatient experience, provides opportunities for the Fellow to develop clinical competence in the field of endocrinology, diabetes and metabolism. Clinical experience includes opportunities to diagnose and manage adult outpatients and inpatients, representing the full spectrum of endocrine and metabolic diseases and variable acuity. The program also includes opportunities to function in the role of an endocrinology consultant for patients and other physicians and services in both outpatient and inpatient settings.
The Fellows are given opportunities to assume responsibility for and to follow patients throughout the training period in both outpatient and inpatient settings and observe the evolution and natural history of these disorders, as well as the effectiveness of therapeutic interventions. To accomplish these goals, the program devotes more than 50 percent of the clinical training in outpatient care settings.
Outpatient Endocrine Clinics
The Division offers complete diagnostic and therapeutic services for patients with endocrine and metabolic disorders. Staff physicians work closely with referring primary care physicians as well as other subspecialty services including General Surgery, Cardiothoracic Surgery, Neurosurgery, Ophthalmology, Radiology, Nuclear Medicine, Nutrition and Podiatry to coordinate the diagnosis and management of complex endocrine diseases.
Eight half-day clinical sessions (including the Obesity Consultation Center) are conducted each week focusing on specific areas within Endocrinology. The Subspecialty Endocrine Clinics are supervised by Attending Physicians who have an interest and expertise in the particular field. This arrangement provides for a unique educational experience for the Fellows. For a brief description of the Subspecialty Clinics, please view our Outpatient Endocrine Clinics.
Our outpatient volume is approximately 5,500 visits a year. Over 60% of them are seen with the Fellows. Fellows are required to attend the:
- Neuroendocrine and Pituitary Clinic
- General Endocrinology Clinic
- Bone Metabolism Clinic
- Thyroid Disease Clinic
- Fine Needle Aspiration Clinic
- Diabetes Clinic
Other electives that fellows may participate in include:
- Weight and Wellness Center
- Pediatric Endocrinology
- Lifestyle Coaching Program for Diabetes Reversal
Inpatient Consultation Service
The program also emphasizes training in the inpatient setting as a way to broaden the exposure to endocrine disorders and the educational experience.
The Inpatient Consultation Service is composed of the General Endocrine Service (covered by an endocrinology Attending) and the Diabetes Management Service (covered by a Diabetes specialist). The Diabetes Management Service provides consultative and continuing management care for in-patients with diabetes mellitus. Over three fourths of the consultations are from the surgical services (general, cardiothoracic, vascular, transplant, SICU) for peri-operative management of patients with diabetes mellitus.
The Fellows will gain experience in the management of uncontrolled diabetes, use of insulin drips, and the peri-operative management of patients with diabetes. Emphasis is placed on the management of hyperglycemia but other metabolic and endocrine issues are addressed as well. This is usually the busier of the two aspects of the Inpatient Consultation Service, and therefore creates an enormous learning opportunity for the Fellows to become proficient in the management of diabetes mellitus. First-year Fellows cover both services when on-call and rotate responsibility every month.
Fellows will obtain a comprehensive understanding of indications, contraindications, limitations, techniques, complications and interpretations of procedures that are required for diagnosis and management of patients with endocrine disorders. The Faculty will determine when a Fellow has mastered a procedure. For Thyroid FNA, a minimum of 10 aspirations must be done before a trainee can be considered to be proficient. During the program, the Fellows perform at least 30 [change to: an average of 70] thyroid FNAs during their 1st year as part of their rotation through the Thyroid US and FNA Clinic and continue to do FNAs throughout their 2nd year.
Thyroid US is also taught during the Training Program. The Fellows are encouraged to attend the AACE Certification on Thyroid Ultrasound and Ultrasound Guided FNA at some point during their fellowship to obtain their Endocrine Certification in Neck Ultrasound (ECNU) under the mentorship and supervision of our ECNU-certified faculty.