Fellowship Program Description (doc)

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  • 1. CHILDREN'S HOSPITAL HARVARD MEDICAL SCHOOL JOSLIN DIABETES CENTER TRAINING PROGRAM IN PEDIATRIC ENDOCRINOLOGY Introduction endocrine service. While on the inpatient rotation fellows maintain four half-day clinic sessions per The Training Program in Pediatric month, of which one is in the Diabetes Program at Endocrinology at Children's Hospital Boston and Children's Hospital. Joslin Diabetes Center, Harvard Medical School On the outpatient service at Children's consists of a comprehensive clinical and research Hospital, the fellow is exposed to a wide range of experience spanning three years. This program is endocrine disorders in four to five half-day clinics intended for physicians who desire to pursue a career each week. The clinics include general pediatric in academic medicine, which combines both clinical endocrinology, type 1 diabetes, type 2 diabetes, and research activities, and to prepare future obesity, metabolic bone diseases, reproductive academic leaders in endocrinology and diabetes. The endocrinology, thyroid, and brain tumor/ clinical management of outpatient and inpatient neuroendocrine dysfunction. In the diabetes endocrine disorders, including diabetes, is programs at Children's Hospital Boston, the fellow emphasized in the first year. The second and third works with multidisciplinary teams that include years are primarily devoted to an in-depth nurse educators, nutritionists, and social workers, to investigation of an area of basic or clinical research treat both type 1 and type 2 diabetes. As with the under the supervision of a faculty preceptor. Each inpatient rotations, fellows on the outpatient rotations year, the program accepts four fellows. closely interact with members of the Endocrinology Division faculty. The end of each clinic session is The First Year highlighted by a lively post-clinic conference at which all fellows, house staff, students, and faculty In the first year, fellows divide their time review the differential diagnosis and management of between monthly inpatient and outpatient rotations. instructive patients seen in clinic that day. In Each fellow sequentially experiences the inpatient addition, an adult endocrinology clinic is held at endocrinology service at Children’s Hospital, the BIDMC. inpatient diabetes service at Children’s Hospital, the During the 3 months of the urgent care/ outpatient endocrine general and subspecialty educational outpatient rotation at Children’s services at Children’s Hospital, and an outpatient Hospital, the fellow sees predominantly new patients rotation at Children’s Hospital focusing on more for urgent consultations, evaluates outpatient pre- urgent endocrine disorders and educational activities, operative consultations, attends approximately one to each for a total of 3 months. Children's Hospital, two endocrine subspecialty clinics per week, and has being both an active primary care hospital as well as approximately 5 to 10 hours/week available for a major tertiary care center for the northeastern scholarly activities. The fellow on this rotation is United States, has a large and varied patient encouraged to carry out an independent clinical population with a unique mixture of endocrine research project. diseases and their complications. These range from During the first year, each fellow is more common disorders such as diabetic responsible for preparing and conducting ketoacidosis and disorders of growth, to more approximately 15 clinical conferences attended by uncommon disorders such as congenital adrenal endocrinologists at Children's Hospital, Joslin hyperplasia, precocious puberty, glycogen storage Diabetes Center, BWH, BIDMC, and the other diseases, and acquired endocrine dysfunction Harvard-affiliated teaching hospitals in the Harvard secondary to systemic diseases such as cystic Medical School area. These conferences give the fibrosis, congenital heart disease, and brain tumors. fellow the opportunity to investigate clinical topics in The two inpatient fellows, in conjunction with the depth and to engage a group of senior Endocrinology Division faculty, evaluate and endocrinologists in discussion. manage all endocrine consultations within the First year fellows take diabetes outpatient hospital and the newborn nurseries at the adjacent evening call from outside the hospital from 6 PM to Brigham and Women's (BWH) and Beth Israel 10 PM one night per week, overnight call from Deaconess Medical Center (BIDMC) Hospitals. In outside the hospital one night per week and every addition, they supervise the care of all endocrine 10th weekend (Fr-Su). Second and third year fellows patients admitted to the Children's Hospital
  • 2. take call every 10th weekend, and diabetes outpatient of type 1 and type 2 diabetes; Role of endoplasmic call on a similar schedule. reticulum stress in insulin action, beta cell function, and energy regulation; Role of insulin resistance in The Second and Third Years the metabolic syndrome; Regulation of appetite and energy expenditure. In the second and third years, the fellow, Genomic Research in Endocrinology under the supervision of a faculty preceptor selected (Preceptors: Joel Hirschhorn, M.D., Ph.D., Ingrid during the first year, undertakes a comprehensive Holm, M.D., M.P.H.) Pathology of type 1 and type 2 investigation of one area of basic or clinical research. diabetes, obesity, puberty and growth disorders due In both the second and third years, each fellow also to polygenic mutations. continues longitudinal clinics for general Mammalian Stress Response (Preceptors: endocrinology (3/month) and diabetes (1/month) at Joseph A. Majzoub, M.D., David Breault, M.D., Children's Hospital. All first or second year fellows Ph.D) Regulation of the hypothalamic-pituitary- spend one week at a residential summer camp for adrenal axis by corticotropin-releasing hormone children with diabetes, where practical issues in (CRH) and vasopressin in vitro and in vivo; Role of diabetes outpatient management are emphasized CRH in fetal development and timing of parturition; under the guidance of attending staff. Stem cells in endocrine gland development, function, and disease. Research Opportunities Obesity Clinical Research (Preceptors: David Ludwig, M.D., Ph.D., Cara Ebbeling, Ph.D., Research opportunities within Children's Hospital Erinn Rhodes, M.D., M.P.H.) Role of dietary Division of Endocrinology and Joslin Diabetes composition on appetite and body weight regulation Center include: in humans and animal models. Use of low glycemic index diets to prevent and treat obesity, Division of Endocrinology, Children's Hospital cardiovascular disease and diabetes mellitus. Boston Neuroendocrinology Research (Preceptor: Laurie Cohen, M.D.) Causes of hypothalamic A wide variety of projects at the level of obesity in patients with brain tumors. Uses of patient-oriented research, isolated genes, cells, and growth hormone treatment in children. intact organisms that include transgenic, knockout, Thyroid Pathophysiology in Children and knockin mouse models of human diseases are (Preceptors: Stephen Huang, M.D., Rosalind Brown, available. M.D., Jessica Smith, M.D., Jeremi Carswell, M.D.) Bioinformatics, Medical Informatics Biology of thyroid metabolism in normal and disease (Preceptors: Isaac Kohane, M.D., Ph.D., Marco states, pathology of autoimmune thyroid diseases in Ramoni, PhD., Daniel Nigrin, M.D.) Functional children; diagnosis and management of thyroid genomics: bioinformatics analysis of high cancer in children. throughput RNA and DNA data, microarray analysis of global gene expression in murine models of Joslin Diabetes Center diabetes; Cross-platform integration and confidentiality in electronic medical records; Web- Section on Behavioral and Mental Health based search of medical records in clinical research; Research (Preceptors: Lori Laffel, M.D., MPH, Web-based communication between patients and Katie Wenger, R.N., Ph.D.), (Ann Goebel- caregivers. Fabbri, Ph.D., Korey Hood, Ph.D.) Psychosocial Calcium and Mineral Homeostasis aspects of diabetes; Design and evaluation of (Preceptors: Catherine Gordon, M.D., M.M.Sc., interventions to improve medical, psychosocial, and Ingrid Holm, M.D., M.P.H.,) Epidemiology and quality of life outcomes. Pediatric- focused pathology of vitamin D deficiency; Pathology and assessment, intervention, and outcomes research in therapy of bone loss in anorexia nervosa; Genetics of type 1 and type 2 diabetes. osteopenia. Section on Cellular and Molecular Carbohydrate Metabolism and Diabetes Physiology (Preceptors:, Steve Shoelson, M.D., Clinical Research (Preceptors: Joseph I. Wolfsdorf, Ph.D., Mary-Elizabeth Patti, M.D. Rohit Kulkarni, M.B., B.Ch., Amy Fleischman, M.D., M.M.Sc., M.D., Ph.D., Jongsoon Lee, Ph.D.) Mechanism of Erinn Rhodes, M.D., M.P.H., Maryanne Quinn, action of insulin and related hormones; Investigation M.D.) Pathophysiology and therapies of glycogen of insulin mimetics; Study of signal transduction storage diseases; Etiology of hypoglycemia in pathways by IRS-1 and IRS-2 in normal and acutely ill children; Role of mitochondrial diseased states; Molecular genetics of type 2 dysfunction in insulin resistance and diabetes; diabetes. Outcome evaluation of type 1 and 2 diabetes Section on Clinical Research (Preceptors: treatment. Ed Horton, M.D., Allison Goldfine, M.D., A. Diabetes and Obesity Basic Research Enrique Caballero, M.D., Om Ganda, M.D., Osama (Preceptors: Morris White, Ph.D., Umut Ozcan, Hamdy, M.D., Ph.D., Antoine Kaldany, M.D., James M.D., Sudha Biddinger, M.D., Ph.D., David Olson, Rosenzweig, M.D., Mark Williams, M.D., Howard M.D., Ph.D.) Role of IRS proteins in insulin Wolpert, M.D.) Testing of new medical devices, signaling, pancreatic beta cell biology, and etiology diagnostic tools, and medications; Clinical trials
  • 3. design; Clinical trials to prevent type 1 and type 2 Section on Metabolism (Preceptor: Laurie diabetes and to prevent/postpone complications; and Goodyear, Ph.D.) Mechanisms of action of insulin Study of health care delivery and outcomes research. and insulin-like growth factors; Molecular basis for Study of obesity and defects in endothelial function. resistance to insulin in diabetes and other disorders; Section on Stem Cell Biology (Preceptors: Role of altered insulin and IGF signaling in diabetes T. Keith Blackwell, M.D., Ph.D., Mary Loeken, complications; Regulation of glucose metabolism by Ph.D., Amy Wagers, Ph.D.) Stem cell research, insulin and by exercise; Effects of specific nutrients oxidative stress, and gene regulation using on the insulin/IGF pathways; Understanding how molecular, cellular, and animal techniques. exercise, insulin, and IGF influence the body’s Transcription regulation leading to congenital ability to convert glucose to energy. malformations, especially neural tube defects, in Section on Obesity (Preceptors: C. Ronald offspring of diabetic mothers; Regulation of Kahn, M.D.) Molecular mechanisms of weight embryonic gene expression by glucose and metabolic control; CNS signals that recognize changes in pathways; Genetic polymorphism in susceptibility to energy balance, appetite regulation, energy congenital defects associated with diabetic expenditure; organs involved in weight regulation; pregnancy. adipocyte biology; insulin signaling in fat cells; Section on Eye Research (Preceptors: DNA chip and proteomic techniques in the study of Lloyd P. Aiello, M.D., Sven Bursell, Ph.D., Jerry obesity and diabetes; pathways in type 2 diabetes Cavallerano, O.D., Ph.D., Lloyd M. Aiello, M.D.) involving genes of oxidative phosphorylation. Prevention and treatment of eye complications of Section on Vascular Cell Biology diabetes; Non-invasive methods to detect type 2 (Preceptors: George King M.D., Edward Feener diabetes via hyperglycemia causing changes in light Ph.D., Ph.D., Robert Stanton, M.D.) Vascular absorption within the eye and development of a complications in diabetes; Molecular and functional video-based retinal imaging; Use of vitamin E to changes in blood vessels due to hyperglycemia; Role improve retinal blood flow and lower the risk of eye of angiotensin II in blood pressure regulation, complications. Medical informatics in the detection fibrinolysis, and insulin resistance; Role of protein and management of diabetic eye disease. kinase C in vascular complications; Physiology and Section on Genetics and Epidemiology regulation of retinal blood flow and (Preceptors: Andrzej Krolewski, M.D., Ph.D., Lori neovascularization. Mechanisms of diabetic kidney Laffel, M.D., M.P.H., Alessandro Doria, M.D., complications; Pharmacologic interventions to alter Ph.D.) Renal complications of diabetes; the course of diabetic nephropathy. Identification of genes that contribute to susceptibility to diabetes and complications, using Rounds, Clinics, and Conferences candidate gene approaches as well as genome scanning; Interaction of genes with environmental Monday factors in promoting disease; Study design, cost- 8:30 a.m. Endocrine Inpatient Rounds effectiveness approaches, and study of health care Noon Joslin: Clinical Conference delivery and outcomes research. Pediatric-focused 1:00 p.m. Pediatric Endocrine/Diabetes Clinics assessment, intervention, and outcomes research in 5:00 p.m. Post-clinic Conference type 1 and type 2 diabetes. Section on Immunology and Tuesday Immunogenetics (Preceptors: Diane Mathis, Ph.D., 8:30 a.m. Endocrine Inpatient Rounds Christophe Benoist, M.D., Ph.D., Tihamer Orban, Noon Children’s: Fellows' Case Conference M.D.) Genetic basis and the pathophysiology of Joslin: Research Conference autoimmunity; Identification of genes that lead to 1:00 p.m. Diabetes Clinic type 1 diabetes and its complications; Cellular, 5:00 p.m. Post-clinic Conference humoral, and apoptosis pathways that induce beta cell destruction; Transgenic/knockout models to Wednesday assess the loss of tolerance and immunoregulation 8:30 a.m. Endocrine Inpatient Rounds that lead to diabetes and to generate pseudo- or 9:00 a.m. Brain Tumor/Neuroendocrine clinic super-beta cells; Clinical trials of interventions to Noon Medical Grand Rounds prevent or arrest beta cell destruction. 1:15 p.m. Interhospital Endocrine Grand Rounds/ Section on Islet Transplantation and Cell Clinical Rounds Biology (Preceptors: Gordon Weir, M.D., Susan 2:30 p.m. Endocrinology Seminars/Journal club Bonner-Weir Ph.D., Arun Sharma Ph.D., Myra 4:00 p.m. Thyroid conference (monthly), Lipes, M.D.) Islet transplantation methods to devise alternates with Fellowship Directors’ ways to successfully transplant healthy insulin- Rounds (with Drs. Majzoub, Wolfsdorf, producing islet cells, from humans or animals, into or Stafford) patients with diabetes; Studies of beta cell function 5:00 p.m. Endocrine-Surgery conference (rotating in type 2 diabetes; Growth and differentiation of islet among neurosurgery, general surgery, cells. urology) Thursday 8:00 a.m. Joslin: Pediatric Clinical Case
  • 4. Conference or Journal Club 5:00 p.m. Post-clinic Conference 8:30 a.m. Endocrine Inpatient Rounds 9:00 a.m. Children’s Research group lab Friday meeting/journal club 8:00 a.m. Interhospital Fellows' Teaching Conf. Reproductive Endocrine Clinic 9:00 a.m. BIDMC Endocrine Grand Rounds Obesity Clinic Thyroid Clinic Lipid Clinic Adult Endocrine Clinic 9:30 a.m. Joslin Pediatric Research group lab Type 2 Diabetes Clinic meeting/journal club 9:15 a.m. Endocrine Inpatient Rounds Noon Reproductive Endocrine Conference Noon Mini Grand Rounds (monthly) 1:00 p.m. Metabolic Bone Disease Clinic, Noon Joslin: Metabolism Lecture Series or Gender Management Service Clinic 1:00 p.m. Pediatric Endocrine/Diabetes Clinics For further information contact: Joseph A. Majzoub, M.D., Chief, Division of Endocrinology Director, Training Program in Pediatric Endocrinology at Children's Hospital Boston and Joslin Diabetes Center, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115 Tel 617-919-2930 Fax 617-730-0244 Email joseph.majzoub@childrens.harvard.edu