University of California, San Francisco


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University of California, San Francisco

  1. 1. University of California, San Francisco Department of Pediatrics Division of Endocrinology Fellowship Training Program
  2. 2. Division of Endocrinology Fellowship Training Program Requirements for the UCSF Fellowship Program in Pediatric Endocrinology Page 2 of 9
  3. 3. Division of Endocrinology Fellowship Training Program Fellowship Training Program The department of Pediatrics at UCSF is committed to excellence in research, education and the clinical care of infants, children and young adults. The division of Pediatric Endocrinology shares this commitment and provides opportunities for training in all aspects of clinical pediatric endocrinology and a broad array of basic and applied areas of endocrine research. The program strives to develop in its fellows a commitment to lifelong learning and emphasizes scholarship, self-instruction, development of critical analysis of clinical problems, and the ability to make appropriate decisions. I. Program goals and objectives 1The overall goal of the UCSF Training Program in Pediatric Endocrinology is to provide trainees with the background needed to diagnose and manage endocrine diseases and to understand the physiology of hormonal regulation in infancy, childhood, adolescence and young adulthood. The Program emphasizes fundamentals of clinical diagnosis and management, with special emphasis on compassionate care, history taking, physical examination and interpretation of pertinent laboratory data. Graduates of the program are expected to be proficient in clinical care, both direct and consultative; in research, either clinical or basic; and in teaching and administration. 2 To implement the general goals as stated above, our program is specifically designed to fulfill the following specific goals: 1. To understand the normal physiology of the various endocrine glands and hormones (the “endocrine system”) 2. To understand the common diseases and abnormal physiology of the endocrine system. 3. To know how to recognize, diagnose, and treat the common disorders of the endocrine system. 4. To understand the systematic, scientific approach to disorders of the endocrine system that will permit accurate diagnosis and treatment of uncommon endocrine disorders. 5. To understand the systematic, scientific approach to gaining new information about endocrine systems and diseases. 6. To become proficient in at lease one area of endocrine research. 7. To become conversant with established approaches, principles, and ethics of preparing and publishing research findings. 8. To publish one or more first authored research papers in a major journal. 9. To gain experience in teaching medical students and pediatric residents, and in the formal presentation of lectures, rounds and conferences. 10. 11. To learn some of the history of endocrinology, participate in its present history, and continue the legacy by learning to teach and inspire future generations. 11.Trainees learn about pertinent aspects of genetics, including molecular genetics, biochemical genetics, cytogenetics, the phenotypic manifestations of endocrine Page 3 of 9
  4. 4. Division of Endocrinology Fellowship Training Program genetic disorders and genetic counseling. Page 4 of 9
  5. 5. Division of Endocrinology Fellowship Training Program II. Educational Program A. Clinical and Continuity Experience The UCSF Program in Pediatric Endocrinology is typically 3 years in duration, and includes progressive clinical, technical and consultative experiences that lead the trainee to acquire expertise as a pediatric endocrinologist and leads to eligibility to take the American Board of Pediatrics Subspecialty Examination in Pediatric Endocrinology. Some trainees, especially those from abroad not seeking certification by the subspecialty board, may participate in the program for shorter periods. The program has a commitment to lifelong learning and emphasizes scholarship, self instruction, development of critical analysis of clinical problems, and the ability to make appropriate decisions. The clinical service duties typically consist of 6 months on the inpatient service, providing care for patients admitted to the pediatric endocrinology service, and providing consultations, all under the supervision of the attending teaching faculty. During this time, night call is taken from home, and an average of 1 day in 7 is free of clinical duties. During the other 2 and a half years of the 3 year program, trainees provide care under faculty supervision in the outpatient pediatric endocrinology clinic and pediatric diabetes clinic. Trainees attend both clinics once each week for 18 months and both clinics on alternate weeks in the third year. Trainees in year 2 and 3 occasionally cover for first year trainees to provide time off. The program affords trainees the opportunity to diagnose and treat a wide variety and complexity of endocrine disorders in patients ranging in age from newborn to young adults, including adolescents with normal and abnormal puberty. There is an extensive inpatient admission and consultation experience including intensive care unit and intensive care nursery management of patients, as well as continuing outpatient responsibility for the care of chronic endocrine disorders including diabetes mellitus. Trainees learn, through patient care, about normal and abnormal hormonal regulation; the interaction between endocrine disease and psychosocial problems is stressed. Trainees also participate in weekly endocrine and diabetes outpatient clinics. The scope of training is that described in the General and Special Requirements for Programs in Pediatric Endocrinology as specified by the ACGME. In brief, the trainee must come to understand the pathophsysiology, clinical diagnosis, and management of pediatric endocrine disorders as well as the selection, performance and evaluation of procedures used in the assessment of these disorders. The trainee must acquire clinical experience with both common and unusual problems that occur in patients falling into the following endocrinologic disorders: The clinical experience includes, but is not limited to, patients in the following categories. 1. Short stature, including constitutional delay 2. Disorders of anterior pituitary hormone physiology, including growth hormone deficiency. 3. Disorders of posterior pituitary hormone physiology, including diabetes insipidus Page 5 of 9
  6. 6. Division of Endocrinology Fellowship Training Program 4. Disorders of hypothalamic regulation of hormonal secretion 5. Disorders of thyroid hormone physiology; secretion and synthesis 6. Diagnosis and management of endocrine neoplasia 7. Disorders of the adrenal gland physiology; secretion and metabolism 8. Disorders of androgen and estrogen metabolism; including adolescent reproductive endocrinology 9. Disorders of sexual differentiation and development 10. Disorders of calcium, phosphorous, and vitamin D metabolism 11. Disorders of parathyroid gland physiology 12. Disorders of fluid and electrolyte balance 13. Disorders of carbohydrate metabolism, including diabetes mellitus and hypoglycemia 14. Disorders of nutrition, including eating disorders Didactic teaching opportunities are available throughout the three-year fellowship. Fellows attend a multi-disciplinary Pediatric Endocrinology Conference weekly. There is also a weekly journal club in the division of Pediatric Endocrinology where faculty members and fellows share in presenting research findings, journal club articles, and interesting clinical cases. B. Laboratory Experience Trainees receive instruction in the proper choice and use of various laboratory techniques for the measurement of hormones in body fluids, with particular emphasis on recognizing the limitations of such data and the pitfalls in interpreting laboratory results. Trainees learn the proper interpretation of endocrine stimulation and supression tests, including normal variations in laboratory results at different ages and at different times of the day. Trainees interact directly with specialists in radiology, neuroradiology, nuclear medicine,ultrasonography, CT scanning and magnetic resonance imaging to enable them to utilize current diagnostic procedures for endocrinology. C. Curriculum 1 An essential goal of the curriculum is to provide residents with direct experience in progressive responsibility for patient management. The program provides skills that lead to an in-depth understanding in clinical and basic sciences, including endocrine, physiology, pathology and biochemistry, the embryology of endocrine and related systems with emphasis on sexual differentiation; genetics, including laboratory methods, cytogenetics, enzymology and molecular genetics; and aspects of immunology relevant to endocrine disease, including immunoassay techniques. 1 Page 6 of 9
  7. 7. Division of Endocrinology Fellowship Training Program Mondays 1. Diabetes Outpatient Clinic Management Conference 4-5 pm Tuesdays 2. Inpatient/Consult Management Conference 9:15 -11am Tuesdays 3. Basic Science/Research Tutorials 11am - 12 noon Wednesdays 4. Endocrinology Grand Rounds 8:30 -9:30am Wednesdays 5. Endocrinology Fellows Review Course 10:30 -11:30am Thursdays 6. Pediatric Grand Rounds 8 - 9am Clinical management of inpatients, consultations and outpatients is reviewed at a required weekly meeting. The required conferences include: In addition there are yearly conferences on the ethical conduct of science and ethical conduct of medicine. Clinical Year 1 This year is divided into twenty-six 2-week rotations, as described below. In the first year of the 3-year Fellowship the focus is on clinical management of inpatient and outpatient endocrine disorders. Inpatient Endocrinology Service (Moffit/Long Hospitals) (26 weeks) The fellow is integrated into a team of health care professionals (attending physicians, pediatric resident physicians, nurse specialists, dietician, and social worker) who regularly care for the pediatric endocrine patient. The fellow rounds with the team 1 1/2 hours, 5-7 days per week. Experience in the clinical care of children with endocrine disorders is provided and the importance of team concept in management of these patients is provided. All diagnostic and therapeutic procedures are carried out by the fellow under direct supervision by the attending physician as needed. The fellows are also responsible for presenting a 30-minute talk on a key topic in clinical endocrinology once a week. These conferences provide fellows with the opportunity to discuss clinical topics in depth with leading experts in the field of Endocrinology and Pediatrics. Endocrinology Consultation Service This clinical rotation is intended to expose the trainee to patients with a variety of endocrine disorders that arise in patients not currently hospitalized on the inpatient Page 7 of 9
  8. 8. Division of Endocrinology Fellowship Training Program endocrinology service. Fellows provide consultation service to the busy PICU and PCRC. The rotation allows the fellow to see new outpatient and inpatient consults. Page 8 of 9
  9. 9. Division of Endocrinology Fellowship Training Program Outpatient Specialties Clinics (26 weeks) The fellow attends endocrine outpatient clinics as listed below 3-4 times a week. Fellows manage patients that are undergoing complex testing and evaluation for a variety of endocrine disorders, and many patients that are involved in clinical research trials. Diabetes Clinic – Monday AM/PM, Tuesday PM Endocrine Clinic – Wednesday PM Obesity Clinic – Wednesday AM General Competencies The ACGME has directed that all residency programs assure that each resident demonstrate 6 core competencies: * Patient Care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health * Medical Knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care * Practice-Based Learning and Improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care * Interpersonal and Communication Skills that result in effective information exchange and teaming with patients, their families, and other health professionals * Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population * Systems-Based Practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value" Fellowship Evaluation Fellows are evaluated by a variety of methods to determine if they possess the knowledge, skills and attitudes necessary for pediatric endocrine practice. Monthly evaluations Informal, frequent verbal feedback is given to the Fellow on a monthly basis in the context of individual patient management. Fellows are counseled regarding any areas of deficiency. Biannual Evaluations Attending physicians evaluate Fellows formally every six months. The attending evaluates performance across a variety of areas and also gives a summary statement regarding the Fellows ability to manage endocrine disorders The evaluations are maintained in the Fellows file, and are discussed with the Fellow by the Director of the Program. The fellows are asked to keep a record of the patients seen and their diagnosis. The Fellowship director reviews this list during the biannual evaluations to determine the breadth of experiences, and the need for additional diagnostic training. Page 9 of 9
  10. 10. Division of Endocrinology Fellowship Training Program III. Research Opportunities Research Years (Years 2, 3) During the 2 1/2 years when the trainees are not responsible for the inpatient service, the time that they are not involved in outpatient clinics or conferences is available for research. This is typically about 60% of the trainee's total time during that 2 1/2 year period. All trainees participate in one or more research programs, and some trainees seeking more advanced training may remain beyond the third year. Trainees choose a principal mentor to supervise their research. The principal research mentors include: Walter L. Miller, MD, Professor of Pediatrics Selna L. Kaplan, MD, PhD, Emeritus Professor of Pediatrics Stephen M. Rosenthal, MD, Professor of Pediatrics Robert H. Lustig, MD, Professor of Clinical Pediatrics Synthia H. Mellon, PhD, Professor of Obstetrics, Gynecology and Reproductive Medicine Ira Goldfine, M.D. Professor in Residence, Medicine and Physiology Keith Yamamoto, Ph.D. Professor, Cellular/Molecular Pharmacology and Biochemistry/Biophysics Doloros Shoback, M.D. Professor in Residence, Endocrinology Jeffrey Bluestone, Ph.D., A.W. and Mary Margaret Clausen Distinguished Professor of Metabolism and Endocrinology; Director, Diabetes Center Stephen E. Gitelman, MD, Associate Professor of Clinical Pediatrics Many of the research projects supervised by this core faculty will involve collaborations with other faculty in epidemiology, biostatistics, pharmaceutical chemistry, physiology etc. IV. Policies and Procedures The UCSF Program in Pediatric Endocrinology adheres to all the policies and procedures mandated by the University of California, its Graduate Medial Education Committee and the Accreditation Council of Graduate Medical Education (ACGME). Details of these policies and procedures can be accessed as follows: University of California, San Francisco Housestaff Information Booklet - A guide for residents and clinical fellows. This 58 page pamphlet provides a wealth of details about UCSF, its philosophies and policies. It covers all aspects of appointment and employment, including selection policies, duties, responsibilities, salaries, insurance, evaluation, disciplinary procedures, non-discrimination, sexual harassment, grievance policies and appeals. It contains sections on California medical licensure, narcotic registration, CPR certification, etc. and as well as an extensive section on available services, including loans, parking, legal aid, etc. Full text of the booklet is available at: Page 10 of 9
  11. 11. Division of Endocrinology Fellowship Training Program V. Application Process April-March October November-April July 1st Submit Application CA Board Interviews Program Start For start date of July 1 Certification the following year Program Eligibility and Applications The program selects from among eligible applicants on the basis of their preparedness and ability to benefit from the program. Aptitude, academic credentials, personal characteristics, and ability to communicate are considered in the selection. The division has one of the few NIH Training Grants for Pediatric Endocrinology. This grant provides salary support for U.S Citizens or Permanent Residents. Citizens of other countries who are not permanent residents may also apply for the program, but they must find their own external sources of funding. The program does not discriminate with regard to sex, race, age, religion, color, national origin, sexual orientation, disability or veteran status. Applications are accepted through March 15th each year for a start date of July 1 the following year. CA board certification Pediatric Endocrinology sponsors a highly regarded ACGME-certified, three year fellowship program which trains the next generation of outstanding pediatric endocrinologists. We strive to create a dynamic training program for each fellow. At the end of the training years, each fellow will be eligible to sit for the subspecialty boards in pediatric endocrinology. Interviews Interviews are routinely conducted between October and April with a match taking place at the end of April. Benefits • Medical, dental, vision, life and accidental death and dismemberment, as well as long term disability insurance. Eligible dependents-including Domestic Partners- are also eligible for medical, dental, and vision coverage. • Four weeks of vacation/educational leave per academic year. • 12 days of sick leave per academic year. Page 11 of 9
  12. 12. Division of Endocrinology Fellowship Training Program V. Further Information Contact Information Send application materials to: Barbara Schrader Fellowship Coordinator Department of Pediatrics University of California, San Francisco 513 Parnassus Avenue, Suite S-672 San Francisco, CA 94143-0434. Phone: 415-502-8482 Email: Walter L. Miller, M.D. Director, Pediatric Endocrinology Training Program Department of Pediatrics 513 Parnassus Avenue, Suite S-672 San Francisco, CA 94143-0434. Phone: 415-476-2598 Email: Applicants need to submit: • Downloadable Fellowship Application form • CV • Personal statement • Three letters of reference VI. Download Fellowship Application Form VII. Download Requirements for the UCSF Fellowship Program in Pediatric Endocrinology Page 12 of 9