- Continuity Clinic: Fellows will be working with an assigned physician in three half-day blocks per week when not on hospital service. The fellow is responsible for the initial evaluation of the patient and the development of an initial management plan. The H&P is then presented to the precepting physician and feedback is provided to the fellow. All fellows have an Endocrine Continuity Clinic for two years. This ensures them the opportunity to follow patients long enough to witness the natural history of the endocrine disorder and its therapy unfold. There is a combination of new patients and follow up visits. New visits are allocated one hour, follow up visits are 30 minutes. The clinic is scheduled for 4 hours. Fellows are also trained in thyroid ultrasound, fine needle aspiration, insulin pump management and continuous glucose monitoring technology.There are no call or weekend coverage during this rotation.
- Specialty Rotation: The program emphasis is on ambulatory sub-specialty training which reflects the fact that most of the contemporary practice of endocrinology and metabolism occurs in the outpatient setting. During the outpatient rotations, fellows will rotate in three half-day blocks per week through all sub-specialty teaching clinics (including thyroid, pituitary, metabolic and more) where they focus on pragmatic and scholarly approaches to diagnostic and therapeutic endocrinology. In all rotations, fellows primarily see new consultations, working one-on-one with a staff endocrinologist who is an expert in that sub-specialty.
This rotation involves extensive inpatient exposure to the full spectrum of problems in endocrinology and metabolism including disorders of the thyroid, adrenal, hypothalamus, pituitary, parathyroids and gonads, endocrine hypertension, metabolic bone and calcium disorders, type 1 and 2 diabetes mellitus, and obesity and lipid disorders. The educational purpose of this rotation is for the fellow to:
- Gain experience and achieve competency in the care of in-hospital endocrine disorders.
- Treatment and management of acute and chronic endocrine disorders in the hospital setting.
- Leadership role in organizing the team, receiving consultations, distributing consultations to other team members and supervising students and residents on the service.
- Organize and distribute cases to be presented at Endocrine Grand Rounds (EGR) and present cases and case discussions at EGR.
During the rotation, fellows are expected to work with an assigned endocrinologist and other team members including residents, medical students and/or nurse practitioners. The fellow receives consultations, distributes them to team members, maintains list of active consultations, and ensures appropriate hand-over of cases. The fellow is responsible for the initial evaluation of the patient and development of an initial management plan. The H&P are presented to the attending staff and feedback is provided to the fellow. The fellow also initially supervises the H&P of the students and residents and does rounds on a daily basis to follow his/her patients. The fellow takes call from home 3 nights per week while on the hospital rotation and presenting cases at EGR. Attending core curriculum lectures and journal club meetings are mandatory for all fellows.
Fellows have one day off per week while on hospital service.
Research is a significant part of the training of an endocrinologist. Endocrine fellows are given research opportunities and responsibilities.
Each trainee meets with the program director during his or her first year to discuss research opportunities and is assigned an appropriate mentor. The research experience is expected to occupy 30% of the fellow’s time during the first year and 35% during the second year. Our fellows are provided the time and support needed to complete projects and the expectation is that the experience will lead to authorship of a publication or presentation at a national meeting. All endocrinology fellows are required to take the Investigator Human Subject Research Education course offered by Cleveland Clinic in addition to CITI and HIPAA, online education courses.
There is a seven-bed, NIH-supported, Adult General Clinical Research Center (GCRC) located in the Cleveland Clinic hospital. Additionally, out-patient beds are available for GCRC studies. Many inpatient clinical research studies are performed by Division members on the GCRC.
There are several regularly scheduled educational activities in the department for fellows:
Weekly Endocrine Grand Rounds
- Core curriculum lectures
- EGR: Research talk, cases
- Pituitary tumor boards
- Adrenal tumor boards
- Thyroid tumor boards
- Thyroid Club
- Obesity Club
- Thursday Didactic sessions
The Friday Endocrine Grand Rounds is attended by faculty, fellows, providers from other specialties, house staff, and students. The topics discussed at this conference are clinically relevant, but may include newer developments in the basic sciences which are of increasing importance to a clinician.
The fellows have an opportunity to present interesting cases they have seen and discuss a related area of diagnosis or therapy. Research protocols and results are discussed as well.
Journal Club follows Endocrine Grand Rounds every Friday. Each week, fellows gather to discuss a group of recent articles they believe are of relevance. Often, this conference allows the opportunity to compare the content of the literature with "what we really do."
The focus is very clinical and the goal is to stay up-to-date on a broad range of topics. Fellows often cover articles in depth. A core curriculum lecture is given by a faculty member following EGR.
The Friday morning Research Conference covers new research by fellows at Cleveland Clinic. Members of the Endocrine & Metabolism Institute and visiting scientists present both work that is in progress and new developments. The emphasis is on high-quality, cutting-edge science.
Fellows are also expected to participate in a bi-weekly thyroid conference, an obesity journal club every other month, an annual Endocrine Board Review Course at Cleveland Clinic and annual Diabetes Day. All fellows present at National Endocrine Conferences.
These lectures are part of the Friday morning conference series. Lectures are given by endocrine faculty and/or invited speakers. Additional lecture topics will be added as deemed appropriate by the faculty. Examples of such topics are:
Endocrinology Board Review Course
- Insulin: synthesis, regulation, and molecular mechanism of action
- Developmental endocrinology (growth and development, sexual differentiation, pubertal maturation)
- Genetics (selected endocrine disorders)
- Principles of hormone action and signal transduction pathways
- Creation, validation, and use of laboratory assays
- Immunology of Endocrine Disorders
- Pathogenesis of diabetes mellitus and insulin resistance
- Pancreas transplantation
- Non-genomic actions of steroid hormones
- Radionuclide scanning
The American Association of Clinical Endocrinology/Cleveland Clinic Endocrinology Board Review Course is directed to practicing endocrinologists and other physicians with an interest in endocrinology, metabolism and diabetes.
The goal of this course is to provide the participants an intensive preparation for the endocrinology and metabolism board examination. Topics covered during Endocrine Board Review Course are:
- Endocrinology, including diabetes control and complications
- Nuclear Imaging
- Thyroid Disorders
- Endocrine Pathology
- Hypo- and Hyperadrenalism
- Endocrine Hypertension
- Calcium Disorders
- Pituitary Disorders
- Important Pediatric Endocrine Disorders and Pregnancy
The lecture format will be heavily weighted to board simulation. An interactive Audience Response System is employed to facilitate audience participation. A comprehensive syllabus will be provided.
A course designed to summarize and present the latest knowledge in the management of diabetes to busy practitioners. Areas recently covered during Diabetes Day conference include:
- Combination therapy
- Treatment in hospital setting
- Management and prevention of complications
- Peculiarities in minority ethnic groups and adolescents
- Newer as well as future management options