The first year of the fellowship is primarily focused on clinical training. During this year, the fellow splits his/her time between the inpatient consult service and the outpatient rotation. Under the supervision of a faculty attending physician, the inpatient fellow assumes responsibility for all consultations in addition to teaching medical residents and students. Consultation rounds take place daily with a team consisting of a faculty preceptor, the fellow, one or two medical residents, and one or two senior medical students. This arrangement provides critical longitudinal experience in endocrine diseases, which are frequently chronic in nature.
During the months of outpatient rotation, the fellows participate in daily half-day, general endocrinology clinics where they see a wide range of endocrine patients under the mentorship of faculty members.
Fellows will also have their own continuity clinic on a weekly basis where they will see their own patients under the guidance of a faculty preceptor. Fellows will be responsible for the ongoing care of these patients.
During elective rotations, fellows participate in outpatient subspecialty clinics in pediatric endocrinology, lipid disorders, genetics, reproductive endocrinology, high-risk pregnancy, infertility clinic, endocrine surgery, nuclear medicine (including bone mineral density study) and radiology (focusing on ultrasound-guided fine needle aspiration/biopsy of thyroid).
During all rotations, fellows are expected to participate in regularly scheduled educational activities which include weekly Clinical Endocrinology Conference, Medical Grand Rounds, monthly Diabetes Journal Club, and Endocrinology Research conference every other month.
In addition to the above clinical and educational activities, the first-year fellow is expected to develop and initiate a research project with the assistance of an assigned faculty mentor.
Second and Optional Third Years
The second year of training is divided between six months of clinical activity (alternating inpatient consults with outpatient clinics) and six months of elective time, including research. Participation in the continuity outpatient clinic remains throughout the second year. The option for a third year of training is available for those interested in academic research careers who need to prepare themselves as independent physician scientists. These fellows will be expected to apply to the NIH or an appropriate extramural funding agency/organization for a research fellowship.
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.
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, and nurse practitioners. An active insulin pump program and the use of new technologies such as the Continuous Glucose Monitor Sensor (CGMS) are available.
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.
Multidisciplinary Endocrinology Conferences
Thyroid Unit: held on a monthly basis in conjunction with Nuclear Medicine, Endocrine Surgery and Pathology to review primarily patients with thyroid cancer and their treatment options but also any other interesting thyroid case.
Hereditary Endocrinopathies: held on a monthly basis in conjunction with Endocrine Surgery and Genetics to review patients with hereditary endocrinopathies (multiple endocrine neoplasia types 1 and 2, etc.).
Along with high-quality training in clinical endocrinology, research training is a major focus of our fellowship program. While we welcome all well-qualified applicants, we particularly encourage individuals with an interest in an academic endocrinology career to apply. First-year fellows are introduced to the spectrum of research activities conducted within the Division and by faculty members affiliated with the training program. Within the first three months of the fellowship, the fellow should be able to identify an appropriate research topic and faculty mentor. Fellows are expected to submit a brief research proposal within the first year in order to gain experience in devising an experimental plan. These research proposals are assembled with the guidance of the faculty mentor. Fellows on the academic track are encouraged to apply for extramural funding during the second year to support additional years of training. Fellows are encouraged to attend national meetings and submit abstracts of their research for presentations. They are also expected to submit their data for publication in peer-reviewed journals.
Research opportunities for fellows are available in a variety of endocrine-related disciplines including:
- Endocrine Oncology
- Heart and Vascular Institute
- Obesity and Insulin Resistance
- Ovarian Cell Biology
- Polycystic Ovary Syndrome
A unique, state-of-the-art patient registry database tracks patient outcomes for all diabetes patients within our endocrine clinics and ten primary care sites affiliated with Hershey Medical Center. This functions as a valuable resource for population based diabetes management and research. A number of diabetes related research opportunities exist outside of the Division of Endocrinology, Diabetes, and Metabolism.
Dr. Manni, Chief of the Division, and Director of the Fellowship Program, has a career-long interest in breast cancer research. He plays a major role in promoting collaborative research among clinicians and basic scientists with an interest in breast cancer with the ultimate goal of applying to the NIH for a program project grant. The strong institutional commitment to the developing Penn State Hershey Cancer Institute provides the necessary resources and infrastructure for the conduct of multi-disciplinary research in breast cancer. This provides opportunity for our fellows to work in various laboratories investigating basic aspects of endocrine oncology.