Fellows train during inpatient rotations at Tulane University Hospital & Clinic (TUHC), Medical Center of Louisiana at New Orleans (MCLNO), and the Southeast Louisiana Veterans Health Care System (VA). Daily endocrine consultation rounds are made by the on-call fellow, residents, and students assigned to the service, with supervision by full-time endocrine attendings. Consultation is provided to the general internal medicine service as well as other services, especially general surgery, transplant surgery, gynecology, neurology, neurosurgery, urology, otolaryngology, and oncology.
In this broad-based program, a first year fellow will see approximately 80-100 patients, primarily as a consultant. The in-patient experience during the second year involves progressively more direct care of patients on the endocrine service and on other services (general medicine, cardiology, nephrology and other medical subspecialties) while under the supervision of an attending physician.
Clinics are covered by full-time faculty who guide fellows and rotating residents and students through appropriate diagnostic and therapeutic methods, teach recognition and interpretation of physical findings, and ensure that there is a basic understanding of the broad range of endocrinopathies that present at these clinics:
TUHC--Three general endocrine clinics per week and a Diabetes Education Center providing access to certified diabetes educators and nutritionists.
MCLNO--Two general endocrine and diabetes clinics per week and access to a Diabetes Education Center for patient referral.
VA--Three clinics per week: general, diabetes, and FNA*
Other Clinics: Limited observership of pediatric and reproductive clinics at Children's Hospital and The Fertility Clinic of New Orleans.
Because of the structure of the endocrine service, a fellow will have uninterrupted continuity of care and observation at TUHC (Lakeside) during each year of the program. In view of the chronicity of endocrine problems in general, the continuity clinics afford an excellent opportunity for trainees to follow complicated diagnostic work-ups to completion, to see the evolution of disease processes, and to appreciate the long- term effects of therapy.
*Note on FNA training: Before performing the fine needle aspiration (FNA) of the thyroid procedure in clinic, incoming fellows receive their initial training in the procedure from a faculty member in pathology and are thereafter supervised when the procedure is done in clinic. Fellows will have ample opportunities for performing FNAs in clinical settings. A minimum 10 FNAs is required by the completion of training.
MONDAY CONFERENCE--Fellows present weekly at Journal Club and case conferences before faculty, fellows, and rotating medical students and residents. Evaluation by faculty and peers is based on the importance and relevance of the article/case selected; clarity and organization of presentation; and quality of synthesis and interpretation.
CORE LECTURES--Covering the fundamental topics of endocrinology and metabolism, as well as relevant basic science and research topics, lectures are provided by endocrine faculty with supplementary lectures provided by faculty in adjunct disciplines and by visiting physicians and scholars of note in endocrinology research and/or clinical practice.
MEDICINE GRAND ROUNDS--Weekly presentations by faculty, chief residents, and prominent experts on various topics covering all medicine subspecialties with three to four sessions per year dedicated exclusively to endocrinology. The final GR each month is a Morbidity & Mortality conference lead by the medicine chief fellow and a faculty facilitator. Endocrine fellows are required to attend all GR sessions.
TUMOR BOARD--A multi-specialty joint conference with endocrinology, general and endocrine surgery, radiology, pathology, and other specialties which is directed by the head of endocrine surgery, Emad Kandil, MD. The conference is held on the 4th Wednesday of each month at Tulane's Cancer Center where slides can be viewed using the most technically advanced equipment. Endocrine fellows and other members of the team provide and examine challenging endocrine pathologies.
ENDOCRINE UNIVERSITY --Each March, the program director nominates senior fellows to attend a week at Endocrine University held at the Mayo Clinic in Rochester NY. Sponsored by the American Association of Clinical Endocrinologists (AACE) and the Mayo Clinic Division of endocrinology, the curriculum is designed to help prepare fellows for entering clinical practice with the coverage of topics such as thyroid ultrasound and fine needle aspiration, bone, endocrine laboratory and genetic testing, insulin pump and sensor hands-on instruction, practice management issues, and meet the expect sessions.
ENDOCRINE SOCIETY IN-SERVICE EXAM--Each April, both PGY 4s and 5s are enrolled in the Endocrine Society's Self-Assessment Program-In Training Exam. Although designed for second-year clinical endocrine fellows, first year trainees benefit as well from exposure to the topics and the types of questions that appear on the ABIM certifying exam in endocrinology. Exam results include full answers to all exam questions and may serve as an excellent learning and review tool for trainees.
TEACHING--Fellows interact with residents and students in a supervisory/teaching capacity in clinic and and reinforce their own training in the course of this interaction. Along with issuing assignments and guiding students during endocrine clinics and inpatient rounds, fellows are encouraged to rehearse their own presentations before residents/students as preface to formal presentation before faculty and/or a larger audience at national meetings. Fellows also have the opportunity of teaching patients in a group setting once a month at TUHC's Diabetes Education Center.
While the program does not offer a dedicated research rotation, in keeping with the ACGME requirement that the curriculum advance a trainee's knowledge of the basic principles of research and provide the opportunity for trainees to demonstrate evidence of scholarship, the program provides a large variety of research resources. Whether planning a clinical or academic career, fellows participate in meaningful research and scholarly publication activities from the very beginning of their training. Trainees have the opportunity of participating in ongoing studies by distinguished and widely published faculty.
Research projects and other activities through the NIH supported Louisiana Clinical and Translation Science Center provide numerous opportunities for research and scholarly publication and are an integral part of the training program. Fellows then have the opportunity and are encouraged to present posters or oral abstracts at national meetings of organizations such as The Endocrine Society, The American Diabetes Association, and the American Association of Clinical Endocrinologists.
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