Endocrinology Fellowship Program

The Division of Endocrinology and Metabolism at WMC provides care for patients with a wide variety of disorders including diabetes mellitus, osteoporosis, disorders of the pituitary, thyroid, and adrenal glands, disorders of calcium metabolism, and disorders of female and male reproductive hormones. A very active inpatient consultation service at WMC assists other services with the management of endocrine and metabolic disorders, especially diabetes mellitus. Ambulatory settings, including hospital-based clinics and a faculty practice, provide longitudinal and consultative care learning opportunities. The Division comprises four faculty members, all of whom practice general endocrinology.

The fellowship program in Endocrinology, Diabetes and Metabolism is a comprehensive, two-year, ACGME-accredited training program. The program accepts two fellows per training year.rnrnOur fellows manage a diverse population of inpatients and outpatients, thereby gaining exposure to the full array of endocrine and metabolic disorders.

The inpatient endocrinology service provides consultative care for patients admitted to Westchester Medical Center (WMC). Under the supervision of the attending physicians, our fellows see patients on the general medicine, cardiology, cardiothoracic surgery, neurosurgery, neurology, oncology, transplant, obstetrical, trauma, burn, behavioral health, and rehabilitation services. Daily hospital rounds have a strong academic component, and fellows participate in the teaching of rotating medical residents as well as rotating medical students from New York Medical College.rnrnThe inpatient service is divided into two teams, with one fellow assigned to each team. The fellow on the main team follows the majority of the patients, spending full weekdays in the hospital. The fellow on the secondary team sees a smaller number of patients, devoting half days to the inpatient service.

The outpatient clinics represent a key educational component of the training program. Our hospital-based clinics provide care for patients regardless of their insurance status. They are located in the 19 Bradhurst Avenue building, a modern, full-service medical facility with laboratory and radiology services, within a five-minute drive of the hospital campus. Throughout their two years of training, the fellows participate in the following clinics:

• Continuity Clinic – General Endocrinology. Each fellow builds up a panel of patients that they will continue to see throughout their training. These may be patients with thyroid disease, osteoporosis, primary hyperparathyroidism, obesity, polycystic ovarian syndrome, infertility, pituitary tumors, adrenal adenomas, and other endocrine disorders. The clinic provides care for a large number of patients with thyroid cancer, and fellows gain in-depth exposure to the management of this disease, working closely with our colleagues in the departments of Endocrine Surgery and Nuclear Medicine.
• Continuity Clinic – Diabetes. Each fellow cares for a second panel of patients in the weekly Diabetes Clinic. There is a strong focus on diabetes self-management training and medical nutrition therapy, and certified dietitians staff the clinic alongside the fellows. Fellows learn how to initiate and manage insulin pump therapy, and utilize continuous glucose monitoring systems.
• Thyroid Clinic. In this weekly procedure-based clinic, fellows learn to perform diagnostic neck ultrasound and ultrasound-guided fine needle aspiration (FNA) biopsy of thyroid nodules. Most patients are referred from our own General Endocrinology clinic, or from the Primary Care clinic. For our patients with thyroid cancer, both preoperative neck ultrasound and postoperative surveillance scans are integrated into a system of comprehensive clinical care. Molecular genetic analysis is available for FNA specimens with indeterminate cytology.

• Faculty Practice. Fellows attend half-day sessions at the faculty practice on a regular basis, working alongside the endocrinology attendings and gaining exposure to the private practice setting. The faculty practice is also located in the 19 Bradhurst Avenue building.
• Obesity Medicine Rotation. Each year, fellows spend one block on the division’s outpatient obesity medicine service. Working with our medical director of obesity medicine, the fellows gain expertise on the evaluation and medical management of patients with obesity. This service is part of the faculty practice at 19 Bradhurst Avenue.
• Pediatric Endocrinology Clinic. In their second year of training, fellows spend several sessions with a pediatric endocrinologist, where they learn about the care of young patients with type 1 diabetes, growth hormone deficiency, pubertal delay, and other common conditions. This office is also located at 19 Bradhurst Avenue.

• Endocrine Grand Rounds. Formal presentations on endocrine topics, with in-depth literature reviews, are given by attendings from the Division, outside speakers, and the fellows, on a rotating basis.
• Case conferences and Journal. Case conferences consist of 30-minute case-based discussions of common and uncommon issues in the management of endocrine diseases. At Journal club, a recent article from the endocrine literature is analyzed in depth, and fellows gain an understanding of clinical trial design and how to interpret statistical results. Again, both attendings and fellows participate in the presentations.
• Board review. Each week the fellows meet with the Program Director to work through questions and answers from the annually-updated Endocrine Self-Assessment Program (ESAP).
• Seminars for first-year fellows. In July, a special series of seminars is provided for the new fellows. High-yield topics in clinical endocrinology are presented by our faculty members in small, interactive sessions.

• Year 1: 13 Four-Week Blocks
  Fellows spend four non-consecutive blocks on the main consultation service, during which they attend the weekly General Endocrinology Clinic and all academic conferences.
  Another three non-consecutive blocks are spent on the secondary consultation service; in addition to the General Endocrinology Clinic and the academic conferences, fellows also attend the Diabetes Clinic and Faculty Practice during these blocks.
  During the remaining six blocks of the year, fellows devote time to scholarly activities, and attend all clinics and academic conferences, Faculty Practice, Obesity Medicine Service, and Pediatric Endocrinology Clinic.
• Year 2: 13 Four-Week Blocks
  Fellows spend two non-consecutive blocks on the main consultation service, during which they attend the weekly General Endocrinology Clinic and all academic conferences.
  Another four non-consecutive blocks are spent on the secondary consultation service; in addition to the General Endocrinology Clinic and the academic conferences, fellows also attend the Diabetes Clinic and Faculty Practice during these blocks.
  During the remaining seven blocks of the year, fellows devote time to scholarly activities, and attend all clinics and academic conferences, Faculty Practice, Obesity Medicine Service, and Pediatric Endocrinology Clinic.

Fellows submit at least one abstract each year for poster or oral presentation at a major annual endocrine meeting. They also design and implement a quality improvement project. In addition, opportunities are available for publishing review articles and participating in clinical research projects. All scholarly activities are closely supervised by members of the Division faculty.

Weekend calls are distributed evenly among all four fellows. On average, each fellow is on call every fourth weekend. Fellows are also on-call each night during the week leading up to their weekend call. In the evening, calls are taken from home; occasional emergencies may require the fellow to return to the hospital. The on-call attending is always available.

During each year of their training, all fellows will attend at least one national meeting of a major endocrinology professional organization (The Endocrine Society, American Association of Clinical Endocrinologists, American Diabetes Association, American Thyroid Association). Westchester Medical Center provides financial support for meeting registration and travel costs for fellows whose first authored work is accepted for presentation at national meeting.

Fellows also attend the Endocrine University conferences, which are sponsored by AACE, and the semi-annual meetings of the New York Thyroid Club.