Curriculum for First-Year Fellows

A. Curriculum and trainee responsibilities:

First year of training (first rotation): Along with other Endocrine & Metabolism team members, attends weekly endocrine/metabolism clinics at the Tampa VA Medical Center (including the weekly Endocrine Clinic where 30 to 40 patients are seen each week and the weekly Diabetic Clinic at which approximately 20 patients are seen) and Tampa General Hospital (one clinic/week in which 15-20 general endocrine and diabetic patients are seen). During this year, the trainee will also be directly responsible for promptly answering all inpatient consultations to the Endocrine/Metabolism Division at each of these hospitals as well as education and supervision of medical students and general medicine residents who rotate through the Endocrine Division (on elective) and assist in answering these consultations. The first year Fellows will provide this consultation coverage in blocks of two weeks; one Fellow will cover inpatient consultations for TGH and the other Fellow will cover inpatient consultations for the VA and Moffitt Cancer Center, also, under the supervision of the VA Chief of Endocrinology, will help answer VA outpatient consults. The Fellows will interact with other healthcare personnel in these clinics, including dieticians, diabetic nurse-­educators, social workers, clinical pharmacists, etc., and learn how to work as a member of a multifaceted healthcare team that provides state-of-the-art comprehensive care for endocrine patients. It is expected that during the first block, the trainee has more interaction and supervision from the senior fellow and by the assigned attending, during the second block, it is expected less supervision from the senior fellow, increasing responsibility in patient care, and a more active role in the teaching and supervision on the medical students and residents.

B. Educational Support Activities:

  1. Endocrinology Society/ADA and AACE Meeting
  2. Endocrinology Noon Conferences
  3. Endocrinology Noon conferences Board Review

C. Grand Rounds:

  1. USF Grand Rounds
  2. Research conference H. Lee Moffitt (MOF 3039)
  3. Attending Rounds

D. Continuity Clinics:

  1. JAH VA Hospital, weekly Endocrine Clinics
  2. JAH VA Hospital, weekly Diabetes Clinics
  3. TGH, weekly Endocrine Clinics
  4. USF Medical Clinics

Curriculum for Second-Year Fellows

The curriculum for the second of training differ from the first year; as delineated in the goals, objectives and competencies provided to you, a new set of goal and objectives were added, we expect a higher level of competency for those goals and objectives, also the trainee will have a new set of mandatory rotations such as Pediatric Endocrinology, Reproductive Medicine, Thyroid Biopsy, Research, Bone Density Readings and other elective rotations discussed below.

A. Curriculum, rotation and trainee responsibilities:

  1. Along with other Endocrine & Metabolism team members, attends weekly endocrine/metabolism clinics at the Tampa VA Medical Center (including the weekly Endocrine Clinic where 30 to 40 patients are seen each week and the Tampa General Hospital (one clinic/week in which 15-20 general endocrine and diabetic patients are seen).We expect the trainee to be available for the education and supervision of medical students and internal medicine residents who rotate through the Endocrine Division (on elective) and the endocrine Fellows.
  2. The second year of training also includes four mandatory rotations in pediatric endocrinology, obstetric/gynecologic/reproductive endocrinology, thyroid FNA and direct involvement in research activities:

General Pediatric Endocrinology (mandatory): The main goal of this rotation is to advance general knowledge in the principles and practice of pediatric endocrinology. During this four-week rotation the Fellow is expected to learn the principles of pediatric endocrinology and the specific endocrine issues affecting this group, to analyze the endocrine abnormalities learned during the training with adults during the first year as a Fellow and identify similarities and differences particular for this critical period of age. The Fellow will also learn and understand the normal endocrine physiology and the endocrine abnormalities that are more specific for this age group such as the normal growth physiology and the evaluation and management of the disorder of growth such as short stature and gigantism. To be familiar with the process of normal sex differentiation and the abnormalities of sexual determination and differentiation, to be familiar with the physiology of puberty and learn the evaluation and management of delayed puberty and precocious puberty, adolescence endocrinology and the factor to consider during transition to adulthood. In coordination with the other second year Fellow the trainee is responsible for contacting the Pediatric Endocrinology Program Director in order to arrange this rotation and the trainee will have direct supervision by the designated Attending. At the end of this rotation the trainee will receive a formal evaluation that will be returned to the Endocrinology Division within seven days of completion.

Obstetric/Gynecologic/Reproductive Endocrinology (mandatory): During this four-week rotation the Fellows are expected to be familiar with the anatomy of the female and male reproductive system. To learn the normal physiology of the male and female reproductive system to recognize common causes of infertility, to learn the evaluation and treatment of the male and female infertility and the approach to this issue as a couple, to understand the indications, contraindications and complications of some techniques such as in vitro fertilization and gamete intrafollicular transfer and to understand psychological, economic, demographic, and medical implications of infertility. In coordination with the other second year Fellow is responsible for contacting the reproductive endocrinologist section chief to arrange when to start this rotation; the trainee will have direct supervision by the designated attending. At the end of this rotation the trainee will receive a formal written evaluation that will be returned to the Endocrinology Division within seven days of completion

Based on the trainee's interest and clinical need, the trainee can assist and participate at the VA, Moffitt or USF Clinical Services for training or exposure in other endocrine and non-endocrine issues such as: high-risk pregnancy, genetic inborn errors of metabolism, disorder of the appetite including bulimia or anorexia, obesity, pain management, end of life care, bone density reading and interpretation. If there is interest in receiving training in those areas the trainee should contact the Endocrinology Program Coordinator for additional information.

Thyroid FNA: This rotation is 4 hours/week in the ultrasound Department at the VA. The main goal of this rotation is to learn the techniques used to perform thyroid FNA and at the end of this rotation the trainee will demonstrate competency in this procedure. Another objective is that the trainee have a comprehensive understanding of the indications, contraindications, limitations, and complications of the thyroid FNA, to learn the proper technique used to perform thyroid FNA, to be familiar with the anatomy of the thyroid, blood vessel, nerve and other important structures in the neck, should be able to perform thyroid FNA using thyroid U/S. Faculty supervision will occur during every procedure until proficiency has been acquired. In coordination with the other second year Fellow the trainee is responsible for contacting the attending radiologist to arrange when to start this rotation and you will have direct supervision by him/her. At the end of this rotation and after proficiency has been documented the trainee will receive a written formal evaluation. The endocrine Fellow must provide a logbook documenting at least ten FNA’s initiated and completed by the trainee and with the initial or signed by the supervising attending.

Research: The main goal of this rotation is to advance ones knowledge of the basic principles of research including how research is conducted, evaluated, explained to the patient and applied to patient care and the responsible use of Informed Consent. The trainee will spend at least six months participating in research; he/she will have appropriate protected time for research while maintaining essential clinical experience. The trainee will participate in one (required) or more (elective) research projects involving either clinical studies or basic bench-type laboratory work or both. USF Endocrinology is involved in ground breaking research in Insulin Resistance and Cardiac Hormones and it is recommended that the trainee be involved in one of them. If the trainee elects, he or she can be involved in clinical research in which the trainee will have an Attending who will mentor he/she during this period. It is expected that before graduation the trainee will submit at least one paper for publication, present at least one poster in a scientific or research meeting and a completed research project.

Bone Density Reading and Interpretation: This is a new mandatory rotation that effective July 1, 2009; this rotation is two hours/month until six visits are completed. The main objective of this rotation is for the trainee to be able to demonstrate a comprehensive understanding of the indications and interpretation of bone mineral density. The second year fellow is responsible for contacting the attending rheumatologist to arrange this rotation.

Other elective rotations: based in the trainee's interest and clinical need, the trainee can assist and participate at the VA, Moffitt or USF Clinical Services for training or exposure in other endocrine and non-endocrine issues such as:

High-risk pregnancy, genetic inborn errors of metabolism, disorder of the appetite including bulimia or anorexia, obesity, pain management, and end of life care. These are elective rotations. If there is interest in receiving training in those areas the trainee should contact the Endocrinology Program Coordinator for additional information.

As a second year Fellow the trainee responsibility will progress, , it is expected that during the first six months, the senior fellow provide a more direct interaction, teaching and supervision of the first year fellow, during the last 6 months it is expected that the senior fellow be more involved in the care and supervision of more complex patients. Under the guidance of the Program Director the trainee is responsible for organizing the Tuesday Noon Endocrine Conference lecture series. With the supervision of the VA Chief of Endocrinology, will help assist the first year Fellow in answering VA outpatient consults as needed or when one of the first year Fellows is on leave. The second year Fellows will be involved in direct patient education, specifically in the monthly diabetes basic class, and will be responsible for participating and teaching at least twice a year in these classes. The second year Fellow, in close coordination with the Program Director, the VA Endocrinology Section secretary, and the USF Endocrinology Division secretary, will be responsible for organizing and participating in the interview process of candidate Fellows applying for a position in the Endocrinology Program.

C. Educational Support Activities:

  1. Endocrinology Society/ADA and AACE Meeting
  2. Endocrinology Noon Conferences
  3. Endocrinology Board Review

D. Grand Rounds:

  1. USF Grand Rounds
  2. Research Conference - H. Lee Moffitt (MOF 3039)
  3. Attending Rounds

E. Continuity Clinics:

  1. JAH VA Hospital, weekly Endocrine Clinics
  2. JAH VA Hospital, weekly Diabetes Clinics
  3. TGH, weekly Endocrine Clinics
  4. USF Medical Clinics

F. Rotations:

  1. Pediatric Endocrinology Rotation (Dr. Shulman, All Children's Hospital)
  2. Reproduction Endocrinology Rotation (Dr. Plosker, USF)
  3. Ultrasound-guided thyroid FNA (mandatory, with Dr. Parise at Tampa VA)
  4. Thyroid FNA (elective, with Dr Tourtelot at Moffitt)
  5. Bone Density Reading (Dr. Valeriano and or Dr. Bateman at Tampa VA)