Education

Endocrinology Fellowship Welcome

The training program in Endocrinology Diabetes and Metabolism at Albany Medical College is designed to provide advanced training and experience at a level for the trainee to acquire the knowledge, skills, attitudes and experience required for all of the competencies needed by a consultant in this field.

The program is designed to fulfill the needs of those trainees who anticipate their future activities to be solely the clinical practice of this specialty, those who expect to function as clinician-educators, and those who intend to pursue careers in clinical and/or basic endocrine research.  The program recognizes that some trainees may evolve into specialists whose activities encompass more than one of the above career paths.  The teaching environment and educational experiences for trainees will equip them to become strong clinicians, educators, and investigators.

Goals

1. To learn basic and advanced endocrine biochemistry and pathophysiology, which provide the basis for understanding endocrine disease.
2. To acquire the technical and practical skills that are required to be a consultant in endocrinology
3. To accumulate a critical mass of fundamental information and practical approaches for the diagnosis and management of endocrine disorders
4. To acquire clinical skills in a progressive fashion and with increasing responsibility appropriate for a consultant in endocrinology, diabetes, and metabolism.
5. To acquire knowledge and skills necessary for providing cost-effective, ethical and humanistic care of patients with diabetes and disorders of endocrinology and metabolism.
6. To acquire knowledge and skills necessary for critical analysis of the endocrine literature.
7. To acquire skills in design and performance of hypothesis-driven endocrine research, and to participate in such research or equivalent scholarly activity.  This may include gaining experience in grant writing and scientific presentation.

Objectives
The program will provide training in:

1. Endocrine biochemistry, physiology, and pathophysiology
2. Hormone action and inter-relationships
3. Diagnosis and management of endocrine diseases including
   1. History and physical examination with emphasis on examination of the fundi, thyroid, breasts, penis, testes, and female reproductive system
   2. Selection and interpretation of endocrine biochemical tests
   3. Selection and interpretation of imaging procedures such as sonography, radionuclide scans, computerized axial tomography, magnetic resonance imaging, and positron emission tomography
   4. Fine needle aspiration of the thyroid and interpretation of cytology and pathology
   5. Understanding pharmacotherapy for endocrine disorders and appropriate use of surgery, radiation therapy, treatment with radioisotopes, etc.
4. Procedural and technical skills required by the endocrine subspecialist
5. Professionalism, including peer interactions, communication with patients, their families, and other health care providers; confidentiality and avoidance of conflict of interest
6. Endocrine clinical and basic research
7. Understanding of existing and emerging endocrine literature

Personal scholarship and self-instruction
First year of fellowship:

The first year of training focuses on obtaining a large amount of clinical experience in basic endocrinology.  Most of this occurs in the outpatient setting, consistent with the mix seen by practicing endocrinologists.  The fellow will have patients scheduled (generally in the morning) in the endocrine outpatient clinic on all weekdays except Wednesday (when the patient attends continuity clinic in the morning at the VA medical center).  There is a combination of new patients and follow up visits.  This is a continuity clinic, meaning the trainee will follow individual patients throughout the course of the training period.  All patients are seen and evaluated by the fellow prior to presentation to a faculty member.  The fellow will be responsible for all medical record keeping for these patients (including dictation), laboratory follow up, and subsequent patient contact.

On weekdays, the fellow will be responsible for the hospital endocrine consult service.  New patients are evaluated by the fellow (as well as residents and students who may be rotating with the division) prior to presentation to the service attending later in the day.  This consultation service includes only patients with non-diabetes endocrine problems, and averages about one consult per day.

For approximately 8 weeks per year, the fellow will participate in the endocrine hospitalist diabetes service.  This service, staffed by Dr. Desemone (and covering faculty) and mid level care providers, is responsible for all diabetes consults in the hospital.  During these weeks, the fellow will participate in the evaluation and care of hospitalized patients under the supervision of the attending physician.  There will be no outpatient clinic for the fellow during these weeks.

On call responsibilities consist of one weekend per month and one weeknight each week.  Weekend call requires managing the diabetes and endocrine consult service under the direct supervision of a faculty member.  Weeknight call involves covering phone calls to the endocrine division and managing emergency consults (all under the supervision of a faculty member)

Second year of fellowship:

This year is structured to provide research experience and continued clinical exposure in general and subspecialty endocrinology.  Clinical duties include the fellow’s continuity clinics (AMC and the VA) and the weekly Lipid Clinic.  The second year fellow also attends additional clinical rotations outside the endocrine division (e.g., pediatric endocrinology, reproductive endocrinology, endocrine surgery).  Approximately 50% of time in the second year is devoted to research.  On call responsibilities are the same as during the first year

• Clinical Rotations:
  • Over the course of the year, the following clinical rotations are attended: reproductive endocrinology, neurosurgery, endocrine surgery, ophthalmology, pediatric endocrinology, nuclear medicine, and clinical chemistry.  Additional rotations can be arranged.  The scheduling of these rotations is flexible, as patient availability can be a factor.
• Research:
  • Research projects are individualized.  During the first year, the fellow is exposed to the research being conducted at the medical center.  The fellow is encouraged to seek out a mentor and, with guidance, develop a project.  The fellow should discuss this in the late winter of the first year with the program director so that ample time is available to make preparations.
  • The research project is expected to occupy 50% of the fellow’s time during the year.  Specific goals and responsibilities are set by the mentor and the program director and discussed with the trainee. 
  • The projects can be basic science, clinical, literature based research, or a combination of the above.  It is required that the fellow’s experience include some time in a basic science laboratory.