Endocrinology Fellowship Clinical Training
Inpatient services include both the Vanderbilt University Medical Center (VUMC) and the Nashville Veterans Affairs (VA) Medical Center, which are adjacent to one another. Outpatient services feature the Vanderbilt Eskind Diabetes Clinic, a state-of-the-art facility housing both adult and pediatric endocrinology and diabetes clinics at Vanderbilt. At this full-service clinic, the fellow benefits from a coordinated team approach to diabetes care, as well as multi-disciplinary thyroid and pituitary clinics.
There are also facilities for conducting clinical research. The Nashville Veterans Affairs (VA) Medical Center outpatient clinic offers excellent training opportunities - staffed by members of the Division of Endocrinology-Metabolism and nurse practitioners. It is a key component in the Endocrinology Clinical Training Program.
The first year of training is clinically focused and involves a significant proportion of inpatient and outpatient endocrinology experience. The inpatient experience includes consults at both Vanderbilt University Medical Center (VUMC) and the Nashville Veterans Affairs (VA) Medical Center under the guidance of an experienced teaching faculty. Due to the high volume of consults at VUMC, the Division has 2 Nurse Practitioner -run glucose management services, in which the fellow does not participate. This allows the fellow to have time to learn more deeply about the patients they see without an overwhelming service burden. The outpatient experience is carefully designed to expose each first-year fellow to all the cores subspecialty rotations in endocrinology as well as general endocrinology rotations. Rotations for first years include: thyroid cancer, thyroid biopsy, bone disorders, intensive diabetes, gestational diabetes, lipids, obesity, PCOS, reproductive endocrinology, pituitary and adrenal disorders, pediatric endocrinology and general endocrine clinic. This provides a strong clinical base and exposure to all facets of endocrinology. In the first few months of the first year, fellows select their clinical mentor after rotating through organized clinics with several different clinical mentors on our faculty. The continuity clinic experience involves half a day clinic, which is continued for at least 2, if not all 3 years of the fellowship. In addition to a well-organized clinical curriculum, first year fellows have built in time to initiate research projects and establish a mentor.
The second-year experience is determined by the fellows future plans. A fellow that plans on completing a 2-year clinical fellowship will meet with the program directors toward the end of first year to come up with a tailored clinical schedule for second year. This allows the fellow to focus on areas that they are most interested in, areas they feel they would like to improve, as well as non-core rotations that they find interesting and beneficial to their career. Some examples of non-core rotations that a second year may choose include: neurology, podiatry, endocrine surgery and maternal-fetal medicine. Interested fellows may also use some of their second-year time to pursue a certificate in obesity medicine. A fellow that plans on completing a 3 years clinical and research fellowship will continue continuity clinic as a second year but spend the remaining time in their lab. Second year fellows have significantly less time on the inpatient consult service as compared to the first-year fellows.
Third year of the fellowship is focused on research, but with ongoing exposure to outpatient endocrinology. Inpatient consult time during these years is minimal. Fellows may choose to continue their half day continuity clinic or instead use that time to rotate through subspecialty clinics that are they elect.
Didactics and Conferences
Endocrinology Fellows have very well-organized didactics sessions lasting an hour twice weekly. Lecturers include both Division faculty as well as faculty outside the Division who have expertise on that topic. These encompass the complete breadth of endocrine education.
Once monthly Journal Club and once monthly Case Conference are also geared toward the fellows but with faculty participation. In Journal Club, the first half of the year is dedicated to learning how to read the medical literature accurately, with each session focused on a different type of study design. Basic statistics is reviewed.
Endocrine Grand Rounds is held weekly and includes both adult and pediatric endocrinology. Speakers include both Vanderbilt faculty as well as guest speakers who are internationally known in their field.
Endocrine Tumor Board is a multidisciplinary conference that includes surgery, radiology, pathology, oncology and endocrinology. This is a truly fun and interactive meeting where much is learned from our interdisciplinary discussion.
Pituitary Conference is held weekly with endocrinology and neurosurgery. Fellows learn surgical indications, biochemical evaluations and to read MRIs.
Endocrinology Fellowship Research Training
The Vanderbilt Department of Medicine: Division of Diabetes, Endocrinology, and Metabolism has a long track record of training academic endocrinologists. The fellowship program offers an intense research opportunity for fellows to develop their academic careers and thus the program is 3 years in duration. Fellows participate in research approximately 40% of time in the first year, and 80% of time in the second and third years.
Vanderbilt Medical Center has a rich history of collaborative and multi-disciplinary research. This is reflected in the research programs of the faculty and fellows within the Division and the Diabetes Center as a whole. Although many fellows select projects under the guidance of Division faculty, fellows can choose research mentors from any of the Vanderbilt faculty working in the area of diabetes, hormonal and metabolic disorders, obesity, and endocrinology at Vanderbilt. This is a large and diverse group of potential mentors. For example, there are over 100 faculty members of the Diabetes Research and Training Center. Specific areas of research related to diabetes that have been chosen by recent fellows are:
- hormone action in animals and humans as it relates to diabetes and obesity
- intermediary metabolism
- pancreatic islet biology
- micronutrient effects on metabolic disease
- metabolic regulation
- molecular genetics of metabolic disease
- causes and treatments of obesity
- translation of diabetes care delivery
- type-1 diabetes mechanisms and prevention.
After choosing a research mentor, the fellow works in his/her mentor’s research area. The Vanderbilt laboratory and clinical research facilities are extremely strong. Ones that are especially relevant for fellows in this program are the research laboratories of the Division of Diabetes, Endocrinology, & Metabolism, which occupy approximately 1 the 7th and 8th floors of Medical Research Building IV. This space includes the individual research laboratories, a fully equipped conference room, tissue culture facilities, animal preparation rooms, and shared facilities such as central offices, a break room, instrument rooms and cold rooms. There is additional research space at the VA ACRE building, adjacent to Vanderbilt. Vanderbilt and the Vanderbilt Diabetes Center offer a variety of core facilities (histology, microscopy, molecular biology, mouse metabolic phenotyping, mouse neurobehavior, islet analysis and preparation, mass spectroscopy, and hormone assay) that are very useful for individual research projects. Key to training in clinical research is the Vanderbilt Institute for Clinical and Translational Research, funded by the NIH through a Clinical and Translational Service Award. This facility includes inpatient beds, an outpatient center, as well as a metabolic balance core. It also provides funding and support for individual research projects by the trainees of this program.