Sites of Clinical Training:
The hospitals and clinics of the UPMC and VA Pittsburgh health systems (VAPHS) provide the venues for comprehensive clinical training. The flagship hospital, UPMC Presbyterian is a tertiary referral center for western Pennsylvania, West Virginia, eastern Ohio, and the entire UPMC health system. The VAPHS, also recently modernized, provides rich inpatient and outpatient clinical exposure.
Fellows rotate through a broad range of clinical rotations. This includes the inpatient endocrinology consultation service at the four UPMC hospitals in Oakland, UPMC Shadyside Hospital, and the VA Pittsburgh Healthcare System. At UPMC Presbyterian, there are two separate in-patient consultative teams comprising of fellows, residents and medical students staffed by the endocrine faculty. A nurse practitioner manages the majority of inpatients with diabetes. The neuroendocrine service staffed by neuroendocrinologists manages the perioperative pituitary surgery patients.
Examples of diseases diagnosed and managed during inpatient rotations include but are not limited to diabetes mellitus, abnormal thyroid function tests, hyperthyroidism, adrenal insufficiency, hypercalcemia, diabetes insipidus, and SIADH. Fellows evaluate all new consults and provide recommendations for the primary care team, follow-up relevant disease management on existing consult patients, oversee and manage teams consisting of residents and students, and participate in educational efforts for the team.
Each trainee participates in weekly continuity clinics at the VA, Center for Diabetes and Endocrinology (CDE), and UPMC Shadyside Hospital throughout their fellowship training. The trainees build their own patient population for which they are responsible under faculty supervision for all aspects of endocrine care. In addition, trainees rotate through a wide variety of clinics including the Center for Diabetes and Endocrinology, the Multidisciplinary Thyroid Clinic, the Pituitary Clinic, the Diabetes Clinic, the Osteoporosis Clinic, the Pediatric clinics at the UPMC Children’s Hospital of Pittsburgh, the Reproductive Health Services in Monroeville, and the Multidisciplinary Diabetes Management and Pump Clinics at the VA Pittsburgh.
Even before the COVID-19 crisis, our clinic had been incorporating telemedicine in our daily practice because of the long distances some of our patients had to drive to see us. After the social distancing measures were enforced during the COVID-19 crisis, we very quickly transitioned to a virtual model, scheduling office visits only when necessary. Thanks to our EMR and staff support, we believe that our trainees’ educational experience was not compromised. In fact, they are learning new telemedicine skills, which will surely be helpful in the future.
Our program provides hands-on training for the following procedures, and all fellows are expected to be proficient in these procedures by the end of the fellowship.
- Fine Needle Aspiration Biopsies of the Thyroid
- DXA Bone Scans
- Insulin Pump and CGM System Training
- Thyroid Ultrasound
- Adrenal Conference – A multidisciplinary group comprising of endocrinologists and endocrine surgeons reviews patients with adrenal disorders. The endocrinology and endocrine surgery fellows present cases.
- Bone Club – This is a monthly multidisciplinary conference including members of the Divisions of Endocrinology, Pediatric Endocrinology, Orthopedics, the Graduate School of Public Health, and the Department of Pharmacology. The conference is run by the Endocrinology Division and rotates between clinical case discussions involving difficult and interesting management and diagnosis issues, ongoing research program reviews, outside speakers, and fellow journal clubs.
- Diabetes Journal Club – This journal club is held monthly in which current literature in the field of diabetes is critically reviewed. A broad range of topics relating to diabetes is covered; basic science literature and clinical trials are used as articles for discussion. Typically two articles per month are reviewed.
- Fellows Board Review Sessions – The purpose of this weekly activity attended by all fellows is to review topics for the Endocrinology boards. Literature reviews are undertaken by one of the fellows and discussed with other fellows and an attending. The emphasis is on practical issues for diagnosis and management and is moderated by the Program Director.
- Multidisciplinary Thyroid Cancer Conference – This conference is held monthly where faculty members and trainees from Radiology (Nuclear Medicine, Ultrasound, Nuclear Safety), Endocrine Surgery, ENT, Pathology, and Endocrinology get together. Each month a topic is chosen within the field of thyroid cancer and the presenter leads the discussion based on thorough literature review. The didactic session is followed by the advanced thyroid cancer conference during which challenging cases are discussed and multidisciplinary plans of care are formulated.
- Patient Care Conference – Selected inpatient and outpatient cases are presented weekly at a Patient Care Conference which is attended by all clinical faculty of the division, all fellows and residents and medical students rotating through the inpatient service. This conference is run by the fellows, and allows a review of clinical findings, presentation, discussion and interpretation of laboratory results, radiologic procedures, pathology slides, surgical results and treatment plans. It often leads to a lively discourse and input from other faculty members to supplement that provided by their attending of the month, thus greatly expanding the teaching input for every case.
- Pituitary Conference – A multidisciplinary group comprising of neuroendocrinologists, neuroradiologists, neurosurgeons, neuro-ophthalmologists and neuropathologists reviews patients with hypothalamic or pituitary disorders. The endocrinology fellow presents the cases followed by detailed discussion between trainees and the faculty.
- Research in Progress – Once a month, fellows within the Division present their ongoing research projects in this conference. The conference is attended by members of the division, who constructively criticize and evaluate the research programs of other members.
- Summer Lecture Series – This series occurs weekly for a total of eight weeks during the summer. Relevant principles of basic science, endocrine physiology and biochemistry and the fundamentals of endocrine disorders are reviewed.
- Thyroid Cytology Conference – This conference is hosted monthly by the Pathology department. Interesting or difficult thyroid cytology cases are presented and reviewed with the pathologists and endocrine surgeons. UPMC is a leader in incorporating molecular testing in evaluation of indeterminate cytology specimens. This conference bridges the gap between molecular pathologists and clinical thyroidologists.
- University-Wide Endocrine Conference (Endocrinology Grand Rounds) – This is the weekly one-hour flagship conference of the Division of Endocrinology presented by faculty from the University of Pittsburgh School of Medicine and by nationally recognized guest speakers. Our faculty and trainees, in addition to faculty and trainees from pediatric endocrinology at Children’s Hospital, attend the conference.