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Division of Endocrinology

Fellowship Overview

The goal of the Endocrinology fellowship training program is to provide strong training in clinical endocrinology and research investigation.

There are two institutions participating in our training program: MUSC Medical University Hospital (MUH) and the Ralph H. Johnson VA Medical Center (VAMC). Our training program is fully integrated at both hospitals. We provide consulting services on the inpatient units at both MUH and the VAMC. CDEs supported by MUH are assigned to our Division and are integral members of our MUH consultation service.  The division also employs APPs who support the MUH outpatient and consultation service. At the VAMC one NP-CDE and one PharmD-CDE are assigned to support the VAMC outpatient and consultation service. MUSC also houses a General Clinical Research Center whose facilities are available to Endocrinology faculty and residents.  GCRCs are specialized patient units that provide medical scientists with critical resources for clinical research aimed at improving understanding of human diseases and enhancing therapeutic interventions.

Medical University Hospital: The MUH is the primary teaching hospital for our fellowship program. The 750-bed Medical Center currently has four major hospital facilities-MUH, MUSC Children's Hospital, Storm Eye Institute, and the Institute of Psychiatry and a range of centers for specialized care, such as the Heart and Vascular Center, Digestive Disease Center, Hollings Cancer Center, Transplant Center, Center for Alcohol and Drug Programs, and a Level I Trauma Center.

The Ralph H. Johnson VAMC: The Ralph H. Johnson VAMC is located in Charleston adjacent to the MUSC campus. The VAMC is a primary, secondary, and tertiary referral medical center, providing acute medical, surgical, and psychiatry inpatient care as well as primary care and specialized outpatient services. Currently, there are 144 acute care beds and 28 nursing home care unit beds. The Charleston VAMC is closely affiliated with MUSC.

In joint partnership, MUSC and the VA in 1996 opened the Strom Thurmond Research Building, which contains wet bench laboratories totaling more than 46,000 sq. ft. which includes the Nancy Thurmond Memorial Diabetes Research Laboratories. The Research Service is well integrated with the clinical services at the VAMC and coordinates research activities closely with MUSC. Major areas of research excellence include hypertension, diabetes mellitus, heart failure, stem cell biology, cholesterol, cancer biology, renal diseases, signal transduction, and mental health and addictive disorders.  A growing area of study is in the area of health services research, with foci on racial disparities in health care and post-traumatic stress disorder.

The Division of Endocrinology, Diabetes, and Metabolism has a large and active research component, encompassing NIH or VA-funded grants, and several other private foundation grants. The high priority placed on research and academic productivity within our division is reflected by the fact that our division is among the highest in research support among all divisions within the department.

Subspecialty residents participate in several areas to enhance their skills.

On the consultation services (average 6 months/year during 2 years of fellowship) our subspecialty residents learn inpatient management of diabetes mellitus and a host of complex endocrinopathies. At MUH and VA, all patients with endocrine problems are admitted to the General Internal Medicine/Hospitalist Service and receive endocrine consultation as appropriate. In addition, endocrine residents participate in the Inpatient Diabetes Management Service (DMS). The DMS provides concurrent care for the management of adult inpatient hyperglycemia as part of a team approach to optimized patient care. DMS also provides consultative diabetes care to all adult inpatient services on request. DMS is available 24/7/365 with Endocrinology Attending and Fellow on-call coverage.

General endocrine/diabetes continuity care clinics (average 3 months/year during 2 years of fellowship):

- Fellows Continuity Clinic: weekly clinics serve VAMC patients and a broadly mixed uninsured/indigent and private referral population of MUH patients.

- Thyroid Clinic: this clinic provides an excellent array of thyroid pathology, concentrated in a single setting where both continuity and consistency of care are achieved. The focus of this clinic facilitates close working relationships with Pathology (FNA), Radiology (nuclear medicine and ultrasound) and Endocrine Surgery.

- Thyroid Ultrasound / Procedures Clinic: where residents learn to perform and interpret diagnostic thyroid ultrasound under the supervision of Dr. Soonho Kwon. Participation in this clinic ensures that our subspecialty residents will greatly exceed the number of thyroid ultrasound and FNA procedures needed for board eligibility and ultrasound certification.

- Lipid Disorders Clinic: residents work one-on-one with Dr. Nicoleta Sora. The most challenging lipid disorders are seen in this clinic and their evaluation is supported by an LRC-accredited laboratory directed by Dr. Nicoleta Sora.

- Endocrine Tumor Clinic with Dr. Jyotika Fernandes brings together Endocrinology, Neurosurgery, OHNS, and Endocrine Surgery in a multidisciplinary clinic setting. The focus of this clinic is evaluation and management of patients with pituitary tumors, hypopituitarism, acromegaly, Cushing's disease and other hypothalmic-pituitary disorders, thyroid neoplasia, parathyroid disease, and tumors of the adrenal cortex and medulla.

- Intensive Diabetes Education, Awareness, and Lifestyle (IDEAL) Program, where residents participate in the multidisciplinary clinic that provides the experience of intensively managing both Type I and Type II diabetic patients, in collaboration with a team of experienced MSN-CDE nurse educators, dietitians and counselors. Insulin pump therapy and other intensive insulin therapy regimens are initiated and managed in this clinic, together with state-of-the-art surveillance programs for diabetic complications and risk factors.

- Obesity Clinics: residents participate in evaluation and management of obese patient alongside Internal Medicine physician, psychiatrist, dietitian and psychotherapist.

- Private attending clinics where residents see a vast array of endocrine pathology.

Our residents are assigned to an Elective rotation for average of 3 months of each year. While continuing to attend continuity endocrine clinics and educational conferences, they can devote 50-75% of their effort to a research project during these months. Guidance is provided by the Program Director. Candidates interested in a research or academic career are encouraged to seek more in-depth, laboratory-based projects, with a goal of defining an area and project which will provide a platform for developing a solid research background and the skills to ultimately direct an independent research program. These candidates are strongly encouraged to devote a third year to research training.

Also, residents can work in the following clinics during their elective rotation:

- Pediatric Endocrinology Clincs: They provide care for pediatric endocrinopathy patients referred from the entire coastal Carolina area. In this clinic they gain experience in the evaluation and management of pediatric and adolescent endocrine problems including diabetes mellitus, delayed or precocious puberty, short stature, growth hormone deficiency, hypopituitarism, Turner's syndrome, thyroid disorders and Cushing's disease.

- Gyn-Reproductive Endocrinology. In this community clinic, they gain experience with the diagnosis and management of infertility, a range of ovarian dysfunctions (PCO, hirsutism, annovulatory cycles), as well as evaluation and management of unusual entities such as congenital adrenal hyperplasia, ovarian dysgeneisis, and sex hormone-producing neoplasms.

- Graves Eye Disease Clinic

Nuclear Medicine Rotation (2 weeks per year)

Our residents work under the supervision of Dr. Leonie Gordon of the Department of Radiology. In this clinic they learn the appropriate application and interpretation of nuclear medicine studies in the diagnosis of endocrine disorders. This includes diagnostic and therapeutic use of radioactive iodine in the management of hyperthyroidism and thyroid cancer, parathyroid and adrenal scintigraphy, and the application of combined imaging modalities, such as PET-CT scanning to the diagnosis of endocrine neoplasia.

Educational Conferences

In addition to our subspecialty residents general rotations, they attend conferences on a regular basis to further enhance their skills and knowledge. These conferences are held weekly.

Introduction to Clinical Endocrinology

The Introduction to Clinical Endocrinology series is held weekly during July and August, taking the place of Endocrine Grand Rounds for the first 8-10 sessions. The lecture content is specifically intended for endocrine subspecialty residents, although pediatric endocrinology and internal medicine residents, medical students, and clinical faculty are encouraged to attend. Didactic lectures covering basic aspects of the clinical management of endocrine diseases are presented by clinical faculty of the Division of Endocrinology to provide new subspecialty residents with the basic information they need to transition smoothly from medicine residency to endocrinology fellow.

Concepts in Molecular Endocrinology

The Concepts in Molecular Endocrinology series is held weekly during September and October, taking the place of Research Conference and Journal Club for the first 6 sessions. The series is intended for endocrine subspecialty residents and postdoctoral basic research fellows, although pediatric endocrinology and internal medicine residents, medical students, and basic science and clinical faculty are encouraged to attend. The purpose of the series is to introduce residents to concepts in basic research in molecular endocrinology, do develop a familiarity with the language of basic science and enhance the educational benefit of Research Conference and Journal Club. Didactic lectures are presented by research faculty of the Division of Endocrinology.

Endocrine Grand Rounds

This conference is held weekly throughout the academic year and is attended by all Endocrine subspecialty residents, and clinical teaching faculty, including pediatric, reproductive endocrinology, and endocrine surgery. Faculty and trainees from other collaborating services; e.g. Pathology, Nuclear Medicine, Neurosurgery, Ophthalmology also routinely attend to participate and present data; pathological material, isotopic scans, etc. It is a CME-accredited conference. Cases for this conference are selected to be particularly illustrative, unusual in presentation or response to treatment, or demonstrate a diagnostic challenge. Therefore, all Endocrine Residents have the opportunity to learn from unique cases evaluated by others. Several times each year Endocrine Grand Rounds is presented by a visiting faculty member from another institution who presents recent clinical research relevant to clinical endocrinology.

Journal Club

This literature review conference is held weekly, alternating with Research Conference. The entire teaching faculty attends. Emphasis is not on reviewing a large volume of literature, but rather on learning critical analysis of literature, focusing on selected key articles from subspecialty and general medical journals.

Research Conference

Research Conference is held weekly, alternating with Journal Club. Faculty, senior endocrine residents, or guest faculty from other departments or institutions are invited in advance to present their research in an hour-long seminar format. It is a CME accredited conference. The conference helps to provide cross fertilization and generates collaborative efforts between investigators. A nationally known investigator from outside the university is often the speaker at this conference, and when the presenter is a clinician endocrinologist, they often participate in Endocrine Grand Rounds as well.

Medicine Grand Rounds

Medicine Grand Rounds is held weekly throughout the academic year. All faculty and residents in the Department of Medicine as well as medical students are expected to attend. It is a CME-accredited conference. The purpose of Medicine Grand Rounds is to provide exposure to a broad array of topics including historical aspects of internal medicine, evidence based clinical practice, and important advances in medical practice or research.

Any questions should be directed to the Fellowship Coordinator at 843-792-4747. All correspondence should be directed to the Fellowship Director:

Dr. Nicoleta Sora
96 Jonathan Lucas Street
Suite 822, POB 250624
Charleston, SC 29425

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