Curriculum

Currently there is one fellow in each of the two years of the endocrinology fellowship.

The Outpatient General Endocrinology Clinics

All outpatient clinics are in the morning except for the Diabetic Foot Wound Clinic. General Endocrinology Clinics are scheduled every Monday, Tuesday, and Wednesday morning, with the Insulin Pump and Continuous Glucose Monitor Clinic every Thursday morning.

The general endocrinology clinics are precepted by the key faculty of the division. New patients are scheduled for a one-hour visit and follow up patients for a 30-minute visit to allow adequate time for teaching and mentoring by the clinic attending.

MetroHealth Medical Center is a tertiary care referral center and fellows in the general endocrinology clinics see patients with a wide variety of endocrine problems. The fellows mange patients with type 1 and type 2 diabetes mellitus, hypoglycemia, hyperthyroidism, hypothyroidism, goiters, thyroid nodules, thyroid cancer, adrenal insufficiency, adrenal incidentalomas, congenital adrenal hyperplasia, autoimmune polyglandular syndromes, hyperparathyroidism, hypoparathyroidism, metabolic bone disease, hypopituitarism, gender incongruence, male hypogonadism, gynecomastia, and pituitary tumors including pituitary incidentalomas.

Though not common, we do see patients with rarer endocrine diseases including Cushing’s syndrome, acromegaly, pheochromocytomas, MEN-1, MEN-2, and insulinomas.

Endocrinology-Related Services Available at MetroHealth

MetroHealth Medical Center offers trans-sphenoidal pituitary surgery, all endocrine surgery including thyroid cancer and parathyroid surgery, and radionuclide therapy for hyperthyroidism and thyroid cancer. The Radiology Department offers MRI and PET scanning, nuclear medicine imaging, selective adrenal vein sampling, and selective pancreatic artery calcium infusion for the diagnosis of insulinomas.

Subspecialty Clinic Rotations

The Thursday morning clinic at the main campus is run by Dr. Calles and is solely devoted to the management of patients with insulin pumps and continuous glucose monitors. 7-day Professional Continuous Glucose Monitoring is also offered as a service for type 1 and type 2 diabetics referred by members of the division or primary care providers.

During certain months of the year fellows spend one morning per week rotating through more specialized clinics. The first-year fellow spends four half-days with the Diabetes Self-Management Education program, during which education in Medical Nutrition Therapy for diabetes is provided and the fellow observes and participates in our diabetes education program. The program consists of four two-hour education sessions.

This experience is meant to teach diabetic education topics and techniques to the fellow and to help the fellow understand what patients learn when they are sent to a diabetes education program.

The first-year fellow also spends one half-day per week in September in the Diabetic Foot Wound Clinic learning how to manage diabetic foot ulcers.

During two months of the year the first-year fellow spends one half-day per week in the Pediatric Endocrinology Clinic.

The second-year fellow spends one half day per week during each of two months in the Weight Management Clinic, where the fellow learns nutritional and pharmacologic approaches to weight loss as well as preparation of patients for bariatric surgery and postoperative follow-up.

The second-year fellow also spends one half-day per week during each of two months in the Diabetic OB Clinic learning how to manage diabetes in pregnancy.

Ultrasound-Guided Fine Needle Aspiration Biopsies

By arrangement with the Department of Radiology, our fellows receive training during the second year of fellowship in ultrasound-guided fine needle aspiration biopsy of the thyroid. Fellows are required to perform at least 20 biopsies prior to graduation.

The Inpatient Consultation Service

The fellows spend every other month running the inpatient endocrinology consultation service. This service is managed in the afternoon, usually with the help of one or two internal medicine residents. There are typically 1-2 new consults per day and about 8-10 patients on the census at any one time.

During the consult service month fellows get every other weekend off. The work on-service during the weekends usually ends at noon or 1 PM. Attending rounds are held every day. The fellow pre-rounds with the residents for teaching purposes and then the fellow and residents round with the attending.

The majority of the cases are related to diabetes management but consultations for other reasons are common, especially for hyponatremia, possible adrenal insufficiency, hyperthyroidism, hypothyroidism, possible myxedema coma or thyroid storm, hypoglycemia, hypercalcemia, hypocalcemia, postoperative management after pituitary surgery, and possible pheochromocytoma.

Board Review

The fellows spend 45 – 60 minutes every week reviewing board questions from the Endocrine Society In-Training Examinations or the Endocrinology Self-Assessment Program (ESAP) with the Program Director.

The Weekly Endocrinology Division Academic Meeting

Every Thursday afternoon there is an Academic Meeting attended by all members of the division. These meetings can be devoted to journal club, interesting or difficult cases (plus a review of the progress of the fellows’ quality improvement projects and scholarly activity), discussion of question from the Endocrine Society Self-Assessment Program, presentations from outside speakers, review of interesting thyroid, adrenal, and pituitary images with a radiologist, and formal presentations of reviews of the literature on various topics by the fellows (roughly every other month for each fellow).

The Combined Medicine-Surgery Endocrinology Conference

Four times a year there is a combined Endocrinology Medicine-Surgery Conference, in which trainees from surgery and medical endocrinology meet to discuss interesting cases.  Members of the Department of Medicine and the Department of Surgery alternate in choosing the cases and running the conference.  One of these conferences is typically led by the second-year endocrinology fellow toward the end of the training.

The Didactic Lecture Schedule

There is also a didactic lecture schedule. Once every two weeks the fellows and a faculty member meet to discuss a topic in endocrinology. There is a rolling two-year schedule for these conferences. They may be PowerPoint presentations or discussions revolving around selected articles from the literature. The most recent two-year schedule involved didactic teaching on the following topics:

  • Outpatient Management of Diabetes (2 Sessions)
  • Medical Nutrition Therapy for Diabetes
  • Inpatient Management of Diabetes
  • How to Evaluate a Clinical Research Paper
  • Management of Diabetic Foot Ulcers
  • Hormone-Receptor Interactions – Basic Science
  • Insulin and Glucagon – Basic Science
  • Chronic Macrovascular and Microvascular Complications of Diabetes
  • Planning and Executing a Quality Improvement Project
  • Disorders of Growth
  • Precocious Puberty
  • The Insulin Pump and Continuous Glucose Monitoring
  • Endocrine Procedure: Interpretation and Management of CGM and Insulin Pumps (an Endocrine Society Training Module)
  • Thyroid Goiters and Nodules
  • Management of Thyroid Cancer
  • Thyroid Physiology and Hypothyroidism
  • Thyrotoxicosis
  • Introduction to Thyroid Ultrasound
  • The Euthyroid Sick State
  • Pituitary Physiology
  • Diabetes Insipidus
  • Hyponatremia and Hypernatremia
  • Prolactinomas and Acromegaly
  • Hypopituitarism Including Postoperative Management After Trans-Sphenoidal Surgery
  • Cushing’s Syndrome
  • TSH and Gonadotropin Secreting Pituitary Tumors and Non-Secreting Pituitary Tumors (Including Pituitary Incidentalomas)
  • Adrenal Physiology
  • Adrenal Insufficiency
  • Autoimmune Polyglandular Syndromes
  • Pheochromocytoma
  • Congenital Adrenal Hyperplasia
  • Hirsutism, Virilization, and the Polycystic Ovary Syndrome
  • Hypokalemia and Hyperaldosteronism
  • Hyperkalemia and Hypoaldosteronism
  • Psychiatric Manifestations of Endocrine Disease
  • Energy Metabolism
  • Flushing and “Spells”
  • Interpreting Imaging Phenotypes of Adrenal Disease (An Endocrine Society Training Module)
  • Parathyroid and Vitamin D Physiology
  • Hypercalcemia and Hyperparathyroidism
  • Hypocalcemia and Hypoparathyroidism
  • Basic Laboratory Techniques Including Quality Control, Quality Assurance, and Proficiency
  • Multiple Endocrine Neoplasia Syndromes
  • Diabetes in Pregnancy
  • Metabolic Bone Disease
  • From T to Z: The Basics of DXA Interpretation (An Endocrine Society Meet-the-Professor Lecture)
  • Endocrine Procedures: Interpretation of DXA (An Endocrine Society Training Module)
  • Genetic Screening and Counseling for Endocrine and Metabolic Disorders
  • Hyperlipidemia
  • Male Hypogonadism and Erectile Dysfunction
  • Gynecomastia
  • Treatment of Obesity
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