Endocrine fellows see patients in both the outpatient Endocrine Clinic and on the inpatient hospital consult service. This allows the fellows to assume responsibility for and follow patients to observe the evolution and natural history of various endocrine disorders as well as the effectiveness of therapeutic interventions.
Endocrine fellows attend a variety of conferences on a regular basis throughout their two-year fellowship training program. There is opportunity to teach the Lahey Hospital & Medical Center internal medicine residents and third- and fourth-year medical students from Tufts University School of Medicine.
Fellows see patients at this clinic to develop a basic understanding of the presentation, evaluation and management of a wide variety of disorders encountered in a general endocrine practice. The learning experience evolves from review of history, physical examination and laboratory results with the precepting faculty member, taking direction from the faculty and being provided with references or other learning materials that can be used for self-instruction and subsequent review with the faculty.
Fellows develop a comprehensive understanding of how to evaluate and manage reproductive endocrine disorders including primary and secondary male and female hypogonadism, gynecomastia, erectile dysfunction, polycystic ovary syndrome and fertility disorders. They learn how to evaluate and manage female sexual dysfunction and female androgen deficiency, how to understand the effects of age on the reproductive axis in men and women, and how to counsel postmenopausal women regarding hormone replacement therapy.
The goal of this rotation is for fellows to become competent in the management of obesity, both through dietary means and through the use of various medications used to promote weight loss. In addition, fellows learn about the indications for bariatric surgery and how to prepare such patients for surgery as well as manage them postoperatively, especially as it pertains to management of diabetes in this setting.
Fellows develop an understanding of a wide variety of pediatric endocrine disorders, but special emphasis is placed on those disorders that an adult endocrinologist needs to gain a working knowledge of. These include diabetes mellitus, growth retardation and delayed puberty, precocious puberty and thyroid disorders.
To learn about a variety of diseases of endocrinology and metabolism as they occur in hospitalized patients, fellows see patients on the Inpatient Hospital Consult Service daily for one week, every other week, throughout the two-year endocrine fellowship. Fellows also learn, under supervision, how to interact not only with the patient and family, but also with other physicians caring for the patient.
Fellows are expected to conduct their own clinical research and are encouraged to present the results at regional and national specialty meetings. They work with a mentor on research methodology, IRB submission, and data analysis and interpretation, to ultimately write a manuscript to be submitted for publication in a peer-reviewed journal.
Procedures that fellows must learn to perform include fine needle aspiration biopsy of thyroid nodules, thyroid ultrasounds, interpretation of continuous glucose monitoring system (CGMS) and insulin pump downloads, interpretation of bone densitometry studies, and tests such as insulin hypoglycemia, clonidine suppression, water deprivation, saline infusion, and Dex/CRH.
Fellows are required to develop a Quality Improvement project to identify a potential area of performance improvement based upon their observations and experiences on either the hospital inpatient service or the ambulatory clinics, and to draft a plan to address this. Fellows are expected to eventually present their findings at a hospital-wide symposium.
Fellows are responsible for presenting at weekly conferences to discuss diseases of endocrinology and metabolism in greater depth. Conferences include the Endocrine Clinical, Endocrine Journal Club, Pituitary Tumor, Thyroid/Parathyroid, Endocrine Morbidity and Mortality, Endocrine Research, Endocrine Core Curriculum, Cytology/Pathology, Medical Ground Rounds, Medical Ethics, the Lahey Hospital & Medical Center Resident/Fellow Core Competency Lecture Series, and the Internal Medicine Residency Noon-Time Conference.