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Indiana University School of Medicine
Indiana University School of Medicine
Pediatrics
Pediatric endocrinology fellow discusses patients on rounds with medical students.

Curriculum

Fellows in the Division of Pediatric Endocrinology and Diabetology spend 12 months in clinical training and 24 months conducting either basic laboratory and/or clinical research. Eight months of the first year and two months in each of the subsequent two years are devoted to clinical training. There is a standard curriculum of pediatric endocrinology topics during weekly division conferences.

Combined medicine-pediatrics fellows spend a total of 12 months on clinical pediatric endocrinology, another 12 months on clinical internal medicine endocrinology, and 24 months conducting clinical or basic research. The overlap in research training between the fellowships allows combined fellows to become board-eligible for both the American Board of Pediatrics and American Board of Internal Medicine in four years.

The inpatient pediatric endocrine team includes:

  • Faculty attending
  • Pediatric endocrinology fellow
  • Two pediatric residents
  • One or two medical students
  • Diabetes educator
  • Social workers

The inpatient team provides consultative support to clinical services caring for endocrine patients at Riley Hospital for Children. Typical cases include types 1 and 2 diabetes, disorders of salt and water balance, hypocalcemia, thyroid abnormalities, disorders of sex development and others. In selected cases, children with newly diagnosed diabetes may receive outpatient education or may require an inpatient stay. The inpatient team typically covers 8-20 consult patients. Fellows spend seven months during the first year, two months during the second year and one month during the third year covering the inpatient team.

Each week there are more than 30 half-day endocrine and diabetes clinics, seeing 300 patients weekly. Fellows spend one month in the first year and one month in the third year in these clinics working with members of the faculty at the Riley Outpatient Center in Indianapolis. Faculty members also see patients at satellite clinics in Indianapolis, Bloomington, South Bend, Evansville and Fort Wayne.

There is a variety of subspecialty clinics and programs focusing on conditions requiring special expertise provided by dedicated faculty members. Over the course of their three years, fellows gain experience in these areas that provides extra depth to their training.

  • The Cancer Survivor Clinic is designed to care for children with endocrine diseases related to cancer treatment. This includes patients with pituitary dysfunction related to treatment of brain tumors, thyroid dysfunction in association with head and neck radiation and chemotherapy, and patients with pubertal disorders and gonadal insufficiency resulting from chemotherapy and radiation effects.

  • The Youth Diabetes Prevention Clinic delivers targeted interventions to at-risk adolescents with obesity and pre-diabetes. The clinic evaluates and assesses the needs of adolescents with evidence of prediabetes or obesity in combination with multiple risk factors for the development of diabetes, such as family history of diabetes, gestational diabetes in the mother, acanthosis nigricans, irregular menstrual periods or polycystic ovary syndrome and hypertension. Patients receive care from physicians, nurse practitioners, dietitians and health coaches.

  • The Riley Type 2 Diabetes Clinics treat youth with type 2 diabetes and complications related to diabetes. The diabetes team, consisting of physicians, nurse practitioners, dietitians and social workers, provides comprehensive diabetes education and ongoing medical care in a setting appropriate for youth and their families.

  • The Riley Pediatric Metabolic Bone Disease Clinic is run by Linda DiMeglio, MPH, MD, and Erik Imel, MD, both of whom are members of the American Society for Bone and Mineral Research and are nationally recognized as experts in pediatric bone and mineral disorders. Patients seen in the Riley Pediatric Metabolic Bone Disease Clinic may have conditions such as osteogenesis imperfecta or other disorders associated with low bone density, sclerotic bone disorders including osteopetrosis, or calcium and phosphate disorders, such as X-linked hypophosphatemic rickets.

  • The Prader-Willi Clinic serves as a resource for affected children in central Indiana. The clinic provides expert care from an endocrinologist and a dietitian to ensure that patients receive indicated monitoring and testing according to national guidelines.

Fellows have weekly continuity clinics throughout the three years of training. Over the course of the program, fellows have the opportunity to work with a variety of clinical mentors, allowing them to learn different approaches to common problems and to develop their own.

Research is one of the most important aspects of post-residency training. Regardless of long-term career goals, participating in clinical or basic research gives the fellow a deeper understanding of the questions that must be asked to advance the field and methods used to answer these questions.

The research training program differs for each fellow depending on their individual needs and previous research experience. There are opportunities to obtain master’s degrees in clinical research and translational research that mesh well with the fellowship schedule for those who want additional depth of training. Fellows also have the opportunity to participate in the Clinical Educator Training Pathway, designed to build the skills needed to be a successful director.

Fellows typically present their work at national meetings such as the Pediatric Endocrine Society, the American Diabetes Association, and the Endocrine Society. These presentations are carefully coordinated and the entire division participates in preparing the fellow for these public presentations. Fellows have numerous opportunities for authoring case reports, review articles and book chapters.

Sample Schedule

   First Year Second Year   Third Year
July   Inpatient  Research  Research
 August  Inpatient  Research  Research
 September  Research  Inpatient  Research
 October  Inpatient  Research  Research
 November  Research  Research  Research
 December  Inpatient  Research  Research
 January  Research  Research  Inpatient
 February  Inpatient  Research  Research
 March  Outpatient  Research  Research
 April  Inpatient  Research  Outpatient
 May  Research  Inpatient  Research
 June  Inpatient  Research  Research

 

Call Schedule

Fellows take overnight call from home one night per week and eight weekends per year during all three years of training, always with faculty backup. The frequency of call does not change during months on the inpatient team. Faculty members take call on nights and weekends not covered by fellows. Although some call nights are busy, others are quiet, and the volume is manageable. The program is fully compliant with ACGME work hours guidelines.

Conferences

Fellows and faculty attend a series of regular meetings that expose trainees to new areas of endocrinology as well as innovative research. They allow fellows to sharpen their own skills as they present to different audiences.

This conference is on Mondays at noon. The content generally focuses on diabetes and includes both basic science as well as clinical research topics. Fellows present their research at this meeting during their third year.

The division meets every Tuesday at 10 a.m. The content varies from week to week but includes presentations by the ward team, journal club, outside speakers and quality improvement activities.

This meeting is twice monthly on Tuesdays at 11 a.m. Fellows present their recent outpatients to the faculty for discussion.

Twice every month on Tuesdays at 11 a.m., the fellows meet with a faculty member to review clinical topics related to pediatric endocrinology. Content includes genetics, pathophysiology, clinical features, treatments and outcomes.

This campus-wide conference is at 8 a.m. on Wednesdays and covers a variety of general interest pediatric topics.

The adult endocrinology and pediatric endocrinology divisions co-sponsor this weekly conference, which is at noon on Wednesdays. Speakers include both IU School of Medicine faculty as well as invited speakers from other institutions. The content is more clinically focused than the Monday Research Conference. Fellows present at this conference yearly.

This combined meeting of adult and pediatric endocrinologists happens every Thursday at noon. It is a clinical case conference where attendees discuss patients with disorders of bone and mineral metabolism. Fellows often present interesting or unusual cases at this meeting.

These department-wide sessions occur every two months and cover topics broadly applicable to all fellows, such as clinical ethics, wellness, job searches and quality improvement techniques.

The Clinician Educator Training Pathway is a two-year program that integrates into the second and third years of fellowship. Trainees learn teaching strategies, curriculum development skills and educational leadership while working with a community of educators.