Endocrinology - Education
The goals of the Endocrinology, Diabetes and Metabolism fellowship training program are to provide exceptional training in the clinical practice of endocrinology and to develop the next generation of academic clinician-researchers.
Our training program is based in the Division of Endocrinology, Diabetes & Medical Genetics and is fully integrated at two participating hospitals where we provide outpatient and in-patient care:
The Medical University Hospital is the primary teaching hospital for our fellowship program. The 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 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 87 acute care beds and 28 nursing home care unit beds for a total of 115 operational beds. The Charleston VAMC is closely affiliated with MUSC.
On the consultation services our subspecialty residents learn inpatient management of diabetes mellitus and a host of complex endocrinopathies. At MUH, all patients with endocrine problems are admitted to the General Internal Medicine/Hospitalist Service and receive endocrine consultation as appropriate. In addition, endocrine subspecialty residents participate in the MUH inpatient Diabetes Management Service (DMS), where they work as part of a multi-disciplinary team composed of an Attending Endocrinologist, Nurse Practitioners (NPs), Physician Assistants and Certified Diabetes Educators (CDEs) supported by MUH. The DMS service 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. At the Charleston VAMC, subspecialty residents work with an Attending Endocrinologist, a NP-CDE, and a PharmD-CDE who are assigned to support the VAMC outpatient and consultation service.
Our subspecialty residents participate in selected outpatient clinics year round, with the exception of time spent on the MUH Inpatient Consult Service. In addition residents spend 3 months each year on a dedicated Outpatient Clinic rotation, during which they spend eight(8) half-days each week seeing outpatients in a variety of clinic settings. Elements of the outpatient experience include:
- General Endocrinology/Diabetes Continuity Care Clinics. One of these weekly clinics serves VAMC patients and the others a broadly mixed uninsured/indigent and private referral population of MUH patients. Subspecialty residents also attend our weekly thyroid specialty 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. In ultrasound clinic, residents learn to perform and interpret diagnostic thyroid ultrasound under the supervision of Soonho Kwon, MD. 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. In lipid clinic, residents work one-on-one with Maria Lopes-Virella, MD, PhD, an internationally recognized lipidologist and clinical pathologist. The most challenging lipid disorders are seen in this clinic and their evaluation is supported by an LRC-accredited laboratory directed by Dr. Lopes-Virella.
- Endocrine Tumor Clinic. In our multidisciplinary Endocrine Tumor Clinic residents work with Jyotika Fernandes, MD. This clinic 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. In IDEAL clinic, this multidisciplinary clinic 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.
Our residents are assigned to an Elective rotation for 3 months of each year. While continuing to attend selected continuity endocrine clinics and educational conferences, they devote 50-75% of their effort to a research project during these months. Guidance is provided by the Program Director. Additional clinical training for subspecialty residents on the Elective rotation includes:
- Pediatric Endocrinology Clinics. Our residents work with pediatric endocrinology attendings and their team of midlevel providers and diabetic educators. They provide care for pediatric endocrinopathy patients referred from the entire coastal Carolina area. In this clinic they gain experience in the evaluation and managment 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.
- Nuclear Medicine Clinic. 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.
- Gyn-Reproductive Endocrinology Clinic. Our second year subspecialty residents spend one-half day per week working with Dr. John Schnorr of the Department of Obstetrics and Gynecology, and his colleagues at Coastal Fertility Center. In this community clinic, they gain experience with the routine management of postmenopausal hormone replacement therapy, infertility, a range of ovarian dysfunctions (PCOS, hirsuitsm, annovulatory cycles), as well as evaluation and management of unusual entities such as congenital adrenal hyperplasia, ovarian dysgeneisis, and sex hormone-producing neoplasms.
Subspecialty fellows 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.
The Division of Endocrinology, Diabetes, and Metabolism has a large and active research component, encompassing 24 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 MUSC Department of Medicine. Areas of particular research strength include basic signal transduction, basic and translational study of the causes and treatments of vascular complications of diabetes mellitus, hypertension and hyperlipidemia, and population-based epidemiology and genetics of diabetes and obesity.
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., including the Nancy Thurmond Memorial Diabetes Research Laboratories that house the majority of Division of Endocrinology basic investigators. The Research Service is well integrated with the clinical services at the VAMC and coordinates research activities closely with MUSC. MUSC also houses a General Clinical Research Center (GCRC) 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.
Lectures, Conferences and Seminars
In addition to learning by doing, our subspecialty residents are required to participate in regular conferences and seminar series that further enhance their skills and knowledge. These conferences are held weekly or bi-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 6-8 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, to 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 biweekly, 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 biweekly, 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.
Applying for Fellowship
The Medical University of South Carolina Endocrinology Fellowship program participates in the Electronic Residency Application Service (ERAS).
For general questions regarding Endocrinology Fellowship program at MUSC, please contact Beth Gunnells at (843) 792-4747.