Methodology for Teaching Endocrinology
In order to achieve the goals and objectives for the fellowship program the following experiences have been established for the purpose of teaching Endocrinology fellows. These include:

1. The Ambulatory Endocrinology Experience
2. Ambulatory Rotations with other Clinical Subspecialties
3. Interdisciplinary Interactions
4. Didactic Conferences
5. A Research Experience
6. Continuing Medical Education and Society Participation
7. Development of Teaching Skills.

1. The Inpatient Endocrinology Experience
   Endocrinology fellows are responsible for the performance of inpatient consultations as well as the continued follow up of these patients during their hospitalization. Through this experience, the fellows develop and refine their skills essential for the clinical evaluation of patients with endocrinologic diseases. These skills include the development of appropriate differential diagnoses, assessment of the need for hospitalization, diagnostic evaluation strategies and treatment plans. The fellows also develop skills in providing consultation services, to include communicating with the referring physicians and ensuring support for continuing care of the patients' endocrinologic condition. In addition, Endocrinology fellows participate actively in the teaching activities of the consultation team. Through this experience the fellows also develop a comprehensive understanding of the indications, contraindications, techniques, and complications of thyroid aspiration biopsy as well as the interpretation of results from this procedure. They also acquire the knowledge of and skill in educating patients about the procedure and in obtaining informed consent. Faculty supervision is required in developing these skills.

   Fellows are expected to perform literature research on topics appropriate to the case at hand and make their findings available to the primary care team. The fellows will teach and supervise trainees on the primary care team and endocrinology service with regard to specialized techniques, including performance and cytologic interpretation of Thyroid fine needle aspiration biopsy, Doppler pressure measurements in the leg and foot and Brachial Arterial Reactivity-post-ischemic flow mediated vasodilation.

   At each hospital, it is expected that the fellows will dictate the consultation note after the patient has been presented to the attending endocrinologist and a differential diagnosis and management plan has been formulated.

   (Back to Top)

2. The Ambulatory Endocrinology Experience
   All fellows maintain at least 4 of ½ day clinics per week for the duration of their fellowship, during which time they have progressive responsibility for the care of their patients and are appropriately supervised by dedicated attending faculty members. The goal of this experience is for the fellows to gain expertise in the outpatient evaluation and management of endocrinologic problems. The experience provides an opportunity to develop an understanding for the natural history of these conditions over an extended period of time. During each clinic, fellows are expected to see 1-2 new patients and 4-6 follow-up patients. They are expected to dictate a comprehensive consultation note or letter for each new patient seen.

   (Back to Top)

3. Ambulatory Rotations with other Clinical Subspecialties
   Elective rotations are not offered, however, fellows get a chance to rotate at Children's Hospital Pediatric Endocrinology clinics and one of the largest In Vitro fertilization and infertility clinics of WNY, the private office of Kent Crickard, MD Reproductive and Infertility Associates.

   (Back to Top)

4. Interdisciplinary Interactions
   Endocrinology fellows are provided opportunities to interact professionally with physicians from other disciplines whose expertise is required in the care of patients with endocrinologic diseases. These opportunities include collaboration in the care of patients, multidisciplinary conferences, rotations to one of the largest In Vitro fertilization and infertility clinics of WNY, the private office of Kent Crickard, MD Reproductive and Infertility Associates, and participation in pediatric endocrinology clinics.

   (Back to Top)

5. Didactic Conferences
   The conference schedule for the endocrinology fellowship program is tabulated below:

   Conference	Day of week	Time
   Research Conference	Each Monday of the month	9:00–10:00 AM
   Endocrinology Case Conference	Each Tuesday of the month	8:00–9:00 AM
   Journal Club	1st Thursday of each month	6:30–8:30 PM
   Basic Science Conference	At least 1 Friday per month	4:00–5:00 PM
   Multidisciplinary Conference	At least 1 Friday per month	4:00–5:00 PM
   Didactic Teaching Conference	At least 1 Friday per month	4:00–5:00 PM
   Fellows meeting	Every Friday	2:00–4:00 PM

   Fellows will be encouraged to participate in several conferences, as follows. They will be supervised for critical literature review and will be encouraged to present in these conferences.

   1. Endocrinology Case Conference Meeting (weekly clinical conference): Held every Tuesday to discuss clinical issues. Fellows present clinical cases along with relevant and critical literature reviews, which are discussed within the group of other faculties and fellows and local experts
   2. Weekly Research Laboratory Meeting: Held every Monday to discuss the results of the various research projects and progress of the laboratory located at the Diabetes-Endocrinology Center of WNY. Fellows participate, evaluate, discuss and learn to analyze and interpret various tests or research results. These conferences further enables the fellows to familiarize themselves of special, sophisticated laboratory techniques such as ELISA, Western blot, Electrophoretic Mobility Shift Assay (EMSA) and Polymerase Chain Reaction (PCR)
   3. The Multidisciplinary/Interdisciplinary Vascular and Metabolic Research Group. Held on at least one Friday afternoon per month: invited physicians are asked to present timely multidisciplinary/interdisciplinary issues
   4. Monthly Basic Science Conference: Held on at least one Friday afternoon per month, invited physicians are asked to present timely basic science issues
   5. The Endocrinology Journal Club Meeting (literature review conference): Held once a month, usually the first Thursday of every month; invited physicians, faculties as well as endocrinology fellows, are asked to present reviews on timely endocrinology issues
   6. Didactic Teaching Conferences: Held 1-2 times a month, on Fridays, where faculties, fellows or invited guest speakers will deliver didactic lectures and or seminars.
   7. Endocrinology Fellows meet with the Program Director: Held every Friday; the program director meets with the fellows to discuss fellowship information and other relevant issues. Topics discussed in these regular meetings are wide ranged and include
      1. Expectations, planning and measures to improve the program
      2. Individual fellows clinical, research and teaching experiences
      3. Current literature reviews and its implications
      4. Formulation of diagnostic and management protocols
      5. Counseling of fellows

   (Back to Top)

6. Research Experience
   An active research component is included within the fellowship program. A meaningful research experience with appropriate protected time is available for each fellow. During this phase of training, the fellows work under close guidance of a faculty research mentor The immediate goal of the research experience is for fellows to learn:

   1. sound methodology in designing and performing research studies
   2. the correct interpretation and synthesis of research data
   3. the purposes, goals and characteristics of different phases (e.g. Phase I, II, III) of clinical trials and understanding of the significant differences
   4. biostatistics that will allow the trainee to interpret the published literature and to critically discriminate the impact of such work to their clinical practice
   5. basic elements of proper clinical trial design including identification of target populations, statistical power, proper statistical tools and ethical concerns
   6. the purpose and function of the Institution Review Board and other regulatory bodies that oversee the conduct of clinical investigations
   7. design of informed consent documents and understanding of the ethics related to conducting clinical trials, including issues of industry sponsorship and conflict of interest
   8. to manage a patient on a clinical trial, including the ability to evaluate a patient's eligibility for participation in a specific clinical trial; obtaining the necessary baseline studies; writing the treatment orders as directed in the protocol; following a trial's calendar for assuring that required patient encounters, therapy, diagnostic studies and data collection are performed at the appropriate times; and assessing and reporting responses and adverse events appropriately
   9. general working knowledge of what "translational research" is, how it is performed and what its value is.
   10. To participate in, or have, didactic training in the clinical trial process, including having the opportunity to be involved in the processes of designing research protocols, writing clinical protocols, obtaining regulatory approval for a clinical trial, enrolling patients into clinical trials, performing data analysis, manuscript writing and making formal presentations of data collected
   11. the ability to seek out the existence and details of available clinical trials available at their institution and elsewhere in the course of caring for their patients.
   12. find funding resources for research studies

   (Back to Top)

7. Self-directed learning
   Endocrinology fellows are expected to direct their own learning through reading and utilization of other learning media. In addition, each hospital has a medical library, each with an extensive collection.

   (Back to Top)

8. Continuing medical education and society memberships
   In addition to participating in the organized didactic conferences established within the fellowship program, the fellows are encouraged to become members of the American Association of Clinical Endocrinologists (AACE) and Association for Program Managers in Endocrinology and Metabolism. In addition second year fellows attend the Endocrine University AACE certification course in thyroid ultrasound and biopsy. The curriculum is specially designed to help prepare final year fellows for entering clinical practice by enhancing their exposure to the following six key areas of clinical endocrinology:

   1. Thyroid Ultrasound Accreditation (2 days)
   2. Bone Density Measurement Certification (2 days)
   3. Metabolic Laboratory CLIA Certification (1 day didactic/14 hours e-learning)
   4. Insulin Pump and Sensor Hands-on Instruction (3/4 day)
   5. Reproductive Medicine (Ultrasound Intervention) (1/4 day)
   6. Practice Management Issues (1/2 day)

   (Back to Top)

9. Development of teaching skills
   The program provides an environment for the fellows in which the activities of teaching are fostered and highly regarded. This includes the education of not only medical students, physicians, and other allied health personnel but also the education of the patients. The fellows are expected to teach the medical residents and medical students who rotate on the endocrinology service each month.

   (Back to Top)