Curriculum & Rotations

The curriculum for the pediatric endocrinology fellowship is divided into four areas that correspond to the educational goals of the program - clinical education, research education, teaching education and lifelong learning. Each area involves several teaching methodologies, including one-on-one teaching, "hands-on" education, independent study and formal didactic sessions.

Clinical Education

One-on-One Teaching

The bulk of clinical education is comprised of one-on-one teaching between the fellow and the attending endocrinologist. When on-call, the fellows see all inpatients on the endocrine service, the inpatient consults and the patients undergoing endocrine testing. At other times, the fellows see patients in the outpatient setting. Each patient is discussed in detail with the attending endocrinologist. Through this interaction, all relevant aspects of the endocrinologic problem are discussed. Anatomy, physiology, biochemistry embryology, pathology, pharmacology, immunology, genetics, epidemiology, nutrition and metabolism are covered for the majority of endocrinologic diseases over the course of the training. During these discussions, the topics of diagnostic testing (including methodologies, the definitions of normal and abnormal results, the impact of diurnal patterns, etc.) and socioeconomic and psychological issues in diagnosis and management are covered. The fellows also work with other sub-specialists, as they are involved with specific cases.

Hands-on Education

Pediatric Endocrinologist and ChildWith the above teaching, the fellow sees the patient prior to the attending endocrinologist. This allows the fellow to perfect his/her skills in history taking, physical examination and test evaluation. During the presentation to the attending endocrinologist, the fellow discusses his or her impression and plan for each patient. Then the attending endocrinologist sees the patient and evaluates the fellow's performance. The attending also provides the fellow with feedback and corrective education.

Independent Study

For selected cases, the fellows will be asked to research a particular disease and present (formally or informally) their findings. Through this process, fellows learn how and where to find information on many topics, some of which will be obscure. The fellows learn how to interpret the relevance of individual clinical studies in the literature and information found on the internet. In this way, the fellows perfect their ability to teach themselves when they come across the unfamiliar.

Didactic Sessions

Case Conference

This is a weekly meeting where the division (including nursing and the diabetes team) presents and discusses cases of interest, including some aspect of diagnosis or management. Often, recent articles relevant to the case are presented too. In this forum, the fellows are exposed to rare diseases and unusual cases in a more formal manner. The fellows themselves are asked to present their own cases, as they come up. This meeting is also used to discuss individual clinical practices and outcomes studies in an effort to standardize practices within the division and to continue clinical quality improvement. Discussions about the economics of the practice and of health care in general also occur.

Pediatric Endocrinology Journal Club

This meeting is held every six weeks and involves having fellows and faculty present recent articles for discussion. Through these discussions, fellows learn how to critically read literature in order to determine its relevance. It is also an additional opportunity to improve clinical quality.

Pediatric Ground Rounds

This is a weekly formal presentation by an invited speaker and covers a wide range of topics relevant mostly to the general pediatrician. Fellows are asked to speak at this forum at least once during their training.

Pediatric Tumor Board

Pediatric PatientThis is a weekly meeting where the oncology team meets with the sub-specialists to present and discuss specific cases. All cases of endocrine neoplasia are presented and the division is often invited when patients with other oncologic problems develop endocrinologic complications. The fellows present the relevant cases in which they are involved.

Nemours Education Conference

This is a monthly meeting where a sub-specialty division presents on a topic of general clinical interest. The fellows participate directly when the endocrinology division is scheduled to present.

Endocrine Core Curriculum Conference

At this weekly conference, the fellows meet with one of the faculty members to discuss a specified topic in depth. Topics are drawn from the American Board of Pediatrics Sub-board of Endocrinology topics list.

Endocrine Board Review

This weekly conference is run by the fellows as study session specifically for preparation for the board examination.

Ad Hoc Lectures and Conferences

These are meetings that occur when it becomes clear that the fellows need a subject presented and discussed in depth. Ad hoc conferences generally occur when a visiting speaker is available. They may include other divisions, including the Mayo Clinic - Jacksonville division of endocrinology.

Clinical Topics

The clinical experience of the fellows includes, but is not limited to training in the following areas:

  • Short stature, including constitutional delay
  • Disorders of anterior pituitary hormone physiology, including growth hormone deficiency
  • Disorders of posterior pituitary hormone physiology, including diabetes insipidus
  • Disorders of hypothalamic hormonal regulation
  • Disorders of thyroid hormone physiology
  • Diagnosis and management of endocrine neoplasia
  • Disorders of the adrenal gland physiology
  • Disorders of androgen and estrogen metabolism, including adolescent reproductive endocrinology
  • Disorders of sexual differentiation and development
  • Disorders of calcium, phosphorus and vitamin D metabolism
  • Disorders of parathyroid gland physiology
  • Disorders of fluid and electrolyte balance
  • Disorders of carbohydrate metabolism, including diabetes mellitus and hypoglycemia
  • Disorders of nutrition, including eating disorders

Research Education

One-on-one teaching

During their first year of training, fellows explore the ongoing research projects in the division. On consultation with the program director, a mentor is chosen for each fellow and this person becomes the primary educator for research, including teaching technical skills, experimental and study design, subject recruitment, statistical evaluation of results, data presentation and grant proposal and manuscript preparation. The scientific, ethical and legal aspects of biomedical research, including the process of informed consent are emphasized.

Hands-on education

Fellows become involved in the day-to-day activities of the research project in which they are involved. This includes subject recruitment and obtaining informed consent (under the supervision of the mentor), administrative tasks such as scheduling subjects' procedures, ordering supplies and writing progress reports and running assays. Fellows are involved in designing their own research projects, writing grant proposals, conducting their own data analysis and preparing manuscripts for publication.

Independent study

An important part of research occurs as independent study. This occurs mostly in the form of literature searches on the research subject and research methods, but also includes the preparing of grant proposals and manuscripts.

Didactic sessions in research

Nemours Research Conference

This quarterly meeting is a formal presentation by one of the researchers on their own work. It may include an invited speaker on research topics of wide interest. The fellows will be expected to present their own research findings at least once during their training.

Lab meetings

At these weekly meetings, principal investigators (PIs) in the division meet with their respective research teams to discuss progress, problems and administrative matters. New data are presented and assignments for future projects are made. The fellows are welcome to attend the lab meetings of any of the PIs, but attendance at the meetings of their research mentor's team is required.

Teaching Education

One-on-one teaching

The endocrinologists are available to the fellows when specific issues or topics arise (i.e. help with organizing a presentation and help with presentation software). It is expected that the fellows will seek out this help when needed.

Hands-on education

Pediatric Endocrinologist on ComputerAt this level of training, learning the skills of the educator is primarily done through practice. For clinical topics, there is ample opportunity for informal teaching with the pediatric residents and medical students, as well as with patients and their families. Formal presentations are done at the clinical meetings listed above, including pediatric grand rounds and Nemours education conference. The fellows may be asked to prepare formal presentations for the pediatric residents for their resident conference as well. For research topics, the fellows "teach" in the form of presenting their own research findings.

Another aspect of teaching is the evaluation of one's students. All pediatric residents and medical students that work with the division are evaluated as part of their own program. Fellows are involved in the preparation of these evaluations.

Teaching skills workshop

The University of Florida College of Medicine – Jacksonville holds an annual fellows' teaching skills workshop to promote effective clinical and didactic teaching, as well as leadership development.

Lifelong Learning

The program emphasizes the acquisition of tools required by practicing pediatric endocrinologists to maintain their expertise. Through the clinical case conference and journal club and research lab meetings, the fellows are given the opportunity to demonstrate their ability for self-education. These sessions also serve as opportunities for the faculty to continue their own education and serve as role models for the practice of lifelong learning.

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