Clinical and Research Activities

• Clinical Training
• Outpatient Endocrine Clinics
• Continuity Clinic
• Inpatient Consultation Service
• Coordinated Care Programs
• Division Conferences
• Research Training
• Training for Medical Education

Clinical Training

Fellows training in endocrinology and metabolism at the University of Virginia enjoy an excellent patient mix. All fellows participate in a broad range of endocrine clinics, including those devoted to general endocrinology, diabetes mellitus, metabolic bone disease/mineral metabolism, thyroid, reproduction/infertility, pituitary diseases/neuroendocrinology, adrenal/endocrine hypertension, and joint clinics staffed by cardiovascular/endocrinology and obstetrics/endocrinology. We also encourage rotations with Pediatric Endocrinology colleagues and with a preventive cardiologist. Moreover, options for additional experiences in conjunction with radiology and nuclear medicine are available.

The division’s diabetes and endocrine clinical care program achieve perennial recognition.  Outpatient visits are primarily provided at the division’s main offices in Fontaine Research Park, with additional outpatient encounters at numerous multispecialty clinic locations in the area, including Northridge, Augusta, Zion Crossroads, and Fishersville. Because the UVA Health System is a tertiary care referral center, patients come from a large geographic area, including central, western, and southwestern Virginia and parts of West Virginia, Tennessee, and North Carolina. Moreover, the Division of Endocrinology, the Department of Neurosurgery, and the Department of Radiation Therapy (Gamma Knife Center) have international reputations in pituitary disease, routinely drawing patients from all over the United States and even overseas. Additional outreach is offered through the Diabetes Education and Management Program (DEMP), which provides diabetes and nutrition training to patients as well as nurse educators and dieticians.

The division also staffs a full-time inpatient consultation service with over 600 consultations rendered annually. Inpatient consultations occur via a teaching service (staffed by Endocrinology fellows, and responsible for complex diabetes management in addition to non-diabetes endocrine consults) and a separate nurse practitioner service (primarily responsible for straightforward diabetes management).

The Division of Endocrinology and Metabolism is frequently consulted by our Department of Pathology on matters of hormone measurement systems. These discussions are an integral component of our weekly clinical case conferences, which are multi-disciplinary and attended by faculty from the Department of Pathology, Pediatrics, and Surgery.

Outpatient Endocrine Clinics

Our clinical faculty members have active clinical practices. Fellows rotate through these faculty clinics, engaging faculty members in their specific areas of expertise, which include diabetes mellitus (including diabetes-related cardiovascular disease and dedicated clinics for diabetes technology); obesity; thyroid disease; hypertension/adrenal disease; metabolic bone disease/calcium disorders; neuroendocrinology/pituitary disease; reproductive endocrinology/infertility. The division maintains its own thyroid ultrasound unit. Dynamic endocrine testing is performed in the clinic by trained endocrine nurses, and cytology services are readily available. UVa employs a fully electronic medical record (EPIC).

Continuity Clinic

Throughout their fellowship training, fellows maintain a weekly, half-day longitudinal care (continuity) clinic in which they provide endocrine care to their own roster of patients while learning from faculty preceptors dedicated to teaching and mentorship.

Inpatient Consultation Service

Much of the patient care at UVa is directed by house staff/fellows and staffed by UVa faculty. There are no private patients at the University Hospital, and our fellows do not rotate to other hospitals for training.  The fellows have primary responsibility for the inpatient general endocrinology/diabetes consultation service, which renders over 600 initial consultations annually and involves a wide variety of endocrine pathology. Fellow activities include an initial evaluation, daily follow-up, and being a liaison between the primary and consulting teams. Fellows complete 5-6 months on the consult service during their first year, with 2-4 additional months in the 2nd year (for 2 year fellows) or 1-2 months per year in the 2nd/3rd year (for 3 year research fellows).  Two fellows are on the consult service, allowing them to alternate overnight and weekend calls. The typical census includes 10-15 patients per fellow per day and 3-5 new consultations per day.

Coordinated Care Programs

Our division is an integral part of the Neuroendocrine Service (a combined endocrine and neurosurgery service), which historically performs >100 transsphenoidal pituitary operations and over 50 gamma knife radiosurgery procedures each year. This service has an international reputation, drawing patients from all parts of the globe. Our division also works very closely with the Endocrine Surgery Service (a division of General Surgery) and the Department of Otolaryngology-Head and Neck Surgery to ensure excellent care of patients requiring thyroid, parathyroid, and adrenal surgery.

Division Conferences

• Endocrinology Clinical Case Conference (12:00–1:00 pm, every Tuesday, August through June): Fellows discuss 1-2 clinical cases with the clinical faculty. This is a teaching conference where pathophysiology, diagnostic considerations (e.g., technical aspects of hormone assays), approaches to management, and relevant literature are routinely discussed.
• Endocrinology and Metabolism Grand Rounds (1:00–2:00 pm, every Tuesday, August through June): State-of-the-art lectures by internal and external speakers on clinical and scientific topics. Each fellow also presents a clinical and/or research topic once a year.
• Fellows’ Didactic (Clinical Lecture) Series (2:00–3:00 pm, each Tuesday): Faculty give didactic lectures on a wide array of clinical topics.
• Journal Club (every other month): Fellows and a faculty member review one or two recent scientific publications, focusing on methods (e.g., study design, statistical analysis) and clinical relevance. Often these meetings take place at a faculty member’s home or at a local restaurant.
• Multidisciplinary Thyroid Cancer Case Conference (4:00–5:00 pm, every other Tuesday): Faculty and fellows from Endocrinology, Radiology/Nuclear Medicine, Pathology, and Surgery/Otolaryngology-Head and Neck Surgery discuss complicated thyroid cancer cases. The primary goal is clinical decision-making in a multidisciplinary setting.
• Pituitary Case Conference (7:45–8:45 am, third Friday of the month): Details regarding 4-6 pituitary cases are discussed by faculty/fellows from Endocrinology, Neurosurgery, Neuroradiology, and Neuropathology.
• Endocrine Morbidity and Mortality and Quality Improvement Conference (every 6-12 months): The division discusses specific complications or near misses that highlight a need/opportunity to modify behavior and/or systems to enhance the quality of care on a division-wide level.

Research Training

Our three-year clinical/research training program involves an in-depth research experience. While we recognize that not all fellows will pursue research as a long-term career, we strongly believe such research experiences are beneficial for all clinicians. For example, meaningful participation in research fosters important critical thinking skills; and it provides a deeper understanding of the nature of scientific evidence, which is the foundation of medical practice. For details regarding research activities during fellowship, please see the Research Curriculum page.

Two-year clinical fellows usually pursue an academic project (along with a faculty mentor) during her/his fellowship.

Training for Medical Education

Participation in medical education is valuable for all fellows, and it is especially important for fellows interested in a career as a clinician-educator. In addition to encouraging informal teaching in the clinics and on the wards, we intentionally identify opportunities for fellows to teach in more formalized settings. All fellows develop and deliver several divisional presentations on clinical and/or research topics. Opportunities to participate in additional teaching activities (e.g., medicine resident lectures, medical student lectures, graduate student lectures) are facilitated by faculty members, who are fully engaged in endocrine-related teaching across the School of Medicine.