Clinical and Research Activities

Entrance to the Endocrinology and Metabolism Clinic at UVA.

Entrance to the Endocrinology and Metabolism Clinic at UVA.

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. There are 21 clinical faculty members in the Division of Endocrinology and Metabolism—20 of whom are ABIM board-certified in Endocrinology, Diabetes, & Metabolism—responsible for patient care. Clinical activities included more than 26,000 outpatient visits in FY 2014. These 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 Madison. 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 parts of the globe including the Middle East, Europe, and Asia. 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. An important initiative, the Inpatient Diabetes Management Program—a Cardiovascular Diabetes Consult Service spearheaded by Dr. Jennifer Kirby —provides targeted postoperative management for cardiothoracic surgery patients with diabetes and/or hyperglycemia. Incorporating the lessons learned in its initial years, the division plans to expand the program to other critical-care and post-operative units at UVA Hospital. In coming years, the program and its services will be offered in outpatient settings as well, at satellite clinics, and via telemedicine.

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 routinely attended by faculty from the Department of Pathology, Pediatrics, and Surgery.

Outpatient Endocrine Clinics

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.  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); obesity; thyroid disease; hypertension/adrenal disease; metabolic bone disease/calcium disorders; neuroendocrinology/pituitary disease; reproductive endocrinology/infertility; endocrine disease (e.g., diabetes) in pregnancy; benign breast disease/breast cancer prevention. Endocrinology’s largest clinic is in the 415 Ray C. Hunt building (Fontaine Research Park), where four nurses and a nurse practitioner complete our clinical care group. The division also supervises a multidisciplinary Diabetes Education and Management Program (DEMP) involving nurse educators and dietitians. Through DEMP, diabetes and nutrition education is available every workday. 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

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 at least 6 months on the consult service during their first two years (for three-year fellows, this includes 5.5 months during the first year and at least one month in the second and third years). Currently, two fellows are on the consult service at all times, 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

  • Research in Progress (4:00-5:00 pm, every other Tuesday, September through June): Faculty and research trainees present their research and receive constructive criticism and advice regarding their work.
  • Endocrinology and Metabolism Grand Rounds (12:00–1:00 pm, every Tuesday, September 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.
  • Endocrinology Clinical Case Conference (1:00–2:00 pm, every Tuesday, August through June): Fellows discuss 2-3 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.
  • 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.
  • 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, fourth Friday of the month): Details regarding 5-7 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. While not a formal part of the fellowship curriculum, some of our fellows have pursued formal training in educational methodology via the Center for Teaching Excellence at the University of Virginia.