Pediatric Endocrinology Education

Pediatric Endocrinology Fellowship Program

The overall goal of the fellowship program is to educate and train pediatricians for academic careers as board-certified pediatric endocrinologists. In addition to the development of outstanding clinical and teaching skills, an important component of this training program is to prepare fellows for a career in clinical or laboratory bench research in a field relevant to pediatric endocrinology.

Applications from individuals who self-identify as members of underrepresented groups are particularly welcome.

Applying to the Pediatric Endocrinology Fellowship Program

Please apply through ERAS.  Email Fellowship Director Dr. Brandon Nathan at natha039@umn.edu with questions. You may also contact the Fellowship Coordinator, Ellen Jeffery, at sull0380@umn.edu

Goals of Inpatient and Outpatient Training

Goals of Inpatient and Outpatient Training

The clinical training goals will be presented to the fellows during their initial orientation and will be repeated and reinforced annually and signed by the fellow and the Program Director. Goals may be modified annually based upon changing program requirements and feedback from the fellows. The fellow will keep a running list of diagnoses encountered in clinic and on the wards. Annually, the program director will review the list to ensure that the fellow is adequately exposed to the entire clinical spectrum of pediatric endocrinology. The goal of the training program is that the fellow will demonstrate competence in the following areas during the fellowship program:

  1. Elicit histories and perform general physical examinations geared toward diagnosis of endocrine disorders.
  2. Evaluate normal and abnormal patterns of childhood growth and development.
  3. Interpret and integrate medical literature into patient care.
  4. Understand the principles of endocrine diagnostic laboratory testing and genetic testing.
  5. Counsel patients and their families on prognosis and outcomes of disease and therapy.
  6. Devise and evaluate appropriate endocrinologic therapies.
  7. Provide diagnostic, therapeutic and continuity care for endocrinologic patients from infancy through adolescence.
  8. Coordinate endocrine evaluation and therapies with consulting services.
  9. Clinical experiences will involve all aspects of diagnostic and therapeutic medicine and care in the following:
  • genetic short stature, constitutional growth delay, genetic disorders associated with growth failure including Turner Syndrome, Down Syndrome, intrauterine growth retardation, nutritional and psychosocial growth disorders
  • disorders of the growth hormone axis, growth hormone deficiency and insensitivity
  • disorders of hypothalamic and pituitary function
  • brain tumors and congenital malformations of the hypothalamus-pituitary region
  • tall stature and excessive growth syndromes
  • variations of patterns of pubertal development; delayed and precious puberty
  • adolescent gynecology with emphasis upon sexual function, STD, PCOS
  • testicular and ovarian function, primary and secondary gonadal failure, gonadal tumors
  • thyroid disorders including hyper- and hypofunction, benign and malignant tumors, autoimmune disease, sick euthyroid syndrome, MEN
  • disorders of the adrenal glands; hyper- and hypofunction
  • disorders of sexual differentiation; adrenal steroidogenesis defects, ambiguous genitalia, micropenis, cyryptorchidism
  • disorders of calcium, phosphorus and vitamin D metabolism, parathyroid hormone secretion and action, metabolic bone disease and mineralization defects (rickets, osteomalacia, osteoporosis)
  • regulation of fluid, mineral and acid-base metabolism; DI, SIADH, cerebral salt wasting
  • carbohydrate metabolism; type 1 and 2 diabetes, CF-related diabetes, hypoglycemia
  • evaluation and treatment of obesity and the metabolic syndrome
  • disorders of lipid metabolism
  • autoimmune polyglandular syndromes

Inpatient Clinical Responsibilities

Inpatient Clinical Responsibilities

Year one: 3 months on service
Year two: 3 months on service
Year three: 3 months on service 

All patients admitted on the Endocrinology Consultation Service will be assigned to the fellow when he or she is covering the inpatient clinical service. The average number of inpatients is 4-8 ongoing management patients and 4-10 new consults per week. The fellow is a consultant; the daily care of these patients is entrusted to the house staff. Patients are regularly admitted to University of Minnesota Masonic Children’s Hospital Medical/Surgical Care Units 5 and 6, the Pediatric Intensive Care Unit 3, the Bone Marrow Transplant Unit 4, the Neonatal Intensive Care Unit, the Child and Adolescent Psychiatry Units . Occasional consults originate from the Pediatric Infusion Center, Children’s Rehabilitation, Obstetrics, or Hennepin County Medical Center.

While the attending faculty member is ultimately responsible for all inpatients, the fellow acts as the first-line consultant. A medical student or second year pediatric resident on the Endocrine rotation may accompany the fellow. The fellow’s responsibilities include the primary interactions with the patient/family/nursing staff, with the support and supervision of the attending faculty member. The fellow is responsible for providing a plan for diagnosis and treatment, and arranges for needed consultations and special testing procedures. The fellow is the primary contact with parents of hospitalized children. This includes education of parents, and any needed work with social services and psychological services. The fellow is teacher to the medical students and house officers who are also assigned to the patient through the ward assignment mechanism.

It is policy that all consultation requests are answered and completed within 24 hours of receipt. Completion includes staff supervision, including examination of the patient by faculty and review and signing of the consultation note written by the fellow. One-on-one teaching is done at this time, including initiation of literature searches. Rounds are conducted daily. The fellow is instructed by the attending faculty member on an ongoing basis centered on patient care.

During the inpatient rotation, the fellow takes home-call every night Monday through Friday, unless prior arrangements have been made with the attending physician (on average, the fellow and attending need to come in to the hospital at night once every two months). The fellow is off service on the weekends so that they have a minimum of 4 full days off every 28 days. There is no night call or weekend call when the fellow is not on the inpatient service.

Outpatient Clinical Responsibilities

Outpatient Clinical Responsibilities

The fellow will attend one half day of endocrinology clinic alternating with one half day of diabetes clinic per week each week during the three year fellowship. In addition to general endocrine and diabetes clinics, fellows will attend a one month intensive outpatient rotation consisting of the CAH clinic, brain tumor clinic, bone metabolism clinic, BMT follow-up clinic, Turner syndrome clinic, and community general endocrinology clinic each of the three years of their fellowship. Year-specific goals objectives for each clinic should be followed and the fellows will be evaluated on how well they meet these objectives. 
A description of the outpatient clinics is as follows:

  • The Leo Fung Center for Congenital Adrenal Hyperplasia (CAH) and Disorders of Sex Development (DSD): A multidisciplinary clinical care and research facility that is built upon a unique collaboration between healthcare professionals at the University of Minnesota Medical Center - Fairview and the Minnesota Department of Health Newborn Screening program (MDH-NBS), headed by Dr. Kiki Sarafoglou. The Center addresses the varied and long-term spectrum of clinical needs for patients with CAH and other rare disorders of sex development. Clinics are held monthly and staffed by a pediatric endocrinologist, a pediatric urologist, a genetic counselor, and faculty from the Program in Human Sexuality.
  • Brain Tumor Clinic: A multidisciplinary clinic that provides comprehensive evaluation, therapy, and follow-up of pediatric patients with brain tumors and associated endocrine sequelae. Clinic is held monthly and is staffed by Dr. Miller from Endocrinology, a pediatric neurologist, a neurosurgeon, and neuropsychologists.
  • Metabolism Clinic: A multisiciplinary clinic that provides high quality, compassionate, and thoughtful diagnostic evaluations and follow up care of patients and families at risk for or affected by inborn errors of metabolism, staffed by Dr. Sarafoglou and genetic counselors.
  • Bone Metabolism: Specialty clinic providing care for children with disorders of bone metabolism. This clinic is staffed by Dr. Lynda Polgreen. Fellows may see patients with genetic diseases having bone disordes as part of the spectrum of disease or healthy children with multiple fractures or osteopenia/osteoporosis.
  • Follow-up BMT Clinic: Dr. Anna Petryk staffs the BMT follow-up clinic which serves the post transplant population and associated endocrine problems that may occur.
  • Community general endocrinology: General endocrinology clinic is available at both the Ridges site (staffed by Dr. Nathan) and the Maple Grove site (staffed by Drs. Bellin and Frohnert).

The fellow is assigned one or more new patients at each clinic. In addition, the fellow is assigned several return patients each week. An attempt is made to provide a breadth of experience for each fellow by regulating which patients are seen. Assignment of each clinical patient to the appropriate trainee is monitored by a faculty member. The fellow is the first physician to see the patient. He or she then narrates the history and physical to a member of the faculty on completion of this work-up. The faculty member uses this time for teaching and review of the work-up done by the fellow. Each patient is then seen by the faculty member, and the pertinent parts of the work-up are personally checked. The fellow is then responsible for that patient’s continuing care while attending that clinic. In addition to reviewing the further studies that might be done with the faculty member, the fellow dictates a summary letter to the referring physician or agency. This letter is reviewed, corrected and signed by the faculty member.

During the first year of fellowship, the fellow will not have routine continuity clinic scheduled due to the potential interference of Master’s classes. However, it is a requirement that the fellow continue to attend ½ day of clinic per week. The first year fellow is encouraged to attend as many different clinics as possible to get the greatest breadth of experience in terms of both patients and care providers during this year. If the first year fellow is not involved in taking Master’s courses, a scheduled ½ day continuity clinic will occur. During the second year and the third year, the fellow will have continuity clinics alternating in endocrinology and diabetes, except for any 5th Thursdays in which they will be attending one of the above sub-specialty clinics..

Diabetes Camp:
The fellow will spend one week each summer at Camp Needlepoint (diabetes camp) during their first and second years, where, under the supervision of a pediatric endocrinologist, they will supervise the insulin dosing of campers with diabetes both in camp and out on trail. During the first year this will count as part of the four months on service; during the second and third years it will not be considered time on service.

Research Program

Research Program

All full-time faculty of the Division participate actively in research programs. This provides the fellows with an environment in which intellectual inquiry is intrinsic to all patient care and education experiences. The Pediatric Endocrinology Fellowship program consists of two separate tracks, clinical research or basic laboratory bench research. It is intended that each fellow be sufficiently well grounded in the fundamental underpinnings of their respective track to be able to undertake original research under their own direction by completion of the fellowship.

Regardless of the track chosen, each first-year fellow must select a faculty research mentor at the start of the fellowship. They will work together to select a research project, and the role of the fellow in that project will be defined. The Fellowship Director must approve of the choice of project and mentor, based on the likelihood of success in achieving fellowship goals. The fellow may be involved at this stage in acquiring funding for the project. The project chosen will allow the fellow to learn the broad fundamental concepts of development of scientific hypotheses and specific aims, pertinent background literature review, formation of a research plan, statistical evaluation, a variety of methodologies, and data interpretation and presentation. They will be expected to prepare a peer-reviewed manuscript resulting from this research project and present the data at a national meeting. For fellows on the clinical track, this work will also form the basis for the required master's research thesis. The preliminary success of the research project, the quality of the performance of the fellow, and the quality of the mentor are assessed annually. If necessary, adjustments are made. Appropriate library and office facilities and computer equipment will be available to each fellow.

Clinical Research Track

The clinical track involves completion of a Master's Degree in Clinical Research. The University of Minnesota Medical School in conjunction with the School of Public Health has established an innovative Master's Degree program in the education and training of individuals in the conceptualization, design and implementation of clinical research. This program is designed to be compatible with a clinical fellowship training program. 38 credits are required over a three year period, with the following course content:

  • Fundamentals of Clinical Research (3 credits)
  • Ethics (1 credit) (includes IRB certification)
  • Biostatistics I (4 credits)
  • Biostatistics II (4 credits)
  • Epidemiology (4 credits)
  • Epidemiology Methods (2 credits)
  • Human Genetics (4)
  • Clinical Trials (3 credits)
  • Grant Writing (2 credits)
  • Research Seminar (2 credits)
  • Master's Thesis (10 credits) (fellowship research project)

Basic Laboratory Research Track

Each fellow who chooses the basic laboratory track will enroll in appropriate advanced basic science courses to assist them in learning and applying fundamental laboratory based disciplines. Formal courses, in addition to basic discipline courses, will include, but not be limited to:

  • Ethics (1 credit) (includes IRB certification even if the fellow's primary research does not involve human subjects)
  • Biostatistics I (4 credits)
  • Biostatistics II (4 credits)
  • Human Genetics (4)
  • Grant Writing (2 credits)

Laboratory space will be provided for each fellow within the space allotted to the faculty mentor. It is expected that the fellow will become an integral part of that laboratory team, and that the major portion of the fellow's instruction will occur in that setting. Regularly scheduled laboratory research meetings and seminars will be required.

Additional Training for All Fellows on Either the Clinical or Basic Research Tracks

All endocrinology fellows, whether on the clinical or basic laboratory research tracks, will have formal training in the following:

  1. One week in the second year of fellowship in the FUMC Cytogenetics Laboratory learning basic procedures in diagnostic cytogenetics including cell culture, metaphase banding techniques, FISH, and the principles of karyotype evaluation with particular reference to the X and Y chromosomes. Each year all of the fellows also meet with Dr. Petryk or Dr. Sarafoglou for 1-2 hours at the time the second year fellow is doing the cytogenetics week to review the basics of molecular biology.
  2. Annual day long seminar in the FUMC Endocrine Laboratory and quarterly meetings with Dr. Michael Steffes, the Endocrine Laboratory Director. Emphasis is placed upon the general principles of ELISA, ICMA, IRMA, and RIA assays, actual performance of specific peptide and steroid assays, evaluation of sensitivity an specificity of results, use of varying immunologic detection procedures, organic extractions, and principles of varying endpoint detection systems. In addition, the fellows present clinical cases to discuss the use of endocrine tests in the context of patient care.
  3. The goals of the nuclear medicine curriculum are to understand fundamental aspects of nuclear medicine particularly as they relate to endocrine disorders (thyroid and parathyroid imaging, I131 treatment, diagnosis of neuroendocrine tumors, CNS irradiation). The curriculum includes the following:

    a.  Monthly thyroid cancer rounds with adult endocrinology fellows, surgeons and nuclear medicine physicians led by Dr. Lynn  Burmeister from the Department of Medicine.  The fellows take turns and present cases and lead the discussion related to a focused area of thyroid cancer.  Pediatric endocrine fellows present the cases once a year.
    b.  Annual lecture given by Dr. Jerry Froelich or one of his colleagues on the diagnostic and therapeutic applications of nuclear medicine with respect to endocrine diagnoses.
    c.  One day rotation per year in the Nuclear Medicine Division under the director of Dr. Froelich.
    d.  Participation in nuclear medicine procedures in pediatric patients with endocrine or neuroendocrine disorders on an ongoing basis.
     
  4. Peds endo didactic reviews: Twice a month the fellows will meet with Dr. Moran alternating with Dr. Petryk to review basic pathophysiology. The monthly topics include lipid metabolism, adrenal steroidogenesis/CAH, fluid and electrolyte metabolism, puberty, growth, ovarian failure, thyroid disease, MEN and polyglandular failure, bone and mineral metabolism, hyperandrogenism, testicular failure, Cushings syndrome/adrenal insufficiency.
  5. Fellows Training Curriculum: All fellows in the Department are required to attend 18 one-hour seminars over a three-year period. The content of the program is as follows: Cardiopulmonary resuscitation, Physiology I, Physiology II, Laboratory Medicine I, Laboratory Medicine II, Statistical Methods I, Statistical Methods II, Grant Preparation, Manuscript Preparation, Research Design, Critical reading of literature, Laboratory techniques, Professionalism, Research Ethics, End-of-life Issues, Employment after fellowship, Balancing personal and professional life.
  6. Peds endo board review: Eight times per year at the Division meetings the second and third year fellows will present topics which follow the outline content of the endo boards as published by the AAP. Over the course of three years the entire curriculum will be covered.