Endocrinology, Diabetes, and Metabolism Fellowship Training

Message from Endocrinology, Diabetes, and Metabolism Fellowship Program Director, Dragana Lovre, MD

I thank you for your interest in our program. I, myself, am a graduate of the Tulane Endocrinology Fellowship Program. I have had the opportunity to see this program as a trainee, program faculty, researcher, associate program director, and now as program director, and I couldn’t be prouder of our section’s dedication to teaching and research. We are proud of the scope of our clinical training, adapting to changes in our clinical practice environment and to feedback from our trainees and educators.

The Fellowship Program in Endocrinology, Diabetes & Metabolism at Tulane University of has a rich history of providing our trainees a robust training platform marked by a breadth of clinical experiences, diversity of patients and innovative research. This environment provides trainees with a multitude of opportunities to further the advancement of diverse career paths within the field of endocrinology.

Although we are a 2-year clinical fellowship, some of our graduates have chosen to incorporate some components of a research pathway. The research pathway activities are targeted to fellows planning to embark on a career in research. For these fellows, the clinical pathway is still the primary emphasis, but we assist them with individualized research projects by assigning a suitable mentor and provide guidance to maintain balance during their 2-year clinical fellowship. All fellows, regardless of their focus, maintain continuity clinics throughout the year and receive the required educational, clinical and research exposure to become independent Board-certified endocrinologists.

Tulane University Endocrinology Fellowship provides a supportive environment in which fellows assume progressed levels of independence in caring for patients from culturally and economically diverse backgrounds, who present with from a broad range of endocrine disorders, including diabetes, lipid, metabolic and reproductive disorders, osteoporosis, thyroid, parathyroid, pituitary, adrenal disease, and endocrine neoplasia. Over the two-year training period, fellows acquire the practical and procedural skills necessary to prepare them to provide complete, clinical, patient care services, including, thyroid ultrasound and biopsy, dynamic testing, interpretation of bone densitometry, and radioiodine scanning and therapy. Throughout the Program, ethical behavior, cultural competency, safe practice and proactive burnout prevention strategies are emphasized, as is the impact of socioeconomic factors on health care delivery. Furthermore, our Program provides education and mentoring that prepare our graduates to become active participants and future leaders in both clinical

setting and academia. We accomplish this by providing the advanced training and experience in all competencies including, broad and intensive clinical exposure and teaching, training in and opportunities for teaching and academic presentations and post-doctoral level training in clinical and/or basic research.

The first- and second-year fellows rotate in each of three affiliate hospitals in four-week blocks, and each site has a distinctive patient population. This first six months of fellowship is slightly more intense than the rest as the fellows are navigating several different systems and cross covering each other on the weekends. The result, however, is an exceptional exposure to a broad spectrum of endocrinology and increased comfort level and autonomy with treating more complex cases later in their training. From the start our trainees are offered and encouraged to select a research mentor. While they continue to improve their clinical skills at their continuity clinics and inpatient sites, they are required to complete a QI project and they are encouraged to extend their work into a research project and present their work to the endocrine communities regionally and/or nationally.

 

Clinical

Inpatient Care

Fellows train during inpatient rotations at Tulane University Hospital & Clinic(TUHC), University Medical Center New Orleans (UMCNO), and the Southeast Louisiana Veterans Health Care System (VA). Daily endocrine consultation rounds are made by the on-call fellow, residents, and students assigned to the service, with supervision by full-time endocrine attendings. Consultation is provided to the general internal medicine service as well as other services, especially general surgery, transplant surgery, gynecology, neurology, neurosurgery, urology, otolaryngology, and oncology.Read More

In this broad-based program, a first year fellow will see approximately 80-100 patients, primarily as a consultant. The in-patient experience during the second year involves progressively more direct care of patients on the endocrine service and on other services (general medicine, cardiology, nephrology and other medical subspecialties) while under the supervision of an attending physician.

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Ambulatory Care

Clinics are covered by full-time faculty who guide fellows and rotating residents and students through appropriate diagnostic and therapeutic methods, teach recognition and interpretation of physical findings, and ensure that there is a basic understanding of the broad range of endocrinopathies that present at these clinics:Read More

  • TUHC--Three general endocrine clinics per week and a Diabetes Education Center providing access to certified diabetes educators and nutritionists.
  • UMCNO--Two general endocrine and diabetes clinics per week and access to a Diabetes Education Center for patient referral.
  • VA--Three clinics per week: general, diabetes, and FNA*
  • Other Clinics: Limited observership of pediatric and reproductive clinics at Children's Hospital and The Fertility Clinic of New Orleans.

Because of the structure of the endocrine service, a fellow will have uninterrupted continuity of care and observation at TUHC (Lakeside) during each year of the program. In view of the chronicity of endocrine problems in general, the continuity clinics afford an excellent opportunity for trainees to follow complicated diagnostic work-ups to completion, to see the evolution of disease processes, and to appreciate the long- term effects of therapy.

*Note on FNA training:  Before performing the fine needle aspiration (FNA) of the thyroid procedure in clinic, incoming fellows receive their initial training in the procedure from a faculty member in pathology  and are thereafter supervised when the procedure is done in clinic.  Fellows will have ample opportunities for performing FNAs in clinical settings.  A minimum 10 FNAs is required by the completion of training.

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Didactics

Monday Conference --Fellows present weekly at Journal Club and case conferences before faculty, fellows, and rotating medical students and residents.  Evaluation by faculty and peers is based on the importance and relevance of the article/case selected; clarity and organization of presentation; and quality of synthesis and interpretation.

Core Lectures --Covering the fundamental topics of endocrinology and metabolism, as well as relevant basic science and research topics, lectures are provided by endocrine faculty with supplementary lectures provided by faculty in adjunct disciplines and by visiting physicians and scholars of note in endocrinology research and/or clinical practice. 

Medicine Grand Rounds --Weekly presentations by faculty, chief residents, and prominent experts on various topics covering all medicine subspecialties with three to four sessions per year dedicated exclusively to endocrinology.  The final GR each month is a Morbidity & Mortality conference lead by the medicine chief fellow and a faculty facilitator.  Endocrine fellows are required to attend all GR sessions.Read More

 

Sincerely, 

Dragana Lovre, MD, Program Director 

 

Vivian Fonseca, MD, Associate Program Director

Tumor Board --A multi-specialty joint conference with endocrinology, general and endocrine surgery, radiology, pathology, and other specialties which is directed by the head of endocrine surgery,  Emad Kandil, MD.  The conference is held on the 4th Wednesday of each month at Tulane's Cancer Center where slides can be viewed using the most technically advanced equipment.  Endocrine fellows and other members of the team provide and examine challenging endocrine pathologies.

Endocrine University --Each March, the program director nominates senior fellows to attend a week at Endocrine University held at the Mayo Clinic in Rochester NY.  Sponsored by the American Association of Clinical Endocrinologists (AACE) and the Mayo Clinic Division of endocrinology, the curriculum is designed to help prepare fellows for entering clinical practice with the coverage of topics such as thyroid ultrasound and fine needle aspiration, bone, endocrine laboratory and genetic testing, insulin pump and sensor hands-on instruction, practice management issues, and meet the expect sessions. 

Endocrine Society In-Service Exam--Each April, both PGY 4s and 5s are enrolled in the Endocrine Society's Self-Assessment Program-In Training Exam.  Although designed for second-year clinical endocrine fellows, first year trainees benefit as well from exposure to the topics and the types of questions that appear on the ABIM certifying exam in endocrinology.  Exam results include full answers to all exam questions and may serve as an excellent learning and review tool for trainees.

Teaching--Fellows interact with residents and students in a supervisory/teaching capacity in clinic and and reinforce their own training in the course of this interaction.  Along with issuing assignments and guiding students during endocrine clinics and inpatient rounds, fellows are encouraged to rehearse their own presentations before residents/students as preface to formal presentation before faculty and/or a larger audience at national meetings.  Fellows also have the opportunity of teaching patients in a group setting once a month at TUHC's Diabetes Education Center.

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