The curriculum for the Endocrinology Fellowship varies, depending upon whether a fellow and his or her mentor pursue the Clinical Scholar Track or Research Career Track. However, all clinical training includes patient care, procedures, elective rotations, didactic training and teaching opportunities.
Each rotation represents a focused learning experience in that subspecialty area supervised by a subspecialist.
Inpatient endocrine and diabetes consultation
On your first rotation on the inpatient Endocrinology and Diabetes Consulting Service, you manage straightforward to very complex cases of inpatient hyperglycemia.
Upon returning to the hospital later in the first year and again as a third-year fellow, your role evolves to that of a preceptor as you directly supervise and teach internal medicine residents learning diabetes management, while your consultations are focused on a wide range of inpatient endocrine pathology.
A large nurse practitioner and physician assistant team manages the vast majority of inpatients with diabetes — 6,108 consults in 2015 — allowing you to select the most educational cases from which to learn.
Outpatient subspecialty clinics
During the outpatient rotations, you rotate through all subspecialty teaching clinics (including thyroid, bone, pituitary-adrenal, metabolic, nutrition and more), where you focus on pragmatic and scholarly approaches to diagnostic and therapeutic endocrinology. In all rotations, fellows primarily see new consultations, working one-on-one with a staff endocrinologist who is a subspecialist in the area.
Fellows remain the primary endocrinologist for that patient for the duration of the evaluation at Mayo Clinic and may choose to continue to see the patient in their continuity clinic.
Your training involves hands-on diagnostic thyroid ultrasound and ultrasound-guided fine-needle aspiration (FNA) supervised by staff thyroidologists. The thyroid nodule clinic and rotation is structured such that fellows review the slides of the FNAs they performed and the final pathology is communicated to the patient the same day.
Fellows perform an average of 60 to 70 FNAs during fellowship. Interpretation of bone density by dual energy X-ray absorptiometry (DXA), insulin pump, and continuous glucose monitor are integrated into the outpatient clinic rotations. Fellows will readily meet requirements for competence in endocrine procedures as required for American Board of Internal Medicine (ABIM) endocrine board eligibility.
Based on career goals or to round out clinical experiences, fellows and faculty arrange to work together one-on-one for a week or longer. The fellow sees a concentrated subspecialty patient calendar, including patients with rare disorders followed long term by faculty.
You may spend your elective time pursuing additional clinical experiences in rotations of interest or in other departments with assistance from the program.
Examples of past electives include:
- Women's Health Clinic (menopause and female sexual dysfunction)
- Medical oncology (advanced endocrine neoplasia)
- Preventive cardiology
- Nuclear medicine (iodine 131 therapy)
- Behavioral psychology (motivational interviewing)
- Nephrology (nephrolithiasis clinic)
- Diabetes eye clinic
- Community endocrinology practices in the Mayo Clinic Health System
- Mayo Clinic's campuses in Florida or Arizona
Finally, the Mayo International Health Program coordinates and provides support for fellows to travel to established, underserved international sites for one month.
Staff endocrinologists perform bedside instruction and one-on-one informal teaching as a key teaching method on all rotations. Clinical case and topical conferences and research seminars presented by fellows, small discussion groups with expert faculty, and journal clubs are integral parts of the Endocrinology Fellowship.
Half-day workshops to introduce basic concepts of diabetes technology, thyroid ultrasound, communication and professionalism, quality improvement, cross-cultural medicine, medical education skills, manuscript preparation, grant writing, and other areas are routinely incorporated into your schedule.
The program scheduling, curriculum and evaluation are all managed by MedHub. Extensive electronic resources, including e-books and online journal access, are provided by the Mayo Clinic Libraries. Fellows can expect most, if not all, of the educational resources necessary to be provided by the program.
The Division of Endocrinology, Diabetes, Metabolism, & Nutrition is known internationally for the breadth and depth of its research activities, with expertise in practically every area of these fields. As a result of our research efforts, we had more than 260 peer-reviewed articles published by faculty in 2015.
Basic science support is provided in physiology, biochemistry and molecular biology, pharmacology, microbiology, genetics, immunology, cell biology, epidemiology, statistics, and other areas.
At Mayo, endocrinology fellows' research mentors closely supervise protocol development, the conduct of the study, data analysis and final manuscript preparation. Critical peer and institutional reviews at each stage help ensure high quality. Most Mayo fellows present their work at national meetings and publish several papers.
The integration of basic and clinical research into practice is one of the division's strengths. Some major areas of research include:
You have the opportunity to lecture and facilitate small group discussions in the Mayo Medical School endocrine physiology block. Fellows also routinely teach students and internal medicine residents rotating through our inpatient consulting service and outpatient endocrine clinics.
In addition to feedback after formal conference presentations, time is blocked for fellows to attend a workshop on how to give effective presentations. And in addition to an annual workshop on teaching presented by experienced medical educators and education scholars, course work and mentored experiences are available for fellows seeking to develop a career in medical education.
In addition to conferences in the Division of Endocrinology, Diabetes, Metabolism, & Nutrition, you will find topics of special interest in the dozens of other conferences given daily at Mayo Clinic. Many of these are available as video on demand.
The division's weekly schedule includes:
- Monday — Fellows' case discussion with an expert faculty member or clinical journal club*
- Tuesday — Endocrine Research Seminar or research journal club*
- Wednesday — Endocrine Grand Rounds (morning) and Internal Medicine Grand Rounds (noon)
- Thursday — Core Curriculum Lecture Series
- Friday — Fellows' topical conference*
*Fellows present at these conferences.
To ensure you achieve your greatest potential and to meet Accreditation Council for Graduate Medical Education Next Accreditation System requirements, your progression toward competence and beyond is assessed regularly.
In addition to informal face-to-face feedback, you are formally evaluated by your supervising faculty member after completing each rotation. Evaluations also include routine direct observation using a video-camera-equipped examination room in the clinic, stimulated chart recall, objective structured clinical examination (OSCE), multisource evaluations and an in-training examination.
You meet at least semiannually with the program director to review these evaluations. Endocrinology fellows typically progress to limited supervision in the third year based on these evaluations.