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 achieves 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 Drs. Jennifer Kirby and Anthony McCall—provides targeted post-operative 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 housestaff/fellows
and staffed by UVa faculty. There are no private patients at the
University Hospital, and our fellows do not rotate to other
hospitals/clinics for training. (Although the Division staffs clinics
in surrounding cities, fellows are not required to participate in
clinics outside of Charlottesville.) 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 and ovarian ultrasound units. Dynamic endocrine testing
is performed in the clinic by trained endocrine nurses, and cytology
services are readily available. UVa employs a fully electronic medical
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 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 call. The typical census includes 12-15 patients 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 performs 150-250 transphenoidal pituitary operations and over 50 gamma knife radiosurgery procedures each year. This service has an international reputation, routinely 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.
- Research in Progress (8:30–9:30 am, each 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 excepting Journal Club days): Faculty give didactic lectures on a wide array of clinical topics.
- Journal Club (2:00–3:00 pm, second Tuesday of the month): Fellows and a faculty member review a recent scientific publication, focusing on methods (e.g., study design, statistical analysis) and clinical relevance.
- Multidisciplinary Thyroid Cancer Case Conference (4:00–5:00 pm, last Tuesday of the month): 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 (8:00–9:00 am, fourth Friday of the month): Details regarding 6-8 pituitary cases are discussed by faculty/fellows from Endocrinology, Neurosurgery, Neuroradiology, and Neuropathology.
- Endocrine Morbidity and Mortality and Quality Improvement Conference (every 3 months): The division discusses specific complications or near misses that highlight a need/opportunity to modify behavior and/or systems to enhance quality of care on a division-wide level.
- Fellowship Quality Improvement (QI) Conference
(every 3 months): This conference time is used to discuss QI principles
and to formulate, trouble-shoot, and receive guidance on fellow-driven
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 are required to 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.