The inpatient and outpatient clinical experiences will cover the broad range of endocrine diseases. Clinical rotations are conducted primarily at Brigham and Women's Hospital/Dana-Farber Cancer Institute (BWH/DFCI), and all fellows also rotate at Boston Children's Hospital (BCH) and Massachusetts General Hospital (MGH).
Inpatient Rotations
Typically, first year endocrine fellows spend nine months performing inpatient consultations at BWH. With the supervision of the attending endocrinology faculty, fellows perform the initial evaluation and provide ongoing diagnostic and management recommendations to the primary inpatient care teams. Teaching rounds occur Monday through Friday and ad hoc on weekends. These rounds are designed for education, presentation of new patients, and discussion of ongoing cases and treatment plans.
Each first year fellow will cover approximately fourteen weekends throughout the academic year. Holiday coverage is split evenly between the first year fellows.
Outpatient Rotations
First year fellows typically participate in two to five clinics per week, spanning the breadth of endocrinology and allowing the fellows to work closely with experts in the field.
The clinics include continuity clinics where the fellows can follow their own patient panel:
- Fellows’ General Endocrine Longitudinal Clinic (weekly)
- Fellows’ Diabetes Clinic (weekly). Fellows see patients with complex diabetes, including patients with insulin pumps and with continuous glucose monitors (CGM). Fellows are also involved in the pre- and post-procedure care for patients undergoing transplants (renal, pancreas, heart, lung) and islet cell autotransplants.
- Thyroid Clinic (monthly). Fellows see patients with hypo- and hyperthyroidism, thyroid nodules, and thyroid cancer.
In addition, the fellows rotate through a range of subspecialty clinics, including:
- Neuroendocrine Clinic (monthly). Fellows see a range of patients with functional and non-functional masses of the pituitary and hypothalamus, and care for patients with hypopituitarism.
- Adrenal clinic (every other month). Fellows see patients with adrenal nodules, adrenal cancer, adrenal insufficiency, Cushing’s syndrome, hyperaldosteronism, and pheochromocytomas.
- Thyroid Biopsy Clinic. Fellows perform fine needle aspiration biopsies of thyroid nodules.
- Skeletal Health and Osteoporosis Clinic. This includes training in reading bone mineral density (DXA) reports.
- Diabetes in Pregnancy Clinic. Fellows see patients with pre-pregnancy type 1 and type 2 diabetes, gestational diabetes and other endocrine diseases in pregnancy in collaboration with BWH Maternal Fetal Medicine.
- Reproductive Endocrine / IVF clinic: Fellows assist staff in the Center for Infertility and Reproductive Surgery with assisting infertile couples achieve successful pregnancies via advanced endocrine methods.
- Men’s Health/Andrology: The fellows see patients with a range of derangements of normal male gonadal function, such as male hypogonadism, erectile dysfunction, etc.
- Pediatric Endocrine Clinic: This rotation takes place at Boston Children’s Hospital, where the fellows work closely with endocrine faculty seeing patients with pediatric endocrine disorders with relevance for the adult endocrinologist, such as disorders of growth and puberty.
- Lipid/Prevention Clinic. The fellows work with endocrinologists specializing in the management of complex lipid disorders, including dyslipidemia in statin-intolerant patients and genetic lipid disorders. This rotation takes place at Massachusetts General Hospital (MGH).
- Weight Management: The fellows are part of a multidisciplinary team that implements rigorous lifestyle changes to assist patients with weight loss through non-surgical means. Some sessions are dedicated to patient counseling, including referrals to bariatric surgery when appropriate.
- Female Reproductive Endocrinology. The fellows see patients with common and uncommon disorders of the female reproductive system, such as PCOS, amenorrhea, hirsutism and complicated menopause.
- Endocrine Genetics. Fellows work with genetic counselors and endocrinologists with expertise in genetic endocrine disease to evaluate patients for these conditions.
- Transgender Health. Fellows have the opportunity to get experience in managing gender-affirming hormones through the BWH Center for Transgender Health.
The clinical experiences in the second and third year of fellowship depends on the track:
- Fellows in the Research track cover the inpatient service for approximately 2 weeks per year and cover approximately 3 weekends each per year. They participate in a weekly General Endocrine Longitudinal Clinic, which can be replaced with a subspecialty focused clinic upon fellow request. Some of the above subspecialty clinics are scheduled in the second year, and fellows may also schedule additional clinical rotations on an elective basis. Final-year fellows can be offered to act as attendings in their continuity clinic, on a case-by-case basis. The rest of the time is reserved for research.
- Fellows in the Academic Leadership track cover the inpatient service for approximately 8 weeks in their second year, none in their third year. They cover approximately 4 weekends per year. Second- and third-year fellows are expected to have 4 clinics per week, with the exact focus of these clinics to be determined based on the fellow’s clinical interests. In the final year, fellows act as attendings.
