Clinical Training

The University of New Mexico offers a comprehensive two-year training curriculum in the clinical aspects of Endocrinology, Diabetes, and Metabolism. Endocrinology fellows are assigned to clinical duties for nine months during their first year of training, and three months during their second year. Fellows (in conjunction with assigned Internal Medicine housestaff and students) participate in Inpatient Endocrinology consultations at two large, tertiary care hospitals which serve as referral facilities for much of the southwestern region: the 350-bed University of New Mexico hospital, and the 400-bed Albuquerque Veterans Administration hospital. Consultations typically cover the breadth of endocrinologic disease, allowing excellent exposure to challenging and rewarding problems in patient management.

The outpatient clinical experience is similarly diverse. The fellows attend weekly continuity specialty clinics at both the University and VA hospitals. First year fellows also participate in pediatric endocrinology and reproductive endocrinology clinics. This provides the opportunity to build a patient base and to follow patients long-term as diseases evolve and management issues change.

Perhaps the greatest degree of learning occurs in the numerous clinical conferences that occur year-round at the University of New Mexico Hospital. Organization of these conferences is the primary responsibility of the clinical fellow. They include:

§ A weekly clinical case conference. Interesting and/or problematic cases are presented and discussed by the department members with frequent reference to the relevant medical literature.

§ A semi-weekly textbook review conference. The conference is designed to cover the fundamentals of endocrinology over the course of the two-year curriculum and to provide preparation for the national board examination in Endocrinology and Metabolism.

§ A monthly endocrine pathology conference. Surgical pathology specimens and thyroid aspirate cytology specimens are reviewed with members of the pathology department.

§ A monthly neuro-endocrine conference. Current radiologic studies are reviewed with members of the neuroradiology department.

§ A monthly nuclear-endocrine conference. Isotopic studies of bone and the thyroid are reviewed and discussed.

§ A monthly journal club. Current articles are discussed in detail.

 Research Training

All fellows in the University of New Mexico program are expected to become involved in some of the many on-going departmental research projects. The University of New Mexico has a strong reputation for producing important metabolic research. It is one of the foremost philosophies of the department that all endocrinologists, whether pursuing careers in academic or private medicine, need to develop an appreciation and understanding of the important scientific questions pertaining to metabolic disease and the methods used to address these questions in a laboratory or controlled clinical setting. Thus, it is a major goal of the training program that fellows develop their own interest and expertise in endocrinologic research.

Research activities are allotted equal time to clinical duties during the first two years of training, and an optional third year of training devoted entirely to research is available to individuals interested in an academic career. First year fellows spend three (3) months performing research with one of the department members, during which time they are expected to identify both a mentor among the department faculty and a potential research question to address during their second year. Second year fellows are allotted nine (9) months for research pursuits. Research duties are performed in conjunction with selected faculty members, and they include:

The formulation of a relevant question and development of a plan for addressing the question scientifically.

Drafting a description of the experimental protocol and guiding it through the necessary review process at UNM.

Patient recruitment and performance of all necessary clinical or laboratory studies.

Data analysis and preparation of scientific abstracts and/or manuscripts.

Presentation of study results at the appropriate regional or national scientific meetings.

Grant preparation in anticipation of becoming an independent investigator.

Research facilities at the University of New Mexico are state-of-the-art, due in large part to the presence of a six-bed General Clinical Research Center (GCRC). The GCRC receives funding support through the National Institutes of Health. This unit is frequently busy with endocrine and metabolism related research. GCRC support provides access to many useful (and expensive!) research tools that can improve the quality and merit of any given project.

Members of the University of New Mexico endocrinology section perform a diverse spectrum of research. This variety of research allows fellows exposure to virtually any avenue of investigation that they wish to pursue. The following is a brief description of the work being done by current faculty members:

 Dr. David Schade, Vice Chairman for Research, is interested in describing the pathophysiologic mechanisms of endocrine disease. He concentrates primarily on diabetes and the metabolic decompensation that occurs during diabetic ketoacidosis. He is involved in the development and assessment of new therapeutic agents and modalities, such as the use of growth hormone and insulin-like growth factor in the treatment of AIDS wasting syndrome.

  Dr. Patrick Boyle is the director of General Clinical Research Center. His clinical studies relate to diabetes mellitus, with a particular emphasis on describing the adaptation made by the central nervous system during brief and prolonged hypoglycemia.

 Dr. Richard Dorin is an expert in microbiologic techniques. He is interested in abnormalities of gene expression, especially in regards to the hypothalamic-pituitary regulation of corticotropin releasing hormone secretion.

  Dr. Mark Burge's clinical studies are designed to improve disease management in patients with diabetes mellitus. Current projects include investigation into the mechanisms of development of sulfonylurea-induced hypoglycemia, and studies designed to optimize the use of newly developed insulin analogues. He is involved with intervention development to prevent diabetes in at-risk patients, and he studies the role of blood glucose in carbohydrate malabsorption.

  Dr Kathleen Colleran is the Program director for the Division of Endocrinology and Metabolism. Her research interests are in cardiovascular disease risk factors, endothelial function and oxidative stress. She is the Medical Director of the Cardiovascular Risk Reduction Clinic.

 Structured Curriculum

Professional goals of the Endocrinology & Metabolism Fellowship:

 Clinical practice/competence

Textbook familiarity with normal and abnormal pathophysiology

Hands-on experience with normal and abnormal clinical endocrinology

Clinical and hospital experience in gathering data, stimulation and suppression testing, radiological imaging, nuclear medicine challenging, and interpretation of findings

Personal responsibility for fostering in-patient and family interaction regarding endocrine pathologies

Teaching and mentoring experience. Responsibility in normal and abnormal pathophysiology with medical students and residents

Sophisticated communication. Ability to use verbal and nonverbal skills when discussing endocrinology patients with referring physicians

Detailed understanding of current costs of diagnosis and therapy of endocrinopathies

 Clinical research competence

Grant writing
§ Writing an abstract
§ Presenting a 10 minute research talk at a regional/national meeting
§ Writing a case report
§ Writing a research manuscript
§ Writing a small research grant to industry
§ Writing a research proposal to a foundation
§ Understanding the process of preparing a research grant to NIH
 Experimental design: 
§ Bench research technology (radioimmunoassay, radio ELIZA assay, southern blot, ultracentrifugation, HPLC, mass spectrometry)
§ Biostatistical analysis (population epidemiology, T-test, Chi-square, non-parametric, compartmental kinetic analysis)
§ Clinical study experimental design (timing of sampling, diet preparation, family screening for pedigree, urine collection.)

 Clinical investigation: 
§ Investigator-initiated clinical investigation
§ Industry-initiated clinical investigation
§ Clinical investigation in response to an NIH RFLP, or VA cooperative study

 Communication expertise 
 Lecture to medical students, housestaff, faculty at noon-conference, grand rounds, and clinical update conferences for CME
 Writing skills in terms of abstracts, manuscripts, lectures, grants, and communications to other physicians

 Curriculum Objectives: 

 Achieve goals and objectives of housestaff curriculum.
 Organize and select three current articles for 12 Journal Club meetings. Use a computer search of the literature for each.
 Organize clinical cases for 50 weekly conferences. Include case presentation and literature review.
 Utilize and be authoritative about endocrine material in Endocrinology by Greenspan, and in Principles and Practice of Endocrinology by Becker.  Review and answer all endocrinology sample questions from the Board of Internal Medicine exam.
 Attend all Endocrine Conferences.

 Clinical Objectives:

 To become familiar with the most common clinical endocrine pathologies
 To become familiar with the endocrine clinical emergencies
 To become familiar with the investigation issues current in clinical endocrinology
 To develop a friendship with the endocrine faculty

 Specific Common Clinical Endocrinology Diseases:

§ Diabetes mellitus
§ Obesity
§ Thyroid disorders
§ Parathyroid disorders
§ Pituitary disorders of all trophic hormones
§ Hypothalamic disorders
§ Gonadal disorders
§ Impotence
§ Infertility
§ Genetic diseases
§ Metabolic bone disease
§ Hyponatremia
§ Lipoprotein disorders
§ Adrenal disorders

 Endocrine Emergencies:

§ Diabetic ketoacidosis
§ Hyponatremia
§ Hypernatremia
§ Hyperosmolar coma
§ Adrenal crisis
§ Thyroid storm
§ Hypoglycemia

Components of Familiarity:

§ Understanding of pathophysiology
§ Understanding of natural history
§ Understanding of therapeutic interventions
§ Understanding of longitudinal clinical and laboratory evaluation
§ Understanding questions and issues that need to be resolved
§ Having access to appropriate text and serial literature

Evaluation process:

 Evaluation of fellows
Fellows are evaluated quarterly by the endocrinology faculty. Each faculty member completes a written evaluation form. These forms are kept in the fellows' cumulative file.
The written evaluation forms are discussed with each fellow during a meeting with the program director.
The fellow responds to the evaluations and makes a plan for the next quarter.
The faculty is present during conduct of procedures, and document the experience in the chart. The fellow maintains a record of procedures performed that is reviewed at six-month evaluations with the division chief.

 Evaluation of faculty
Each fellow fills out written evaluation forms for faculty members at six-month intervals.
At the time of the reviews, the fellows are asked to fill out an evaluation form on each of the key faculty. This form is discussed with the division chief at the time of the bi-annual meeting.

 Evaluation of program by staff and fellows
Staff and fellows periodically evaluate the training program.
When a problem area of problem is identified, the fellows are asked to explain their issues and the faculty meets to discuss and brainstorm solutions. A solution is presented to the fellows for feedback and approval or further comments.
Periodically the program outline is revised and augmented as needed to meet the changing needs of the fellows and faculty.

 Texts:
Fellows are urged to utilize the copies of Greenspan and Forsham, Basic and Clinical Endocrinology. Copies of many endocrinology texts are available in each faculty member's office. The use of computer searches is urged at every opportunity, with ad hoc discussion at any time.


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