Duration: 3 years
Prerequisite Training: Applicants must have completed a certified residency program prior to starting fellowship
VISAS accepted by Program: J-1

The UCI/CHOC Pediatric Endocrinology Fellowship program is a three-year program designed to provide in-depth training for board eligible/ board certified pediatricians for an independent career in academic and clinical pediatric endocrinology and diabetes.  We aim to provide the fellow with:
• Structured one-on-one mentoring to help guide their chosen career path
• Opportunities for conducting and presenting research (basic science, translational, clinical and educational) as well as quality improvement projects
• Promoting a collaborative culture and ensuring protection to the fellow to ensure wellness and minimize “burnout”
• Experience to provide patient-centered, evidence-based, high quality and innovative care to patients and their families.

Goals & Objectives
In accordance with the ACGME, the first year of fellowship program will be largely dedicated to acquiring clinical skills in pediatric endocrinology.  The second and third years will mainly be focused on the research training in either clinical or basic laboratory research.

The general expectations and responsibilities of the fellows are as follows:
• Fellows will communicate with attending physicians and consulting services.
• Fellows assume progressive responsibility for patient care.
• Fellows are expected to actively seek the most up-to date information to guide practice.
• Fellows take an active role in teaching medical students and residents through bedside teaching, morning reports, noon conferences, and grand rounds.
• With the assistance of the Scholarly Oversight Committee (SOC), fellows will be required to initiate and complete a scholarly project in either clinical or basic science research that meets ACGME program requirements.
• Fellows scholarly progress will be monitored by the Scholarly Oversight Committee (SOC) on a semiannual basis.
• Fellow progress will be assessed through a Clinical Competency Committee (CCC).
• Fellows will receive education and participate in a quality improvement project.

• As part of the UCI system, fellows will have a housing stipend ($2,900/ year), professional licensure and exam stipend ($1,000) and also get white coats/laundering service.
• The Pediatric Endocrinology Fellowship program will provide up to $1,500 per year for each fellows’ educational needs, such as books, software, and board review courses (for example, the AAP’s online PREP ID Self-Assessment) Educational conferences ($2,000/ year)
• Health insurance, dental insurance, disability insurance, mental health insurance.

The first year is structured to provide extensive clinical training focused on both outpatient and inpatient endocrine/ diabetes disorders, supervised by an attending physician from the division to provide a quality education experience. The fellow will be expected to become proficient in diagnosis and management of the common endocrine disorders, as well as become familiar with the psychosocial and ethical aspects of care for these patients. The large volume and broad range of endocrine pathology seen by CHOC endocrinologists ensures an optimal clinical experience for endocrine fellows. Fellows will be trained in the following areas: Endocrine focused history and physical examination; Interpretation of auxological data; Performance and interpretation of endocrine related diagnostic tests; and care of patients in the outpatient, inpatient and intensive care.

Rotations will follow a 13-block template where the fellow will rotate every one to two weeks between: Inpatient Diabetes and Endocrine service/ Consult service, and outpatient Endocrine and Diabetes clinics/ specialty clinics/ continuity clinics. The assignment of rotations will be structured so as to minimize the frequency of transitions and be sufficient to provide continuity of patient care, supervision, opportunities to build longitudinal relationships with faculty members who will in turn provide quality and meaningful assessment and feedback. During the first year, the fellow will also have 4 weeks total of protected research time to allow for collaboration with an attending on designing a scholarly project, that may translate into a presentation at a local/national or international meeting.

Our inpatient service is quite robust and the fellow will be exposed to a plethora of different endocrinopathies including diabetes mellitus, hypoglycemia, ambiguous genitalia, disorders of calcium homeostasis, abnormal thyroid function tests, adrenal insufficiency, and diabetes insipidus to list a few. The fellow will be expected to work closely with the attending physician on service and other team members (Nurse Educators, Nurse Practitioners, Social Workers, Dieticians, Nurses, Psychologists).

In addition, the fellow will gain experience in teaching, at the bedside, by leading rounds, and in formal sessions, to residents and other trainees about common endocrine conditions and their management.

During the first year, the fellow will establish a continuity clinic from former inpatient consultations as well as referrals from the community where he/she will then provide longitudinal care. All patients are seen in conjunction with a faculty member with direct supervisory care.

During the outpatient clinic rotations, the fellow will also rotate through various subspecialty clinics to see patients with attending physicians in the division. This allows exposure to a broad range of diagnoses, and management styles. For example, the fellow will participate in specialty clinics in Thyroid Cancer, Cancer Survivorship, Turner syndrome, Disorder of Sex Development, Congenital Adrenal Hyperplasia, Klinefelter syndrome, Transgender care, Red Cell clinic, Prader-Willi Syndrome clinic, and Type 2 Diabetes.

The second and third years are largely devoted to clinical or basic research with a mentor(s) chosen by the fellow, based on the area of interest. During these two years, the fellow will be expected to gain experience in study design, conducting hypothesis-driven research, laboratory methodology, statistical analysis, IRB preparation, and if applicable, grant preparation and submission. The fellowship research project is expected to culminate in the submission of at least one manuscript to a peer-reviewed journal or translate into ACGME accepted scholarly activity. The fellow has a wide choice of possible mentors at the Children's Hospital of Orange County and the University of California at Irvine and will have access to the generous resources available at both CHOC and UCI as they conduct their research.

The fellow is required to attend and present his or her research at institutional, local and national meetings. Although largely research based, the senior fellows will also continue to conduct his/her weekly continuity/ specialty clinics and continue taking call on the weekday and weekend in line with the call schedule. The second and third year fellow will also do a total of four and three weeks, respectively, of inpatient duties to help further solidify their clinical skills.

The continuity clinics will continue throughout the first, second, and third years of fellowship. These will be supervised by the attending physician. This clinic minimizes transitions by providing continuity of patient care and will also serve to receive ongoing supervision through longitudinal relationships with faculty members who provide assessment and meaningful feedback.

The fellowship program will require the senior fellows to organize and administer the logistics of scheduling for the other fellows. This will include the on-call schedule, time-off, time away for conferences and emergency coverage.

The fellow will also participate in educational conferences/ lectures and be required to serve on a hospital wide committee of choice, such as quality improvement. In regards to teaching, the fellow will participate in both bedside and formal lecture based conferences to the pediatric residents, medical students, and the endocrine division including:

• Endocrine grand rounds: 1 or 2 lectures per year pertaining to Endocrine topics
• Journal Club: Fellow chooses and reviews, using Evidence-Based techniques, a recent journal article relevant to Endocrinology; once or twice yearly.
• Fellow Case Conference: fellows bring challenging cases from their clinic to discuss with attending and other fellows. This is an opportunity to get management advice on their toughest patients as well as learn from other fellows’ cases and other perspectives from attending physicians.
• Noon conference and/or morning report—provide 1-2 lectures per year to the Pediatric Residency program, other divisions, and outside hospitals as part of community outreach. Additional division education: every Wednesday morning there will be a division-wide clinical conference. This is an informal opportunity for any provider to present a challenging clinical case (inpatient, outpatient, or consults) to the group to receive input. This conference is not always fellow driven, but participation will be encouraged to further the learning experience. The conference series is also held every Wednesday and is designed to review ABP content specifications in order to successfully prepare the fellow to sit for the pediatric endocrinology boards. The faculty and fellow are both responsible for administering lectures in this conference series.

All fellows are directly supervised by faculty members (CHOC, UCI) specific to that rotation. This attending physician will always be available to the fellow and can serve as a back-up call in situations of fatigue. It is the responsibility of the fellow to communicate effectively and in a timely fashion with the attending physician as well as other team members. At each stage of training, the goal is to provide a level of supervision that ensures patient safety and maximizes education and promoting the fellow’s progress towards independence and autonomy. The expectation of the faculty and other team members then is to provide ongoing feedback as part of the 360° evaluations.

Clinical activity occurs at the CHOC Hospital in Orange County (Orange and Newport Beach, CA).

• Inpatient: Fellows spend a total of ~7 months on the inpatient service, ~5 months in the first year, 4 weeks in the second year and 3 weeks in their third year.
• Outpatient: Fellows spend a total of ~5 months in their first year and ~2 months in their second and third years of training. This outpatient clinical experience includes the weekly continuity endocrine clinics and diabetes clinics, and subspecialty clinics (e.g. transgender, disorders of sex development, Turner syndrome.
• Continuity clinic begins in the first year of fellowship allowing fellows to follow a cohort of patients through their three years of training.

After-hours call for pediatric endocrine fellows is "at home call" and will start at 4:30 pm and continue until 7 am the following morning. This will require the fellow to answer phone calls from parents of patients, outpatient phone consults and inpatient consults (ED & community physicians). Rarely will this require going to the hospital after hours for an urgent consult. First year pediatric endocrine fellows take call up to 7 days per month, including one weekend. Second and third year pediatric endocrine fellows take call up to 7 days per month, including one weekend.

As research is an integral part of fellowship, this will begin in the first year to provide the fellow an opportunity to conduct research, choose an area of interest for scholarly activity, identify a mentor and commence research. In the first year, fellows have 4 weeks dedicated to research to allow for the identification of a mentor and a project. Fellows will then prepare a research proposal with the guidance of the mentor.

With the guidance from the program director, the fellows will select a Scholarly Oversight Committee (SOC) to help oversee their research design and progress.

The SOC is composed of at least 3 faculty members who:

Meet with the fellow as a group at least twice per year
Review the training progress of the fellow
Making recommendations to the fellow regarding aspects of their progress.

During the 2nd and 3rd year of fellowship, fellows are expected to complete 2 years of research training.
- 80% of their time will be spent working on research projects under the direction of a primary mentor.
- Progress will be assessed by the research mentor, SOC and CCC.
- Fellows will be encouraged to submit abstracts to national meetings, submit and publish study results and consider submission of grant applications.
- Fellows will receive education regarding study design, IRB preparation, epidemiology, biostatistics and other elements to help promote a successful research project from the research mentor, pediatric endocrine faculty, and the Fellow’s Core Curriculum. Multiple scholarly opportunities exist within the division as well as with collaboration with other sections of the Department of Pediatrics and University of California at Irvine.
- The Islet Program at UCI offers the fellow a unique experience in diabetes bench research (e.g. islet transplantation) with direct mentorship and supervision.

Himala Kashmiri, DO – Program Director. Assistant Clinical Professor of Pediatrics, UC Irvine School of Medicine. Publications and research interests include growth, thyroid cancer, and disorders of sex development.
The program director shall ensure the fellow fulfills the requirements of the ACGME related to the six general core competencies. The program director will also be responsible for creation of a core curriculum in scholarly activities, incorporate feedback and responsibilities to guide the fellow in his/her career path, help the fellow identify a mentor, participate in the Scholarship Oversight Committee responsible for overseeing and assessing the progress of each trainee, and provide verification to the ABP of the successful completion of training of the fellow.

Mark Daniels, MD – Division Chief. Associate Clinical Professor of Pediatric, UC Irvine School of Medicine. Publications and research interests include diabetes, transgender and endocrinopathies in long-term cancers.

Amrit Bhangoo, MD – Assistant Clinical Professor of Pediatrics, UC Irvine School of Medicine. Publications and research interests include growth disorders, disorders of sex differentiation, insulin resistance

Timothy Flannery, MD – Assistant Clinical Professor of Pediatrics, UC Irvine School of Medicine. Publications and research interests include growth disorders, pituitary and calcium disorders.

Nikta Forghani, MD – Assistant Clinical Professor of Pediatrics, UC Irvine School of Medicine. Publications and research interests include Turner syndrome, transgender, and ovarian failure.

Sejal Kadakia, MD – Assistant Clinical Professor of Pediatrics, UC Irvine School of Medicine. Publications and research interests include Prader-Willi syndrome, thyroid cancer, type 1 diabetes.

Christina Reh, MD – Assistant Clinical Professor of Pediatrics, UC Irvine School of Medicine. Publications and research interests include cystic fibrosis related diabetes, transgender, and Turner syndrome.

Lien Trinh, MD – Assistant Clinical Professor of Pediatrics, UC Irvine School of Medicine. Publications and research interests include congenital adrenal hyperplasia, long term cancer survivorship, and Prader-Willi syndrome.

Daina Dreimane, MD – Assistant Clinical Professor of Pediatrics, UC Irvine School of Medicine. Publications and research interests include type 2 diabetes and diabetes technology.

In addition, our team includes 3 licensed nurse practitioners, 9 diabetes educators, 3 dieticians, a psychologist, and a social worker. We are an ADA accredited program and offer patients and their families a highly educational diabetes and pump program with a variety of classes available.

The “Lecture Series” are designed to emphasize the ABP content specifications for required material to successfully pass the Pediatric Endocrinology certification exam and covers a broad range of endocrine topics.

• Faculty will provide weekly lectures, but the fellows will also take a role in presenting to allow for development of presentation skills and knowledge-based teaching.
• Core topics are covered in a curriculum so to provide a repetition of core topics at least twice during his/ her fellowship. Assignments are varied based on each fellow’s interests and each fellows’ knowledge base.
• Attendance is required and monitored.

• Grand Rounds is Wednesdays from 8-9 am.
• These conferences provide updates and reviews on a broad range of both general pediatric and subspecialty pediatric topics.
• Attendance is encouraged at pertinent conferences. Fellows will also give Grand Rounds with the supervision of a faculty mentor, if desired.

• Weekly meeting between 9-9:30 to discuss clinic operations, business development, QI discussions.
• The fellow will have exposure and an opportunity to participate in the administrative aspect of the division.

Endocrine Case Conference
• Case(s) presentation of diabetic and endocrine cases generated from the outpatient and/or inpatient setting.
• The fellow will be required to participate and will be encouraged to present cases for discussion and provide opportunities for education.

Disorder of Sex Development Conference
• This is a monthly multidisciplinary conference with our pediatric urology team, medical geneticist, and psychologist or psychiatrist (if needed) to discuss the presentation and management needed in patients with disorders of sex development.

Pediatric Med/Surg Morbidity and Mortality Conference
• Fellow will participate in discussions in the morbidity and mortality case discussions in a variety of different divisions including PICU and NICU.

Monthly Conferences
Journal Club
• A rotating schedule for faculty presenters and fellow will be made to present and lead a discussion on a peer-reviewed evidence based Endocrine topic. Research methodology, strength of study, clinical applications, study design, and statistics are amongst the potential discussion topics.

Fellows’ Core Curriculum
• Fellow is expected to participate and attend a joint fellowship curriculum with other pediatric subspecialty fellows on a variety of topics including epidemiology, biostatistics, clinical and lab research methodology, study design, grant preparation, principles of EBM, research ethics, teaching, professionalism, systems-based practice.

• These are monthly multidisciplinary rounds with our social worker, psychiatrist, psychologist, therapists, CDE’s, RN’s and rotating residents to discuss patients with challenging psychosocial situations.

• The fellow will be expected to present an Endocrine topic to the General Pediatric Residents on a variety of different topics. This morning report is quarterly and will not always be led by the same fellow, as an attending may also be part of this rotation to present on Endocrine Topic to the general pediatric residents.
• The fellow will be required to give at least one lecture per year to the residents as part of their noon conference on an Endocrine topic. This will provide the fellow an opportunity to be an educator and present endocrine specific topics that meet ABP specifications in general pediatrics.

In an effort to continually improve all aspects of our pediatric endocrinology program and in order to meet the standards put forth by the ACGME for competency-based learning, we encourage our fellows to perform a quality improvement (QI) project during training which may also be a scholarly project if deemed applicable.  For a successful QI project, access to data on quality metrics and benchmarks related to his/her patient populations will be essential.  The QI project must identify and institute a sustainable systems-based change to improve patient care.

• This project can be anything that improves our core mission of education, research, and clinical care. Examples of such projects that have been completed include updating the DKA protocol and establishing neonatal hypoglycemia care guidelines.
• During the 1st and 2nd year fellows choose a QI project, coordinate with an attending for guidance, and implement the change.
• Documentation of the effort involved in completing the QI project must be maintained by the fellow and copies provided to the fellowship coordinator.

• Fellows are required to take the ABP in-training examination annually. The examination provides important content-based feedback by determining individual strengths and weaknesses in knowledge.
• Examination scores are considered a relevant measure of the fellow’s clinical performance.