UCI-CHOC Pediatric Endocrinology Fellowship Program

The first year is structured to provide extensive clinical training focused on both outpatient and inpatient endocrine and diabetes disorders, supervised by an attending physician from the division to ensure a high-quality educational experience. The fellow will be expected to become proficient in the 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 Rady Children’s Health endocrinologists ensure 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
• Care of patients in the outpatient, inpatient and intensive care.

Rotations will follow a 13-block template, with the fellow rotating every one to two weeks between inpatient diabetes and endocrine service, consult service, and outpatient endocrine and diabetes clinics, specialty clinics and 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 a total of four weeks of protected research time to collaborate with an attending on designing a scholarly project, which may result in 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:

• Diabetes mellitus
• Hypoglycemia
• Ambiguous genitalia
• Disorders of calcium homeostasis
• Adrenal insufficiency
• Diabetes

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).

The fellow will gain experience in teaching, at the bedside, 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 and community referrals, providing longitudinal care. All patients are seen in conjunction with a faculty member with direct supervisory care.

During outpatient clinic rotations, the fellow will also rotate through various subspecialty clinics, including:

• Thyroid cancer
• Cancer survivorship
• Turner syndrome
• Differences of sex development
• Congenital adrenal hyperplasia
• Klinefelter syndrome
• Red cell
• Prader-Willi syndrome
• Obesity
• Adrenoleukodystrophy
• Bone/osteogenesis imperfecta
• Type 2 diabetes clinics.

The second and third years are largely devoted to clinical or basic research with mentor(s) chosen by the fellow based on their area of interest. During these two years, fellows are expected to gain experience in:

• Study design
• Conducting hypothesis-driven research
• Laboratory methodology
• Statistical analysis
• Institutional Review Board (IRB) preparation
• Grant preparation and submission (if applicable)

The fellowship research project is expected to culminate in:

• Submission of at least one manuscript to a peer-reviewed journal, or
• Completion of an ACGME-accepted scholarly activity

Fellows have access to a wide range of mentors at Rady Children’s Health in Orange County and the University of California, Irvine, as well as the extensive research resources available at both institutions.

Fellows are required to attend and present their research at:

• Institutional meetings
• Local meetings
• National meetings

Although primarily research-focused, senior fellows will continue to:

• Participate in weekly continuity clinics
• Attend specialty clinics
• Take weekday and weekend call, in accordance with the call schedule

Second- and third-year fellows will also complete inpatient clinical duties to maintain and strengthen their clinical expertise:

• Second year: 12 weeks
• Third year: 8 weeks

Continuity clinics are integrated throughout all three years of fellowship and are supervised by attending physicians. These clinics promote consistent, longitudinal patient care while minimizing transitions. They also provide ongoing supervision and support, allowing fellows to build lasting relationships with faculty who offer regular assessment and meaningful feedback.

The fellowship program will require the senior fellows to organize and administer the scheduling logistics 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 and lectures and will be required to serve on a hospital-wide committee of choice, such as a quality improvement committee.

In regard to teaching, the fellow will participate in both bedside and formal lecture-based conferences for the pediatric residents, medical students and the endocrine division, including:

• Endocrine Grand Rounds: One to two lectures per year on endocrine topics.
• Journal Club: The fellow selects and reviews a recent endocrinology journal article using evidence-based techniques once or twice per year.
• Fellow Case Conference: Fellows present challenging cases from their clinics for discussion with attending physicians and other fellows. This provides an opportunity to receive management guidance on complex patients and to learn from peers’ cases and faculty perspectives.
• Noon Conference and/or Morning Report: Fellows deliver four to six 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 is a division-wide clinical conference. This informal forum allows any provider to present a challenging clinical case (inpatient, outpatient or consult) to the group and receive input. While this conference is not always fellow-driven, participation is encouraged to enhance the learning experience.

Lecture Series: This conference series is also held every Wednesday and is designed to review ABP content specifications to prepare fellows for the pediatric endocrinology board exam. Both faculty and fellows are responsible for delivering lectures in this series. The curriculum spans approximately 16 months, allowing fellows to complete it twice during their fellowship.

All fellows are directly supervised by faculty members from Rady Children’s and UCI, specific to each rotation. The attending physician is always available to the fellow and may serve as backup call in situations of fatigue. Fellows are responsible for communicating effectively and in a timely manner with the attending physician and other team members. At each stage of training, supervision is structured to ensure patient safety while maximizing education and promoting the fellow’s progression toward independence and autonomy. Faculty and team members are expected to provide ongoing feedback as part of 360° evaluations.

All fellows are directly supervised by faculty members from Rady Children’s and UCI, specific to each rotation. The attending physician is always available to the fellow and may serve as backup call in situations of fatigue. Fellows are responsible for communicating effectively and in a timely manner with the attending physician and other team members. At each stage of training, supervision is structured to ensure patient safety while maximizing education and promoting the fellow’s progression toward independence and autonomy. Faculty and team members are expected to provide ongoing feedback as part of 360° evaluations.

After-hours call for pediatric endocrinology fellows is “at-home call” and begins at 4:30 p.m. and continues until 7 a.m. the following morning. This requires the fellow to respond to phone calls from parents of patients, outpatient consults (including emergency department and community physicians) and inpatient consults. Rarely, this may require going to the hospital after hours for an urgent consult.

First-year pediatric endocrinology fellows take call up to seven days per month, including one weekend. Second- and third-year pediatric endocrinology fellows also take call up to seven days per month, including one weekend. Third-year fellows have one call-free month.

As research is an integral part of the fellowship, it begins in the first year to provide fellows with the opportunity to choose an area of interest for scholarly activity, identify a mentor, and begin their research. During the first year, fellows have four weeks dedicated to research to support the identification of a mentor and the development of a project. Fellows then prepare a research proposal under their mentor’s guidance.

With guidance from the program director, fellows select a Scholarly Oversight Committee (SOC) to oversee their research design and progress. The SOC is composed of at least three faculty members who:

• Meet with the fellow as a group at least twice per year
• Review the fellow’s training progress
• Provide recommendations to the fellow regarding their progress

During the second and third years of fellowship, fellows are expected to complete two years of research training. Approximately 80% of their time will be dedicated to research projects under the direction of a primary mentor. Progress is assessed by the research mentor, Scholarly Oversight Committee (SOC) and Clinical Competency Committee (CCC).

Fellows are encouraged to:

• Submit abstracts to national meetings
• Publish study results
• Consider submitting grant applications

Fellows receive education in:

• Study design
• IRB preparation
• Epidemiology
• Biostatistics
• Other key elements to support successful research projects

This education is provided through guidance from their research mentor, pediatric endocrinology faculty and the fellows’ core curriculum. Multiple scholarly opportunities are available within the division and through collaborations with other sections of the Department of Pediatrics and the University of California, Irvine.

The Islet Program at UCI offers fellows a unique opportunity to participate in diabetes bench research (e.g., islet transplantation) with direct mentorship and supervision.

Lecture Series

The lecture series is designed to emphasize ABP content specifications and prepare fellows to successfully pass the pediatric endocrinology certification exam. It covers a broad range of endocrine topics.

Faculty provide weekly lectures, and fellows also participate in presentations to develop their presentation skills and knowledge-based teaching. Core topics are organized within a structured curriculum to ensure repetition at least twice during fellowship, as this is a 16-month curriculum. Assignments are tailored based on each fellow’s interests and knowledge base. Attendance is required and monitored.

Grand Rounds

Grand Rounds is held on Wednesdays from 8–9 a.m. These conferences provide updates and reviews on a broad range of general pediatric and subspecialty pediatric topics. Attendance is encouraged for relevant sessions. Fellows may also present at Grand Rounds under the supervision of a faculty mentor, if desired.

Endocrine Team Meeting

This is a weekly meeting held from 9–9:30 a.m. to discuss clinic operations, business development and quality improvement initiatives. Fellows are exposed to and have the opportunity to participate in the administrative aspects of the division.

Endocrine Case Conference

Case presentations of diabetes and endocrine cases generated from the outpatient and/or inpatient setting. Fellows are required to participate and are encouraged to present cases for discussion, providing opportunities for education.

Differences of Sex Development Conference

This is a monthly multidisciplinary conference with the pediatric urology team, medical geneticist and psychologist or psychiatrist (as needed) to discuss the presentation and management of patients with disorders of sex development.

Pediatric Med/Surg Morbidity and Mortality Conference

Fellows participate in morbidity and mortality case discussions across a variety of divisions, including the PICU and NICU.

Journal Club

A rotating schedule of faculty and fellows is established to present and lead discussions on peer-reviewed, evidence-based endocrine topics. Discussion topics may include research methodology, study design, statistical analysis, strength of evidence and clinical applications. This is a monthly conference.

Fellows’ Core Curriculum

Fellows are expected to participate in and attend a joint fellowship curriculum with other pediatric subspecialty fellows. Topics include epidemiology, biostatistics, clinical and laboratory research methodology, study design, grant preparation, principles of evidence-based medicine (EBM), research ethics, teaching, professionalism and systems-based practice.

Psychosocial Rounds

These are monthly multidisciplinary rounds with social workers, psychiatrists, psychologists, therapists, certified diabetes educators (CDEs), registered nurses (RNs) and rotating residents to discuss patients with challenging psychosocial situations.

Multidisciplinary Thyroid Cancer Conference

This is a monthly conference with nuclear medicine, ENT, case management and endocrinology to review thyroid cancer cases. The team also participates in a combined conference with CHLA.

Adult/Pediatric Case Conference

This is a twice-monthly case conference covering a variety of endocrine disorders in both adult and pediatric endocrinology.

Pediatric Residency Education

Fellows are expected to present endocrine topics to general pediatric residents on a variety of subjects. This morning report is held quarterly and may be led by either a fellow or an attending physician.

Fellows are also required to deliver at least one lecture per year to residents as part of the noon conference on an endocrine topic. This provides an opportunity for fellows to develop their teaching skills and present endocrine topics aligned with ABP specifications in general pediatrics.

In an effort to continually improve all aspects of the pediatric endocrinology program and to meet ACGME standards for competency-based learning, fellows are encouraged to complete a quality improvement (QI) project during training, which may also qualify as a scholarly project if applicable.

For a successful QI project, access to data on quality metrics and benchmarks related to the fellow’s patient population is essential. The project must identify and implement a sustainable, systems-based change to improve patient care.

• This project may focus on any initiative that improves the program’s core mission of education, research or clinical care. Examples of completed projects include updating the DKA protocol; establishing neonatal hypoglycemia care guidelines; developing a DI protocol; and improving compliance with adrenal insufficiency emergency letters.
• During the first and second years, fellows will select a QI project, coordinate with an attending physician for guidance and implement the change. Fellows are expected to complete at least two PDSA cycles for their QI project.
• Documentation of the effort involved in completing the QI project must be maintained by the fellow, with 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 identifying individual strengths and weaknesses in knowledge.

Examination scores are considered a relevant measure of the fellow’s clinical performance.