Endocrinology and Diabetes | Fellowship | Program Overview

The Washington University/St. Louis Children’s Hospital Pediatric Endocrinology Fellowship Program is a three-year comprehensive ACGME-accredited program for pediatricians interested in pursuing an academic medical career in pediatric endocrinology. Our mission is to provide excellence in patient care, teaching and research. The first year of the program focuses on clinical training, and the second and third years are dedicated to research training, either patient-oriented or basic laboratory research.

Clinical Training and Rotations

The first year of the program is dedicated primarily to clinical training in pediatric endocrinology while fellows begin planning their research project. The primary pediatric endocrinology clinical site is on campus at St. Louis Children’s Hospital. The fellows have a shared office in the adjacent administrative building. Each fellow is provided a clinical mentor from faculty.

All fellows are required to complete outpatient rotations in adult endocrinology, transgender care, and metabolic bone disease (at nearby Shriners Hospital St. Louis Center for Metabolic Bone Disease and Molecular Research). Additionally, fellows may choose to rotate through the following sub-specialty clinics: Cystic Fibrosis, Healthy Start (Obesity), Differences in Sex Development, Turner Syndrome, Neuro Oncology, Transition Clinic (transitioning from pediatric to adult diabetes care) and have the option to complete a rotation in Genetics.

During the first year, each fellow establishes a Continuity Clinic with patients assigned from inpatient admissions and referrals from the community. A rotation of faculty members provides direct supervision as the teaching attending, exposing fellows to a variety of management styles. A broad range of diagnoses are seen in outpatient clinic, with diabetics comprising approximately one-third of the patient mix and two-thirds general endocrinology. Fellows collaborate with diabetes educators, dieticians, social workers, nurse practitioners, and psychologists to provide optimal care to their patients.

The Inpatient Diabetes and Endocrine Service sees a high volume of diabetic patients, and a vast variety of endocrine disorders. Fellows work closely with the attending physician on service and lead daily rounds. During service, fellows’ academic time is protected so that they can attend didactic seminars without interruption.

Below is a table of clinical requirements during fellowship.

Currently call is taken from home.

Fellowship Year Inpatient Service ** Clinics per Week *
1 ~16 weeks 2
2 ~10 weeks 1
3 ~6 weeks*** 1

* All clinics are ½ day. Fellows participate in an additional ½ day clinic for new urgent patients during the time that they are on inpatient service.

** Fellows complete a minimum of 32 weeks of inpatient service over the three-year program. Fellows interested in clinical/clinical research careers will typically distribute inpatient service as follows: 1st year ~ 16 weeks, 2nd year ~ 10 weeks, 3rd year ~ 6 weeks. Fellows pursuing basic science careers or planning other specialized training during fellowship may shift more inpatient weeks to the 1st year to give more protected time for research during the 2nd and 3rd years.

*** Often called the “pre-tending” time, 3rd year fellows are encouraged to act as the supervising physician for the endocrine team during their inpatient service time while still under the supervision of an attending physician.

Research Training

The second and third year fellows have protected time to focus on research training of clinical (patient-oriented) and/or basic science research to ultimately produce a scholarly work to submit in a peer-reviewed journal. The selection of a research project is guided by each fellow’s ultimate career goals, and is individualized to develop the skills needed to succeed in their chosen path. Mentor selection is facilitated by the Program Director with the goal to have an outlined proposal for their scholarly work by the end of their first year. Fellows take advantage of the highly collaborative environment at the School of Medicine to work with faculty from the entire university depending on their area of interest to compose a scholarly oversight committee, which meets twice annually. This includes faculty from:

Specific research interests of recent fellows within the division of Pediatric Endocrinology have included: β-cell physiology in zebrafish models of neonatal diabetes and congenital hyperinsulinism; effects of maternal vitamin D supplementation during pregnancy on child metabolic parameters; screening for monogenic diabetes by assessing sulfonylurea responsiveness; characterization of X-linked hypophosphatasia due to 3’UTR PHEX mutation; and characterization of uterine parameters affecting pregnancy in patients with primary ovarian insufficiency.

Fellows designate at least three faculty members to be a part of their Scholarly Oversight Committee (SOC). This committee meets twice annually to guide and oversee the fellow’s research. Fellows present their work at division meetings, University research symposiums, Diabetes Day, and at national meetings.

During research training, fellows are also encouraged to pursue didactic training in research methods through various programs at the medical school. Fellows may qualify for grant/scholarship funding through these degree programs.

Second-year fellows are eligible to apply for the Julio Santiago Memorial Fellowship award, an institutional $7000 grant for diabetes research which is given to a pediatric endocrinology fellow. Recent fellows have successfully applied for T32 training grants, travel scholarships to national meetings, and the Pediatric Endocrinology Society Research Fellowship Award. Washington University offers an extensive list of training grant opportunities (https://crtc.wustl.edu/otg/washington-university-training-grants/), including several that are directed at pediatric research.

The program and the department support the development of its fellows’ research and grant-writing skills through a comprehensive, progressive three-year curriculum for all fellows in the Department of Pediatrics.  During the academic year, this monthly fellows’ conference covers all ACGME-required training in general topics related to the conduct of research including biostatistics, study design and study implementation.

Didactic Learning

Fellows are provided with a comprehensive core didactic lecture series in which the full spectrum of endocrine physiology and pathophysiology is presented over a two-year cycle. Weekly lectures are given by faculty within both the pediatric and adult endocrine divisions. Recognized experts invited to speak from outside Washington University further add to the rich educational experience. Participation at these conferences is a required component of the training program. Due to the importance of this training activity, fellows’ attendance time is protected from clinical duties during these lectures. Throughout the year, fellows are expected to present at a variety of conferences, from journal clubs to case discussions. A monthly journal club is held at a neighborhood pub, giving fellows and faculty the opportunity to interact in an informal setting outside of the medical school campus. Summer sessions provide a comprehensive overview of common endocrine disorders and their management to incoming fellows.

Please see the Conference Schedule link for more details.

Teaching Opportunities

Fellows complete a QI project each year, and present their work within the division and frequently to other divisions within the hospital. Fellows lead daily rounds during inpatient service, and have the opportunity to teach residents informally in this setting and at the bedside. They also prepare weekly American Academy of Pediatrics PREP slides and lead the discussion amongst faculty and fellows.

In addition, fellows present at our yearly community Diabetes Caregiver course, and teach at the regional Diabetes Camp (Camp EDI), and in our Diabetes Support Group for children and their families.

Education and Meetings

Fellows are expected to attend, and hopefully present at, one national meeting each year. In addition to receiving travel awards and grants, our fellows take advantage of an annual travel allowance provided by the University. Fellows have presented at PES (Pediatric Endocrine Society), ASBMR (American Society for Bone and Mineral Research), the ADA (American Diabetes Association), and the Endocrine Society.

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