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diabetes-endocrinology

Houston, Texas

Anatomy instruction at Baylor College of Medicine
Medicine/Endocrinology
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Fellowship Training

Program Duration

Five new endocrine fellows, with the official title of subspecialty residents, are selected approximately one and one-half years prior to beginning their fellowship. The program begins on July 1 of each year. This is intended to be a three-year program but under certain circumstances, a two-year fellowship may be granted. Two years of endocrine subspecialty training meets the ACGME requirement for endocrinology and diabetes board certification.

Clinical Training

The first year of clinical training provides the trainee opportunities to diagnose and manage a substantial number of patients with an extremely wide variety of endocrine disorders. The patient mix is diverse as each of the training hospitals provides care to large and unique populations. First year fellows have 2.5-month rotations in each of the five teaching hospitals, all of which are located within the Texas Medical Center campus.

  • Ben Taub Hospital, the tertiary care referral center for the Harris Health System which provides comprehensive general and specialist care for over 250,000 persons.
  • MD Anderson Cancer Center, which is supported from the State of Texas to care for cancer patients throughout the state, and is recognized nationally and internationally as a major cancer center.
  • St. Luke's Episcopal Hospital, the primary private teaching hospital for adult patients at Baylor College of Medicine, recognized as a top 10 medical center for cardiovascular disease in the United States.
  • Michael E. DeBakey Veterans Affairs Medical Center, a new facility with 850 active beds serving veterans in a large area of Texas and Louisiana, and a cardiovascular referral hospital for the central portion of the United States.
  • Texas Children's Hospital, the largest pediatric hospital in the country and a premier academic institution, with a large pediatric endocrine faculty serving a broad array of children and adolescents with endocrine disease.

Second-year fellows are sponsored by the division to attend an intensive course organized the American Association of Clinical Endocrinologists and the Association of Program Directors in Endocrinology and Metabolism, which leads to certification in bone density measurement, thyroid ultrasound and fine needle aspiration, and endocrine clinical laboratory supervision.

Clinics

There are over 40 subspecialty endocrine clinics in the program, covering every possible aspect of endocrine disease and endocrine neoplasia, including clinics dedicated to endocrine testing, thyroid ultrasound / FNA, endocrine disorders in pregnancy, and specialized forms of diabetes. The addition of Texas Children’s Hospital in 2005 as a formal, required rotation has broadened the exposure of adult endocrine fellows to a wide range of pediatric and adolescent endocrine disorders. First-year fellows have four half-day outpatient clinics each week in addition to their inpatient consult duties. Three of these are in the hospital to which the fellow is currently assigned, and the fourth is a longitudinal, two-year continuity clinic at Ben Taub Hospital. During the second year, fellows have a minimum of one half-day clinic each week. Clinics are optional for third year fellows.There also is opportunity to attend elective reproductive endocrinology clinics during the second year.

Research Opportunities

Much of the second and third years of the program are spent training in laboratory and/or in clinical research, under one or more faculty mentors. Two special research training tracks are available to fellows wishing to undertake at least two years of intense research training following the first (clinical) year:

  1. NIH funded Molecular Endocrinology Training Grant (T32): an integrated research program in any area of basic endocrine science involving faculty with joint appointments in the endocrine division of the department of Medicine and the department of Molecular & Cellular Biology (see faculty list).
  2. NIH funded Molecular Medicine Training Program (directed by Dr. Lawrence Chan): a mentored research training program, including opportunities for training in a wide range of laboratories involved in molecular and translational endocrine research, available to senior fellows on a competitive basis.
  3. Another NIH-funded research training opportunity, the Clinical Scientist Training Program, is offered to all senior fellows at Baylor on a competitive basis. This didactic and research-oriented program leads to diploma, masters or doctorate status in clinical research. In addition, short courses are held at different times of the year on biostatistics, epidemiology, genetics and molecular biology.

Faculty research interests span the breadth of endocrinology.

  • Dr. Lawrence Chan heads a large group (that includes Dr. Benny Chang, Dr. Pradip Saha, and others) investigating the molecular regulation of lipoprotein and lipid metabolism, insulin secretion, islet neogenesis and the molecular basis of diabetic complications. The group makes extensive use of cellular and animal models, with clinical implications for diabetes, atherosclerosis and obesity.
  • Dr. Ashok Balasubramanyam studies molecular aspects of muscle development (with Dr. Dinakar Iyer), and characterizes novel phenotypes and mechanisms of ketosis-prone diabetes. His group is also studying the molecular and metabolic basis of HIV-associated lipodystrophy.
  • Dr. Mandeep Bajaj conducts clinical and translational metabolic research related to the pathophysiology of lipotoxic insulin resistance and type 2 diabetes.
  • Dr. Glenn R. Cunningham is conducting studies on the inpatient management of diabetes and in the treatment of hypogonadism at SLEH.
  • Dr. Rajagopal V. Sekhar directs the Translational Metabolism Unit and uses human and mouse models to study glutathione turnover and oxidative stress in diabetes and aging; and metabolic defects in HIV lipodystrophy, aging and growth hormone deficiency.
  • Dr. Vijay K.Yechoor conducts basic research on circadian control of metabolism, and also islet biology including regeneration and characterization of putative islet stem cells.
  • Dr. Susan L. Samson acts as associate program director under Dr. Balasubramanyam. Her laboratory research is focused on understanding how at-risk genes for human diabetes alter beta cell function in mouse models. Her clinical interests are in the field of pituitary disorders.
  • A comprehensive research program in molecular aspects of endocrine neoplasias by Drs. Robert R. Gagel, and Gilbert Cote and bone metabolism exists at the M. D. Anderson Cancer Center.
  • Dr. Steven I. Sherman conducts extensive clinical research in the field of thyroid cancer.
  • Drs. Victor R. Lavis and Naifa Busaidy conduct clinical research in diabetes related to cancer.
  • Drs. Camilo Jimenez and Mouhammed Habra conduct clinical research into neuroendocrine tumors.
  • Dr. Anita K. Ying conducts outcomes research.
  • Clinical research studies in the areas of hypogonadism, growth hormone deficiency, diabetes and wasting disorders take place at the Michael E. DeBakey Veterans Affairs Medical Center Clinical Research Unit under the direction of Drs. Marco Marcelli and Jose M. Garcia. They also conduct basic and translational research in the areas androgen receptor and ghrelin physiology using in-vitro and animal models.
  • Dr. Morali D. Sharma has a special interest in pituitary diseases and conducts metabolic studies in growth hormone deficient patients.
  • Dr. Ramaswami. Nalini conducts outcomes research in the optimal management of diabetic complications and ketosis-prone diabetes.
  • Drs. Steven G. Waguespack and Mimi I. Hu conduct clinical research into metabolic bone disorders..

Clinical research programs in diabetes and its complications, lipids, pituitary tumors, thyroid pathophysiology, BPH and androgen deficiency are integrated into the basic research programs. As a trainee advances, the development of independent ideas, communication skills, and the art of grant writing are also stressed so that upon completion of the training period, the individual is well prepared for an academic career.

Fellowship Evaluation

Fellows are evaluated by their clinical attending physician at the end of each service period. In addition, each fellow meets formally with Dr. Balasubramanyam or the Associate Director, Dr. Susan L. Samson, every six months, to monitor progress and address any issues of concern. Fellows have the opportunity to evaluate and provide feedback on the program during meetings of the Fellowship Curriculum Committee (chaired by Dr. Marcelli); the committee includes all fellows and a faculty representative from each hospital. This committee discusses academic issues concerning the fellowship program every two months.

Policy

Moonlighting activities are not part of the training program. They must be approved by the program director, associate chairman of the Department of Medicine, and senior vice president and dean of medical education. Employment in the emergency rooms at the VA and Ben Taub Hospital and the intensive care units at St. Luke's Episcopal Hospital is considered to be related to the training program and may be approved by the program director.

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