Clinical Experience – BWH Endocrinology Fellowship

The first year of fellowship consists of a range of inpatient and outpatient clinical experiences to cover the broad range of endocrine diseases. Clinical rotations are conducted primarily at BWH, and all fellows also rotate at Boston Children's Hospital (BCH). The division also offers a 4-year combined training program in adult and pediatric endocrinology for candidates who have completed a combined internal medicine-pediatrics residency program, in conjunction with Boston Children's Hospital. Interested candidates should reach out to the fellowship program director for more information on this track.

Inpatient Rotations

Typically, first year endocrine fellows spend nine months performing inpatient consultations at BWH. With the supervision of the attending endocrinology faculty, fellows perform the initial evaluation and provide ongoing diagnostic and management recommendations to the primary inpatient care teams. Teaching rounds occur Monday through Friday and ad hoc on weekends. These rounds are designed for education, presentation of new patients, and discussion of ongoing cases and treatment plans.

Each first year fellow will cover approximately fourteen weekends throughout the academic year; the second and third year fellows cover approximately three weekends each per year. Holiday coverage is split evenly between the first year fellows.

Outpatient Rotations

First year fellows typically participate in two to five clinics per week, spanning the breadth of endocrinology and allowing the fellows to work closely with experts in the field.

The clinics include continuity clinics where the fellows can follow their own patient panel:

• General Endocrine Longitudinal Clinic (weekly)
• Fellows’ Diabetes Clinic (weekly). Fellows see patients with complex diabetes, including patients with insulin pumps and with Continuous Glucose Monitors (CGM). Fellows are also involved in the pre- and post-procedure care for patients undergoing pancreas transplants and islet cell autotransplants.
• Thyroid Clinic (monthly). Fellows see patients with hypo- and hyperthyroidism, thyroid nodules, and thyroid cancer.
• Neuroendocrine Clinic (monthly). Fellows see a range of patients with functional and non-functional masses of the pituitary and hypothalamus, and care for patients with hypopituitarism.
• Adrenal clinic (every other month). Fellows see patients with adrenal nodules, adrenal cancer, adrenal insufficiency, Cushing’s syndrome, hyperaldosteronism, and pheochromocytomas.

In addition, the fellows rotate through a range of subspecialty clinics, including:

• Thyroid Biopsy Clinic. Fellows perform fine needle aspiration biopsies of thyroid nodules.
• Skeletal Health and Osteoporosis Clinic. This includes training in reading bone mineral density (DXA) reports.
• Diabetes in Pregnancy Clinic. Fellows see people with pre-pregnancy type 1 and type 2 diabetes, as well as people with gestational diabetes.
• Reproductive Endocrine / IVF clinic: Fellows assist staff in the Center for Infertility and Reproductive Surgery with assisting infertile couples achieve successful pregnancies via advanced endocrine methods.
• Men’s Health/Andrology: The fellows see patients with a range of derangements of normal male gonadal function, such as male hypogonadism, erectile dysfunction, etc.
• Pediatric Endocrine Clinic: This rotation takes place at Boston Children’s Hospital, where the fellows work closely with endocrine faculty seeing patients with pediatric endocrine disorders with relevance for the adult endocrinologist, such as disorders of growth and puberty.
• Lipid/Prevention Clinic. The fellows work with cardiologists specializing in the management of complex lipid disorders, including dyslipidemia in statin-intolerant patients and genetic lipid disorders.
• Weight Management. The fellows are part of a multidisciplinary team that implements rigorous lifestyle changes to assist patients with weight loss through non-surgical means. Some sessions are dedicated to patient counseling, including referrals to bariatric surgery when appropriate.
• Female Reproductive Endocrinology. The fellows see women with common and uncommon disorders of the female reproductive system, such as PCOS, amenorrhea, hirsutism and complicated menopause.
• Endocrine Genetics. Fellows work with genetic counselors and endocrinologists with expertise in genetic endocrine disease to evaluate patients for these conditions.
• Transgender Health. Fellows have the opportunity to get experience in managing gender-affirming hormones through the BWH Center for Transgender Health.

Second- and third-year fellows participate in a weekly General Endocrine Longitudinal Clinic, with the rest of their time reserved for research. These fellows may schedule additional clinical rotations on an elective basis. Final-year fellows can be offered to act as attendings in their continuity clinic, on a case-by-case basis.