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Endocrinology, Metabolism and Diabetes

Ajay Chaudhuri and Erlin Marte Alevante, MD.

“In our program, you’re assured of acquiring the skills and experience you need to thrive in clinical, academic and research environments,” says Ajay Chaudhuri, MD, program director, (left), with fellow Erlin Marte Alevante, MD.

Our two-year fellowship training program in endocrinology, metabolism and diabetes is aimed at providing intense training and experience such that the fellows on graduation:

  • will have the specialized, currently accepted and up-to-date knowledge and clinical skills required to function as a consultant in endocrinology
  • are capable of working in a variety of settings
  • possess habits of lifelong learning to build upon their knowledge, skills and professionalism

They will be able to clinically manage common endocrine conditions, diabetes, metabolic syndrome, obesity and osteoporosis, and thyroid diseases in particular. In addition, they will be able to manage conditions related to hypothalamic, pituitary adrenal, and gonadal problems in general.

During their concomitant research training, fellows will be able to:

  • think critically
  • analyze data that they read in journals
  • formulate independent hypotheses
  • set out plans of investigation
  • carry out those plans

At the end of the training program we intend to have well-trained physicians who can do good clinical research incorporating themes that are both clinical and analytical at the cellular and molecular level.

Training Sites

The training is based at major centers within the university’s affiliated hospitals.

Methodology for Teaching Endocrinology

In order to achieve the goals and objectives for the fellowship program, the following experiences have been established for the purpose of teaching endocrinology fellows:

  • Inpatient Endocrinology
  • Ambulatory Endocrinology
  • Ambulatory Rotations with other Clinical Subspecialties
  • Interdisciplinary Interactions
  • Didactic Conferences
  • Research
  • Self-Directed Learning
  • Continuing Medical Education and Society Participation
  • Development of Teaching Skills

Inpatient Endocrinology

Endocrinology fellows are responsible for the performance of inpatient consultations as well as the continued follow-up of these patients during their hospitalization.

Through this experience, the fellows develop and refine their skills essential for the clinical evaluation of patients with endocrinologic diseases. These skills include the development of appropriate differential diagnoses, assessment of the need for hospitalization, diagnostic evaluation strategies and treatment plans.

The fellows also develop skills in providing consultation services to include communicating with the referring physicians and ensuring support for continuing care of the patients’ endocrinologic condition.

In addition, fellows participate actively in the teaching activities of the consultation team. Through this experience the fellows also develop a comprehensive understanding of the indications, contraindications, techniques and complications of thyroid aspiration biopsy as well as the interpretation of results from this procedure. They also acquire the knowledge of, and skill in, educating patients about the procedure and in obtaining informed consent. Faculty supervision is required in developing these skills. 

Fellows are expected to perform literature research on topics appropriate to the case at hand and make their findings available to the primary care team. The fellows will teach and supervise trainees on the primary care team and endocrinology service with regard to specialized techniques, including performance and cytologic interpretation of thyroid fine needle aspiration biopsy, Doppler pressure measurements in the leg and foot, and brachial arterial reactivity post-ischemic flow-mediated vasodilation.

At each hospital, it is expected that the fellows will dictate the consultation note after the patient has been presented to the attending endocrinologist and a differential diagnosis and management plan has been formulated.

Ambulatory Endocrinology

All fellows maintain at least four half-day clinics per week for the duration of their fellowship, during which time they have progressive responsibility for the care of their patients and are appropriately supervised by dedicated attending faculty members.

The goal of this experience is for the fellows to gain expertise in the outpatient evaluation and management of endocrinologic problems.

The experience provides an opportunity to develop an understanding for the natural history of these conditions over an extended period of time. During each clinic, fellows are expected to see one to two new patients and four to six follow-up patients. They are expected to dictate a comprehensive consultation note or letter for each new patient seen.

Ambulatory Rotations with other Clinical Subspecialties

Elective rotations are not offered, but fellows get a chance to rotate at pediatric endocrinology clinics at Women and Children’s Hospital of Buffalo and in one of the largest in vitro fertilization and infertility clinics of Western New York — the private office of Kent Crickard, MD, Reproductive and Infertility Associates.

Interdisciplinary Interactions

Endocrinology fellows are provided opportunities to interact professionally with physicians from other disciplines whose expertise is required in the care of patients with endocrinologic diseases.

These opportunities include collaboration in the care of patients, multidisciplinary conferences, rotations in one of the largest in vitro fertilization and infertility clinics of Western New York —  the private office of Kent Crickard, MD, Reproductive and Infertility Associates — and participation in pediatric endocrinology clinics.

Didactic Conferences

The conference schedule for the endocrinology fellowship program is:

Research Conference Mondays 9-10 a.m.
Endocrinology Case Conference Tuesdays 8-9 a.m.
Journal Club First Thursday of the month 6:30-8:30 p.m.
Basic Science Conference At least one Friday per month 4-5 p.m.
Multidisciplinary Conference At least one Friday per month 4-5 p.m.
Didactic Teaching Conference At least one Friday per month 4-5 p.m.
Fellows Conference Fridays 2-4 p.m.

Fellows also will be encouraged to participate in the conferences below. They will be supervised for critical literature review and will be encouraged to present in these conferences.

Endocrinology Case Conference Meeting (weekly clinical conference): Held every Tuesday to discuss clinical issues. Fellows present clinical cases along with relevant and critical literature reviews, which are discussed within the group of faculty, fellows and local experts.

Weekly Research Laboratory Meeting: Held every Monday to discuss the results of the various research projects and progress of the laboratory, located at the Diabetes-Endocrinology Center of Western New York. Fellows participate, evaluate, discuss and learn to analyze and interpret various tests or research results. These conferences further enable the fellows to familiarize themselves with special, sophisticated laboratory techniques such as ELISA, Western blot, Electrophoretic Mobility Shift Assay (EMSA) and Polymerase Chain Reaction (PCR).

The Multidisciplinary/Interdisciplinary Vascular and Metabolic Research Group: Held on at least one Friday afternoon per month. Invited physicians are asked to present timely multidisciplinary/interdisciplinary issues.

Monthly Basic Science Conference: Held on at least one Friday afternoon per month. Invited physicians are asked to present timely basic science issues.

The Endocrinology Journal Club Meeting (literature review conference): Held once a month, usually the first Thursday of every month. Invited physicians, faculty and endocrinology fellows are asked to present reviews on timely endocrinology issues.

Didactic Teaching Conferences: Held 1-2 Fridays per month. Faculty, fellows or invited guest speakers will deliver didactic lectures and/or seminars.

Endocrinology Fellows Meet with the Program Director: Held every Friday. The program director meets with the fellows to discuss fellowship information and other relevant issues. Topics discussed in these regular meetings are wide-ranging and include:

  • expectations, planning and measures to improve the program
  • individual fellows’ clinical, research and teaching experiences
  • current literature reviews and its implications
  • formulation of diagnostic and management protocols
  • counseling of fellows

Research

An active research component is included within the fellowship program. A meaningful research experience with appropriate protected time is available for each fellow. During this phase of training, the fellows work under the close guidance of a faculty research mentor.

The immediate goals of the research experience are for fellows to learn:

  • sound methodology in designing and performing research studies
  • the correct interpretation and synthesis of research data
  • the purposes, goals and characteristics of different phases (e.g., Phase I, II, III) of clinical trials and understanding of the significant differences
  • biostatistics that will allow the trainee to interpret the published literature and to critically discriminate the impact of such work to their clinical practice
  • basic elements of proper clinical trial design including identification of target populations, statistical power, proper statistical tools and ethical concerns
  • the purpose and function of the Institutional Review Board and other regulatory bodies that oversee the conduct of clinical investigations
  • design of informed consent documents and understanding of the ethics related to conducting clinical trials, including issues of industry sponsorship and conflict of interest
  • to manage a patient on a clinical trial, including the ability to evaluate a patient’s eligibility for participation in a specific clinical trial; obtaining the necessary baseline studies; writing the treatment orders as directed in the protocol; following a trial’s calendar for assuring that required patient encounters, therapy, diagnostic studies and data collection are performed at the appropriate times; and assessing and reporting responses and adverse events appropriately
  • general working knowledge of what “translational research” is, how it is performed and its value
  • to participate in, or have didactic training in, the clinical trial process, including having the opportunity to be involved in the processes of designing research protocols, writing clinical protocols, obtaining regulatory approval for a clinical trial, enrolling patients into clinical trials, performing data analysis, manuscript writing and making formal presentations of data collected
  • to seek out the existence and details of available clinical trials available at their institution and elsewhere in the course of caring for their patients.
  • how to find funding resources for research studies

Self-Directed Learning

Endocrinology fellows are expected to direct their own learning through reading and utilization of other learning media.

In addition, each hospital has a medical library with an extensive collection.

Continuing Medical Education and Society Participation

In addition to participating in the organized didactic conferences established within the fellowship program, the fellows are encouraged to become members of the American Association of Clinical Endocrinologists (AACE) and the Association for Program Managers in Endocrinology and Metabolism.

In addition, second-year fellows attend the Endocrine University AACE certification course in thyroid ultrasound and biopsy. The curriculum is specially designed to help prepare final-year fellows for entering clinical practice by enhancing their exposure to the following six key areas of clinical endocrinology:

  • thyroid ultrasound accreditation (2 days)
  • bone density measurement certification (2 days)
  • metabolic laboratory CLIA certification (1 day didactic/14 hours e-learning)
  • insulin pump and sensor hands-on instruction (3/4 day)
  • reproductive medicine (ultrasound intervention) (1/4 day)
  • practice management issues (1/2 day)

Development of Teaching Skills

The program provides an environment for the fellows in which the activities of teaching are fostered and highly regarded. This includes the education of not only medical students, physicians and other allied health personnel, but also the education of the patients.

The fellows are expected to teach the medical residents and medical students who rotate on the endocrinology service each month.

Calendar

Endocrinology fellows participate in the following clinics. At each rotation, the residents/fellows will learn about diabetes mellitus and general endocrinology. However, depending upon the training site — especially in relation to the uniqueness of the patient population, the interest and expertise of the faculty or the availability of the facilities — there would be different stress on different areas within the curriculum.

Hospital/Site Clinic Day Fellow Participation
Millard Fillmore Suburban Hospital (MFSH)

Continuity Clinic

 

Other clinics in ambulatory setting, including continuity experience

Wednesday afternoons

 

Monday, Tuesday Thursday all day; Wednesday and Friday mornings

Weekly for 2 years (new patient and continuity clinic)

 

During MFSH rotation (8 months total for first-year fellows; 4 months for second-year fellows)

Erie County Medical Center (ECMC) Other clinics in ambulatory setting, including continuity experience

Monday mornings

 

 

 

 

 

 

Tuesday and Wednesday mornings

During ECMC and Buffalo VAMC rotations (2 months for first-year fellows; 4 months for second-year fellows at each) except when on the 1-month pediatrics clinics during the Buffalo VAMC rotation

 

During ECMC rotations (2 months for first-year fellows; 4 months for second-year fellows)

 

Buffalo VA Medical Center (Buffalo VAMC) Other clinics in ambulatory setting, including continuity experience

Tuesday, Wednesday and Friday mornings

 

 

Tuesday afternoons

 

During the Buffalo VAMC rotations (2 months for first-year fellows; 4 months for second-year fellows)

 

 

During ECMC and Buffalo VAMC rotations (2 months for first-year fellows; 4 months for second-year fellows at each)

Women and Children’s Hospital of Buffalo (WCHOB) Pediatric endocrinology clinics Monday mornings, Tuesday afternoons During 1 month of the Buffalo VAMC rotation each fellowship year
Kent Crickard, MD, Infertility and In Vitro Fertilization Medical Associates of WNY In vitro fertilization and infertility clinic Friday afternoons During 1 month of the Buffalo VAMC rotation; second-year fellows only
Lakeshore Family Medicine Center (Irving, NY) Rural clinic First, second and third Thursday of the month, all day Once or twice during MFSH rotations
United Memorial Hospital (Batavia, NY) Satellite clinic Fourth Thursday of the month, all day Once during MFSH rotation
Amherst General (Flint Road clinic) Suburban clinic Second and fourth Saturday of the month Once a month throughout the fellowship

During continuity clinics, fellows see their own patients to provide them with a continuing care experience with a wide variety of patients. These clinics are supervised by attending physicians, and the fellows’ experience is evaluated semiannually.

Fellows coordinate the inpatient endocrinology consultation services on a rotation basis at Millard Fillmore Suburban Hospital, Erie County Medical Center and the Buffalo VA Medical Center. Fellows work under the supervision of an endocrinology faculty member at each institution.

Endocrinology fellows are on-call at home on a rotating basis at night and over the weekend for emergencies at Millard Fillmore Suburban Hospital, Erie County Medical Center and the Buffalo VA Medical Center.

Contact Us

Fellowship Program Director

Chaudhuri, Ajay

Ajay Chaudhuri, MD

Clinical Professor of Medicine

Diabetes-Endocrinology Center of WNY, 705 Maple Road, N/A Williamsville, NY 14221

Phone: 716-580-7300; Fax: N/A

Email: achaudhu@buffalo.edu

Training Program Administrator

Noemi Voelker

Training Program Administrator

ECMC, 462 Grider St., DK Miller Bldg., First Floor, Buffalo, NY 14215

Phone: (716) 961-6956; Fax: (716) 961-6960

Email: ntamoga@buffalo.edu