I. Goals and Scope of Training
The purpose of the UCSF Training Program in Pediatric Endocrinology is to provide trainees with the background needed to diagnose and manage endocrine diseases and to understand the physiology of hormonal regulation in infancy, childhood, adolescence and young adulthood. The Program emphasizes fundamentals of clinical diagnosis and management, with special emphasis on history taking, physical examination, and interpretation of pertinent laboratory data. Graduates of the program are expected to be proficient in clinical care, both direct and consultative; in research, either clinical or basic; and in teaching and administration.
To implement the general goals stated above, our program is specifically designed to fulfill the following specific goals:
1. To understand the normal physiology of the various endocrine glands and hormones
(the "endocrine system") .
2. To understand the common diseases and abnormal physiology of the endocrine system.
3. To know how to recognize, diagnose, and treat the common disorders of the endocrine system.
4. To understand the systematic, scientific approach to disorders of the endocrine system that will permit
accurate diagnosis and treatment of uncommon endocrine disorders.
5. To understand the systematic, scientific approach to gaining new information about endocrine systems
6. To become proficient in at least one area of endocrine research.
7. To become conversant with established approaches, principles, and ethics of preparing and publishing
8. To publish one or more original first authored research papers in a major journal.
9. To gain experience in teaching medical students and pediatric residents, and in the formal presentation
of lectures, rounds and conferences.
10. To learn some of the history of endocrinology, participate in its present history, and continue the legacy
by learning to teach and inspire future generations.
Trainees learn about pertinent aspects of genetics, including molecular genetics, biochemical genetics, cytogenetics, the phenotypic manifestations of endocrine genetic disorders and genetic counseling.
The clinical faculty includes:
Stephen E. Gitelman, MD, Professor of Clinical Pediatrics, Director, Diabetes Program, (Chief of Endocrinology)
Walter L. Miller, MD, Professor of Pediatrics
Saleh Adi, MD, Associate Professor of Clinical Pediatrics, Director, Madison Clinic for Pediatric Diabetes
Felix A. Conte, MD, Professor of Clinical Pediatrics, Emeritus
Melvin M. Grumbach, MD, Professor of Pediatrics, Emeritus
Robert H. Lustig, MD, Professor of Clinical Pediatrics, Director, Weight Assessment for Teen and Child Health (WATCH) Program
Stephen M. Rosenthal, MD, Professor of Pediatrics; Program Director; Director, Pediatric Endocrine Clinics; Director, Child and Adolescent Gender Center
In addition, appropriate consultant faculty and staff are available in related disciplines, including surgery, obstetrics/gynecology, internal medicine, child and adolescent psychiatry, nephrology, neurology, neurosurgery, radiology, nuclear medicine, opthalamology, urology and diabetes education.
III. Facilities and Resources
UCSF operates subspecialty pediatric clinics in diabetes and in general endocrinology in the UCSF Ambulatory Care Center on the main campus. Inpatients are admitted to the UCSF Moffit/Long Hospital which is fully equipped for tertiary care including a pediatric intensive care unit, a level 3 nursery, a pediatric bone marrow transplant unit and a Pediatric Clinical Research Center. There is a complete chemistry laboratory with immunoassay facilities and karyotyping; nuclear ultrasonic and radiologic imaging services suitable for all forms of endocrine disease; endocrine surgical service; pathology service for interpretation of surgical and cytologic specimens, including immunohistochemistry. There is a close working relationship with the dietary/nutrition services.
IV. Educational Program
A. Clinical and Continuity Experience
The UCSF Program in Pediatric Endocrinology is typically 3 years in duration, and includes progressive clinical, technical and consultative experiences that lead the trainee to acquire expertise as a pediatric endocrinologist and leads to eligibility to take the American Board of Pediatrics Subspecialty Examination in Pediatric Endocrinology. Some trainees, especially those from abroad not seeking certification by the subspecialty board, may participate in the program for shorter periods. The program emphasizes scholarship, self instruction, development of critical analysis of clinical problems, and the ability to make appropriate decisions.
The clinical service duties typically consist of 6 months on the inpatient service, providing care for patients admitted to the pediatric endocrinology service, and providing consultations, all under the supervision of the attending teaching faculty. During this time, night call is taken from home, and an average of 1 day in 7 is free of clinical duties. During the other 2 and a half years of the 3 year program, trainees provide care under faculty supervision in the outpatient pediatric endocrinology clinic and pediatric diabetes clinic. Trainees attend both clinics once each week for 18 months and both clinics on alternate weeks in the third year. Trainees in year 2 and 3 regularly cover for first year trainees to provide time off.
The program affords trainees the opportunity to diagnose and treat a wide variety and complexity of endocrine disorders in patients ranging in age from newborn to young adults, including adolescents with normal and abnormal puberty. There is an extensive inpatient admission and consultation experience including intensive care unit and intensive care nursery management of patients, as well as continuing outpatient responsibility for the care of chronic endocrine disorders including diabetes mellitus. Trainees learn, through patient care, about normal and abnormal hormonal regulation; the interaction between endocrine disease and psychosocial problems is stressed. Trainees also participate in weekly endocrine and diabetes outpatient clinics.
The clinical experience includes, but is not limited to, patients in the following categories.
1. Short stature, including constitutional delay
2. Disorders of anterior pituitary hormone physiology, including growth
3. Disorders of posterior pituitary hormone physiology, including
4. Disorders of hypothalamic regulation of hormonal secretion
5. Disorders of thyroid hormone physiology; secretion and synthesis
6. Diagnosis and management of endocrine neoplasia
7. Disorders of the adrenal gland physiology; secretion and metabolism
8. Disorders of androgen and estrogen metabolism; including adolescent reproductive
9. Disorders of sexual differentiation and development
10. Disorders of calcium, phosphorous, and vitamin D metabolism
11. Disorders of parathyroid gland physiology
12. Disorders of fluid and electrolyte balance
13. Disorders of carbohydrate metabolism, including diabetes mellitus
14. Disorders of nutrition, including eating disorders
B. Laboratory Experience
Trainees receive instruction in the proper choice and use of various laboratory techniques for the measurement of hormones in body fluids, with particular emphasis on recognizing the limitations of such data and the pitfalls in interpreting laboratory results. Trainees learn the proper interpretation of endocrine stimulation and supression tests, including normal variations in laboratory results at different ages and at different times of the day. Trainees interact directly with specialists in radiology, neuroradiology, nuclear medicine,ultrasonography, CT scanning and magnetic resonance imaging to enable them to utilize current diagnostic procedures for endocrinology.
The program provides instruction in clinical and basic sciences, including endocrine, physiology,pathology and biochemistry, the embryology of endocrine and related systems with emphasis on sexual differentiation; genetics, including laboratory methods, cytogenetics, enzymology and molecular genetics; and aspects of immunology relevant to endocrine disease, including immunoassay techniques.
Clinical management of inpatients, consultations and outpatients is reviewed at a required weekly meeting. The required conferences include:
1. Diabetes Outpatient Clinic Management Conference - Mondays, 4-5pm
2. Inpatient/Consult Management Conference - Tuesdays, 9:15 -11am
3. Basic Science/Research Tutorials - Tuesdays, 11am - 12 noon
4. Endocrinology Grand Rounds - Wednesdays, 8:30 -9:30am
5. Endocrinology Fellows Review Course - Wednesdays, 10:30 -11:30am
6. Pediatric Grand Rounds - Thursdays, 8 - 9am
In addition there are yearly conferences on the ethical conduct of science and ethical conduct of medicine.
During the 2 1/2 years when the trainees are not responsible for the inpatient service, the time that they are not involved in outpatient clinics or conferences is available for research. This is typically about 60% of the trainee's total time during that 2 1/2 year period. All trainees participate in one or more research programs, and some trainees seeking more advanced training may remain beyond the third year. Trainees choose a principal mentor to supervise their research. The principal research mentors include:
- Stephen E. Gitelman, MD. Professor of Clinical Pediatrics (Chief of Endocrinology)
- Walter L. Miller, MD. Professor of Pediatrics
- Mark S. Anderson, MD, PhD. Associate Professor of Medicine
- Dan D. Bikle, MD, PhD. Professor of Medicine and Dermatology
- Jeffrey A. Bluestone, Ph.D. Professor of Medicine and Pathology; Director of the Diabetes Center
- David G. Gardner, MD. Professor of Medicine
- Donna M. Ferriero, MD. Professor of Neurology and Pediatrics
- Susan J. Fischer, PhD. Professor of Cell and Tissue Biology
- Michael S. German, MD. Professor of Medicine
- Linda C. Giudice, MD, PhD. Professor and Chair of Obstetrics, Gynecology and Reproductive Medicine
- Ira D. Goldfine, MD. Professor of Medicine and Physiology
- Holly Ingrahm, PhD. Professor of Physiology
- Robert H. Lustig, MD. Professor of Clinical Pediatrics
- Synthia H. Mellon, PhD. Professor of Obstetrics, Gynecology and Reproductive Medicine
- Thomas B. Newman, MD, MPH. Professor of Pediatrics and Epidemiology
- Anthony A. Portale, MD. Professor of Pediatrics and Medicine
- Neil J. Risch, PhD. Professor of Genetics
- Stephen M. Rosenthal, MD. Professor of Pediatrics
- Dolores M. Shoback, MD. Professor of Medicine
- Deepak Srivastava, MD. Professor of Pediatrics
- Christian Vaisse, MD, PhD. Professor of Medicine
- Keith Yamamoto, Ph.D. Professor of Cellular/Molecular Pharmacology and Biochemistry/Biophysics
Many of the research projects supervised by this core faculty will involve collaborations with other faculty in epidemiology, biostatistics, pharmaceutical chemistry, physiology etc.
VI. Policies and Procedures
The UCSF Program in Pediatric Endocrinology adheres to all the policies and procedures mandated by the University of California, its Graduate Medial Education Committee and the Accreditation Council of Graduate Medical Education (ACGME). Details of these policies and procedures can be accessed as follows:
1. University of California, San Francisco Housestaff Information Booklet - A guide for residents and clinical fellows. This 58 page pamphlet provides a wealth of details about UCSF, its philosophies and policies. It covers all aspects of appointment and employment, including selection policies, duties, responsibilities, salaries, insurance, evaluation, disciplinary procedures, non-discrimination, sexual harassment, grievance policies and appeals. It contains sections on California medical licensure, narcotic registration, CPR certification, etc. and as well as an extensive section on available services, including loans, parking, legal aid, etc.
The full text of the Housestaff Information Booklet is available at:
2. Further details are available for the following crucial areas :
Home Site of Graduate Medical Education (GME) Program Policies http://meded.ucsf.edu/gme/policies-and-procedures-0
University of California Policy on Substance Abuse
UCSF Graduate Medical Education Moonlighting Policy
Sexual Harassment Informal complaint Procedures
UCSF Policy on sexual harassment and non-discrimination
Zero Tolerance Standard for workplace Violence
Policies Applying to Campus Activities, Organizations, and Students
Policy on Information Security, Procedures, and Guidelines
University of California's Policy on Conflict of Interest
University of California's Policy on Recruitment
University of California's Policy on Appointment
University of California's Policy on Admissions
University of California's Policy on grievance procedures
University of California's Policy on Performance Appraisal