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Graduate Medical Education (GME): Endocrinology and Metabolism

Monica C. Skarulis, MD

Eligibility Criteria
This program accepts medical Residents who are Board-eligible or Board certified in internal medicine and are able to complete a three-year program.

Structure of the Clinical Training Program

A. General overview
The NIH Inter-Institute Endocrinology Fellowship Program provides a comprehensive training experience and is ideal for physicians who seek a broad education in both research and clinical endocrinology. Fellows train at the world's largest clinical research complex, the NIH Clinical Center. The NIH Clinical Center houses basic and clinical research facilities that are among the most extensive and highly regarded in the world. It also serves as a 240-bed inpatient hospital dedicated to outstanding patient care.

Fellows are selected for a period of three years by the Inter-Institute Endocrine Training Program Faculty. The institutes participating in this program are:

B. Training program
Clinical training occurs largely in the first year. Fellows function as primary care physicians for the adult and pediatric endocrinology inpatient services at the Clinical Center and serve on the endocrine consult services at Georgetown University Hospital and the Washington Hospital Center. Elective consult service experience at the Walter Reed National Military Medical Center is also available.

In the first year, the fellows spend sixty percent (60%) of their time on inpatient care and consultations, thirty percent (30%) on ambulatory care and procedures, and ten percent (10%) on research.

The remaining two years are spent primarily in laboratory or clinical research under the direction of a senior investigator in one of the several endocrinology branches of the NIH. During this research period, active clinical experience continues through three-half day clinics; a community-based clinic; consult service; and participation in clinical conferences. In the second year, approximately sixty percent (60%) of the fellow's time is allocated to research and forty percent (40%) to clinical work. In the third year, the research time increases to ninety percent (90%) and clinic time decreases to ten percent (10%) so as to allow the fellow dedicated time to successfully complete research projects and publish manuscripts prior to graduation.

Fellowship Structure:

1st Year

  • NIH Clinical Center Rotation: 6 months, divided into two 3 month blocks
  • Georgetown University Hospital: 8 weeks
  • Washington Hospital Center: 8 weeks
  • Weekly continuity clinic at NIH Clinical Center: 2 half days per week
  • NIH Lipid Rotation: 4 weeks
  • NIH Clinical Research Training in Endocrinology: 4 weeks
  • NIH Reproductive Endocrinology and Infertility: 2 weeks

2nd Year

  • Research
  • Two-half day sessions of the weekly Continuity Clinic at NIH Clinical Center
  • One-half day session of the NIH Diabetes Clinic and one half day session of the MobileMed/Suburban Hospital Community Clinic on the alternate week
  • Consult service: 4-6 weeks per year: includes Blood Glucose Management Service (BGMS)

3rd Year

  • Research
  • Consult Service 4-6 weeks per year
  • Clinic: Weekly Continuity Clinic, Diabetes Clinic, and the Mobile Med/Suburban Hospital Community Clinic modified per needs of fellow

NIH Clinical Center Rotations
At any one time on the inpatient service of the NIH, first year fellows are responsible for five to ten patients. The trainee has total responsibility for all aspects of the patient's care, under the supervision of the endocrine faculty. Fellows make daily rounds, discuss patients with the attending physicians, and participate in management decisions related to both patient care and clinical investigation.

Patients with a wide variety of endocrine diseases are studied at the Clinical Center providing clinical experience of substantial depth and breadth. Although all patients are admitted under peer-reviewed research protocols, there are many other aspects of diagnosis and patient care that fall completely under the discretion of the endocrine fellows. In addition, second and third year fellows on the endocrine service serve as consultants to other services at the Clinical Center and lead the Blood Glucose Management Service (BGMS). Thus, the fellows gain experience with common problems of endocrine disease that may occur in any general medical ward. The fellow also has responsibility for the training of medical students who rotate on the endocrine service.

The weekly 2-half-day sessions of continuity clinic continues throughout the fellowship. Some patients are followed for problems of research interest to the faculty however, a large proportion of the patients are seen as referrals from the surrounding community.

C. Structure of the Research Training Program

Basic Research Programs
There are extensive programs in the study of basic hormone action for nearly every endocrine system. The molecular basis of endocrine disease is extensively studied in close collaboration with the clinical research activities. NIH researchers have pioneered the elucidation of signal-transduction systems for virtually all polypeptide hormones and catecholamines having plasma-membrane receptors as well as those with nuclear receptors. There are major programs related to the control of biosynthesis of polypeptide hormones, neurotransmitters, thyroid and steroid hormones. A variety of endocrine diseases with a genetic basis have a parallel basic science program in molecular genetics. Examples of such programs include studies of multiple endocrine neoplasia type 1; Carney Complex, pheochromocytoma, insulin, thyroid hormone, glucocorticoid resistance;,and defective action of parathyroid hormone. NIH investigators were among the leaders in defining the molecular pathophysiology of these disorders.

Clinical Research Programs
Clinical research activities include protocols for all patients seen in the endocrine inpatient services, and for many outpatient studies. Study design, outcome measures, statistical analysis and ethical and regulatory issues are stressed. Fellows are encouraged to take the course, "Introduction to the Principles and Practice of Clinical Research" and to participate as associate investigators in protocols.

Rounds and Conferences
The conferences at NIH integral to this program include:

  • Specialty conferences: once-weekly ward rounds with emphasis on quality assurance and improvement, outpatient clinic conference, endocrine grand rounds, and twice monthly journal club
  • Research conferences: Laboratory dependent
  • Interdepartmental subspecialty conferences: weekly rounds in nuclear medicine and radiology, neurosurgery and endocrine surgery
  • Internal medicine grand rounds, weekly

Research Courses and Seminars
Fellows contribute to basic science seminars and journal clubs, and are encouraged to take courses in areas such as statistics, molecular biology, biochemistry, neurophysiology, or cell biology through the Foundation for Advanced Education in the Sciences. In addition, the NIH conducts a postgraduate clinical endocrinology course that is attended by three hundred endocrinologists each year. Finally, since most NIH trainees are planning careers in academic medicine, they have the opportunity to receive extensive training in the mechanisms of funding for both basic and clinical endocrine research.

Members of the extramural program regularly conduct seminars with third-year fellows, discussing such topics as grant writing, mechanisms of support for young and more advanced investigators, as well as other aspects of a research career.

D. Institutes, Branches, and Faculty
Within the institutes there are several different branches/sections in which a fellow may choose to work:

National Institute of Diabetes and Digestive and Kidney Diseases

  • Diabetes, Endocrinology and Obesity Branch: This branch conducts clinical and basic research in the area of diabetes, insulin resistance, thyroid physiology and pathology, metabolism and body weight regulation. Investigators treat patients with extreme insulin resistance, lipodystrophy, hypoglycemia, acromegaly and other disorders of carbohydrate and lipid metabolism. Studies of pancreatic islet biology, neuroendocrinology and immune modulation are conducted. Using the tools of the metabolic clinical research units, energy expenditure and thermoregulation are explored. Additionally, disorders of thyroid growth and function are studied providing clinical experiences in the treatment of thyroid nodules and cancer
  • Metabolic Diseases Branch: This branch sees disorders of calcium metabolism, and metabolic bone disease, including hyperparathyroidism (e.g., multiple endocrine neoplasia). Other patients include those with various forms of rickets and hypocalcemia.

National Institute of Child Health and Human Development

  • Program in Developmental Endocrinology and Genetics: This group admits patients with pediatric endocrine disorders (such as short stature, precocious puberty, delayed puberty, pituitary tumors, obesity) and patients with Turner's syndrome and adrenal causes of Cushing's syndrome.
  • Program in Reproductive and Adult Endocrinology: This group admits patients with pituitary tumors, hyperprolactinemia, panhypopituitarism, Cushing's syndrome, pseudocushing states, adrenal insufficiency, endocrine hypertension (including hyperaldosteronism and pheochromocytoma), congenital adrenal hyperplasia (both late-onset and classical), hirsutism, autoimmune endocrinopathies and premature ovarian failure.

National Institute of Dental and Craniofacial Research

  • Craniofacial and Skeletal Diseases Branch: The Branch is actively engaged in studies that focus on fibrous dysplasia of bone, including within the context of McCune-Albright syndrome. Current studies are based in determination of the pathophysiology of fibrous dysplasia using cellular and molecular techniques, active clinical protocols for the study and treatment of fibrous dysplasia, and development of novel therapeutic modalities.
Program Faculty and Research Interests

NIDDK

  • Dr. Monica C. Skarulis, Program Director, conducts multidisciplinary research in the area of obesity, weight loss and recidivism. She also conducts research in thyroid disease and neoplasia.
  • Dr. Francesco Celi, Staff Clinician, studies the role of the peripheral conversion of thyroid hormone and how it relates to glucose and energy homeostasis.
  • Dr. Giovanni Cizza, Staff Clinician, is interested in the hypothalamic regulation of appetite, energy expenditure, body temperature and sleep and conducts research on the effects of chronic sleep deprivation on metabolism, weight, cognition, inflammation and other parameters.
  • Dr. Marvin C. Gershengorn, Chief, Clinical Endocrinology Branch, conducts research aimed at characterizing the progenitors of pancreatic islet cells including extracellular regulatory factors, and signal transduction mechanisms. Studies of the structure-function relationships of G protein-coupled receptors (TRH, GLP-1) are also conducted.
  • Dr. Phillip Gorden, Director Emeritus and Senior Investigator, is currently interested in clinical studies related to etiology, pathophysiology and therapy of insulin resistance including the treatment of lipodystrophic diabetes with leptin.
  • Dr. Stephen J. Marx, Chief, Metabolic Diseases Branch, studies clinical and basic features of the genes that cause endocrine tumors, with emphasis on hyperparathyroidism.
  • Dr. William Simonds, Chief, Endocrine Signaling & Oncogenesis Section, studies the pathogenesis of familial isolated hyperparathyroidism, parathyroid cancer, and the hyperparathyroidism-jaw tumor syndrome, as well as the function of the G protein beta5/R7-RGS/ R7BP signaling complex in neurons.
  • Dr. Marc Reitman, Chief, Diabetes, Endocrinology and Obesity Branch, is interested in the mechanisms underlying energy homeostats8s in cluding metabolic rate and body temperatire regulation, brown adipose tissue physiology, drug treatments for obesity, and BRS-3 (bombesin recrptor bustype-3).
  • Dr. Lee Weinstein, Chief, Signal Transduction Section, studies the pathogenesis and treatment of Albright hereditary osteodystrophy, pseudohypoparathyroidism, and related disorders. He also studies animal models to examine the regulation and role of G proteins in metabolism and hormone action.

NICHD

  • Dr. Smita Abraham, Associate Program Director, studies hypothalamic-pituitary-adrenal axis pathophysiology. She is currently studying mechanisms responsible for the development of adrenal insufficiency in critically ill patients.
  • Dr. Lawrence M. Nelson, Head, Integrative Reproductive Medicine Unit, investigates the menstrual cycle and ovarian function both in the clinic and in the basic science laboratory. His major focus is the pathogenesis of premature ovarian failure.
  • Dr. Lynnette K. Nieman, Clinical Investigator, studies the regulation of reproduction in normal and infertile women and disorders of cortisol deficiency and excess. Dr. Carolyn Bondy's research aims at differentiating the respective roles of genome and hormone in gender-specific aspects of normal development and disease susceptibility. Studies encompass transgenic murine and non-human primate models, with clinical studies focused on monosomy X or Turner syndrome.
  • Dr. Karel Pacak, Chief, Neuroendocrine Unit, conducts research designed to elucidate the molecular genetic bases for the clinical manifestations, laboratory findings, responses to treatment, and prognosis of patients harboring adrenal and extra-adrenal pheochromocytoma.

Pediatric Endocrine Training Program Faculty (within NICHD unless noted)

  • Dr. Constantine A. Stratakis, Program Director, is interested in clinical and molecular genetics of multiple endocrine neoplasias, Carney complex and related disorders, as well as in other genetic syndromes affecting the pituitary and adrenal glands.
  • Dr. Jeffrey Baron, Chief, Section of Growth and Development, studies the cellular and molecular mechanisms responsible for childhood growth in an effort to improve our understanding of childhood growth disorders, and to gain insight into the unregulated growth of childhood neoplasms.
  • Dr. Deborah Merke, Chief, Pediatric Services, leads an effort to expand our understanding of the pathophysiology, genetics and clinical manifestations of congenital adrenal hyperplasia (CAH), an autosomal recessive disease of the adrenal gland. Insights into the mechanism are used to generate new treatment approaches.
  • Dr. Kristina Rother, Senior Staff Clinical Investigator (NIDDK), conducts studies focused on improving beta cell function in type 1 and type 2 diabetes. Her trials include studies of islet transplantation, administration of oral interferon alpha and induction of beta cell rest in various pediatric diabetic populations.
  • Dr. Jack A. Yanovski, Head, Unit on Growth and Obesity, studies the pathophysiology and treatment of obesity. Investigations include genetic studies of conditions causing abnormal adiposity, such as abnormalities in leptin signaling pathways, and novel pharmacotherapeutic approaches.

NIDCR

  • Dr. Michael T. Collins, Chief, Skeletal Clinical Studies Unit, studies bone and mineral metabolism. His approach is to study and treat patients with rare disorders of bone and mineral metabolism as models through which to understand human bone and mineral biology and physiology.
Application Information

The Inter-Institute Endocrinology Program is accredited by the Accreditation Council for Graduate Medical Education. Our program is a participant in the National Resident Matching program (NRMP). Upon completion of this program, fellows are eligible to take the boards in endocrinology/metabolism. This program accepts medical residents who are board-eligible in internal medicine. This includes residents in the Clinical Investigator Pathway. There will be essentially no difference in the type of training offered these two groups of candidates. There are currently five positions available in adult endocrinology each year, approximately two from NICHD and three from NIDDK. Applicants may apply 1 year to 6 months in advance. The expected length of stay is three years, and for exceptional trainees this may be extended to a fourth or even fifth year.

All interested applicants are encouraged to apply early. You may apply through ERAS at www.aamc.org/eras [disclaimer], as we are a participating institution. The deadline for completed applications is July 15, 2012. All completed applications will be reviewed by a core committee and interviews will be held on Wednesdays in July, August and September 2012. You may call the program coordinator, Ms. Sandra M. Wallace, at (301) 496-1913 for additional information.

The following information is needed to complete your application for Academic Year 2013:

  • A cover letter stating your current residency status and academic year for which you wish to apply, e-mail address, home mailing address and contact telephone numbers.
  • A photo of yourself
  • A personal statement describing your area of interest (research and clinical)
  • A current copy of your curriculum vitae/bibliography
  • THREE Original Letters: One letter of recommendation from your current program director and two additional letters of recommendation from physicians who know you well
  • Copies of your USMLE, NBME, COMLEX, and/or FMGEMS score reports
  • A copy of your medical school transcript (in English)
  • A copy of your ECFMG certificate (if applicable)
  • Copies of all VISA documents including Permanent Resident, J-1, H1-B passport, etc.

All of the above documents (i.e., letters of recommendation) should be addressed to the Program Director:

Monica C. Skarulis, M.D.
Building 10, CRC, Room 6-3940
10 Center Drive
Bethesda, Maryland 20892-1613

Electronic Application
The quickest and easiest way to find out more about this training program or to apply for consideration is to do it electronically [disclaimer].

The NIH is dedicated to building a diverse community in its training and employment programs.


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This page last reviewed on 02/13/14

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