Training & Education

The overall goal of our training program is to provide broad and comprehensive clinical and didactic training in endocrinology and metabolism, as defined by the ACGME. Toward that end our four fellows participate in the following clinical and didactic activities.

Fellows

Class of 2017
Braden Barnett, MD
Patricia Lorenzo, MD
Class of 2018
Daniel DeMoss, MD
Asma Hasan, MD

Inpatient Consultative Services

This service provides trainees with direct consultation experience (diagnosis and management) in the care of hospitalized patients with a wide variety of endocrine and metabolic disorders, including: diseases of the hypothalamus, pituitary, thyroid, adrenals, gonads, kidneys and skin; diabetes mellitus, its acute complications and acute manifestations of chronic complications; hypoglycemia; disorders of bone and mineral metabolism; fluidelectrolyte and acid-based disorders; perioperative management of endocrine patients; and endocrine emergencies. The service provides trainees with experience in the education of medical students, house staff and peers regarding the above disease processes.

All fellows achieve the goals and objectives for inpatient and consultative services through participation in inpatient/ consultative rotations for a total of 14 months during the period of training and continual participation in outpatient clinics.

LAC+USC Medical Center

The Endocrinology and Diabetes inpatient consultative service provides consultative care across a full spectrum of adult endocrine diseases for 100-200 patients each month. The service rotation provides trainees with experience in the management of inpatients with diseases of the hypothalamus, pituitary, thyroid, adrenals, gonads, parathyroids and bone and mineral metabolism; fluid-electrolyte and acid-based disorders; endocrine emergencies; hormoneproducing neoplasms; treatment of endocrine neoplasia; and endocrine physiology in systemic diseases. For 10 months during training, fellows rotate through the service to evaluate patients directly or supervise the evaluation of patients by house staff and students who rotate through the consult service. Fellows also provide didactic teaching relevant to the endocrinological problems encountered by the service. Cases, including pertinent diagnostic test results (hormone levels, MRI/CT scans, ultrasounds), are reviewed with full-time faculty members during faculty rounds, which are held for approximately two hours per day on weekdays.

During this consult service rotation, fellows are responsible for the performance of all thyroid fine-needle biopsies (two to four per week). Dr. LoPresti and a cytopathologist conduct formal review of the cytological material. Fellows also perform any special diagnostic tests (e.g., insulin hypoglycemia, TRH stimulation tests) that are indicated. Fellows are required to keep a log of the biopsies and other special procedures performed during training.

Keck Medical Center of USC

The Division of Endocrinology and Diabetes provides full consultative services to Keck Hospital of USC (KH) and USC Norris Cancer Hospital (Norris). Each fellow rotates through the KH Endocrine-Metabolism Service for four months during the training period. Fellows see all consult patients (30-40 per month) and provide management recommendations and/or manage the patients under the supervision of full-time endocrine-metabolism faculty members (primarily Drs. Singer, Baron, Carmichael and Nguyen). KH’s busy neurosurgical and ophthalmology services provide fellows with considerable experience in the diagnosis and perioperative management of pituitary, hypothalamic and ophthalmological disorders. Specialized consultations for pituitary tumor management are supervised by Dr. Carmichael. Consults from Norris are primarily for the management of diabetes (including patients on enteral and parenteral nutrition), hormone-secreting neoplasia and endocrine abnormalities in systemic disease.

Outpatient Services

These activities provide trainees with diagnosis and management experience in the care of ambulatory patients with a variety of endocrine and metabolic disorders, including diseases of the hypothalamus, pituitary, thyroid, adrenals, gonads, kidneys and skin; diabetes mellitus and its chronic complications; hypoglycemia; disorders of bone and mineral metabolism; fluid-electrolyte and acid-based disorders; reproductive endocrinology; pediatric endocrinology; and lipid disorders.

Throughout their training, trainees are required to attend outpatient clinics within the Division of Endocrinology and Diabetes for a minimum of two half-days each week. To ensure continuity of care and experience with the long-term management of endocrine and metabolic disorders, each fellow devotes three half-days per month to his/her own continuity-of-care clinics in diabetes, general endocrinology and thyroid disorders (one half-day per month in each clinic). In addition, fellows attend weekly clinics in those three areas on a rotating basis. Finally, fellows spend two to three months each year attending specialty clinics to obtain training in the following areas: hyperlipidemias, reproductive endocrinology, pediatric endocrinology and endocrinology of pregnancy (including diabetes). During their rotations at KH (two to three months per year of training), fellows attend two outpatient clinics.

Conferences

Conferences and lectures complement clinical training by providing trainees with basic education in the normal physiology of endocrine systems, mechanisms of endocrine disease, laboratory techniques in clinical endocrinology and research techniques in endocrinology and metabolism.

Division of Endocrinology and Diabetes Grand Rounds is a weekly, topic-oriented one-hour conference that varies in format from case presentations and discussions by fellows to didactic presentations by USC and visiting faculty members. Full-time and volunteer faculty, fellows, students and residents attend these conferences. During their training, all first-year fellows are required to present at one Grand Rounds, and all second-year fellows are required to give two presentations. A visiting professor program has been established that allows nationally recognized leaders in areas of endocrinology and diabetes to give grand rounds and meet separately with trainees to discuss their clinical and research activities and career development.

Fellows participate in the Endocrine-Metabolism Core Curriculum, a weekly didactic lecture series, which covers basic mechanisms of endocrine function and dysfunction, management of endocrinologic and metabolic disorders, and clinical laboratory measurements in endocrinology and metabolism.

Journal Club is a monthly one-hour conference. Fellows present a case and a related paper, which is approved by a faculty member with relevant clinical or research expertise. Fellows discuss with faculty members the structural aspect of the paper (study design, data presentation and analysis, and discussion) and its relevance to management of the clinical case.

Research Fellows either choose a topic of interest or develop a study to address a question and hypothesis they want answered. In addition, fellows present his or her research project, if applicable.

Diabetes Teaching Rounds is a one-hour conference held bi-monthly.

During the weekly, one-hour Thyroid Conference, a fellow or resident presents one paper about some aspect of thyroid disease for the first half-hour (paper selected by thyroid faculty). For the remaining time, a patient who is to be seen in the thyroid clinic that morning is presented by a trainee, and the physical findings, diagnostic tests (including thyroid and CT scans and MRIs) and management are discussed by the fellows and faculty.

At the semi-annual Performance Reviews, each fellow’s attendance at Division Grand Rounds and Core
Curriculum lectures is reviewed from conference sign-in sheets. Fellows are counseled if attendance does not meet the required levels: all of the Thyroid Conferences, at least two-thirds of the Core Curriculum Lectures, and at least two-thirds of the Endocrine-Diabetes Grand Rounds and Journal Clubs.

Formal Evaluation of Training for each trainee’s performance focuses on written evaluations, performance in clinics and inpatient/consultation services. Semi-annual performance reviews are administered by Fellowship Program Director Dr. LoPresti. At the end of each rotation, fellows must also complete an evaluation of the faculty and the experience. A final evaluation of each trainee is completed by Dr. LoPresti at the end of the training period.