Endocrinology and Metabolism Fellowship Training Program at the

University of Virginia

P h o t o g r a p h s ( c l o c k w i s e , s t a r t i n g f r o m u p p e r l e f t ) : R o t u n d a a n d T h e L a w n , U n i v e r s i t y o f V i r g i n i a ( U Va ) ; s i g n l o c a t e d c l o s e t o F o n t a i n e R e s e a r c h P a r k ; w i n d o w a t e n t r a n c e t o E n d o c r i n o l o g y C l i n i c ; l a w n b e t w e e n b u i l d i n g s , F o n t a i n e R e s e a r c h P a r k ; U Va H o s p i t a l

Alan C. Dalkin, MD Program DirectorEndocrinology and Metabolism Fellowship Training ProgramPO Box 801412, University of Virginia Health SystemCharlottesville, VA 22908Phone: 434-243-2603 E-mail: acd6v@virginia.edu

The major purpose of the Endocrinology and Metabolism Training Program at the University of

Virginia (UVa) is to prepare physicians for a successful career in academic endocrinology by providing intensive clinical and research training. Our graduates can then choose from a wide range of career paths involving varied combinations of scientific investigation, clinical care, and medical education. A firm grounding in the fundamentals of endocrine research and clinical practice is eminently useful to the future clinician, educator, and investigator alike.

The primary strength of our training program is our faculty, many of whom are nationally and internationally known for clinical and research excellence. Members of our clinical faculty have a wide range of clinical and research interests, and the division has active research programs with state-of-the-art facilities. Because of the quality and accomplishments of our faculty—in addition to the exceptional clinical environment and infrastructure at UVa—our division has been repeatedly ranked among the top 12 endocrinology programs in the country (US News and World Report). Moreover, since our most recent Residency Review Committee (RRC) visit, our division has gained exceptional standing, earning recognition as the UVa Diabetes and Hormone Center of Excellence for its leadership in both clinical care and scientific study. And of great importance for prospective applicants, each member of our faculty is fully committed to the development of our trainees. Therefore, our fellows receive the finest educational experience available, and they develop into outstanding endocrinologists.  

We are approved by the Accreditation Council for Graduate Medical Education (ACGME) to accept four fellows each year. We are looking to attract highly-motivated, bright, and energetic individuals with a broad range of prior experiences in medicine. In addition to possessing excellent clinical abilities, applicants must be interested in scientific study and qualified to pursue research grant funding. Applications are accepted from December 1st to March 30th through the Electronic Residency Application Service (ERAS). (Click

here for Fellowships Applicant Site). Interviews usually occur between January and April, and decisions are made via the National Resident Matching Program (NRMP) for endocrinology subspecialty programs.

The purpose of this brochure is to briefly highlight the strengths of our training program. Where appropriate, hyperlinks are provided for those wanting greater detail. We very much welcome your interest in our program, and we encourage you to contact us if we can be of any help.

The standard fellowship experience encompasses three years. Fellows generally complete approximately 80% of

required clinical rotations during the first year of training, with the balance being completed in the second year. During the first year of fellowship, fellows meet with potential research mentors and select an area of investigation. Research projects begin no later than the end of the first year, a time when clinical requirements decrease. Overall, about 25-50% of a fellow’s time is spent in clinical endocrine rotations, with the remainder in research training.

CLINICAL TRAINING: Our fellows enjoy an excellent patient mix and are exposed to all major endocrine disease entities. As a tertiary care referral center, the UVa Health System cares for patients from an extensive geographic area that includes central, western, and southwestern Virginia, in addition to parts of West Virginia, Tennessee, and North Carolina.

UVa Health System: This state-of-the-art facility is located adjacent to the University grounds. It includes a 589-bed, full-service teaching hospital (opened 1989); a number of modern research buildings; and an outstanding biomedical

library. Most patient care is directed by housestaff/fellows and staffed by UVa faculty; and in 2008, our medical staff managed over 30,000 inpatient admissions and nearly 700,000 out-patient visits. There are no private patients at the University Hospital, and our fellows do not rotate to other hospitals/clinics for training.

Outpatient endocrinology clinics: All clinical faculty have active clinical practices, and our division sees over 12,000 out-patients a year. Fellows rotate through these faculty clinics, engaging faculty members in their specific areas of expertise (see page 3), which include benign breast disease and breast cancer prevention; diabetes mellitus; obesity; diabetes and cardiovascular disease; metabolic bone disease and calcium disorders; endocrine disease ( e . g . , d i a b e t e s ) i n p r e g n a n c y ; hypertension and

Endocrinology and Metabolism Training Program: Educational Environment

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A fellow discusses a clinic patient with Dr. Liu

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Fellowship-related conferences Endocrine Pathology Conference (9:00–10:00 am, 2nd Tuesday of the month): Endocrine fellows and pathology faculty review surgical/cytopathological cases using a multi-headed microscope. Endocrinology Grand Rounds (12:00–1:00 pm, every Tuesday): State-of-the-art lectures on clinical and scientific topics. Lectures are given by a variety of internal a n d e x t e r n a l s p e a k e r s . I n addit ion, each fellow presents a c l in ical and/or research topic once a year. Endocrinology Clinical Case Conference (1:00–2:00 pm, every Tuesday): Fellows present 2-3 clinical cases to the clinical faculty. This is a teaching conference where pathophysiology, diagnostic considerations (e.g., technical aspects of hormone assays), approaches to management, and relevant literature are routinely discussed.Fellows’ Clinical Lecture Series (2:00–3:00 pm, each Tuesday excepting Journal Club days): Faculty give didactic lectures on a wide array of clinical topics.Journal Club (2:00–3:00 pm, second Tuesday of the month): Fellows and a faculty member review a recent scientific publication, focusing on methods (e.g., study design, statistical analysis) and clinical relevance. Thyroid Cancer Case Conference (4:00–5:00 pm, last Tuesday of the month): Faculty and fellows from Endocrinology, Radiology/Nuclear Medicine, Pathology, and Surgery review and discuss 4-6 complicated thyroid cancer cases. The conference is primarily geared toward clinical decision-making in a multidisciplinary setting.Research in Progress (8:30–9:30 am, each Wednesday September through May): Faculty and research trainees present their research and receive constructive criticism and advice regarding their work. Pituitary Case Conference (8:00–9:00 am, fourth Friday of the month): Details regarding 6-8 pituitary cases are discussed by faculty/fellows from Endocrinology, Neurosurgery, Neuroradiology, and Neuropathology. Diabetes Conference (12:30–1:30 pm, first Friday of the month): Faculty, fellows, nurses, and dietitians discuss patient care, new therapies/technology, and recent science in the field of diabetes mellitus.

Shupnik, 2007-2008) and the American Diabetes Association (Eugene Barrett, 2003-2004), Secretary-Treasurer of the Endocrine Society (John Marshall, 2010-2013), a member of the International Society of Endocrinology Executive Committee (Richard Santen, 2004-2010), and the President of the Association of Program Directors in Endocrinology, Diabetes, and Metabolism (Alan Dalkin, 2007-2009).

University of Virginia and Charlottesville: UVa is located in Charlottesville, which is nestled in the foothills of the Blue Ridge Mountains and considered by many to be one of the finest cities in the country. Charlottesville and Albemarle County offer a broad range of cultural events and outdoor activities, in addition to a number of historical landmarks. And with low crime rates and exceptional school systems, Charlottesville is an excellent place for families.

adrenal d isease; neuroendocrinology/ pituitary disease; r e p r o d u c t i v e endocrinology and i n f e r t i l i t y ; a n d t hy ro i d d i s e a s e.F e l l o w s a l s omaintain a weekly longitudinal care (continuity) clinic in which they provide endocrine care to their own roster of patients while learning from faculty preceptors dedicated to teaching (Dalkin, Liu, Kozlow, McCartney).

Endocrinology’s largest clinic is in the 415 Ray C. Hunt building (Fontaine Research Park), where four nurses and a nurse practitioner complete our clinical care group. The division also supervises a large multidisciplinary Diabetes Education and Management Program (DEMP) involving nurse educators and dietitians. Through DEMP, diabetes and nutrition education is available every workday. The division maintains its own thyroid and ovarian ultrasound machines, as well as a DEXA scanner. Dynamic endocrine testing is performed in the clinic by trained endocrine nurses, and cytology services are readily available. UVa employs a fully electronic medical record.

Inpatient Consultation Service: The fellows have primary responsibility for the inpatient consultation service, which renders over 600 initial consultations annually and involves a wide variety of endocrine pathology. Fellow activities include initial evaluation, daily follow-up, and being a liaison between the primary and consulting teams. Two fellows are on the consult service at all times, allowing them to alternate overnight and weekend call. Coordinated care programs are in place for pituitary, thyroid, parathyroid and adrenal surgical procedures.

Neuroendocrine Service: This combined endocrine and neurosurgery service performs 150-250 transphenoidal pituitary operations and over 50 gamma knife radiosurgery procedures each year. This has an international reputation, routinely drawing patients from all parts of the globe.

Specialized procedures: Fellows will gain facility with thyroid ultrasound, ultrasound-guided thyroid biopsy, dual energy X-ray absorptiometry, ovarian ultrasound, and ovulation induction. Additional procedures with which trainees gain experience include: adrenal vein and inferior petrosal sinus sampling, adrenalectomy, bariatric surgery, bone biopsy, intrauterine insemination, islet cell transplantation, parathyroidectomy (including minimally invasive parathyroid surgery, intra-operative PTH assays, and parathyroid autotransplanation), pancreas/kidney transplantation, pituitary adenomectomy, radioisotope treatment and diagnostic scans, and thyroidectomy.

Networking: Our faculty members are heavily involved in national/international endocrinology organizations, which facilitates networking to advance the career development of trainees. Our faculty include recent presidents of the Endocrine Society (Robert Carey, 2008-2009; Margaret

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Entrance to Endocrine Clinic building

Clinical facultyA primary strength of our program is a large number of clinical faculty committed to excellence in clinical care, teaching, and research. Our clinical faculty have diverse clinical and research interests. Click on a name for more information.

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PARTICIPATING FACULTYWe work closely with many other faculty to provide comprehensive endocrine care, including:

Reid B. Adams, MD (pancreatic and gastrointestinal surgery)

J. Fritz Angle, MD (inferior petrosal sinus and adrenal vein sampling)

Kristen A. Atkins, MD (breast pathology)

Christine M. Burt Solorzano, MD (pediatric endocrinology)

Kenneth L. Brayman, MD (kidney/pancreatic/islet cell transplantation)

David E. Bruns, MD (clinical endocrine laboratory)

William L. Clarke, MD (pediatric endocrinology)

Mark D. DeBoer, MD (pediatric endocrinology)

Eduard E. de Lange, MD (abdominal/ pancreatic imaging)

John B. Hanks, MD (thyroid, parathyroid, adrenal surgery)

Jennifer A. Harvey, MD (breast imaging)

John A. Jane Jr., MD (pituitary neurosurgery)

Paul A. Levine, MD (head and neck surgical oncology)

M. Beatriz S. Lopes, MD (pituitary pathology)

Edward H. Oldfield, MD (pituitary neurosurgery)

Patrice K. Rehm, MD (nuclear medicine)James F. Reibel, MD (head and neck

surgical oncology)Alan D. Rogol, MD (pediatric

endocrinology)Bruce D. Schirmer, MD (bariatric

surgery)Jason P. Sheehan, MD, PhD (gamma

knife radiosurgery)Ladislau Steiner, MD, PhD (gamma

knife radiosurgery)Edward B. Stelow, MD (thyroid

pathology/cytopathology)Brian R. J. Williamson, MB, ChB

(nuclear medicine)

Stacey M. Anderson, MD Clinical: general endocrinology,

thyroid disease Research: hypoglycemia,

continuous glucose monitors, artificial pancreas project

Eugene J. Barrett, MD, PhD a Clinical: general endocrinology, diabetes mellitus

Research: insulin action on carbohydrate/protein metabolism

Susan K. Blank, MD Clinical: general endocrinologySue A. Brown, MD Clinical: general endocrinology,

metabolic bone disease/calcium Research: metabolic bone diseaseZachary M. Bush, MD Clinical: general endocrinology Research: neuroendocrinology/

pituitary tumorsRobert M. Carey, MD Clinical: general and cardiovascular

endocrinology, adrenal disease, hypertension

Research: hormonal control of blood pressure, fluid/electrolyte balance, and renal function

Margaret K. Crook, MD Clinical: general endocrinologyAlan C. Dalkin, MD b Clinical: general endocrinology,

metabolic bone disease/calcium Ayotunde Dokun, MD, PhD Clinical: general endocrinology Research: peripheral arterial

disease

Christine A. Eagleson, MD Clinical: general and reproductive

endocrinology, female infertilityWilliam S. Evans, MD Clinical: reproductive

endocrinology, infertility Research: PCOS, mathematical

modeling of the hypothalamic-pituitary-ovarian axis

Susan E. Kirk, MD Clinical: general endocrinology;

diabetes and other endocrine disease in pregnancy

Wende M. Kozlow, MD Clinical: general endocrinology,

metabolic bone disease, calcium disorders

Zhenqi Liu, MD Clinical: general endocrinology,

thyroid disease Research: insulin action/resistance,

cardiovascular disease in diabetesJohn C. Marshall, MD, PhD Clinical: general and

reproductive endocrinology, neuroendocrinology/pituitary

Research: GnRH physiology and PCOS; regulation of gonadotropin gene expression

Anthony L. McCall, MD, PhD Clinical: general endocrinology,

cardiovascular disease in diabetes Research: hypoglycemia, genetic

and cardiovascular risk in diabetes, and glucagon secretion

Christopher R. McCartney, MD Clinical: general endocrinology,

thyroid disease Research: GnRH physiology

and PCOS, pubertal hyperandrogenemia

Shetal H. Padia, MD Clinical: general endocrinology Research: hypertension, obesity,

and the renin-angiotensin systemRichard J. Santen, MD Clinical: general endocrinology,

benign breast disease, breast cancer prevention

Research: estrogen action and breast cancer growth

Helmy M. Siragy, MD Clinical: adrenal disease, endocrine

hypertension Research: endocrine hypertension,

angiotensin receptors, renal paracrine hormones

Michael O. Thorner, MB, DSc Clinical: neuroendocrinology/

pituitary, obesity Research: regulation of growth

hormone secretion, ghrelin physiology

Mary Lee Vance, MD Clinical: neuroendocrinology/

pituitary Research: neuroendocrinology,

regulation of growth hormone secretion

a Director, General Clinical Research Center b Chief, Div. of Endocrinology and Metabolism; Associate Chair of Clinical Affairs, Dept. of Medicine

Our general faculty also include Terry Saunders, PhD, and Joyce Green-Pastors, RD, MS, CDE, who (along with Dr. McCall) spearhead the Virginia Center for Diabetes Professional Education.

Specialized resources Research by trainees is facilitated

by specialized programs at UVa. The following programs are available to enhance fellowship training.

Research centers General Clinical Research Center

(GCRC)Center for Research in

ReproductionDiabetes CenterCancer CenterSmall Animal Multi-Modality

Imaging CenterCardiovascular Research CenterCenter for Biomathematical

TechnologyCenter for Biomedical Ethics and

HumanitiesCenter for Contraceptive and

Reproductive HealthCenter for Cell SignalingCenter for Cellular ImagingCenter for Public Health Genomics

Formal training programs Accelerated PhD Program for MDsDepartment of Public Health

Sciences (Master of Clinical Research, Master of Public Health)

Multidisciplinary Training program in Clinical Investigation (MTPCI) (Certificate of Clinical Investigation)

Teaching Resource Center (TRC)(Programs to enhance teaching ability for faculty and fellows)

Research Ethics Course

Informational resourcesSchool of Medicine Office for

Research Biomedical Sciences Postdoctoral

ServicesUVa Research Channel on YouTube

Institutional training grantsResearch training is a large

component of fellowship training at UVa. Institutional training grants allow fellows to obtain funding for their research training and salary support for their second and third years of fellowship. There are three training grants—awarded to our division by the National Institutes of Health (NIH)—available to fellows:

Cellular and Physiological Mechanisms in Reproduction

Director: John Marshall, MD, PhD

Research Training in Diabetes and Hormone Action

Director: Eugene Barrett, MD, PhD

Research Training in Neuroendocrinology

Director: Robert Carey, MD

An NIH training grant awarded to the Division of Cardiovascular Medicine is also available for endocrine fellows interested in vascular biology:

Vascular Biology Training Program Director: Coleen McNamara, MD

Research facultyIn addition to our clinical faculty

who engage in clinical and/or basic research, we have outstanding research faculty who are dedicated to both basic scientific investigation and teaching. Fellows may work with any of these faculty to learn basic research in the context of their areas of expertise. Click on a name to link to more extensive profile.

Sarah Aiyar, PhD (cancer therapeutics for treatment of hormone-dependent breast cancers)

Leon S. Farhi, PhD (mathematical modeling of endocrine feedback systems)

Bruce Gaylinn, PhD (growth hormone-releasing hormone and ghrelin physiology)

Daniel J. Haisenleder, PhD (regulation of gonadotropin gene expression)

Susanna R. Keller, MD (insulin signaling; insulin-regulated membrane trafficking and modification of cell surface function)

Suzanne M. Moenter, PhD a (GnRH neuron function and animal models of PCOS)

Ralf M. Nass, MD (ghrelin physiology)Craig S. Nunemaker, PhD

(mechanisms of inflammatory-mediated pancreatic islet cell dysfunction)

Suna Onengut-Gumuscu (genetics of type 1 diabetes mellitus)

Margaret A. Shupnik, PhD b (regulation of gonadotropin gene expression; estrogen action in neuroendocrine tissues and breast cancer)

Wei Yue, MD (estrogen and breast cancer initiation/progression)

a Vice Chair for Research Operations, Dept. of Medicineb Associate Dean for Basic Research, School of Medicine

The Aurbach Research Building (450 Ray C. Hunt Drive) houses a majority of the division’s research labs

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esearch trainingR UVa ranks in the top 30% of U.S. institutions in funded National Institutes of Health (NIH) grants. Our faculty currently have over 25 NIH R01 or equivalent grants. Research is an important part of our training program for a number of reasons: it is a major foundation of an academic career; it fosters skills (e.g., critical thinking, problem solving) that significantly strengthen clinical acumen; and it offers

enhanced expertise in a specialized area of endocrinology. Second year fellows are usually supported by institutional training grants from the National Institute of Health (NIH) (see below), and all fellows are expected to submit an entry-level grant application (e.g., National Research Service Award [NRSA] from the NIH, or equivalent) during their second year of training. Pursuing grant support is a valuable component of research training, and our fellows have been highly successful in obtaining extramural support. Fellows are also expected to present their research results at local, regional, and national meetings and to submit their work for publication in peer-reviewed journals.

For more information, contactAlan C. Dalkin, MD

Program Director, Endocrinology and Metabolism Fellowship Training ProgramPO Box 801412, University of Virginia Health System

Charlottesville, VA 22908Phone: 434-243-2603

E-mail: acd6v@virginia.edu