During the fellow's clinical training, he/she evaluates patients with a wide range of endocrine disorders: thyroid diseases (including fine needle aspiration of thyroid nodules and radioactive iodine therapy for hyperthyroidism and thyroid cancer), metabolic bone disorders (osteoporosis, osteomalacia, Paget's disease), hyper- and hypocalcemia, hyperandrogenism in women, sexual dysfunction and infertility, diabetes mellitus, male hypogonadism, endocrine causes of hypertension (Cushing's syndrome, hyperaldosteronism, pheochromoctyoma), and pituitary dysfunction. A major portion of the clinical effort in the fellowship program is devoted to evaluation and treatment of patients in an ambulatory care setting.

Ambulatory training is provided to the Fellows in Endocrinology, Diabetes, and Metabolism through active participation throughout their period of training in subspecialty endocrine clinics at each of the three hospitals in the program, in which both new and continuity patients are seen. These ambulatory care venues insure exposure to an economically and ethnically diverse spectrum of individuals with diseases and syndromes across the entire spectrum of endocrine and metabolic problems.

During the first year, fellows evaluate patients in the following settings: Penn Endocrinology, Penn Pituitary Center, Penn Thyroid Center (a clinic where ultrasound guided fine-needle aspiration thyroid biopsies are performed), Penn Rodebaugh Diabetes Center, and VAMC General Endocrine Clinic. First year fellows are assigned to three to four weekly clinics depending upon their rotation. 

Second year fellows following the research educational pathway maintain a weekly endocrine continuity clinic of their choice, which may be composed of two six-month consecutive blocks in two different clinic settings. Second year fellows pursuing the clinical educator pathway have a total of four weekly clinics, one of which is focused on the care of diabetic patients, and the others are selected by the fellow and may include an additional thyroid biopsy clinic. Two weekly sessions will be at the VAMC.  Two of the weekly clinics must be at least of six month duration to be considered continuity clinics. In addition, all second year fellows rotate through the Perelman Endocrine Urgent Care Clinic for two to four months. Lastly, reproductive endocrine, lipid, and pediatric endocrine rotations are done in the second year by all fellows.  Third and fourth year fellows (required by the Accreditation Council for Graduate Medical Education (ACGME) and American Board of Internal Medicine (ABIM) for fellows in the ABIM Research pathway who complete only two years of an internal medicine residency prior to commencement of fellowship) maintain a weekly continuity clinic, which may be composed of two six-month consecutive blocks in two different clinic settings.

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