- Introduction
- Curriculum
- Clinical training
- Research training
- Training as a subspecialty teacher
- Evaluation, feedback, & career development
- What happens to program graduates?
- Salary & perquisites
- The application and selection process
- Further information
For more than forty years, The Johns Hopkins Endocrinology and Metabolism Fellowship Program has trained academic endocrinologists who plan careers as physician-scientists, clinical-investigators, or health services investigators. The program is based in the Division of Endocrinology & Metabolism in the Department of Medicine. We have the faculty, facilities, and curriculum to provide fellows with both excellent clinical training and outstanding research experience.
The Division faculty have broad clinical expertise in all major areas of the specialty of endocrinology, diabetes, and metabolism. Their clinical teaching is augmented by faculty in the Divisions of Pediatric and Reproductive Endocrinology at Johns Hopkins. Fully staffed and equipped outpatient and inpatients facilities provide an effective environment for patient care and clinical teaching. The institution is one of the principal tertiary referral centers in the nation and the world for patients with endocrine disorders. It is also the provider of primary endocrine consultative services to a large urban and suburban population in the mid-Atlantic region. Consequently, fellows in clinical training are exposed a large number of patients with the full spectrum of endocrine conditions, ranging from all common disorders to the most exotic diseases.
Fellows can pursue one of three research training pathways: 1) the Physician-Scientist Pathway, learning how to perform basic studies of hormone expression and action; 2) the Clinical-Investigator Pathway, pursuing clinical research training related to novel therapeutic agents and delivery systems for endocrine and metabolic disorders; or 3) the Health Services Research Pathway, developing the expertise to undertake outcomes, cost-effectiveness, and health policy research related to the subspecialty of Endocrinology, Diabetes, and Metabolism. Our faculty's research interests are extensive and diverse. Resources for research training include fully equipped molecular and cell biology laboratories, four NIH-funded Clinical Research Centers, a Clinical Studies Unit for industrially funded clinical research, and a Comprehensive Diabetes Center. In addition, fellows may pursue investigative training study in one of several closely affiliated laboratories and clinical research facilities at the Johns Hopkins Medical Institutions. The Division holds two NIH-funded training grants--one for Endocrine Molecular and Cell Biology Research Training, and the second for Clinical and Epidemiological Research Training in Diabetes and Endocrinology. These grants along with additional NIH training programs in affiliated departments, institutional endowments, and other funds provide ample support for basic, clinical, and health services research training of fellows.
The Department of Medicine Diversity Council was created at Johns Hopkins University to promote increased recruitment, retention and advancement of underrepresented minority faculty, fellow and residents, as well as to promote cultural diversity across the department. The Department of Medicine and the Diversity Council have implemented new programs such as:
- Reaching out to minority applicants
- Promoting new hiring goals for the recruitment of minority faculty
- Creation of mentoring teams for minority residents, fellows and faculty
- Minority Visiting Clerkships
- Annual Visiting Minority Professorship
- Diversity workshops for faculty and staff
For more information, please visit the Diversity Council Web Site
Intensive clinical training is the primary aim of the first fellowship year. First-year fellows spend each weekday morning in endocrine subspecialty clinics and ten months on our inpatient consultation services. Fellows also rotate through the Pediatric and Reproductive Endocrinology Clinics. Throughout the three-year program, fellows maintain their own weekly endocrine consultative practice in the Fellows Clinic.
Research training is the principal focus of the second and third years of fellowship. Fellows select a faculty research preceptor who is responsible for supervising the didactic and experiential aspects of their training as an endocrine investigator. At the end of this two-year period, fellows are expected to have mastered a set of fundamental investigative skills in their chosen pathway, to have contributed significantly to original research that is published or submitted, and to be prepared to join the faculty of an academic health center to pursue the next phase of their careers.
The program emphasis on ambulatory subspecialty training reflects the fact that most contemporary practice of endocrinology and metabolism occurs in the outpatient setting. Twelve one-half day clinic sessions are held weekly at the Divisions' three institutions: five at Johns Hopkins (General Endocrine, Diabetes and Lipid, Calcium and Metabolic Bone Disorders, Neuroendocrine-Pituitary, and Thyroid Clinics), four General Endocrine Clinics at Sinai Hospital, and General Endocrine and Metabolic Bone Disease Clinics at Hopkins Bayview Medical Center. The clinics in all three institutions occupy recently renovated, fully equipped offices with nursing, laboratory, and administrative support. Adjacent special procedure and conference rooms are available. During each of their approximately 200 sessions during the first year alone, fellows see an average of 1.5 new consultations and 2.5 follow-up patients: a total of 300 new endocrine consultations and 500 endocrine follow-up visits in the first year alone. Faculty actively supervises fellows in every clinic.
In addition, fellows rotate through other ambulatory settings to round out their comprehensive clinical training experience: 1) The Johns Hopkins Comprehensive Diabetes Center, an education and evaluation center for patients with diabetes, which includes a conference room-learning center, nurse's and dietitian's offices, and two consultation--examination rooms; 2) The outpatient General Clinical Research Center; 3) the Preventive Cardiology Clinic; 4) the Department of Pediatrics' Endocrine Clinic; and 5) the Department of Obstetrics and Gynecology's Reproductive Endocrine Clinic.
First-year fellows also attend on active Inpatient Endocrine Consultation Services at the three participating institutions: Johns Hopkins Hospital (six months), Sinai Hospital of Baltimore (two months), and Bayview Medical Center (two months). Fellows have primary responsibility for all patients admitted to or consulted upon by faculty in the Divisions of Endocrinology and Metabolism. For admissions directly to the Divisions' services, the fellow has primary responsibility for analysis of clinical and laboratory findings, formulating a diagnostic and therapeutic plan, obtaining required consultations, monitoring the patient's hospital course, instructing residents, communicating with the attending, and discharge planning and orchestration of subsequent management. For inpatient consultations, the fellow has analogous responsibilities for the patient's endocrine and metabolic problems. In approximately one-half of these cases, the fellow assumes primary responsibility for follow-up and orchestration of subsequent visits. To fulfill these responsibilities, fellows see direct admissions daily (seven days per week) and consultations daily until endocrine and metabolic problems have stabilized or resolved. At Johns Hopkins, fellows typically are the responsible admitting specialty physician for 1-2 inpatients, see 1-3 new consultations per day, and follow 8-12 other patients.
Fellows review all inpatient consultations with a faculty attending on attending rounds, which last approximately two hours each day Monday through Friday. All patients are presented to the attending, who personally interviews and examines the patient before leading a discussion that is intended 1) to approve diagnostic and therapeutic plans for the specific case, and 2) to elucidate relevant general clinical and investigative issues arising from its example. The progress of inpatients is reviewed daily at these rounds. The attending is available around-the-clock, 7 days per week 365 days per year for consultation with the fellow in emergencies or whenever any questions or concerns about patient management arise. As the year proceeds, fellows are entrusted with greater responsibility and independence as their individual proven knowledge base, judgment, and skills warrant it.
Procedures in endocrinology and metabolism are all supervised by a faculty attending. All thyroid fine needle biopsies, radioactive iodine therapies, and potentially complicated provocative hormonal testing (e.g. insulin-induced hypoglycemia) are performed only after advanced consultation and with the immediate attendance of a faculty member.
The numerous and varied patients admitted to the three institutions, Bayview, Johns Hopkins and Sinai, ensure that all fellows encounter the entire spectrum of commonly encountered endocrine and metabolic disorders (e.g., diabetes mellitus and thyrotoxicosis) as well as unusual diseases (e.g., adrenoleukodystrophy and the MEN II syndrome). The worldwide Johns Hopkins tertiary referral cachement area complements the primary care populations served by the three participating institutions. Furthermore the Division's intensive schedule of regular conferences (see below) ensures that all fellows benefit from patients seen at any time by the consultative service.
A comprehensive conference series contributes to the fellow's clinical training. Endocrine Grand Rounds, which are held weekly, feature Endocrine Research Conference and outside presentations on state-of-the-art topics in clinical and investigative endocrinology. An informal luncheon case conference is held following the Fellows Clinic each week. Regular Endocrine Journal Club, Endocrine Case Conference, Endocrine Surgery Conference, Endocrine Pathology Conference, Endocrine Laboratory Conference, Metabolic Bone Disease Conference, Thyroid Tumor Center Conference, Thyroid Cytopathology Conference sessions are held.
Program fellows pursuing laboratory research training work in an exemplary environment. The division faculty have 6,500 square feet of recently renovated wet laboratory space equipped with all necessary facilities for endocrine investigation, including centrifugation, chromatography, nucleotide hybridization and cloning, scintillation counting, cell culture, cell sorting, radioimmunoassay, and radioreceptor assay. Adjacent facilities are available in the institution for peptide and nucleotide sequencing and synthesis. In addition to the Division's own laboratories, fellows may pursue endocrine-related research with other outstanding investigators at The Johns Hopkins Medical Institutions and in the past have undertaken projects in the Cancer Biology, Neuroscience, Biochemistry, and Molecular Biology laboratories.
Program fellows and faculty have access to outstanding facilities for clinical investigation. Johns Hopkins has four NIH-funded General Clinical Research Centers. One member of the division faculty is a leader of the General Clinical Research Center: Dr. Christopher Saudek, who is Director. These are valuable and versatile resources for clinical investigation by the program's fellows.
Fellows pursuing health services research training have access to additional faculty preceptors and didactic training opportunities in the Division of General internal Medicine, the Welch Center for Clinical Epidemiology and Prevention, and the Johns Hopkins School of Hygiene and Public Health. Some fellows have chosen to pursue a Masters of Public Health degree as a part of the fellowship-training curriculum.
All fellows are encouraged to have a didactic component to their investigative training. A special institutional course is offered in clinical investigation, covering principles of clinical research, trial design, biostatistics, and informed consent. Another departmental course offers an introduction the techniques of molecular biological research. Special tutorial series related to research preparation are held during the Sinai Hospital and Bayview Medical Center rotations during the first year. Dr. David Cooper, Division Director at Sinai Hospital and a Corresponding Editor of JAMA, tutors fellows regarding medical writing and publication, including an opportunity for them to participate in the review of articles currently being submitted. In addition, a Research Ethics Conference and Internet Resources Conference are each held several times during the year.
Graduates have accepted academic positions at numerous academic institutions.
Training as a subspecialty teacher
Fellows share responsibility with the faculty attending for teaching, supervising, and evaluating medical students (25-30 per year), internal medicine residents (18 per year), and other fellows (Reproductive and Pediatrics Endocrinology) rotating on the service. These trainees provide fellows with an opportunity to hone teaching and supervisory skills.
A team consisting of a faculty member and a fellow coordinates each of the Division's conferences. This leadership involves format definition, topic selection, scheduling, and evaluation. In addition, fellows are expected to present in rotation at Endocrine Journal Club (all three years), Endocrine Research Conference (second and third years), and Endocrine Subspecialty Conference (all three years). Furthermore, the fellows themselves orchestrate a series of Core Clinical Endocrinology Conferences, which are held three times per week to present basic topics in clinical endocrinology and metabolism for the residents and students rotating on service. By the end of their three years, fellows have accumulated a repertoire of brief talks on most major areas of clinical endocrinology.
Evaluation, feedback & career development
We individualize details of each fellow's program to meet her or his goals and needs. A major feature of this effort is selection of an Advisory Committee assigned to each fellow. The Committee consists of 4 or 5 faculty members who meet twice a year to discuss the fellow's progress and to give the fellow the advantage of having four or five experienced faculty suggest routes toward successful pursuit of his or her targets. Each fellow meets with a senior member of the Division faculty (currently Dr. Kenneth Zierler) to discuss the fellow's research experience and initial and long term goals. From this discussion the fellow and Dr. Zierler select an advisory Committee to serve for one year. For first year fellows, the Advisory Committee is composed mainly of Division faculty who will be concerned mainly with the fellow's progress as a clinical endocrinologist.
The chairperson of all first year Advisory Committees is Dr. David Cooper, a superb clinical teacher who enjoys this role and is ideally suited for it. The composition of each Advisory Committee is changed for the second and third year fellows to reflect primarily the fellow's research interest. Again, the revised Advisory Committee is selected by a discussion between the fellow and the senior Division faculty member. The fellow's research mentor is a member of the Advisory Committee but cannot be its chairperson. Members of the Advisory Committee may be drawn from any appropriate department of the Johns Hopkins University, and even from outside the University. For example, for a fellow taking the clinical investigator route, faculty from Department of Biostatistics or of Epidemiology in the Bloomberg School of Hygiene of the Johns Hopkins University may serve on the Committee. The Committees discuss the fellow's training progress, any impediments to success and potential grants and awards to support training and career development. During the third year the Committee is also concerned with development of the fellow's career plans and identification of suitable positions following completion of the fellowship. In addition to those selected for the Advisory Committee, Dr. Ladenson, Director of the program serves ex officio on all Advisory Committees. Minutes of Advisory Committee meetings are incorporated in each fellow's file to help provide continuity of advice and recommendations.
Finally, Dr. Zierler's office is located next to the fellows' offices. His door is always open to discuss any problem, personal or professional, the fellow may wish to discuss.
First-year fellows are evaluated each month based on the criteria of the American Board of Internal Medicine by attending faculty members on their inpatient and outpatient services. Second and third-year fellows have semiannual clinical evaluations. Their progress with laboratory, clinical, or health services research training is evaluated in writing by their individual faculty preceptor, who reports to the fellow's Advisory Committee every six months. The Committees then review these reports personally with each fellow. In addition, the Director of the Division Endocrinology and Metabolism reviews all fellows' evaluation forms and regularly meets them to assess their progress.
The program faculty and curriculum are also regularly evaluated by the Division Director, who is also responsible for monitoring the effectiveness of the clinical and research training program. Regular Fellows Luncheons with the Director provide an opportunity for fellows to discuss areas needing improvement.
What happens to program graduates?
The Johns Hopkins Endocrine Training Program invests substantial effort and takes great pride in the success of its graduates. Hopkins fellows taking the subspecialty board examination in Endocrinology, Diabetes, and Metabolism have passed without exception. Recent program graduates have accepted academic positions at a number of academic institutions.
Former Fellow
Institutional Affiliation
Alejandro Ayala, MD
National Institute of Health
Lewis T. Blevins, MD
Vanderbilt University
Michael Boyne, MD
University of the West Indies
Anne Cappola, MD
University of Pennsylvania
Samer El-Deiry, MD, PhD
SUNY - Albany Group Practice
Elizabeth Hopkins Holt, MD, PhD
Yale University
Alan Krasner, MD
Pfizer Pharmaceuticals
Julie S. Krop, MD
Millennium Pharmaceuticals
Matthew D. Ringel, MD
Ohio State University
Steven I. Sherman, MD
University of Texas - Houston and Baylor University School of Medicine
Kristy Silver, MD
University of Maryland
John Williams, MD, PhD
Knoxville - Group Practice
Justina Wu, MD, PhD
Emory University
First-year fellows who have completed three years of Internal Medicine residency receive a salary of $40,920 per year. New fellows with additional years of postgraduate training may receive higher salaries. Fellows' salaries increase by $1,000 per year; fellows garnering individual fellowship awards are permitted to accept larger salaries if they are provided. Fellows receive personal health, disability, life, and malpractice insurance coverage. Each fellow is given $1,000 per year for professional travel to meetings and courses; each fellow is given $300 for the professional expenses, e.g., journal subscriptions, books, and dues.
The application and selection process
Applications must be submitted through the Electronic Residency Application Service. Applicants who are selected for interviews will be notified well in advance to help facilitate arrangements.
For further information, please contact:
Division of Endocrinology & Metabolism
Johns Hopkins University
1830 East Monument Street, Suite 333
Baltimore, MD 21287Telephone: (410) 955-3663
Fax number: (410 955-8172
E-mail: Division of Endocrinology & Metabolism
