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INTRODUCTION The Integrated Training Program in Diabetes, Endocrinology and Metabolism (DEM Program) at the University of California, San Francisco is aimed primarily at training physicians who ultimately plan to pursue a career in academic medicine. This fully ACGME-accredited program consists of one exclusively clinical year, followed by two years of postdoctoral experience with scientific investigation. The program provides the qualifications for specialty board certification in Endocrinology, Diabetes and Metabolism and sufficient research experience for pursuit of a career in academic medicine. The majority of the trainees go on to careers in academic medicine or in the pharmaceutical or biotechnology industry. Our record of placing graduates in first-rate facilities has been excellent. In general, preference for acceptance into the program is given to those qualified applicants who wish to follow a career in academic medicine.
CLINICAL TRAINING There are separate divisions of Diabetes, Endocrinology and Metabolism at the San Francisco General Hospital, the Department of Veterans Affairs Medical Center, and the University of California Hospitals. The clinical year involves a four-month rotation at each of the three hospitals. These rotations involve extensive inpatient and outpatient exposure to the full spectrum of problems in Diabetes, Endocrinology and Metabolism which include disorders of the thyroid, adrenal, pituitary, parathyroids, and gonads; endocrine hypertension; metabolic bone diseases; type 1 and 2 diabetes mellitus; lipid disorders; and endocrine surgery. The clinical year gives trainees a broad exposure to a large full-time and part-time clinical faculty (> 75 faculty members) with specialized expertise in these problems. Fellows lead a weekly clinical conference throughout the year and present two individual divisional seminars in their clinical year. There is an emphasis throughout on outpatient endocrinology and consultative endocrinology. Approximately 40% of a fellow's time is spent in endocrinology subspecialty clinics, including diabetes, lipid, thyroid, metabolic bone, pediatric and endocrine surgery clinics. All fellows have an Endocrine Continuity Clinic for two years. This ensures them the opportunity to follow patients long enough to witness the natural history of endocrine disease and its therapy unfold. Clinic conferences are supplemented with in-depth individualized faculty training and mentoring. All fellows attend the monthly Endocrine Fellows-Faculty Journal Club. Fellows are encouraged and supported to attend one national meeting in diabetes, endocrinology, and metabolism.
RESEARCH TRAINING Research training typically follows one of two pathways, the Basic Scientist Pathway and the Clinical Investigator Pathway.
The Basic Scientist Pathway. Recognizing that our pool of fellows consists of individuals with disparate backgrounds in science and research, there are several options for training in basic research. One option consists of being mentored in the laboratory of an established bench investigator and supplementing practical lab-based training with formal courses in cell biology, molecular biology, genetics, immunology, biochemistry, and other topics offered through the UCSF graduate programs [e.g., the Biomedical Sciences (BMS) Program or the Program in Biologic Sciences (PIBS)]. A second option, often pursued by endocrine fellows with previous research experience, is to have their research training experience take place in the laboratory of their chosen mentor, supplemented with ongoing seminars and conferences in that laboratory or department. A third option would be to apply to the UCSF Molecular Medicine Training Program (MMTP) for a research fellowship. This competitive institution-wide program provides fellowship support for trainees to pursue one year of formal course-work and seminars in molecular and cell biology. This is combined with in-depth research under the guidance of a mentor in the MMTP. The MMTP program faculty is larger and broadly based. Many faculty serving as mentors for the DEM Program are also faculty in the MMTP. More information on this training option is available when you visit our program. A fourth option is to pursue a PhD degree in the BMS Program at UCSF, an elite graduate program in integrative biology with an emphasis on the study of human disease. One can apply to this program before or after arriving on campus.
The Clinical Investigator Pathway. Like the Basic Scientist Pathway, this program recognizes the need for an organized preparation for individual research training. The required curriculum for this pathway includes the ORACLE and ATCR (Advanced Training in Clinical Research) courses offered by the UCSF Department of Epidemiology and Biostatistics. These courses cover basic clinical study design, biostatistics, epidemiology and medical ethics. These courses are described in detail in an accompanying brochure.
Clinical research training for a DEM fellow is typically jointly mentored by a faculty member from one of the Endocrinology or Metabolism Divisions of one of our three hospitals and a faculty member from the Epidemiology/Biostatistics Department at UCSF. The clinical research training experience is planned by the fellow in conjunction with his/her chosen preceptors and includes a variety of topics in hyperlipidemia, cardiovascular endocrinology, osteoporosis, growth hormone therapy, pituitary and adrenal disorders, wasting syndromes, and diabetes. Available research projects span the full range of clinical investigation, from studies of metabolism in the General Clinical Research Center to epidemiologic aspects of osteoporosis.
Plans for research training and selection of mentors are discussed with the Program Director and endocrine faculty in the first year of training. Regardless of the training option chosen, fellows will choose a mentor from approximately 75 distinguished research faculty members at UCSF. Faculty members are drawn from ten academic departments (Anatomy, Biochemistry, Epidemiology and Biostatistics, Physiology, Pharmacology, Medicine, Pediatrics, Obstetrics/Gynecology, Radiology and Surgery) and represent every discipline within Endocrinology-Metabolism and its related basic and clinical sciences.
The breadth of research opportunities available to trainees is illustrated by the attached research summaries. About one-half of trainees in either of these pathways typically choose a preceptor outside the Department of Medicine.
Research training in the DEM Program is primarily funded by a Training Grant from the National Institute of Diabetes, Digestive and Kidney Diseases, NIH.
APPLICATION PROCEDURE Applicants interested in applying to the program should apply at least 18 months prior to the desired start date. That is, for the 2008 academic year, you should apply by December 1, 2006. Our application process is done exclusively through ERAS (the Electronic Residency Application Service). We typically invite about 20 applicants to San Francisco for interviews. We are generally able to issue these invitations within two to four weeks of the receipt of your application. We will schedule your interview at your convenience. We have typically made our final choices for the Integrated Training Program in Diabetes, Endocrinology and Metabolism in February, 16 months before the start date for the fellowship.
For specific questions or further information about research opportunities in a specific field, you are encouraged to contact the Director of the Integrated Training Program in Diabetes, Endocrinology and Metabolism at the VA Medical Center, 4150 Clement Street, 111N, San Francisco, CA 94121 or 415-750-2089.
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