Since most endocrine care is delivered in an ambulatory setting, the ambulatory experience is emphasized through the entire duration of the program.

Educational Purpose: To learn about a variety of diseases of endocrinology and metabolism, through consultation and provision of continuing care.

Teaching Methods: Ambulatory care is both consultative and continuing. For each interaction, the trainee spends sufficient time with the patient to carry out an appropriate history and physical examination and then to interact with and be directly supervised by the endocrine faculty assigned to that ambulatory activity. The learning experience surrounding a patient interaction evolves from review of history, physical examination and laboratory results with the faculty, taking direction from the faculty and employing references or other learning materials that can be used for self-instruction and subsequent review with the faculty.

The continuity clinic is an important aspect of the training. This is a general endocrinology clinic. The fellow presents the case to an attending who also sees the patient; the attending confirms or modifies the management plan. Since the same fellow provides the initial consultation and all subsequent follow up on the same patient the continuity clinic is an important experience to develop a complete understanding of the disease process and response to intervention.

The other outpatient experiences include general endocrinology, thyroid, diabetes and bone and mineral metabolism clinics. The experience acquired here has a different flavor, the fellows are exposed to different attending with different approaches and skills; and therefore, these clinics provide the fellows with diverse experience and skills in all the competencies of the fellowship program.

The pediatric endocrinology and reproductive endocrinology outpatient experiences are provided through skilled faculty at the department of Pediatrics of the Children Hospital of Michigan (CHM) and the Division of Reproductive Endocrinology of the Department of Obstetrics and Gynecology.

Procedures and Services: Dynamic endocrine studies and fine needle aspiration biopsy of the thyroid will be taught and performed by the trainees in the ambulatory setting. Appropriate laboratory testing, including imaging, will be ordered and results reviewed as part of the doctor/patient/attending interaction. Cytological and pathological matter will be reviewed and analyzed as needed with the appropriate specialists.