Constantine Stratakis, MD, DSc
Entry Id: TP-69

Pediatrics

National Institutes of Health
National Institute of Child Health and
Human Development

Introduction
The fellowship in Pediatric Endocrinology is a three-year ACGME-accredited program providing comprehensive training in clinical patient management and guidance in the development of research skills. The fellowship is at the National Institute of Child Health and Human Development (NICHD) and based at the National Institutes of Health (NIH) Clinical Center, in Bethesda, Maryland (NIH-CC). The NICHD program is based at one of the largest and most sophisticated research institutions in the United States. The clinical center maintains clinical research protocols investigating the treatment of adrenal and pituitary tumors, congenital adrenal hyperplasia, precocious puberty, idiopathic juvenile osteoporosis, Cushing’s syndrome, obesity, and others. The fellow gains critical skills in the construction and execution of clinical research projects while learning about some of the more rare pediatric endocrine disorders.

Participating institutions include the National Human Genome Research Institute (NHGRI) within the NIH, and outside the NIH, those represented by the National Capital Consortium and based at the Uniformed Services University of the Health Sciences (USUHS), Walter Reed Army Medical Center (WRAMC) and National Naval Medical Center, Bethesda (NNMC), Johns Hopkins University (JHU) Department of Pediatrics, Division of Pediatric Endocrinology, Children’s Hospital, Washington, DC, and, finally, the cosponsoring institution, Georgetown University (GU) Department of Pediatrics. GU, JHU, WRAMC, and NNMC serve as primary care facilities, and WRAMC and NIH-CC house large tertiary care referral and research centers. These facilities make available to our fellows pediatric endocrine, diabetes, oncology, metabolic, bone disorders, and other pediatric subspecialty clinics and consult services, and general pediatric inpatient and intensive care units. The program has also entered in agreement with GU and provides a one-month elective on Pediatric Endocrinology and Clinical/Medical Genetics at the NIH for GU residents. Since 2004, 12 residents (PL-2) per year, from GU spend one month at the NIH-CC wards and clinics. The fellowship is designed to provide clinical and research exposure that allows for the development of academic Pediatric Endocrinologists with experience in both clinical and bench research. The first year of the fellowship is dedicated to the acquisition of necessary clinical skills from all aspects of the principles and practice of Pediatric Endocrinology. It is during that year that the fellows rotate through the NIH-CC and the participating hospitals. The second and third years are focused research years allowing for training in laboratory or clinical research. During these two years, fellows also receive appropriate courses on statistics, biotechnology and laboratory methods, grant and scientific paper writing, and the development and execution of clinical trials. Pediatric Endocrine fellows maintain a weekly continuity clinic with a variety of patients at the NIH-CC and have the option of attending continuity clinics at the participating institutions beyond their first clinical year.

The NICHD fellowship program in Pediatric Endocrinology is among the largest and most prestigious in the world. Detailed information regarding the fellowship is available at http://pe.nichd.nih.gov/.

Educational Program
The Pediatric Endocrinology Fellowship at NIH consists of one year of clinical training, and two year of combined clinical training and research training.

Clinical Training Rotations
A typical training schedule for first-year fellows includes the following rotations:

Rotation	Duration	Program Director
Johns Hopkins University Hospital	8 weeks	David Cooke, MD
Georgetown University & Children’s Hospital, DC	6 weeks	Douglas Sobel, MD & Paul Kaplowitz, MD
Walter Reed Medical Center/National Naval Hospital	8 weeks	Andrew Bauer, MD
NIH Clinical Research Center (CRC)	5 months	Constantine Stratakis, MD, DSc
Genetics (NIH CRC)	4 weeks	Maximilian Muenke, MD

See also:

1. USUHS Department of Pediatrics Fellowship: http://www.usuhs.mil/pediatrics/fellowships/endocrinology.htm
2. Georgetown University Hospital Pediatric Endocrinology Fellowship: http://www.georgetownuniversityhospital.org
3. Georgetown Pediatrics: http://www.georgetownpeds.org

During the second and third years, mandatory clinical responsibilities are limited to a half-day continuity clinic/week and providing inpatient pediatric endocrine consultation on an on-call basis.

Didactic Training
Regularly scheduled didactic courses, seminars, and case conferences enhance clinical experience. These include the following weekly events:

• Endocrine Grand Rounds
• Pediatric Endocrine Case Conference
• Pediatric post-clinic conference
• Lecture series covering both clinical and research topics
• Journal Club (once a month)
• Board review (weekly)

Fellows are encouraged to attend at least one national/international professional meeting/year during the three fellowship years.

Research Training
Fellows learn how to develop a research protocol, conduct a study, evaluate the results, and create a presentation or a manuscript suitable for publication. Work in a laboratory setting performing state-of-the-art basic science research is closely supervised by internationally known mentors. During the first year, a research mentor is chosen and the project for each fellow and progress on it are monitored by a committee, as recommended by the American Board of Pediatrics (see www.abp.org). With the mentor’s help, a topic of special interest is defined and a research protocol is developed. The second and third years of the fellowship are dedicated to the successful completion of the selected project(s) with minimal clinical duty requirements. Check also the following sites for more information on research training at the NIH:

• NIH Graduate Partnerships Program: http://gpp.nih.gov
• NIH Office of Intramural Training and Education: http://www.training.nih.gov

Call Frequency
There is no in-house call. During the first year, pediatric endocrine fellows are on call from home, supported by one of the endocrine attendings. During the second and third years, fellows take call from home when they participate in the pediatric endocrine consult service. Third-year fellows attend one month in the wards of the NIH-CRC and they are on-call from home for the ward for these 4 weeks.

Teaching Opportunities
Third-year fellows are required to take a supervisory role and cover the pediatric endocrine inpatient service at the NIH-CC for one month. During these 4 weeks, the senior fellow supervises first-year fellows, residents, and students and is responsible for teaching rounds and conferences.

Evaluation and Quality Assurance
The fellow meets with the program director, the mentor, and the supervising committee on a regular basis to assess personal goals and objectives, and to review evaluations from the staff. All fellows and other staff participate in regular staff meetings, and quality assurance is monitored both at the program and at the hospital level by regular (weekly and other) meetings.

• Constantine A. Stratakis, MD, DSc
  Director & Chief, Section on Endocrinology & Genetics/DEB & Heritable Disorders Branch, NICHD
  Genetics of adrenocortical and pituitary diseases and related pediatric genetic syndromes (http://dir2.nichd.nih.gov/nichd/deb/segen/index.html)
• Jeffrey Baron, MD
  Head, Unit on Growth & Development, NICHD
  Regulation of skeletal growth (http://eclipse.nichd.nih.gov/nichd/deb/ugd/index.htm)
• Carolyn Bondy, MD
  Chief, Developmental Endocrinology Branch, NICHD
  The IGF system, Turner syndrome and the X chromosome (http://eclipse.nichd.nih.gov/nichd/deb and http://turners.nichd.nih.gov)
• Penelope Feuillan, MD
  NHGRI, NICHD
  McCune-Albright and other genetic syndromes with pediatric endocrine manifestations
• Deborah Merke, MD
  Chief of Pediatric Services Clinical Center, NIH
  Congenital adrenal hyperplasia (CAH) and related disorders
• Kristina Rother, MD
  NIDDK, NIH
  Pediatric diabetes mellitus, islet cell transplantation, lipodystrophy and related disorders
• Jack Yanovski, MD, PhD
  Head, Unit on Growth & Obesity, NICHD
  Physiology, psychology and genetics of obesity (http://eclipse.nichd.nih.gov/nichd/deb/ugo/ugo.htm)
• Margaret F. Keil, MS, PNP
  Director, Pediatric Endocrine Clinical Services, Pediatric Endocrinology Training Program
  Treatment, diagnostics, and nursing and quality-of-care issues for pediatric endocrine patients with CAH, other adrenal and pituitary diseases

Applicants will need to provide/complete:

• On-line Application
• Cover letter
• Curriculum vitae
• Bibliography
• Statement of Research Interests and Goals
• Three letters of recommendation

The NIH is dedicated to building a diverse community in its training and employment programs.