Endocrinology

At the end of the training, the trainee will have demonstrated:

• Broad knowledge of basic and clinical endocrinology.
• Expertise in a broad range of clinical problems in the ambulatory setting.
• Through a longitudinal ambulatory clinic experience, developed the knowledge and skills necessary for the long-term management of endocrine patients.
• Skills in inpatient consultation and investigation.
• Effective team leadership skills and teaching skills.
• Skills of critical appraisal of medical information as it pertains to endocrinology and metabolism.
• Effective clinical problem-solving in the approach to pediatric endocrine problems.

All activities of the Division are located at The Hospital for Sick Children.

Clinical fellows will also have designated time for research and are given opportunities to present their research work. They will meet with Staff to determine the research of interest. Primary research activities in the Division of Endocrinology are in the area of clinical investigation. Current research carried out by division faculty members includes studies of:

• Prevention of beta-cell loss in those at risk of Type 1 diabetes and in new-onset disease through the NIH Type 1 Diabetes TrialNet Study Group.
• Outcomes in children with disorders of sex development.
• Understanding the early pathophysiology of diabetic nephropathy in adolescents with Type 1 diabetes.
• Calcium disorders in neonates, the role of Vitamin D in pathogenesis of diabetes complications, and the management of osteoporosis among children and youth.
• Diabetes complications including celiac disease in Type 1 diabetes as well as the evaluation of early atherosclerosis in young patients with endocrine conditions who are at high risk of cardiovascular disease including, obesity and Type 1 and Type 2 diabetes.
• Prevention of long term micro and macrovascular complications of Type 1 diabetes in the pediatric population.
  • Current research includes:
    • The identification of adolescents with Type 1 diabetes at high risk of developing complications based on urinary albumin excretion rates and
    • A randomized placebo-controlled trial looking at the potential of early initiation of lipid-lowering agents and angiotensin-converting enzyme inhibitors to prevent long term cardio and renal complications in this high-risk population (AdDIT).
• Evaluation of the effectiveness and optimal timing of initiating continuous glucose monitoring in paediatric Type 1 diabetes insulin pump users.
• Evaluation and treatment of infants with hypoglycemia, particularly those with congenital hyerperinsulinism.
• Insulin resistance and pancreatic beta-cell function and the metabolic complications of obesity in childhood, specific populations of children known to be at risk for future cardiometabolic disease (e.g. Turner Syndrome, hypothalamic obesity-related to central nervous brain system tumours such as craniopharyngioma, infants exposed to hyperglycemia in utero, Type 2 diabetes).
• Understanding variations in the timing and pace of pubertal development using a combination of clinical research and an active laboratory-based program designed to identify and study genetic factors that modulate the timing of puberty Improving treatment outcomes in Types 1 and 2 diabetes

Evaluation of fellows is done through various formats including:

• In-Training Evaluation Reports (ITERs) of overall progress and continuity clinics
• On-service evaluation forms
• Allied health feedback
• Presentation reviews
• Yearly observed history and physical examination
• Participation in a national in-training examination

Fellows meet regularly with the Program Director to discuss progress. All fellows also benefit from form research and career mentorship programs.

There are a number of different opportunities and committees for fellows to participate, which include: Training Program Committee for Pediatric Endocrinology (PETPC), Fellow Wellness Committee, etc.

Weekly activities in the Division include:

• Twice  weekly endocrinology rounds/case presentations/journal club
• Weekly multidisciplinary diabetes meetings
• City-wide Endocrinology rounds in conjunction with Division of Endocrinology in the Department of Medicine, University of Toronto
• Weekly Academic Half Day in endocrinology in conjunction with the adult Endocrinology Subspecialty Training Program at the University of Toronto
• Weekly paediatric endocrinology fellow seminar series

Canadians apply through CARMS.

To apply to the program, applicant must submit a fellowship application through our online form and include the following attachments:

• Current Curriculum Vitae
• Copy of Medical Degree
• Academic Transcripts (undergraduate and postgraduate)
• Copy of Paediatrics Specialty Certificate (if you are currently a Paediatric trainee, please arrange for your Program Director to provide us with a letter of good standing)
• Letter of Intent describing your interest in endocrinology and career interests

In addition, three reference letters are to be submitted. The confidential letters in support of the applicant are to be submitted to endo.program@sickkids.ca. One letter should come from the applicant's residency program director. Referees should comment upon the applicant's interpersonal skills, clinical skills and provide us with some insights regarding background or potential for research.

Please note any sponsored trainee must apply through PGME.

Applicants will need to have completed pediatric training by the time fellowship training begins.

The elective program is geared towards Paediatric Residents training in Canada as well as Canadian and International Medical Students. This is a three to four-week elective designed to be a mix of clinics plus inpatient service. The rotation is not divided into separate clinics and service weeks. This is to maximize clinical exposure and introduce residents to the organizational skills required to balance inpatient and outpatient work, which many Paediatricians need to manage.

There will be hands-on patient care, ward rounds, divisional rounds and attendance at diabetes, endocrine and calcium bone clinics. Students are also exposed to the academic activities of the Division of Endocrinology, including case discussions, case reviews and journal clubs. This elective is coordinated though the Electives Office at the University of Toronto in consultation with Dr. Jennifer Harrington, Program Director.

Due to the lengthy process required for permits, licensing and registrations, the Division of Endocrinology currently does not accept international Paediatric Resident Electives. However, we do have an Observership Program.

Application Procedures for Paediatric Residents training in Canada

Applications are submitted through U of T/PGME Electives Portal

Application Procedures for Canadian Medical Students

Applications are submitted through MEDSIS

Applications for international medical students

Applications are submitted through the AFMC Portal

Please note that international medical students will be required to submit their CV showing their past clinical experience as well as their TOEFL scores.

The Division of Endocrinology supports this endeavour through a one-month observership where the individual observes activities in clinics, ward and divisional rounds. These physicians must be in a paediatric endocrinology training program or currently practising in paediatric endocrinology and meet the criteria for an observership in our division.

Training Program Director

Diane Wherrett

Phone: 416-813-7654, extension 228186

Fax: 416-813-6304

Email: diane.wherrett@sickkids.ca

Education Administrative Coordinator

Enza Andreacchi

Phone: 416-813-5991

Fax: 416-813-6304

Email: enza.andreacchi@sickkids.ca