UCI/CHOC Pediatric Endocrinology Fellowship Program
The University of California at Irvine (UCI) in partnership with CHOC offers a three-year training program in a fully ACGME accredited, university-based fellowship program. Our endocrine and diabetes program aims to prepare fellows for careers as leaders in clinical or academic medicine through a superior academic, professional, and collegial atmosphere. The first year of fellowship will be largely clinically based in a high-volume inpatient and outpatient setting followed by two years of largely basic science, clinical or translational research within the division, Department of Pediatrics and/or Islet program at University of California at Irvine. Our program is designed to meet the ACGME requirements for fellowship training so fellows may be eligible and successful in attaining board certification.
The training and education of medical students, residents and fellows has been a longstanding focus of CHOC. Each year, CHOC trains about 290 residents and fellows from 38 different training programs, along with 190 medical students.
CHOC Endocrinology Program Ranked 16th
CHOC Endocrinology Program is ranked 16th for diabetes and endocrinology in the Best Children’s Hospitals by U.S. News & World Report 2020-21. The Best Children’s Hospitals rankings were introduced by U.S. News in 2007 to help families of children with rare or life-threatening diseases find the best medical care available. Only the nation’s top 50 pediatric facilities earn recognition as a best children’s hospital by U.S. News & World Report.
Prerequisite Training: Applicants must have completed a certified residency program prior to starting fellowship
VISAS accepted by Program: J-1
The UCI/CHOC Pediatric Endocrinology Fellowship program is a three-year program designed to provide in-depth training for board eligible/ board certified pediatricians for an independent career in academic and clinical pediatric endocrinology and diabetes. We aim to provide the fellow with:
• Structured one-on-one mentoring to help guide their chosen career path
• Opportunities for conducting and presenting research (basic science, translational, clinical and educational) as well as quality improvement projects
• Promoting a collaborative culture and ensuring protection to the fellow to ensure wellness and minimize “burnout”
• Experience to provide patient-centered, evidence-based, high quality and innovative care to patients and their families.
Goals & Objectives
In accordance with the ACGME, the first year of fellowship program will be largely dedicated to acquiring clinical skills in pediatric endocrinology. The second and third years will mainly be focused on the research training in either clinical or basic laboratory research.
The general expectations and responsibilities of the fellows are as follows:
• Fellows will communicate with attending physicians and consulting services.
• Fellows assume progressive responsibility for patient care.
• Fellows are expected to actively seek the most up-to date information to guide practice.
• Fellows take an active role in teaching medical students and residents through bedside teaching, morning reports, noon conferences, and grand rounds.
• With the assistance of the Scholarly Oversight Committee (SOC), fellows will be required to initiate and complete a scholarly project in either clinical or basic science research that meets ACGME program requirements.
• Fellows scholarly progress will be monitored by the Scholarly Oversight Committee (SOC) on a semiannual basis.
• Fellow progress will be assessed through a Clinical Competency Committee (CCC).
• Fellows will receive education and participate in a quality improvement project.
• The Pediatric Endocrinology Fellowship program will provide up to $1,500 per year for each fellows’ educational needs, such as books, software, and board review courses (for example, the AAP’s online PREP ID Self-Assessment) Educational conferences ($2,000/ year)
• Health insurance, dental insurance, disability insurance, mental health insurance.
Rotations will follow a 13-block template where the fellow will rotate every one to two weeks between: Inpatient Diabetes and Endocrine service/ Consult service, and outpatient Endocrine and Diabetes clinics/ specialty clinics/ continuity clinics. The assignment of rotations will be structured so as to minimize the frequency of transitions and be sufficient to provide continuity of patient care, supervision, opportunities to build longitudinal relationships with faculty members who will in turn provide quality and meaningful assessment and feedback. During the first year, the fellow will also have 4 weeks total of protected research time to allow for collaboration with an attending on designing a scholarly project, that may translate into a presentation at a local/national or international meeting.
Our inpatient service is quite robust and the fellow will be exposed to a plethora of different endocrinopathies including diabetes mellitus, hypoglycemia, ambiguous genitalia, disorders of calcium homeostasis, abnormal thyroid function tests, adrenal insufficiency, and diabetes insipidus to list a few. The fellow will be expected to work closely with the attending physician on service and other team members (Nurse Educators, Nurse Practitioners, Social Workers, Dieticians, Nurses, Psychologists).
In addition, the fellow will gain experience in teaching, at the bedside, by leading rounds, and in formal sessions, to residents and other trainees about common endocrine conditions and their management.
During the first year, the fellow will establish a continuity clinic from former inpatient consultations as well as referrals from the community where he/she will then provide longitudinal care. All patients are seen in conjunction with a faculty member with direct supervisory care.
During the outpatient clinic rotations, the fellow will also rotate through various subspecialty clinics to see patients with attending physicians in the division. This allows exposure to a broad range of diagnoses, and management styles. For example, the fellow will participate in specialty clinics in Thyroid Cancer, Cancer Survivorship, Turner syndrome, Disorder of Sex Development, Congenital Adrenal Hyperplasia, Klinefelter syndrome, Transgender care, Red Cell clinic, Prader-Willi Syndrome clinic, and Type 2 Diabetes.
The fellow is required to attend and present his or her research at institutional, local and national meetings. Although largely research based, the senior fellows will also continue to conduct his/her weekly continuity/ specialty clinics and continue taking call on the weekday and weekend in line with the call schedule. The second and third year fellow will also do a total of four and three weeks, respectively, of inpatient duties to help further solidify their clinical skills.
The fellow will also participate in educational conferences/ lectures and be required to serve on a hospital wide committee of choice, such as quality improvement. In regards to teaching, the fellow will participate in both bedside and formal lecture based conferences to the pediatric residents, medical students, and the endocrine division including:
• Endocrine grand rounds: 1 or 2 lectures per year pertaining to Endocrine topics
• Journal Club: Fellow chooses and reviews, using Evidence-Based techniques, a recent journal article relevant to Endocrinology; once or twice yearly.
• Fellow Case Conference: fellows bring challenging cases from their clinic to discuss with attending and other fellows. This is an opportunity to get management advice on their toughest patients as well as learn from other fellows’ cases and other perspectives from attending physicians.
• Noon conference and/or morning report—provide 1-2 lectures per year to the Pediatric Residency program, other divisions, and outside hospitals as part of community outreach. Additional division education: every Wednesday morning there will be a division-wide clinical conference. This is an informal opportunity for any provider to present a challenging clinical case (inpatient, outpatient, or consults) to the group to receive input. This conference is not always fellow driven, but participation will be encouraged to further the learning experience. The conference series is also held every Wednesday and is designed to review ABP content specifications in order to successfully prepare the fellow to sit for the pediatric endocrinology boards. The faculty and fellow are both responsible for administering lectures in this conference series.
• Inpatient: Fellows spend a total of ~7 months on the inpatient service, ~5 months in the first year, 4 weeks in the second year and 3 weeks in their third year.
• Outpatient: Fellows spend a total of ~5 months in their first year and ~2 months in their second and third years of training. This outpatient clinical experience includes the weekly continuity endocrine clinics and diabetes clinics, and subspecialty clinics (e.g. transgender, disorders of sex development, Turner syndrome.
• Continuity clinic begins in the first year of fellowship allowing fellows to follow a cohort of patients through their three years of training.
With the guidance from the program director, the fellows will select a Scholarly Oversight Committee (SOC) to help oversee their research design and progress.
The SOC is composed of at least 3 faculty members who:
Meet with the fellow as a group at least twice per year
Review the training progress of the fellow
Making recommendations to the fellow regarding aspects of their progress.
During the 2nd and 3rd year of fellowship, fellows are expected to complete 2 years of research training.
- 80% of their time will be spent working on research projects under the direction of a primary mentor.
- Progress will be assessed by the research mentor, SOC and CCC.
- Fellows will be encouraged to submit abstracts to national meetings, submit and publish study results and consider submission of grant applications.
- Fellows will receive education regarding study design, IRB preparation, epidemiology, biostatistics and other elements to help promote a successful research project from the research mentor, pediatric endocrine faculty, and the Fellow’s Core Curriculum. Multiple scholarly opportunities exist within the division as well as with collaboration with other sections of the Department of Pediatrics and University of California at Irvine.
- The Islet Program at UCI offers the fellow a unique experience in diabetes bench research (e.g. islet transplantation) with direct mentorship and supervision.
The program director shall ensure the fellow fulfills the requirements of the ACGME related to the six general core competencies. The program director will also be responsible for creation of a core curriculum in scholarly activities, incorporate feedback and responsibilities to guide the fellow in his/her career path, help the fellow identify a mentor, participate in the Scholarship Oversight Committee responsible for overseeing and assessing the progress of each trainee, and provide verification to the ABP of the successful completion of training of the fellow.
Mark Daniels, MD – Division Chief. Associate Clinical Professor of Pediatric, UC Irvine School of Medicine. Publications and research interests include diabetes, transgender and endocrinopathies in long-term cancers.
Amrit Bhangoo, MD – Assistant Clinical Professor of Pediatrics, UC Irvine School of Medicine. Publications and research interests include growth disorders, disorders of sex differentiation, insulin resistance
Timothy Flannery, MD – Assistant Clinical Professor of Pediatrics, UC Irvine School of Medicine. Publications and research interests include growth disorders, pituitary and calcium disorders.
Nikta Forghani, MD – Assistant Clinical Professor of Pediatrics, UC Irvine School of Medicine. Publications and research interests include Turner syndrome, transgender, and ovarian failure.
Sejal Kadakia, MD – Assistant Clinical Professor of Pediatrics, UC Irvine School of Medicine. Publications and research interests include Prader-Willi syndrome, thyroid cancer, type 1 diabetes.
Christina Reh, MD – Assistant Clinical Professor of Pediatrics, UC Irvine School of Medicine. Publications and research interests include cystic fibrosis related diabetes, transgender, and Turner syndrome.
Lien Trinh, MD – Assistant Clinical Professor of Pediatrics, UC Irvine School of Medicine. Publications and research interests include congenital adrenal hyperplasia, long term cancer survivorship, and Prader-Willi syndrome.
Daina Dreimane, MD – Assistant Clinical Professor of Pediatrics, UC Irvine School of Medicine. Publications and research interests include type 2 diabetes and diabetes technology.
In addition, our team includes 3 licensed nurse practitioners, 9 diabetes educators, 3 dieticians, a psychologist, and a social worker. We are an ADA accredited program and offer patients and their families a highly educational diabetes and pump program with a variety of classes available.
Core Conferences and Educational Experience
• Faculty will provide weekly lectures, but the fellows will also take a role in presenting to allow for development of presentation skills and knowledge-based teaching.
• Core topics are covered in a curriculum so to provide a repetition of core topics at least twice during his/ her fellowship. Assignments are varied based on each fellow’s interests and each fellows’ knowledge base.
• Attendance is required and monitored.
• These conferences provide updates and reviews on a broad range of both general pediatric and subspecialty pediatric topics.
• Attendance is encouraged at pertinent conferences. Fellows will also give Grand Rounds with the supervision of a faculty mentor, if desired.
• The fellow will have exposure and an opportunity to participate in the administrative aspect of the division.
• Case(s) presentation of diabetic and endocrine cases generated from the outpatient and/or inpatient setting.
• The fellow will be required to participate and will be encouraged to present cases for discussion and provide opportunities for education.
Disorder of Sex Development Conference
• This is a monthly multidisciplinary conference with our pediatric urology team, medical geneticist, and psychologist or psychiatrist (if needed) to discuss the presentation and management needed in patients with disorders of sex development.
Pediatric Med/Surg Morbidity and Mortality Conference
• Fellow will participate in discussions in the morbidity and mortality case discussions in a variety of different divisions including PICU and NICU.
• A rotating schedule for faculty presenters and fellow will be made to present and lead a discussion on a peer-reviewed evidence based Endocrine topic. Research methodology, strength of study, clinical applications, study design, and statistics are amongst the potential discussion topics.
Fellows’ Core Curriculum
• Fellow is expected to participate and attend a joint fellowship curriculum with other pediatric subspecialty fellows on a variety of topics including epidemiology, biostatistics, clinical and lab research methodology, study design, grant preparation, principles of EBM, research ethics, teaching, professionalism, systems-based practice.
• The fellow will be required to give at least one lecture per year to the residents as part of their noon conference on an Endocrine topic. This will provide the fellow an opportunity to be an educator and present endocrine specific topics that meet ABP specifications in general pediatrics.
• This project can be anything that improves our core mission of education, research, and clinical care. Examples of such projects that have been completed include updating the DKA protocol and establishing neonatal hypoglycemia care guidelines.
• During the 1st and 2nd year fellows choose a QI project, coordinate with an attending for guidance, and implement the change.
• Documentation of the effort involved in completing the QI project must be maintained by the fellow and copies provided to the fellowship coordinator.
• Examination scores are considered a relevant measure of the fellow’s clinical performance.
About the Program Director
Dr. Himala Kashmiri is the program director for the UC Irvine-CHOC Pediatric Endocrinology fellowship program. Dr. Kashmiri completed his undergraduate training at University of Texas at Austin and then attended medical school at University of North Texas Health Science Center. He went onto complete his pediatric residency at the Ronald McDonald Children’s Hospital in Maywood, IL and then his fellowship in Diabetes and Endocrinology at the Medical College of Wisconsin (Milwaukee, WI). In addition to his general Endocrine and Diabetes practice, he also leads the Thyroid Cancer clinic and Disorders of Sex Development clinic. In his spare time, he enjoys fitness, basketball, traveling, and spending time with his family.
University of California, Irvine
UCI provides extensive, high quality education and clinical training, with 560 full-time faculty members and more than 1300 volunteer faculty members from 26 clinical departments. UCI sponsors a multitude of innovative and highly productive research programs. In addition to its adult programs, UCI serves as the sponsor for residencies in Pediatrics, Child Neurology, Combined Pediatrics/Anesthesia, and Medical Genetics, as well as fellowships in Neonatal/Perinatal Medicine, Pediatric Pulmonology, Pediatric Critical Care, Pediatric Infectious Disease, Pediatric Urology, Child and Adolescent Psychiatry.
Read more about UCI Graduate Medical Education…
CHOC Hospital in Orange
CHOC is an academic, community-based hospital that serves as the main site for training in the fellowship. It has 334 beds, including a 30-bed PICU, 12-bed Cardiac ICU, 72-bed NICU and separate Oncology and Neuroscience units. In 2016-2017, there were 12,891 hospital discharges with 89,791 ED visits and 4,252 transports to CHOC. CHOC’s ED is a Level II pediatric trauma center. CHOC also operates primary care and specialty clinics throughout the county. The hospital serves about 2 million patients over 4 counties. The training and education of medical students, residents and fellows has been a longstanding focus of CHOC. Each year, CHOC trains about 290 residents and fellows from 38 different training programs, along with 190 medical students.
CHOC has an active Innovation Institute. The Sharon Disney Lund Medical Intelligence and Innovation Institute (MI3) at CHOC is a unique and first-of-its-kind institute that creates, focuses and executes projects in the areas of intelligence and innovation in pediatric medicine. These two interrelated disciplines, extremely limited in development in the pediatric realm, hold great promise to change the trajectory of pediatric care around the world. MI3 aims to foster robust developments in artificial intelligence methodologies, as well as innovative advances in emerging areas such as genomic medicine, regenerative medicine, robotics, nanotechnology and medical applications/devices. MI3 is dedicated to empowering data intelligence and medical innovation at CHOC and driving innovation leadership in the international pediatrics community. Fellow physicians in our program will be exposed to MI3 and have the opportunity to partake in an innovation project during their training if they choose.