Clinical Training Program
A large number of patients are seen with a wide variety of endocrine, infertility, and genetic problems. These include amenorrhea, anovulatory bleeding, endometriosis, hirsutism, intersex problems, pituitary tumors, thyroid disorders, female infertility, recurrent pregnancy loss, adrenal disorders, and related dysfunctions. Fellows participate in clinical activities at UCSF and San Francisco General Hospital. Fellows spend 6 months (once weekly) in the pediatric endocrinology clinic for exposure to intersex conditions, precocious puberty, metabolic and growth disorders, and 6 months (once weekly) in the medical endocrinology clinic for exposure to posterior pituitary, adrenal and thyroid disorders. Learning opportunities unique to UCSF include a multi-disciplinary PCOS clinic, fertility preservation program, and participation in a delivery of low-cost, low-complexity IVF to underserved women. Additionally, due to the multi-disciplinary nature of the practice at UCSF, fellows have exposure to and actively participate in reproductive urology and male reproductive health, psychology and genetic evaluation and counseling. There is also the opportunity to obtain a High Complexity Lab Director (HCLD) certification if desired.
Fellows participate in the Reproductive Endocrinology and Infertility (REI) practice located in a private building across from the Mission Bay Campus of UCSF. The Chan-Zuckerberg bio-hub resides in the same building presenting opportunities for collaborative research with leading scientists. This facility occupies over 30K square feet with new clinical facilities, embryology, endocrine and andrology lab space, space for ambulatory procedures and recovery, and potential space for bench and clinical research. Additionally, the Mission Bay campus has a large number of developmental biology scientists to complement the faculty in the Center for Reproductive Sciences (CRS - see below). Physician members of the Division of Reproductive Endocrinology and Infertility provide daily supervision in the clinical setting. Fellows’ clinical participation includes: managing ovulation induction, performing oocyte retrievals, saline sonograms and office hysteroscopy. The embryology and andrology lab are available for fellow education and projects. Operative infertility surgery, including hysteroscopy, laparoscopy, myomectomy, Mullerian anomalies and complex endometriosis procedures are performed in the main hospital on the same campus with REI and MIGS faculty.
At Zuckerberg San Francisco General (ZSFG), fellows participate as the attending physician for the residents in the REI clinic. Clinical experience at ZSFG ensures that fellows work with a diverse population of patients. Additionally, jointly with ZSFG, UCSF – CRH runs a low cost, low complexity program to support IVF for patients from ZSFG. This is a largely fellow run practice and encourages independence in managing and counseling for ART, including retrievals and transfers.
Research Training Program
Two research “tracks” are available to the REI fellows: 1) basic science research track, and 2) a clinical investigative track. However, at UCSF, while fellows will focus their research experience in one primary type of research, they are encouraged to complete both a basic science and clinical project in the same topical area. This plan encourages an in-depth reading, and understanding, of the literature and the application of the two skill-sets in an interactive translational format. This will uniquely develop a graduate with the expertise needed to compete in a changing research environment. The strong relationship between the bench and clinical researchers at UCSF has enabled this unique form of training.
In the basic science research track, the fellow spends the bulk of her/his time planning a research project with the faculty member (s) involved, learning the laboratory techniques necessary to carry out the project, performing all aspects of the project with appropriate supervision, and analyzing, writing and presenting the data. Basic laboratory research projects are carried out in the extensive facilities of the Center for Reproductive Sciences (CRS) under the direction of Dr. Marco Conti. The growth of the Human Embryonic Stem Cell Program, which is an integral part of the CRS, has allowed recruitment of outstanding basic scientists including Dr. Robert Blelloch, Dr. Diana Laird and Dr. Miguel Ramos-Santos, further increasing research opportunities for our fellows. Drs. Rinaudo has his laboratory with this group.
Investigative training in the CRS continues to be a major focus in our fellowship program. Interdisciplinary research within the Center embraces faculty members and experiences throughout the UCSF departments and units, including: Obstetrics, Gynecology and Reproductive Sciences; Physiology; Biochemistry and Biophysics; Developmental and Stem Cell Biology; Molecular medicine; Program in Biomedical Sciences; and Anatomy. Through workshops, retreats, core laboratory facilities and daily collegial interactions our faculty provides a breadth of experience and feedback that exceed the obvious mentoring and collaboration associated with authorship on manuscripts.
The clinical investigative track is very similar in construct, but the “laboratory” is the Center for Reproductive Health in which clinical studies of normal subjects and patients are carried out by the fellows under REI faculty supervision. This track is complemented by the Training in Clinical Research (TICR) program, at UCSF, directed by the Department of Epidemiology and Biostatistics. This program, originally developed by Dr. Steve Hulley, has been a model for similar programs around the country. All fellows participate in the TICR introductory program beginning summer/fall of their first year as well as basic biomedical statistics. Here they learn about study design and are required to develop a clinical research project to be completed during their fellowship. For those who choose the “clinical research track”, a one-year certificate program and a two-year Masters in Clinical Research is available. Several large clinical databases (infertility, ovarian aging, cancer, PCOS), established tissue banks and an environment that fosters research integrated into clinical care has supported publication of over 50 manuscripts, including 3 randomized controlled trials, in the past 2 years. Main topical areas of research include: cancer and fertility preservation (Rosen); PCOS (Huddleston); environment (Fujimoto; Segal); ovarian aging (Cedars); recurrent pregnancy loss (Cakmak, Jaswa); ethnicity (Fujimoto); transgender health (Mok-Lin); and infertility and IVF.
The tracks are not mutually exclusive, and as above, the goal is for all fellows to pursue a collaborative approach to their learning and research.
Additionally, academic programs that focus on advocacy and access to care (Anaya) and patient education (Noel) are being developed
Didactic Instruction, Seminars and Workshops
Fellows attend seminars and have the opportunity to take a variety of courses. The American Board of Obstetrics and Gynecology (ABOG) no longer requires two university graduate-level courses, however, we believe this didactic portion of a fellow’s education is critical to furthering the foundation for a successful career. One course is in quantitative techniques which should include biostatistics, epidemiology, research design and implementation. The second course must be relevant to the specific subspecialty and is frequently selected, in conjunction with the fellowship director and research mentor, in an area unique to one’s individual research path. Fellows are also encouraged to take additional courses of interest to them. Pursuit of advanced degrees (MS, MPH, PhD) is possible.
Graduate-level Courses Available
Year 1 Year 2
Fall
EPI 180.04 - Designing Clinical Res. EPI 213 – Decision/Cost Effectiveness Analysis
EPI 216 - Getting Funded EPI 206 - Medical Informatics
EPI 201 - Responsible Conduct of Research Biomedical Sciences 255 – Basic Genetics & Genomics
Genetics 200A - Genetics & Development
Biostat. 103 – Intro. to Statistical Analysis (required)
Winter
Biochemistry 201A – Biological Regulatory Mechanisms
Spring
EPI 212 - Publishing and Presenting Clin. Res. EPI 219 - Molecular Methods in Clin. Res. III
EPI 217 - Molecular Methods in Clin. Res. I EPI 222 - Clin. Res. with Diverse Communities
Biostat 209 – Biostat. Methods for Clin. Res. III
Biochem 246 - Developmental Biology
Biomedical Sciences 260 - Cell Biology
Genetics 224 - Advanced Human Genetics
There are also a series of divisional and departmental didactics, seminars and workshops that are required (Tuesday afternoon sessions and Thursday CRS meeting) or available to trainees.
Seminars and Workshops
1) Obstetrics and Gynecology Grand Rounds: a weekly lecture sponsored by the department addressing topics of general interest to all faculty, fellows, residents and medical students.
2) Endocrine Grand Rounds: a weekly lecture sponsored by the UCSF Medical Endocrinology division.
3) Reproductive Biology Workshop: a weekly meeting designed for informal discussion and constructive criticism of a project currently in progress or contemplated in the laboratories.
4) Reproductive Biology Seminar: a monthly conference for Center faculty and researchers, other faculty members within the University featuring a distinguished visiting scientist who is engaged in a novel aspect of research in reproductive biology.
5) Tuesday Reproductive Endocrinology Didactics: This is a 1 hour conference weekly where fellows and faculty review the ABOG learning objectives for fellowship. All materials are kept on-line for review.
6) Tuesday IVF Conference: A weekly conference, involving not only all REI faculty and fellows but other members of our interdisciplinary team including genetics, psychology, urology, embryology and andrology. During this time, upcoming IVF cases, relevant journal articles, past IVF cycles and IVF related research protocols are presented and discussed.
7) Tuesday Reproductive Endocrinology Journal Club: a monthly conference, directed by Dr. Rinaudo, and attended by the REI faculty and all of the fellows, in which contemporary endocrinology articles are presented and discussed.
8) Tuesday Reproductive Endocrinology and Infertility Fellows Research Conference: an informal monthly meeting, attended by REI faculty and fellows in which clinical investigative protocols are developed, discussed and progress reviewed. Each meeting is devoted to a single fellow’s project.
9) Combined endocrine conference: This is a monthly clinical conference combining the 3 disciplines of reproductive endocrinology, pediatric endocrinology and medical endocrinology with fellow-led case presentations.
10) Pediatric Endocrine Fellow didactics: weekly conference that allows broadening of foundational knowledge for subjects/conditions less frequently seen in REI
11) Medical Endocrine Fellow didactic: weekly conference that allows broadening of foundational knowledge for subjects/conditions less frequently seen in REI
Human Subject Protection Training and Health Insurance Portability and Accountability Act
The CRH and CRS adhere to the guidelines established by the University of California, San Francisco to comply with federal regulations designed to protect patients and human research subjects. On-line training modules to address the protection and rights of clinical patients and research subjects will be completed by fellows upon entry into the program.