Gastroenterology Fellowship

Introducción

Our fellowship is focused on producing well-rounded gastroenterologists who are fully equipped for both passing their board as well as entering practice. We utilize a variety of teaching techniques, including a large range of conference styles and focuses. Fellows also see patients in a variety of specialty clinics. All of this is enhanced by the fellows running the inpatient GI service at two diverse hospital settings.

Our facility also offers access to advanced clinical simulation for gastroenterology. Fellows are introduced to endoscopy skills by using the Symbionix GI Mentor II Simulator during orientation, and they are encouraged to use it every day for the first month of training. This allows the fellow to be comfortable with the equipment as well as the anatomy and possible patient situations before they actually insert a scope in a live patient.

The GI Mentor II Simulator simulates a variety of cases, such as upper GI bleeding, colonoscopy with polypectomy, ERCP with stone extraction and EUS.

Fellows are given immediate feedback on their performance and are monitored for improvement through time.

Mission Statement

The Gastroenterology Fellowship is a dynamic program that focuses on training the highest level of tomorrow’s gastroenterologists. This includes a high level of professionalism, skill, self-learning and leadership. Our fellows will have a full balance of highly academic research exposure, highly personalized patient care and highly skilled endoscopy technique training. We strive to produce well-rounded, competent physicians who can easily enter either academic or private practice as independent practitioners.

Specialty tracks

During the second and third years, fellows can focus most of their clinical time, research and away rotations in liver disease, nutrition, IBD, women’s GI health, research (clinical or basic), masters of public health or advanced procedures.

We are uniquely positioned to have multiple faculty members with a wide range of subspecialty interests, include:

• Enfermedad del higado
• High-level EUS and ERCP
• Endoscopic therapy for
  Barrett's esophagus
• Esophageal motility
• IBD
• Capsule endoscopy
• Hospital administration
• Education and research

Rotations

Inpatient service

Our inpatient gastrointestinal service has an average daily census of 20-30 patients. The gastroenterology fellow assigned to the service participates actively in the supervision and teaching of medical students, interns and residents assigned to the service. In addition, the fellow, under supervision of the staff consultant, provides consultations in gastroenterology for all medical and surgical services.

Outpatient service

An important part of the fellows' clinical training consists of a rotation through the outpatient clinic. Here, the fellows conduct initial and follow-up evaluations of new patients with primary gastrointestinal and liver problems and provide consultations in gastroenterology for the other medical and surgical services within the clinic.

A proper balance is sought between careful supervision of junior trainees and more independent clinical activities of senior fellows. Faculty members assigned to review the fellows' evaluation and their diagnostic and therapeutic plans. Fellows also have a continuity clinic each week where they follow patients with chronic gastrointestinal or hepatic diseases for the duration of their fellowship.

Endoscopy

Fellows receive ample training and experience under direct faculty supervision in contemporary GI endoscopic techniques in a large, modern and very active GI endoscopy unit. They also receive extensive exposure to advanced diagnostic and therapeutic procedures, including diagnostic and therapeutic ERCP and diagnostic and invasive endoscopic ultrasound.

Gastrointestinal radiology

In addition to a regular rotation through the radiology department by gastroenterology fellows, a weekly combined GI/radiology/general surgery conference is conducted. Additionally, gastroenterology fellows are invited to attend a monthly gastroenterology radiology conference with radiology residents.

Clinical gastrointestinal laboratory

Fellows participate in a wide variety of diagnostic techniques, including esophageal manometry, PH+ and impedance monitoring through both catheter-based and capsule-based techniques.

Call schedule

The only required weekend and evening call responsibilities are during the two-week blocks of hospital service.

• GI-1s have 12 one-week blocks of hospital service
• GI-2s have four to eight one-week blocks of hospital service
• GI-3s have four one-week blocks of hospital service

Otherwise, third-year fellows who wish to become proficient in EUS and ERCP are encouraged to rotate call for weekend advanced procedures; however, this is not required.

Conferences

GI core curriculum

These weekly 7 a.m. conferences explore basic and complex GI topics. Three-fourths of the lectures are led by fellows and one per month is led by staff, either internal or external.

Multidisciplinary conference

The monthly case conference discusses one to two patients in conjunction with surgeons, radiologists or other subspecialists who were involved in the case.

GI tumor board

Our bi-monthly noon conference discusses all the GI tumors diagnoses the week prior. This involves pathology, radiology, surgery, interventional radiology, radiation oncology, oncology, genetics and coordinators, all in attendance to formulate a unique plan of action for the individual patient.

IBD conference

This monthly noon meeting reviews didactic cases and general reviews.

Endoscopy conference

The bi-monthly conferences focus on rapid case sharing with endoscopic photos and group discussions. This is often supplemented by five-minute focused didactics.

Journal review

During this casual monthly evening meeting, each fellow is pre-assigned one article to review in depth with the group.

Journal club

This casual monthly evening meeting is held a at a senior staff’s home. Each fellow will be pre-assigned one article to review in depth with the group.

Hepatology interest group

This monthly noon meeting sets aside 20-30 minutes to discuss liver didactic, followed by four to six recent liver cases from liver fellow of the month and inpatient fellow.

Research conference

The monthly noon meetings feature outside speakers, often invited by the Digestive Disease Research Center. This is also a venue for fellows to discuss their proposed ongoing research.

Morbidity and mortality

Quarterly meetings discuss near misses, bad outcomes, autopsies or legal issues.

Pathology conference

The bi-monthly morning meetings discuss interesting luminal or liver pathology in detail alongside pathology residents.

Investigación

All fellows attend national meetings at least annually. They are encouraged to submit posters or podium presentations. All fellows are expected to submit manuscripts for publication by the end of their third year.

Fellows have ample opportunities to participate in innovative research, including intensive basic cholangiocarcinoma research with PhDs at the Digestive Disease Research Center. Fellows also have access to advanced electronic medical records, tumor registry, EUS database and HMO databases.

Clinical studies on efficiency of practice, patient safety, finances of GI practice and compliance with national guidelines are common. Quality improvement in endoscopy is a regular focus of fellow-led research in our program.

Ongoing clinical research includes:

• Hepatitis C quality of life after treatment
• Obesity related HMO cost analysis three years after gastric bypass surgery versus
  no surgery
• Mortality in elderly TIPS patients
• Hepatitis B recurrence in patients undergoing chemotherapy
• Hepatitis screening and colonoscopy
• IBD and hormone studies