In year I, each first-year fellow will spend 7 months on Consult Service (during which they do inpatient consults and procedures), 4 1/2 months of protected endoscopy rotation to facilitate endoscopic skills, and two weeks of nutrition support elective. By the end of the first year, the fellows have been able to meet the requirements for competency in the basic endoscopic core procedures of Gastroenterology. All fellows participate in one half-day clinic session with the same attending preceptor for 6-12 months, before rotating with another faculty member. In addition, there is a (faculty supervised) fellow long-term continuity clinic which provides a panel of patients for whom the fellow is the principal (consultant) care provider for 3 years.
First-year fellows participate in supervising the medical residents and students rotating on their Gastroenterology elective. They rotate responsibility with the other fellows in preparing didactic conferences, which include weekly case-based clinical topic conference, and monthly basic science conference. For the weekly clinical conference, they are assigned to the more basic clinical topics. They select cases for review in Pathology joint conferences, and they present literature reviews at monthly Journal Club.
A GI-Board Review Conference Series is also held, which helps provide an overview of the entire specialty to the first year fellows. Research conference and Morbidity and Mortality conference are held monthly. Evening and weekend calls are shared in rotation with the other fellows. First year fellows are mentored by clinical faculty in preparing clinical abstracts for submission in June (end of first year) to the American College of Gastroenterology, and if accepted for presentation, the fellow is sponsored to travel to the scientific meeting to present his/her poster. All first year fellows participate in the Fellowship Steering Committee.
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In year II, 8 months are set aside for the fellow to participate in a dedicated research project, and 4 months are set aside for participation in a Transplant Hepatology rotation. The Transplant Hepatology rotation is a saturated outpatient and inpatient experience in pre- and post-liver transplant assessment and management with our Transplant Hepatology attendings. Second-year fellows are sponsored to attend the annual national Digestive Disease Week conference held in May, which is an extensive scientific session on clinical and bench research in Gastroenterology and Hepatology, sponsored by the major professional societies in these disciplines.
The fellow will also be sponsored to attend any additional scientific meetings to which he/she has had a paper accepted for presentation. During year II, educational activities, call duties, and clinic duties continue. The fellows continue to participate in an attending preceptor? clinic 1 half-day session per week, and continue their weekly long-term continuity clinic. They continue to participate in didactic conference presentations, most often being assigned to the more clinically integrated topics.
They continue to present critical reviews of the scientific literature at Journal Club, and continue to attend Morbidity and Mortality conference, Morning Report, GI-Pathology Conference, the GI Board Review Conference Series, Basic Science Conferences, and one of the second year fellows chosen by their peers is selected to participate in the Fellowship Steering Committee. In addition, during this research year, the fellows present their work at research conference. Evening and weekend calls are shared in rotation with the other fellows.
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In year III, the fellows perform a supervisory role on the Consult rotation and rotate as Chief Fellow. The supervisory role is principally clinical oversight and guidance to the first-year fellows, teaching of the first-year fellows and rotating medical residents and students, and participation in procedures. The experience is designed to allow for a deeper exploration of clinical issues, with the expectation that more time is available for assisting the first-year fellows in medical literature reviews. The remainder of the year is devoted to endoscopy, including advanced procedures and techniques, and 2 months of structured elective time is encouraged under supervision of the Program Director and Division Chief.
These electives ideally allow the fellow to uniquely enhance and develop competencies in a manner that enriches their clinical training. All senior fellows receive training in the techniques and interpretation of motility studies. During year III, educational activities, call duties, and clinic duties continue. The senior fellows participate in an attending preceptor clinic one half-day session per week, and continue their long-term continuity clinic exposure. They continue to participate in didactic conference presentations, and are now being assigned to more focused and controversial topics for review.
They continue to present critical reviews of the scientific literature at Journal Club, and continue to participate in GI-Pathology Conference, Basic Science Conferences, the GI Board Review Conference Series, Morbidity and Mortality conference, and one of the third year fellows chosen by their peers is selected to participate in the Fellowship Steering Committee. Evening and weekend calls are shared in rotation with the other fellows. Third-year fellows are sponsored to attend national meeting if they are making a presentation. Chief Fellows are involved in formal review of program evaluations, teaching participation of second year medical students in the Disease Processes and Therapeutics course of the medical school, participation in committee work such as peer selected representation to Internal Review of other residency programs, and organize and coordinate the fellow call schedules and conference schedules.
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With respect to advanced procedures (particularly ERCP and EUS), the issue is now specifically addressed at a national level by the core curriculum in Gastroenterology. The core curriculum was constructed by the AGA, the ASGE, the AASLD, and ACG (our professional colleges), and adopted for implementation by the American Board of Medicine and the ACGME effective July 1, 2005 pertinent to the issues of training in advanced endoscopic procedures. In essence, the curriculum states that training in ERCP or EUS is not part of the core training during GI fellowship, but may be available to trainees who fulfill the requirements of what has been designated level II training.
Our program will provide exposure of these advanced procedures to each fellow. We reserve the right to subjectively identify which trainee, if any, possesses sufficient skill to be considered for full training in such a procedure, with the intention to credential the trainee in that procedure if they demonstrate sufficient competence. This specifically means that not every fellow will be trained to a level of competence in ERCP and/or EUS.
The specific educational goals of the clinical and research activities and the specific division policies on a variety of issues are presented throughout the curriculum.
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