Gastroenterology and Hepatology Fellowship
The 3-year Fellowship in Gastroenterology at the University of Maryland School of Medicine is designed to provide broad training in both clinical gastroenterology and hepatology and in clinical and basic research. The fellowship leads to board eligibility in Gastroenterology and is designed to prepare fellows for a career in academic medicine or clinical practice.
Outline of training program:
- General Gastroenterology Consultation service (approximately 11 months over first year and 2 - 4 months in the second and third years)
Consultations at University Hospital or Baltimore VAMC
Routine and daytime emergency GI procedures at assigned hospital
Supervision of residents, students, case presentations at patient management conference
- Hepatology service (approximately 6 months during fellowship)
Liver consultations at University Hospital
Inpatient endoscopy on hepatology patients
Attend Hepatology clinic
Case presentations, Hepatology conference
- Inflammatory Bowel Disease Consultation service
Inpatient consultations in inflammatory bowel disease at University Hospital
Attend IBD clinic
- ERCP service (approximately 1 - 8 months, primarily in third year)
ERCP (both diagnostic and therapeutic) at University Hospital and Baltimore VAMC
Outpatient endoscopy at Baltimore VAMC
Advanced endoscopic procedures, including laser, APC, stent placement, PDT.
Endoscopy case presentations at patient management conference
- Endoscopic ultrasound service (approximately 1 - 6 months in second and third year)
EUS at University Hospital
Outpatient endoscopy at Baltimore VAMC
EUS case presentations at patient management conference
- Subspecialty rotations (1 - 2 months in first year, 1 - 6 months in second and third year)
Outpatient endoscopy at University Hospital
Esophageal motility ”“ performance and interpretation
Esophageal 24 hour pH monitoring ”“ setup and interpretation
Wireless capsule endoscopy ”“ setup and interpretation
- Outpatient Continuity Clinic (three years)
Throughout the training period, all fellows will follow their own patients in the clinics at the VA and University Hospital or in the practice of faculty members. Direct faculty supervision is present at all sites.
- Clinical/basic research (approximately 6 months in second year, more as appropriate)
Develop and complete research project(s) with faculty mentor
Detailed research presentations (GI grand rounds)
More time can be arranged based on fellows interest.
- Emergency consultations
All fellows share night and weekend call in rotation for emergency consultations and procedures, performed with direct attending supervision.
GI Consultation Service
Fellows carry out inpatient consultations in gastroenterology and hepatology at the University of Maryland Medical Center and Baltimore Veterans Administration Medical Center (BVAMC) on a daily basis, under the close supervision of a full-time faculty member. Fellows usually will supervise medical residents and/or students doing a GI subspecialty rotation. The consultation service includes didactic teaching and bedside evaluation of patients on work rounds. Fellows participate in any GI procedures required for the patient's evaluation.
The hepatology rotation provides a comprehensive experience in outpatient and inpatient consultation in liver diseases, management of patients with acute and chronic liver diseases, evaluation of patients for liver transplantation, and consultative services for patients pre and post liver transplantation. Instruction is provided in techniques of liver biopsy, interpretation of liver biopsies, and participation in hepatology/transplantation rounds and conferences. For fellows desiring further expertise in liver diseases, additional time can be devoted to hepatology during the 2nd and 3rd years of training.
There are two outpatient continuity clinics per week for fellows, one at University Hospital and one at the Baltimore VAMC, with a total of approximately 4,650 patient visits (3,500 VA, 1,150 UMMC) which provide fellows with extensive experience in outpatient management of common gastrointestinal problems. Additional opportunities for outpatient experience are available with clinical faculty members. The clinical faculty evaluates and treats outpatients with gastrointestinal and liver disorders in the Faculty Practice Office or in the Digestive Health Center on a referral basis.
Approximately 7,300 procedures performed per year in the Division of Gastroenterology. Combined inpatient/outpatient endoscopy facilities are present at University Hospital and the Baltimore VAMC. Fellows are closely supervised and are trained progressively in upper endoscopy, flexible sigmoidoscopy, colonoscopy and polypectomy, percutaneous endoscopic gastrostomy placement, management of variceal and non-variceal GI bleeding, foreign body retrieval, and dilation of esophageal strictures. Training is also provided in performance and interpretation of esophageal motility studies, 24 hour pH monitoring, wireless capsule endoscopy, double balloon enteroscopy, and percutaneous liver biopsy. Fellows receive training in diagnostic and therapeutic ERCP, biliary manometry and endoscopic ultrasound primarily in their 3rd year of fellowship. Procedural training meets all board eligibility requirements and is designed to prepare fellows for clinical practice. Computerized endoscopy reporting systems are used at each hospital.
Considerable emphasis is placed on clinical and basic research to prepare trainees for academic careers and careers as tertiary referral subspecialists. Funding is available through the NIH T32 training grant in Gastroenterology. The current research activities of the Division are listed below.
The GI Division has extensive basic laboratory research space in the adjacent Bressler Building, the Baltimore VAMC, and the Health Sciences Facility. These facilities contain state-of-the-art equipment for molecular biology, cell culture, animal research, and biochemical and microbiological studies. Through collaborations there are extensive core facilities available for specialized projects. Major areas of current federally funded investigation include bile acids and colon cancer and immunologic mechanisms of hepatobiliary injury. Clinical research projects are carried out in the inpatient and outpatient facilities. In addition, a Clinical Research Unit (GCRC) is utilized, which includes a coordinator and clinical research nurses. Current areas of clinical research include hepatitis C treatment, esophageal cancer and Barrett's esophagus ”“ novel endoscopic techniques for treatment, inflammatory bowel disease ”“ telemanagement, evaluation of racial disparities, and impact of polypharmacy.
The Division provides 24 hour per day service throughout the year. On evenings and weekends, the GI fellow on call takes calls regarding management of inpatients, emergency room patients, and telephone calls from outpatients. Fellows take call in rotation with other fellows in the program. Call assignments are more frequent in the first year then decrease in the second and third years. Fellows do not remain in the hospital while on call, although a call room is available if needed for overnight stay. On weekends, work rounds are conducted with an attending physician.
A faculty attending is also assigned to night call and is always available for consultation. All procedures at night or on weekends are supervised directly by the attending physician.
Emphasis is placed on day-to-day feedback to fellows on individual cases and procedures. In addition, attendings provide written and informal feedback at the end of the rotation for each fellow. Written evaluations are available for review by the fellow and are discussed with the program director at least every six months. Likewise, fellows provide written confidential evaluations of each faculty member and of the training program. The fellow has ample opportunity for discussion with the program director throughout the training period.
In addition to the minimal requirements above, emphasis is placed on mentoring trainees by individual faculty members regarding research projects, didactic presentations, and long-range career goals.