Gastroenterology and Hepatology Fellowship Training Outline
The University of Maryland's Gastroenterology and Hepatology fellowship is designed to provide fellows with a comprehensive experience to best prepare them in both clinical and research settings to be future leaders in their practice. The ACGME-accredited three-year fellowship includes training in the following areas:
General GI Consultation
- Approximately 11 months over first year and 2 - 4 months in the second and third years
- Consultations at UMMC or BVAMC
- Routine and daytime emergency GI procedures at assigned hospital
- Supervision of residents, students, case presentations at patient management conference
- Outpatient clinic
Fellows carry out inpatient consultations in gastroenterology and hepatology at the University of Maryland Medical Center on a daily basis, under the close supervision of a full-time faculty member typically 2-3 fellows at a time.
Fellows 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 all GI procedures required for the patient's evaluation.
- Approximately 6 months during fellowship
- Liver consultations at UMMC
- Liver biopsies
- Inpatient endoscopy on hepatology patients
- Attend hepatology clinic
- Case presentations, hepatology conference
The hepatology rotation provides a comprehensive experience in outpatient and inpatient consultation of liver diseases, management of patients with acute and chronic liver diseases, evaluation of patients for liver transplantation, consultative services for patients pre and post liver transplantation.
As The University of Maryland currently performs the 3rd most liver transplants in the country, our experience is robust. The rotation features participation in a weekly multidisciplinary Transplant Committee Meeting, as well as dedicated weekly didactic teaching of the interpretation of liver biopsies. There are typically 2-3 fellows on this service at a given time. For fellows desiring further expertise in liver diseases. UMMC also participates in the ABIM and AASLD sponsored pilot program for training in Transplant Hepatology during the 3rd year of GI fellowship, as well as a 4th year fellowship in Transplant Hepatology.
Advanced Endoscopy Consults
- Approximately 1-8 months, primarily in third year
- ERCP (both diagnostic and therapeutic) at UMMC and BVAMC
- Outpatient endoscopy at BVAMC
- 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 UMMC
- Outpatient endoscopy at BVAMC
- EUS case presentations at patient management conference
Advanced endoscopy offers consultative service for patients in the hospital with a need for ERCP, EUS or other advanced endoscopy procedures such as small bowel enteroscopy, advanced stenting, endoscopic suturing, etc. Fellows are also exposed to and have the opportunity to participate in outpatient advanced endoscopy procedures during this rotation. Additionally, UMMC offers a 4th year Advanced Endoscopy fellowship.
Fellows have the opportunity to pursue internal or external elective rotations in their 2nd and 3rd year, based on personal interest and future career goals. Examples of elective rotations include bariatric endoscopy, esophageal/anorectal manometry, advanced therapies and management of patients with Barrett’s esophagus, intensive outpatient hepatology or IBD experience.
- All fellows share night and weekend call in rotation for emergency consultations and procedures, performed with direct attending supervision
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.
Inflammatory Bowel Disease
- Inpatient consultations in inflammatory bowel disease at UMMC
- Attend IDB clinic
The IBD consult rotation provides a unique opportunity to manage the complex care of IBD patients in a rotation that features a weekly multidisciplinary meeting with colorectal surgery, social work and nutrition. We also participate in IBD-LIVE, a multi institutional, multidisciplinary video conference on a monthly basis. For fellows interested in IBD, additional time can be devoted to the care of patients with Crohn’s disease and ulcerative colitis during 2nd and 3rd years of training. Additionally, UMMC offers a 4th year Inflammatory Bowel Diseases fellowship.
- 1 - 2 months in first year, 1 - 6 months in second and third year
- Outpatient endoscopy at UMMC
- Esophageal motility - performance and interpretation
- Esophageal 24 hour pH monitoring - setup and interpretation
- Wireless capsule endoscopy - setup and interpretation
Combined inpatient/outpatient endoscopy facilities are present at the University of Maryland Medical Center Main Campus, Midtown Campus 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, single balloon enteroscopy, and percutaneous liver biopsy.
Fellows receive exposure to diagnostic and therapeutic ERCP, biliary manometry and endoscopic ultrasound and other advanced procedures primarily in their 3rd year of fellowship. Procedural training meets all board eligibility requirements. Computerized endoscopy reporting systems are used at each hospital.
Fellows are given dedicated months of endoscopy training – typically 1 month first year and 1-2 months during the second and third years. In addition, second and third year fellows are allotted one half-day per week of endoscopy time. Lastly, fellows perform the necessary procedures on patients seen during a consultative rotation.
Outpatient Community Clinic
- All three years
- All fellows will follow their own patients in the clinics at BVAMC and UMMC or in the practice of faculty members. Direct faculty supervision is present at all sites.
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, as well as other research grants awarded to our faculty. 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 nuclear receptors as related to colon cancer progression. Clinical research projects are carried out in the inpatient and outpatient facilities. Current examples of clinical research include telemanagement of patients with IBD, adherence to colorectal cancer screening in African American men, histologic predictors of relapse in ulcerative colitis, and outcomes in endoscopic eradication therapy in patients with Barrett’s esophagus.
Fellows typically spend 1-2 months per year providing consultative service at the Baltimore VA Medical Center (BVAMC), which is physically connected to the University of Maryland Medical Center. This rotation includes exposure to all aspects of gastroenterology, including general GI, liver diseases, pancreaticobiliary disorders, and inflammatory bowel diseases. Fellows will also have the opportunity to participate in outpatient endoscopy cases at the BVAMC during this rotation.
Located 1.3 miles (5 min drive) from the University of Maryland Medical Center, the UMMC Midtown Campus offers an additional site for fellow training. Fellows typically spend 1-2 months per year provided consultative services to patients admitted to UMMC Midtown Campus, covering all disciplines of gastroenterology. Fellows also have the opportunity to participate in outpatient endoscopy cases while rotating at UMMC Midtown Campus.