Curriculum

First year

First year fellows spend the majority of their time acquiring cognitive skills; learning how to apply them effectively in answering consults; and begin to learn diagnostic and therapeutic endoscopy.

They are taught fundamentals of consultation in gastroenterology and hepatology and serve as the primary contact on the inpatient services, and they also start to learn ambulatory care.

They are taught all basic endoscopy procedures including:

• upper endoscopy
• esophageal dilation
• sigmoidoscopy
• mucosal biopsies
• gastrostomy
• colonoscopy

They rotate through all four participating hospitals and in addition have a half-day continuity GI clinic weekly at UHealth Tower, JMH, or VAMC. They have at least one month of blocked research time. They attend 3 hours of conference per week and are responsible for presenting at conferences, including Journal Club, M&M, and multi-disciplinary conferences like surgery in addition to presenting their scholarly work at research conference. As the primary inpatient consultation fellows, the first years play a critical role in teaching the residents and students rotating on our services. All six of the core ACGME competencies are taught and evaluated, with the expectation of reaching specialty-accepted milestones before proceeding to the next level of training.

Second Year

Second year fellows expand on the aforementioned skills learned in their first year by assisting first year fellows in all aspects of their experience.

They are responsible for helping in the education of the first year fellows as well as providing further higher-level education to the rotating students and residents.

Second year fellows further refine the endoscopic skills obtained in their first year and also learn advanced endoscopic procedures, including:

• percutaneous and laparoscopic liver biopsy
• colonoscopy with polypectomy
• endoscopic control of bleeding (variceal and non-variceal)
• pH and motility studies
• ERCP, endoscopic ultrasound
• capsule and deep enteroscopy
• enteral stenting

They rotate through all four participating hospitals and in addition have a half-day continuity GI clinic weekly at either JMH, UMHC, or VAMC. They also continue to refine their knowledge in inpatient and outpatient consultative gastroenterology and hepatology and rotate on the subspecialty services. They can also do electives in multidisciplinary areas both within and outside of Internal Medicine like oncology, genetics, radiology, surgery, and pathology. The second year fellows start to appreciate the subtle differences in care provided at public, government, and university institutions including cultural differences, access to care, and differing electronic health records. They continue to participate in the scholarly work that had been initiated during their first year, both longitudinally and in at least one month of blocked research time. These middle-level fellows attend 3 hours of conference per week and present at the Journal Review and Inflammatory Bowel Disease conferences. They also present their scholarly work at Research conference. All six of the core ACGME competencies are taught and evaluated, with the expectation of reaching specialty-accepted milestones, before proceeding to the next level of training.

Third Year

Third year fellows further expand on their cognitive and procedural base by supervising first and second year fellows and learning the subtleties of advanced and therapeutic endoscopic procedures while fine-tuning their skills in basic endoscopy to become ready to perform procedures independently. They also serve in the role of team leader on the consultative and primary inpatient services in gastroenterology and hepatology at all locations, being allowed progressively more independent decision-making while still having faculty oversight at all times. In this capacity too, they are being readied for independent practice.

They rotate through all four participating hospitals and in addition have a half-day continuity GI clinic weekly at UHealth Tower, JMH, or VAMC. The third year fellows rotate through more of the subspecialty and elective services and gain a further appreciation for the practice of our specialty in various settings. They conclude their scholarly work, both longitudinally and in at least one month of blocked research time, with most fellows producing presentations at national meetings and/or manuscripts in peer-reviewed journals. For some fellows, this research serves as a springboard for continued research productivity in their careers. The fellows at this level of training can spend a greater block of time focusing on an area of subspecialty (either clinically or in research) or continue mastering general Gastroenterology and Hepatology. In their role as senior fellows, their teaching skills are further refined, providing education to students, residents, more junior fellows, and other health care professionals. They attend 3 hours of conference per week and present at Motility, Endoscopy, and Inflammatory Bowel Disease conferences; they also present their scholarly work at Research conference. All six of the core ACGME competencies are taught and evaluated, with the expectation of reaching specialty-accepted milestones before graduating; the full 36 months of training provides the fellows the tools to be successful in academic or community-based settings, either in general or niche-specific practices, with the ability to serve effectively as clinicians, educators, and/or researchers.