Gastroenterology Fellowship Program Rotations
During the three-year Accreditation Council for Graduate Medical Education (ACGME) accredited University of Maryland/NIH Clinical Scholars Gastroenterology Fellowship Program, fellows will complete the following rotations.
Gastroenterology Consultative Rotations (approximately 9 months in year 1)
Fellows carry out inpatient consultations in gastroenterology at the University of Maryland Medical Center (UMMC) or the Baltimore VA Medical Center (BVAMC) during their first year. At UMMC, fellows are closely supervised and are trained progressively in upper endoscopy, flexible sigmoidoscopy, colonoscopy and polypectomy, percutaneous endoscopic gastrostomy placement, heater probe, bipolar circum-active probe (BICAP) and injection treatment of gastrointestinal (GI) bleeding, endoscopic band ligation of esophageal varices, 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.
Along with performing consultations at UMMC, fellows will also participate in
- routine and emergency GI procedures
- outpatient clinics at UMMC
- continuity clinic at BVAMC
Hepatology Consultative Rotations (approximately 6 months in years 1-3)
Fellows perform inpatient consultations in hepatology at UMMC or BVAMC during their first year. During the second and third years, inpatient and outpatient hepatology consultations are performed exclusively at the NIH Clinical Center. On average, the NIH hepatology consult service receives over 300 consults per year. The hepatology rotation provides a broad experience in outpatient and inpatient consultation in liver diseases and management of patients with acute and chronic liver diseases. Instruction is provided in techniques of liver biopsy, interpretation of liver biopsies, and participation in hepatology rounds and conferences.
The hepatology rotation includes
- liver consultations at UMMC and BVAMC during the first year
- liver consultations at the NIH Clinical Center during the second and third years
- liver biopsies
- inpatient endoscopy on hepatology patients
- outpatient hepatology continuity clinic
- case presentations
- attendance at NIH conferences (years 2 and 3) including: Hepatology Clinical Care Conference, Multispecialty GI Tumor Board Conference, Hepatology Pathology Conference, Hepatology Journal Club and GI/Hepatology Radiology Conference.
Gastroenterology Subspecialty Rotations (1-2 months in year 1)
During a gastroenterology subspecialty rotation, fellows will participate in
- outpatient endoscopy at UMMC and BVAMC
- esophageal motility performance and interpretation
- esophageal 24 hour pH monitoring setup and interpretation
- wireless capsule endoscopy setup and interpretation
- inflammatory bowel disease consultative services.
Outpatient Management (years 1-3)
There are two outpatient continuity clinics per week for fellows, one GI clinic and one hepatology clinic, which provide extensive experience in outpatient management of common GI problems. Additional opportunities for outpatient experience are available with clinical faculty members and with research protocol patients. During the first year, all fellows follow their own patients at the UMMC and BVAMC clinics. During their second and third years, all fellows follow their own patients in the NIH Clinical Center GI and liver continuity clinics. Direct faculty supervision is available at all sites.
Emergency Night and Weekend Consultations (years 1-3)
During the first year, fellows will provide emergency night and weekend consultations at UMMC and BVAMC. In the second and third years, fellows will provide emergency night and weekend consultations at the NIH Clinical Center.
Fellows rotate on-call shifts with other fellows in the program. On evenings and weekends, the on-call GI fellow takes calls regarding management of inpatients and telephone calls from outpatients. Call assignments are more frequent in the first year then decrease in the second and third years. While on-call, fellows do not remain in the hospital.
A faculty attending is assigned to night call and is always available for consultation. All procedures at night or on weekends are supervised directly by the attending physician. At the NIH Clinical Center, emergency and after-hours procedures are also supported by NIH Clinical Center endoscopy staff.
NIH Clinical Center GI and Hepatology Consultation Service (approximately 3 months per year in years 2 and 3)
Fellows carry out inpatient consultations in gastroenterology at the NIH Clinical Center during their second and third years. On average, the gastroenterology consult service receives approximately 800-900 consults per year at the NIH Clinical Center. Consultations occur on a daily basis under the close supervision of a full-time faculty member. Fellows may supervise medical residents and/or students doing a GI subspecialty rotation. The consultation service includes didactic teaching, bedside evaluation of patients on work rounds, and consult service conference rounds. Fellows participate in any GI procedures required for the patient's evaluation. Fellows also participate and/or present in twice weekly conferences including: GI Case Conference, GI Research Conference, GI Grand Rounds, GI Core Curriculum Conference (simulcasted with UMMC), GI Radiology Conference, GI Pathology Conference, GI Journal Club, GI Board Review, Foregut Multidisciplinary Conference and Gastrointestinal Oncology Rounds.
GI Procedural Training (years 2 and 3)
At the NIH, procedural training meets all board eligibility requirements and is designed to prepare fellows for academic clinical practice. Fellows in the University of Maryland/NIH Clinical Scholars Gastroenterology Fellowship Program typically graduate with 900-1000 endoscopic procedures. At the NIH Clinical Center, fellows are closely supervised and continue to improve on their skills in upper endoscopy, flexible sigmoidoscopy, colonoscopy and polypectomy, percutaneous endoscopic gastrostomy placement, wireless capsule endoscopy, single balloon enteroscopy, esophageal pH monitoring and high resolution manometry, heater probe, BICAP and injection treatment of GI bleeding, endoscopic band ligation of esophageal varices, foreign body retrieval, gastrointestinal stent placement and retrieval, and dilation of esophageal strictures. Computerized endoscopy reporting systems are used at all hospitals.
Clinical Research Experience (18 months in years 2 and 3)
Considerable emphasis is placed on clinical research to prepare trainees for academic careers. For interested fellows, the Gastroenterology Fellowship Program also supports the opportunity for enrolling in courses towards a concomitant Master's Degree in Clinical Research, which is a collaborative program between the NIH Clinical Center and Duke University Medical Center. Fellows are also encouraged to participate in classes held on the NIH Campus such as “Introduction to the Principles and Practice of Clinical Research,” along with other classes offered by the Office of Clinical Research Training and Medical Education (OCRTME) and the NIH Clinical Center library. Clinical research projects are carried out in the inpatient and outpatient facilities of the NIH Clinical Center. Fellows will be able to develop and complete their research project(s) with a faculty mentor during their projected research time at NIH. They will also have the ability to participate in detailed research presentations during GI grand rounds. Some current areas of GI clinical research include, but are not limited to
- Familial carcinoid syndrome
- Zollinger-Ellison syndrome
- Novel applications of confocal laser endomicroscopy
- GI graft-versus-host disease
- GI disease in chronic granulomatous disease (CGD)
- Natural history and therapy of Immune related inflammatory bowel disease
- Eosinophilic GI disease
- Natural history and endoscopic practices in hereditary diffuse gastric cancer
- Novel techniques for gastric acid analysis
- Novel endoscopic techniques for colonoscopy
- Characterization of gastrointestinal disease in autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED)