Standards of Performance
It is assumed that all trainees will have acquired the basic skills of general internal medicine and will be board eligible in Internal Medicine at the time of entry into the program. Prior to completion of specialty training in gastroenterology, they should become ABIM certified. ABIM certification is a prerequisite for eligibility for board certification in gastroenterology. The training program will build upon the skills of internal medicine to develop clinical and technical competence in the subspecialty of gastroenterology.
Specific areas of training:
1. Medical knowledge
2. Clinical and procedural skills
3. Clinical and medical judgment
4. Commitment to scholarship
5. Professional attitude and humanistic qualities
6. Moral and ethical standards
Click here for Details on the above Specific Areas of Training:
The training program consists of three years of training: The first two years will focus on clinical training in Gastroenterology and Hepatology with allocated time for research. The third year focuses on therapeutic endoscopy, liver transplant and further opportunities for research.
This training will be obtained by rotating through the following services:
|
1st Year
|
2nd Year
|
3rd Year
|
- 6 months University Consult
- 6 months VA
- 1/2 Day VA or UU Clinic
|
- 6 months VA Endoscopy
- 3 months Liver TX
- 3 months Research
- 1/2 day VA or UU Clinic
|
- 6 months Therapeutics - Advanced Endoscopy
- 3 months Liver TX
- 3 months Research
- 1/2 day Therapeutics Clinic
|
|
Following is more information on:
EVALUATION OF PERFORMANCE:
Continual feedback by faculty members will be provided to the trainee in each teaching setting (clinic, rounds, conferences, etc.). Quarterly written formal evaluations using the ABIM format will be performed for each trainee. The results of these evaluations will be provided to the trainee. Each trainee will meet with the program director quarterly (more frequently, if needed). Specific feedback will be provided in these meetings regarding the trainee’s progress, strengths, and weaknesses. Information for these sessions will be provided from all sources, both formal and informal. It will include the results of quarterly evaluations, as well as information that may be provided by faculty, nurses, and technical staff. Specific suggestions for improvement will be provided. The trainee will also be asked to give feedback to the program director. If there is inadequate performance or inappropriate conduct, a warning will be given, and the trainee will be formally notified of the specific deficiencies to be corrected. Failure of the trainee to correct these problems may result in dismissal from the program, failure to graduate form the program, or the need to repeat part or all of the training.
Once training has been completed satisfactorily, the fellow will be given a certificate indicating satisfactory completion of the program. If otherwise eligible, the candidate will be recommended to the American Board of Internal medicine to sit for the subspecialty examination in gastroenterology.
Back to Information Links
THIRD YEAR GI FELLOWSHIP:
The third year of the fellowship is a year in which the trainee acquires a higher level of skills in a more specialized area. In general, the third year will include 6 months of research plus 6 months of either Hepatology or therapeutic endoscopy. It is recognized that, depending on the career goals of the trainee, the entire year could be spent in research or, in the case of those seeking an academic career, 18 months of the three years could be spent in research. Also, for those trainees whose primary career foal is in therapeutic endoscopy, some will need an extra 6-12 months of therapeutic endoscopy.
Back to Information Links
RESEARCH TRAINING:
All trainees are required to do at least 6 months of research. In general, they will do this in the third year, but those desiring an academic career will start their research in the second year and do at least one year of research. For those seeking a clinical career, the research rotation will be 6 months. Trainees will be supervised directly by one or more faculty members during their research rotation, and will be educated in study design, performance of appropriate study procedures, data collection, data interpretation, ethics of human and animal experimentation, and on how to present the results of the study.
Specific Objectives:
- To appreciate the contribution of research to the advancement of the discipline of gastroenterology
- To acquire the ability to critically assess the quality of research in the literature
- To appreciate the ethics of medical research involving humans and animals
- To acquire skills in either clinical or basic research that will serve as tools for further research
Rationale:
The trainee, with the advice of a mentor, will be expected to design, execute, and write up a clinical or basic research project.
Specific activities will include:
- Protocol design
- Statistical design and assessment
- Institutional Review Board or animal Rights Board application
- Acquisition of specific skills needed to execute the protocol
- Collection of the data
- Analysis of the data
- Writing the report in the form of a manuscript
- Optional grant application for those seeking an academic career
Back to Information Links
RESEARCH ACTIVITIES:
Clinical trials
The trainee will be expected to participate in at least one clinical trial during the training year. Prospective trials in the field of interventional endoscopy are anticipated. This research will be planned in conjunction with a faculty member, but will be the primary responsibility of the trainee. The project should be initiated at the start of the training period.
Basic research
By special arrangement, opportunities for participation in ongoing basic research are available.
Other activities
A commitment to scholarship is an integral part of the training program. In addition to a prospective clinical trial, the trainee will be expected to prepare at least one additional manuscript for publication. This may be a case report, critical subject review, or retrospective study.
Participation in annual meetings
During the course of the training period, the trainee will be expected to submit an abstract for presentation at one national meeting AGA, ASGE, AASLD, or ACG).
Evaluation
Trainees will be evaluated quarterly on clinical, endoscopic, and cognitive skills. Evaluations will be performed by individual faculty members based on a standard American College of Physicians format. A summary trainee evaluation will be prepared by a faculty committee. This summary will be promptly provided to the trainee, with an opportunity for feedback.
Back to Information Links
HEPATOLOGY TRAINING:
Hepatology is an elective in the third year of training. The trainee will spend 6 months doing clinical hepatology and liver transplantas well as an extensive review of a clinical hepatology project.
Specific Objectives:
-
To become a competent consultant in liver diseases
-
To complete an extensive review of a research or clinical topic of the trainee’s choice
-
To be able to do the preoperative assessment and postoperative care of liver transplant patients
Rationale:
Hepatology is a rapidly advancing discipline in the area of gastroenterology, both in terms of clinical and basic science. Liver transplantation is widely available, with about 5,000 patients per year receiving organs. Rapid advances in therapeutics are being made. It is anticipated that there will soon be separate boards in Hepatology. Many gastroenterologists will practice primarily hepatology in the future.
Specific activities will include:
-
Daily consultation/inpatient rounds at either the University or VA Hospital
-
Liver clinic – 1 half-day at the VA during the 1st and 2nd year
-
Liver biopsy session at the University
-
Transplant evaluation clinic at the University : 1.5 days during 2nd and 3rd year
-
Transplant conference at the University
-
GI Multidisciplinary Conference – fellows to do one conference per month on a contemporary liver case
-
Journal Club – 3 Journal Clubs on liver-related topics
-
Review of liver topic of fellow’s choice to be written up journal-style and presented during basic science seminar
Back to Information Links
ADVANCED ENDOSCOPY TRAINING:
The 6 month training block in therapeutic endoscopy is designed to give the trainee extensive experience in therapeutic and interventional endoscopy, including the technical aspects of the procedure, the consultative aspects of therapeutic endoscopy including indications, contraindications, risks, and potential benefits. In addition, the fellow will be expected to do a clinical research project while on this service.
Rationale:
The field of therapeutic endoscopy is advancing rapidly and replacing many standard surgical procedures for the management of biliary and luminal gastrointestinal diseases. While not every gastroenterologist will become competent in this area, this rotation is designed to introduce the fellow to the field and to help them develop skills in this area. Training will occur at the University Hospital and the Veterans Hospital. The trainee will be part of an interventional endoscopy team performing interventional procedures, evaluating patients pre- and post-procedure, and evaluating the results of therapeutic endoscopy.
Back to Information Links
ENDOSCOPIC TRAINING:
ERCP
Diagnostic and therapeutic endoscopy of the pancreas and biliary tree will be performed at both hospitals. Specific procedures include cholangiography, pancreatography, sphincterotomy, sphincter of Oddi manometry, biliary and pancreatic dilation and stenting, and stone extraction and lithotripsy in both the pancreatic and biliary tree. Limited experience in cholangioscopy is available. Close collaboration with diagnostic and interventional radiologists will provide additional training in the interpretation of radiographs.
Endoscopic hemostasis
Training will be provided in all available methods for endoscopic treatment of gastrointestinal bleeding. These include multipolar electrocautery, heater probe, injection therapy, and argon plasma coagulation and endoscopic clips. Band ligation of esophageal varices is included in this experience. Emergency procedures will be performed on an on-call basis. Elective procedures will be scheduled through the endoscopy lab.
Endoscopic Ultrasound
The program will provide exposure to basic endoscopic ultrasonography. More intensive training is available, depending upon the interest and skill of the trainee.
Other endoscopic experience
Additional training will include percutaneous gastrostomy and jejunostomy, endoscopic mucosal resection, enteral stents, foreign body removal, colonic decompression, dilation of structures of the esophagus, pylorus and colon, pneumatic dilation for achalasia and endoscopic therapy for Barrett's esophagus.
Back to Information Links
HOSPITAL CONSULTATIONS:
The trainee will participate as a member of the therapeutic endoscopy team for both hospitals. Consultations from various services regarding interventional procedures will be performed and staffed by a faculty member. Emphasis will be placed upon the appropriate use of endoscopic procedure, including the indications, contraindications, risks and benefits of different procedures. Close working relationships with the medicine, surgery and radiology faculty facilitate this training.
Outpatients Clinics
Participate in a weekly outpatient clinic will allow the evaluation of patients for potential endoscopic therapy and the subsequent care of patients after the procedure is completed. This longitudinal care will emphasize the appropriate role of endoscopy in the overall management of different medical problems.
Conferences
The training program involves participation in all conferences of the Gastroenterology Division. These include a weekly multi-disciplinary conference, monthly journal club, and pathology, radiology, and research conferences, as well as a monthly motility conference.
| 
