CURRICULUM

First Year Fellow:

• The first year fellow will spend the majority of his or her time on clinical services with major emphasis on general gastroenterology and hepatology.
• The fellow will be introduced to various endoscopic procedures including flexible sigmoidoscopy, upper endoscopy, colonoscopy, liver biopsy and paracentesis.
• He or she will dedicate his or her time to developing consultative skills and assisting delivery of care to a variety of patients with digestive diseases.
• The fellow will be involved in understanding the principles and process of management of GI emergencies while under direct supervision of a responsible faculty.
• The fellow will communicate with other attending, residents and students regarding various aspects of management of consulted patients while on service.
• The fellow will be involved on a regular basis with didactic sessions that will include GI-radiology, GI-surgical, journal clubs, mortality-morbidity conferences and Grand Rounds. In addition they will be involved along with the staff attending in the supervision and teaching of residents and medical students who rotate periodically on the Gastroenterology Service.
• Every fellow is expected to identify a faculty member as his/her research mentor and lay the groundwork for a research project that should be completed by the end of the training.
• Clinic Responsibilities:  Adult Health Care Clinic will serve as continuity clinic for the fellows. During their one-half day a week of continuity clinic, each GI fellow will follow a cohort of patients with a wide spectrum of gastrointestinal and liver disease. Under GI faculty supervision, each fellow will, on average, be responsible for 4-8 patients during each ½ day session. GI fellow will also have an additional half day/week of outpatient experience designated for evaluation and follow-up of patients with liver transplants, complicated pancreato-biliary diseases and those with gastrointestinal neoplasms.  In this clinic the patient cohort predominantly includes those who are referred from the community gastroenterologists for tertiary level care and highly specialized procedures/services, not available elsewhere in the central valley.  GI faculty will supervise fellows directly in this setting.
  

Second Year Fellow

The second year’s fellow spends the majority of time on clinical services. In addition to the responsibilities of a first year fellow, a second year fellow:

• Will have additional focus on endoscopic skills, which will emphasize colonoscopy and therapeutic endoscopy including polypectomy, treatment of variceal bleeding, bleeding ulcers, dilatation of complex strictures, and use of devices such as endoclips.  
• Will refine their consultative skills including management of complications of cirrhosis in the pre-transplant state.
• Will also spend 2-3 months on a multi-specialty rotation that will include GI-pathology, GI-radiology including CT colonography and clinical nutrition (both enteral and parenteral with PEG, PEG/J placements)
• Will have three months dedicated research time

Third Year Fellow:

• This year stresses the balance between research and clinical work. Six months will be spent on the clinical services, which will include the general Gastroenterology Service.
• Endoscopic skills will be refined with introduction to therapeutic endoscopy. Exposure to ERCPs and other advanced endoscopic procedures will be based on individual interest and aptitude.
• The third year fellow will be expected to teach medical residents and students on rounds and be available to provide consultation and information to all residents involved in the care of mutual patients. In addition, the fellows are assigned specific lectures given to medical residents and students during the course of the year. They are also expected to be involved in the medical residents' teaching rounds in order to provide insight for gastrointestinal patients on their service.
• Multispecialty training including esophageal motility, interpretation and evaluation of esophageal manometry and 24-hour pH studies and refinement of clinical nutritional skills including management of patients with complicated bowel surgeries.
• The third year fellow will have three months dedicated research time.
  
   As a result of the clinical fellowship training in gastroenterology, the fellows should be able to:

• Understand and describe details of gastrointestinal and hepatic anatomy and physiology.
• Describe the physiologic basis for gastrointestinal hepatic function testing.
• Possess a knowledge base regarding pathophysiology, natural history, and treatment of patients with gastrointestinal/liver disease.
• Integrate knowledge with clinical evaluation skills, including history-taking and physical examinations, interpreting laboratory radiographic studies, in order to develop treatment plans, which should also incorporate important psychosocial aspects of disease.
• Describe indications, contraindications, risks, cost, and benefits associated with the following procedures in this specialty:
• Esophagogastroduodenoscopy
• Esophageal dilatation
• Proctoscopy and flexible sigmoidoscopy
• Colonoscopy and polypectomy
• Percutaneous liver biopsy
• Paracentesis
• Percutaneous endoscopic gastrostomy
• Biopsy of mucosa of the esophagus, stomach, small bowel, and colon
• Gastrointestinal motility studies
• Non-variceal hemostasis
• Variceal hemostasis
• Enteral and parenteral alimentation
• Endoscopic retrograde cholangiopancreatography, sphincterotomy, and biliary stent placement
• Endoscopic ultrasonography