Gastroenterology Fellowship Curriculum

Each Fellow will have opportunities to customize their schedule to a certain extent.  The following represents the major areas of training throughout the Fellowship. 

Each year at a glance

Year 1

Each Fellow will spend nine months on the clinical service. Fellows rotate through the following services: inpatient GI consult service, inpatient liver consult service and ambulatory Hepatology service. Fellows will spend time in the continuity clinic for the entire three year experience. During the first year, fellows will meet with clinical and research faculty to identify career interests and formulate plans for the second year fellowship. For fellows who have a clear understanding of their career goals prior to fellowship, focused meetings and projects may begin in the first year. By the end of the first year, fellows will have identified a mentor and will have identified time allocation requirements for research and/or focused clinical training.

Year 2

Typically, a second-year fellow will spend nine months on the clinical service, with a mix of general and specialty training. Fellows will become more independent in year 2. During this time, the fellow will confirm career goals and will plan the third year electives accordingly. Year 2 fellows interested in advanced training usually apply for a fourth-year position during this year. Career guidance and counseling are available throughout the three years of training, but most fellows begin to focus on post-fellowship plans during their second year.

Year 3

All fellows will receive at least three months of pancreaticobiliary training during the year 3 fellowship. In addition, fellows will have expanded research time to complete ongoing projects during the three year fellowship. Fellows will also have expanded time for electives of their choice. Counseling and guidance will be offered to all Year 3 fellows, as they focus on post-fellowship career opportunities and position offers.

Consult rotations

Inpatient consult rotations are based at both main Lehigh Valley Hospital Campuses in Allentown and Bethlehem. The consult team consists of an attending, a fellow and may include an internal medicine resident and/or medical student. The gastroenterology consult service provides inpatient subspecialty consultations for patients with gastrointestinal and pancreatic/hepatic/biliary tract disorders.

Endoscopy (Years 1-3): Endoscopic training occurs during all three years of the fellowship and is an integral component of most rotations including:

• Inpatient consult: Fellows assist in performing endoscopic procedures for the patients they see as inpatient consults.
• Outpatient continuity: Fellows assist in performing endoscopic procedures for the patients they see in their outpatient continuity clinics.
• Advanced endoscopy: During the third year of training, three months are devoted to an introduction to advanced endoscopy

Inpatient Hepatology – The inpatient Hepatology consult service introduces you to management of patients with liver diseases. During this period, you will have the opportunity to assess a wide variety of acute and chronic hepatology conditions. You will participate in increasing levels of management/treatment involvement with patient needs and procedures depending on your level of experience. You will be expected to formulate the differential diagnosis, institute diagnostic studies and recommend therapy. The amount of learning obtained from this rotation is directly proportional to the amount of time spent in the evaluation of the patients:

• Year 1 – one month
• Year 2 – one month
• Year 3 – two months

Ambulatory Hepatology – You will see patients in the Hepatology office with the attending for three months during the three-year program. Patients are referred to the office by their primary care physicians or by other specialists for consultation regarding diagnosis and management of a wide range of hepatobiliary disorders.

Advanced procedures: On this procedurally focused rotation, you’ll work one-on-one with expert faculty evaluating and managing patients with challenging diseases of the pancreas and biliary system. You will achieve significant exposure in performing ERCP, sphincterotomy and stent placement in the biliary and pancreas ducts. You’ll also gain exposure to advanced endoscopic techniques such as complex dilations, enteral stent placement, cystgastrostomy and pancreatic necrosectomy. Because our busy endoscopic ultrasound service is involved in the evaluation of many of these patients, on this rotation you’ll also gain significant exposure to this important technology, though we believe that formal training in EUS and advanced endoscopic techniques requires an additional year of training. In collaboration with our busy bariatric surgical service, you’ll also gain hands-on experience in the ever-growing field of endoscopic management of complications of these surgeries. The rotation takes place during Year 3 and lasts three months.

Continuity clinic: The continuity clinic will serve as the gastroenterology fellow’s office practice. Here each Fellow will follow his/her own patients longitudinally for the entire three year period, providing continuity of care one-half-day per week throughout the fellowship. The clinic is precepted by gastroenterology division faculty. Patients are referred to this clinic by their primary care physicians or by other specialists for consultation regarding diagnosis and management of a wide range of gastrointestinal and hepatobiliary disorders.

Radiology rotation:

• Year 1: Radiology: During the first year, you’ll spend one month in GI radiology, gaining experience with gastrointestinal/biliary imaging, including fluoroscopy, CT scan, MRI and interventional radiology under the supervision of the attending radiologist.

Elective rotations: Fellows spend one month in each of the first two years and two months in the third year doing elective rotations with the goal of meeting individualized training needs for specific career plans. These elective opportunities range from self-designed elective experiences to established, highly structured experiences. Examples of elective rotation include transplant hepatology rotations, motility elective, and pancreaticobiliary elective with a multidisciplinary approach. Each fellow meets with the program director prior to each elective rotation to discuss specific plans and design the elective rotation.

Scholarly conferences

During all three years of training, fellows will participate in conferences involving review of literature and current clinical recommendations as they pertain to providing quality, safe and cost-effective patient care. This includes:

• Journal club – fellows will research and present current literature to the division for critical evaluation and discussion.
• GI grand rounds – fellows will present interesting cases from their clinical rotations for discussion by the division.
• Mortality and morbidity conference – specific to GI subdivisions (e.g. pancreaticobiliary, inflammatory bowel disease, hepatology) on a monthly basis.
• Core Curriculum Conference Series didactic lectures.
• GI Specialty Conferences (e.g. IBD, Hepatology, etc.)
• GI IBD monthly morning conference
• Pathology Conferences held quarterly
• Senior fellows will give informal/didactic lectures to residents/medical students.

A typical day on the consult service

The patients we see in consultation span the breadth of gastroenterology, and about one-third of these consults are for liver disorders. This is the most intense of our educational experiences, as we will typically see five-to-ten new consults and perform five-to-ten inpatient procedures daily on this service. The team comprises three faculty, one fellow, and rotating medicine residents and medical students. Each Fellow will see new consults as well as perform procedures, and the faculty, residents and students see many of the new consults as well. This structure has allowed this intensive experience to be educational and enjoyable, with time for reading and reflection.