Schedules
Our Gastroenterology fellows will receive training in a broad range of facilities. Rotations at other facilities that offer our learners specialty training or expertise that is not available at our University are encouraged based on each fellow’s individual interests within the field. Our ultimate goal with our Gastroenterology recruitment schedules is to provide our fellows with a well-rounded education that provides them with the knowledge and experience needed to provide patients with top-tier care when practicing within the field.
General Overview
The three-year fellowship is divided into 39 four-week blocks or 13 blocks per year. At least 18 months will be devoted entirely to clinical gastroenterology, of which approximately 35% of which will be related to diseases of the liver. The third year of Gastroenterology Fellowship training will stress research, advance therapeutics to include ERCP and endoscopic ultrasound, and motility training. Training in hepatic transplantation, clinical nutrition, and pediatric gastroenterology will also be encouraged. The fellows will also be exposed to approximately three to six months of inpatient consultative rotations during the third year of fellowship. The specific details of the rotations follow.
Examines and treats scheduled and unscheduled patients with a wide variety of common gastrointestinal conditions. Fellows will also see more acute emergency patients with more complex problems, requiring interaction with surgical and radiology departments at all facilities. By their nature, each facility will have different patient populations and consultative experiences, allowing the fellow to learn how to manage inpatients in various settings/practice patterns, which is our goal. Patients are followed up with for their active problems or referred back to their primary physician. When appropriate, long-term follow-up will be continued through the fellow’s continuity clinic. Fellows will perform GI endoscopic procedures on such patients after a determination is made that such procedures are required. The second-year fellow will begin to be exposed to motility as well as some advanced diagnostic and therapeutic procedures during this rotation. When occasionally assigned to this rotation, third-year fellows will focus on the assessment of patients requiring more advanced procedures, and emphasis will be placed on following those patients into the procedure area.
First-Year Fellows
The first-year fellow will be evaluated based on their ability to develop a pertinent and coherent differential diagnosis based on a history and physical. The fellow’s knowledge of indications and contraindications to medicines, therapeutic plans and endoscopy will be assessed for competency and to ensure adequate progression and maturation.
Second- and Third-Year Fellows
The second- and third-year fellows will be expected to have mastered the basic ability to develop a pertinent and coherent differential diagnosis based on a history and physical and will be evaluated on being able to appropriately focus that evaluation on the gastrointestinal tract. The fellow’s knowledge of indications and contraindications to medicines, therapeutic plans and endoscopy will be assessed for competency and to ensure adequate progression and maturation. The fellow should begin to master integration of data to form a coherent assessment and plan.
The third-year fellow assigned to this rotation will have these same expectations and evaluations with an emphasis on complex patients and procedures.
During these rotations, the fellows consult on patients with gastrointestinal problems at all sites (depending upon assignment), who have been hospitalized in various inpatient wards including general medicine, surgical, pediatric wards, and various intensive care units throughout all institutions. The fellow evaluates patients and advises primary care and specialty services physicians of his diagnostic impressions, recommended diagnostic tests and appropriate therapy. The trainee also performs endoscopic procedures or other GI procedures generated by such patient contacts, under the direct supervision of the attending staff.
First-Year Fellows
The first-year fellow will be evaluated based on ability to develop a pertinent and coherent differential diagnosis based on a history and physical. The fellow will also be evaluated on their ability to adequately triage consults. Instruction and assessment will be geared toward allowing the fellow to develop their knowledge base and clinical experience to that end, and therefore the greater percentage of this experience will be at University Hospital and the VA Medical Center. The fellow’s knowledge of indications and contraindications to medicines, therapeutic plans and endoscopy will be assessed for competency and to ensure adequate progression and maturation.
Second-Year Fellows
The second-year fellow will be expected to have mastered the basic ability to develop a pertinent and coherent differential diagnosis based on a history and physical and will be evaluated on being able to appropriately focus that evaluation on the gastrointestinal tract. The fellow will be assessed for their ability to appropriately triage consults and will be expected to be significantly more proficient than during the first year. The fellow’s knowledge of indications and contraindications to medicines, therapeutic plans and endoscopy will be assessed for competency and to ensure adequate progression and maturation. The fellow should be starting to master integration of data to form a coherent assessment and plan and will be expected to begin to transition toward independent inpatient consultation.
Third-Year Fellows
The third-year fellow will be expected to not only have mastered the basic ability to develop a pertinent and coherent differential diagnosis based on a history and physical but also to be able to appropriately focus that evaluation on the gastrointestinal tract. The fellow should be able to consistently make appropriate triage decisions. The fellow should be virtually competent in their knowledge of indications and contraindications to medicines, therapeutic plans and endoscopy will be expected to continue to progress toward being able to practice independently and therefore they will be afforded the opportunity to have the bulk of activity at the Upstate sites. The inpatient staff will specifically assess the fellow’s ability to integrate data to form a coherent assessment and plan. This plan should include appropriate use of ancillary services and assessment of the most medically appropriate venue (i.e., outpatient versus inpatient.) The fellow will be specifically assessed for the ability to transition to independent inpatient consultation.
Fellows will be exposed to research activities by designing a clinical or basic science research protocol, which would then be submitted for approval by the Institutional Review Board and Human Use Sub-Committees of the respective institutions, either Upstate or the Syracuse VA. Once the protocols have been approved, fellows will then conduct the study under the supervision of a staff gastroenterologist, in cooperation with other members of facilities where appropriate. Fellows will be taught how to analyze data and apply statistical techniques to interpret such data. A manuscript will then be prepared, which will be submitted to satisfy fellowship program graduation requirements. Preparation of a publishable piece of investigation, either clinical or basic science, is required for graduation. At the end of each Research rotation, the fellows will be required to submit a Research form to the Fellowship Coordinator, signed by their mentor, outlining what they’ve worked on.
Mentor/Fellow Meeting Schedule:
- Two months BEFORE Scheduled Rotation: Fellows are REQUIRED to meet with their mentor at least two months before their Research block is scheduled to begin to creating a proposal. Failure to do so will result in that block being changed to Outpatient.
- First Day of Scheduled Research Block: Fellows must meet with their mentor on the first day of their Research block to discuss their plan for the block, how they will spend their time, what they plan to accomplish, etc.
- By End of Research Block: Fellows must submit a report to their mentor and the fellowship coordinator no later than the final day of their scheduled research block. Failure to do so will result in their next Research block being changed to Outpatient.
First-Year Fellows
First year fellows will be expected to develop a hypothesis and complete a research proposal and have it evaluated and approved by the appropriate reviewing board. This will be in conjunction with a staff member of the fellow’s choice who agrees to support the project.
Second-Year Fellows
The second year will be expected to complete virtually all of their data collection in conjunction with their staff and in preparation for manuscript preparation, presentation, etc.
Third-Year Fellows
The third-year fellow will be expected to prepare a manuscript in publishable format in conjunction with their staff. This will be reviewed by the collective teaching faculty for adequacy and will be reviewed during a monthly research meeting or journal club.