The program is divided into three years that will allow increasing clinical responsibility, research and advanced endoscopy service.
The first year of training is focused on the clinical inpatient service of Maimonides Medical Center. During the first year, the fellow will be responsible for all consults and procedures (other than ERCP). The two first year fellows will split the consultations. One fellow will be responsible for the Gastroenterology Service, caring for patients with diseases of the esophagus, stomach, bowel, liver and pancreas. The other fellow will be responsible for the "bleeding team." All patients with significant bleeding will be followed and cared for by this team. The service attending physician will supervise care for patients on both services.
Formal teaching rounds occur daily with a service attending each morning. Bedside rounding occurs each afternoon, Monday through Friday. Procedures will be performed daily with an attending faculty member. Outpatient experience will occur with a continuity clinic 1-2 times each week.
Year 2 will include private practice rotation, hepatology and liver transplant and research. There will be a four month rotation to Mount Sinai Medical Center in Manhattan. During this time, the fellow will have no responsibilities at Maimonides Medical Center. The rotation will include one month of pre-transplant, one month of post-transplant and two months of Hepatology Consult Service and Hepatology Clinic.
During the second year of training, the fellow will be rotating among private practice gastroenterologists for 3-4 months. Each month, the fellow will be assigned to a private practice gastroenterologist. The gastroenterologists will have a fellow assist in the care (including procedures) of their inpatients. Formal, organized teaching is required during these practice rotations on a daily basis. The fellow goes to at least three attending physician offices for follow-up outpatient experience over a three month period.
Time for research will be arranged during this year. The goal is to prepare a project that can be implemented and presented prior to graduation. Although fellows are expected to participate on multiple projects, all fellows must prepare and present one project of their own during the fellowship.
The third year of training places emphasis on outpatient care, research and advanced endoscopy experience. The final year of training will be focused on fine-tuning the knowledge, experience and expertise gained within the first two years. In addition to time spent on both the clinical service and private service, the fellow will focus on outpatient care, research and advanced endoscopy skills as well. During the first 3 months, the third year fellow will assist the new, first year fellow on the Service. The remaining 9 months are divided between the following:
- Research — The fellow is required to develop and submit for publication at least one research study. At least one paper is to be presented in abstract form at a national medical meeting (poster and/or podium). The months provided in the first and second year should have led to the preparation and implementation of at least one project to be completed by the end of the third year.
- Advanced Endoscopy — The most complicated procedures including ERCP, EUS (endoscopic ultrasound), lasar, esophageal stent placement, endocinch, etc. are performed by the third year fellow.
- Outpatient Office Management — A structured program provides outpatient experience focused entirely on managing private practice activities including: billing, coding, documentation, processing endoscopes, etc.
- Outpatient Clinic Experience — A clinic dedicated to diseases of the liver will be held once a week. Fellows manage their own clinic. Fellows are responsible for follow-up of lab work and pathology reports from the clinic. In addition, EGDs and colonoscopies will be scheduled with a supervising attending. EGDs will be limited to Barrett's esophagus surveillance. Colonoscopies will be scheduled for patients needing high-risk screening.
The program includes a full range of weekly educational conferences: case conferences, evidence-based medicine conferences, surgical morbidity and mortality conferences, lectures and board review, pathology and radiology journal clubs, attending rounds, and quality improvement conferences.