Clinical Activity and Training Sites

Fellows in Gastroenterology at the University of Cincinnati spend clinical training time both at the University of Cincinnati Medical Center (UCMC) and the Veterans Administration Medical Center (VAMC).

Each institution provides the fellows with different aspects of their education. UCMC is the only major academic tertiary referral center in the area and the hospital which serves the underserved population. UCMC receives referrals from the tri-state area of Kentucky, Indiana, and Ohio. Disease acuity of this patient population is high and diverse.

In addition, UCMC is a major Pancreas Center (including islet cell transplantation) and has a vibrant liver transplant program performing over 100 transplants per year.

The Cincinnati VAMC services a large population of military veterans in the region. We are pleased to serve our veterans and offer them the best care possible.

Our two major training centers provide fellows with a broad exposure to a wide array of patients, illnesses, and disease acuity. Our combined training sites provide a truly diverse clinical experience throughout the three years of training. Both institutions provide a wealth of endoscopic procedures to strengthen Fellowship training.

Core Rotations and Evaluations

Fellows train under the supervision of experienced Digestive Disease faculty from the University of Cincinnati and the Cincinnati Veterans Administration Medical Center. Attending physicians are responsible for providing guidance and education during the rotation. Our training is based upon hands-on participation by the fellow and graded responsibility based on performance.

Faculty members rotate on service every two weeks, and fellow rotations are approximately four weeks. Fellows are evaluated based on the standard core competencies of the ACGME and their endoscopic skills. Currently we use the ASGE evaluation for endoscopic competency. Evaluations are used to monitor the progress of the fellow’s development. We encourage face-to-face feedback between faculty and trainee. All evaluations are reviewed bi-annually by the Clinical Competency Committee (CCC) and with the Program Director and the fellow.

Our consultation teams include medical residents and medical students. Fellows are expected to actively participate in the training of their junior colleagues.

 During the three years of fellowship, trainees will rotate through the Core Rotations at UCMC and VAMC. These include inpatient and ambulatory services and are listed below:

• Hepatology Inpatient Service
• Gastroenterology Consult Service
• Hepatology Consult Service
• Cincinnati VA combined Gastroenterology-Hepatology Consult Service
• Manometry
• Nutrition
• Clinical Research
• Ambulatory Continuity Gastroenterology Clinics
• Ambulatory Continuity Liver Clinics

The UCMC Hepatology Inpatient Service at the University of Cincinnati Medical Center is comprised of a full medical team that cares for patients with liver-related disorders including pre/post liver transplant patients admitted to the medical service. This rotation allows the G.I. fellow to act as a consultant and educator to the medical residents who actually run the team. It affords the fellow the opportunity to function in a role similar to an academic faculty member. The faculty member assigned to this team is a Hepatologist. Mornings are spent rounding with the service attending and the medical team. Afternoons revolve around patient care but are often used to set up didactic conferences, which the fellow will give to the medical team. The G.I. fellow will perform any endoscopic procedures that are needed on the inpatient Hepatology patients.

On the UCMC Gastroenterology Consult Service fellows generally spend mornings performing endoscopic procedures under faculty supervision. Procedures are performed on inpatients seen in consultation as well as those referred from the outpatient clinics. Consultative service rounds occur during the day depending on the endoscopy schedule. Fellows are expected to independently evaluate each consult, summarize the pertinent history and physical findings, and formulate an appropriate diagnostic and therapeutic plan to be discussed with the team and the attending prior to leaving written documentation about consult advice.

Through rotations at the UCMC Liver Consult Service, fellows are intensely trained in the evaluation and management of patients with liver disorders, including pre/post-liver transplantation. Fellows participate in inpatient and outpatient liver consultations, perform all endoscopic procedures on liver patients (including liver biopsies), and provide guidance to the house staff in the management of liver inpatients. They actively participate in the weekly liver transplant selection committee meetings.

Combined GI-Liver Rotations at the Cincinnati VA Medical Center provides additional endoscopic experience and clinical training in gastroenterology, hepatology, and pancreatic disorders.

RESEARCH

Fellows are required to do two months per year dedicated to research. Dr. Khurram Bari, Associate Fellowship Program Director, is the Director of Fellowship Research. He is instrumental in helping fellows find projects and appropriate mentors. Many of the G.I. fellows do research projects at the Cincinnati Children’s Hospital Medical Center (CCHMC).

CORE AMBULATORY-CONTINUITY CLINICS

There are ambulatory clinics for both Gastroenterology and Hepatology at UCMC and VAMC. During the first two years of fellowship, trainees are required to take a half day of G.I. clinic and a half day of liver clinic each week. Fellows may choose to do clinic at either institution. Fellows are assigned to a specific clinic for a minimum of one year to ensure continuity of care and exposure to longitudinal disease processes. The second year of training, fellows switch to the other institution for their clinics. This allows training and exposure to both patient populations. Clinics at both UCMC and VAMC are staffer by one or more faculty mentors.

At both UCMC and VAMC, fellows encounter diverse populations with a variety of acid peptic, motility, functional, neoplastic, and inflammatory disorders of the intestinal tract as well as pancreaticobiliary disease.

Hepatology clinics are located both at University of Cincinnati Medical Center and the Cincinnati VA Medical Center. Fellows gain experience managing infectious, autoimmune, metabolic, and neoplastic disorders of the hepatobiliary system, as well as complications of cirrhosis.

ELECTIVES

During the first and second year of training, fellows are required to take electives in manometry and in nutrition. Other electives, which can be done later in training, include:

• Advanced Endoscopy, which includes a month-long rotation through the pancreas clinic. This is a multidisciplinary clinic located at UCMC.
• Inflammatory Bowel Disease, either one- or three-month rotations.
• Manometry, either one- or three-month rotations.

Fellows are encouraged to create their own electives provided that they meet the guidelines and rigorous specifications of the training program.

CONFERENCES

A variety of regularly scheduled conferences allow for the in-depth discussion of particular cases and topics; the exchange of ideas among internists, surgeons, and pediatricians caring for patients with digestive diseases; and the presentation of scholarly information on clinical problems in gastroenterology. Conferences are on Thursday afternoons from 3 to 6 PM.

Prior to the regularly scheduled year-long conferences, the year begins with a Pre-Summer Lecture Series given by the Program Director to help new fellows transition from being an Internal Medicine Resident to being a G.I. Consultant. This occurs during the first week of training. These lectures discuss professionalism, how to be an outstanding consultant, the role of teamwork in endoscopy, how to obtain proper informed consent, how to disclose an adverse event, and lastly, the ergonomics of endoscopy including an endoscopy simulation session.

Following the Pre-Summer Lecture Series is the Summer Lecture Series. This is a 2-month long series of lectures that covers all of the G.I. emergencies and prepares the trainees to assume the responsibilities of taking emergency on-call coverage. Topics cover gastrointestinal hemorrhage, fulminant hepatic failure, esophageal and other foreign bodies, bowel obstruction and pseudo-obstruction, viral hepatitis, management of esophageal strictures and percutaneous feeding tubes, acute and chronic liver failure, techniques for successful endoscopy, introduction to IBD part one and part two, conscious sedation, antibiotic prophylaxis and anticoagulation management in endoscopy, acute liver failure, introduction to manometry, introduction to nutrition, lover G.I. bleeding and management of acute pancreatitis.

In September, regularly scheduled conferences begin. They include:

• G.I. and Liver Pathology Conferences these are monthly interdepartmental conferences attended by members of the Department of Pathology and the Division of Digestive Diseases. Conference provides an outstanding forum for correlating pathology with the clinical aspects of gastrointestinal and liver disorders.
• G.I. Radiology Conference run by faculty radiologist, this conference serves as a monthly forum to correlate clinical and radiologic findings and to develop an understanding of how to read and interpret radiologic studies.
• Medical/Pediatric Clinical Conference this conference is held on a monthly basis in conjunction with faculty and fellows from the Division of Gastroenterology and Nutrition at Cincinnati Children’s Hospital Medical Center. Selected cases are presented by adult and pediatric G.I. fellows, followed by a short discussion of the topic with group participation. This conference provides the G.I. fellow with exposure to the presentation and management of gastrointestinal diseases in the pediatric population.
• Medical Surgical Conference this conference occurs bi-annually. G.I. fellows team up with the chief surgical residents to discuss assigned topics of mutual interest. Current literature is reviewed, and a relevant discussion if led by both the G.I. fellow and the chief surgical resident, followed by group participation.
• G.I Physiology/Pathophysiology Conference this conference, which is held on a monthly basis, reviews G.I. physiology and pathophysiology and is presented by a fellow and a faculty member from the Division of Digestive Diseases.
• G.I. Journal Club this monthly G.I. Journal Club reviews recently published articles of clinical relevance. Participants include fellows and G.I. faculty.
• Research Conference a research conference for faculty and fellows of the Division of Digestive Diseases is held monthly. Preliminary data from research in progress is presented by the G.I. faculty or fellow. Outside speakers with research interests in Gastroenterology or Hepatology are also invited to present.
• Clinical Topics Conference on a monthly basis, the G.I. faculty presents a formal lecture on topics of clinical relevance within their area of expertise. This is shared with fellows, residents, and students.
• Clinical Case Conference this “working” conference provides a format for the presentation and discussion of difficult diagnostic or management problems by faculty and fellows.
• Multidisciplinary Inflammatory Bowel Disease (IBD) Conference This conference meets every second Monday between 4:00 PM - 5:00 PM and is a virtual conference. This is a discussion and management conference regarding challenging IBD cases. 

 Other conferences selected conferences throughout the year cover additional topics relevant to Fellowship training including morbidity and mortality, invited guest speakers, and Grand Rounds G.I.-oriented topics.

INNOVATIVE CURRICULUM

Affectionately referred to as “Mouse Club”, fellows meet and share lunch on a monthly basis, in a private setting, with the G.I. Fellowship Program Director and Associate Program Director. This is an informal meeting where fellows are encouraged to discuss the program and ideas they would like to put forth to innovate the program, and help make changes to keep the program current and exciting. This time is also used to troubleshoot any issues that need resolution at the level of the fellowship directorship. This forum is also used to invite outside speakers to discuss medical ethics, death and dying, burnout, patient safety, diversity topics, and legal aspects of medicine.