Fellowship Program Directors: Christopher Koh, MD, MHSc; Sheila Kumar, MD, MS; Stephen A. Wank, MD
Overview
The University of Maryland/NIH Clinical Scholars Gastroenterology Fellowship Program is an Accreditation Council for Graduate Medical Education (ACGME) accredited 3-year combined fellowship in Gastroenterology and Hepatology. Qualified candidates must be board-eligible in internal medicine prior to starting the gastroenterology fellowship program. This requires that the applicant is either currently enrolled or will have completed a three-year residency in an approved internal medicine training program within the United States.
The goal of the University of Maryland/NIH Clinical Scholars Gastroenterology Fellowship Program is to train clinical researchers in Gastroenterology utilizing the extensive resources of the NIH Clinical Center and faculty members of the National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK). This fellowship program provides a unique opportunity to train GI fellows to become gastroenterologists who are also outstanding clinical and/or translational researchers.
Program Structure
Year 1 (UMMC/STC/BVAMC):
Gastroenterology Consultative Rotations (6 months):
Fellows carry out inpatient consultations in gastroenterology at the University of Maryland Medical Center (UMMC), R Adams Cowley Shock Trauma Center (STC), or the Baltimore VA Medical Center (BVAMC). Consultations occur on a daily basis under the close supervision of a full-time faculty member. The consultation service includes didactic teaching, bedside evaluation of patients on work rounds, and consult service conference rounds. Fellows participate in any GI procedures required for the patient's evaluation.
Gastroenterology Subspecialty Rotations (3 months)
Fellows participate in the following subspecialty rotations: 1) inflammatory bowel disease consultative services, procedure, and clinic; 2) interventional endoscopy consultative services, procedures, and clinic; and 3) endoscopy service.
Gastroenterology Procedural Training (12 months)
Fellows are closely supervised and are trained progressively in upper endoscopy, flexible sigmoidoscopy, colonoscopy, percutaneous endoscopic gastrostomy placement, endoscopic band ligation of esophageal varices, foreign body retrieval, dilation of esophageal strictures, polypectomy, heater probe, and bipolar circum-active probe (BICAP) and injection treatment of gastrointestinal bleeding. Training is also provided in performance and interpretation of esophageal motility studies, 24-hour pH monitoring, wireless capsule endoscopy, double balloon enteroscopy, and percutaneous liver biopsy.
Hepatology Consultative Rotation (3 months)
Fellows participate in liver consultations at UMMC, STC, and BVAMC. The hepatology rotation provides a broad experience in outpatient and inpatient consultation in liver diseases and management of patients with acute and chronic liver diseases. Instruction is provided in techniques of liver biopsy, interpretation of liver biopsies, and participation in hepatology rounds and conferences.
Outpatient Management (12 months)
Fellows participate in two outpatient continuity clinics per week: one GI clinic and one hepatology clinic, which provide extensive experience in outpatient management of patients with gastrointestinal or hepatologic problems. Fellows follow their own patients at the UMMC and BVAMC clinics and are directly supervised by faculty supervision.
Emergency Night and Weekend Consultations
Fellows provide emergency night and weekend consultations at UMMC and BVAMC. Fellows rotate on-call shifts with other fellows in the program. The on-call GI fellow takes calls regarding management of inpatients, and telephone calls from outpatients. While on-call, fellows do not remain in the hospital. A faculty attending is also assigned to night call and is always available for consultation. All procedures at night or on weekends are supervised directly by the attending physician.
Years 2 and 3: NIH Clinical Center
Gastroenterology Consultation Service (3 months per year)
Fellows carry out inpatient consultations in gastroenterology at the NIH Clinical Center during their second and third years. Consultations occur on a daily basis under the close supervision of a full-time faculty member. The consultation service includes didactic teaching, bedside evaluation of patients on work rounds, and consult service conference rounds. Fellows participate in any GI procedures required for the patient's evaluation. Fellows also participate in presentations and conferences including: Board Review, Journal Club, Case/Research Conference, Grand Rounds, Radiology Conference, Pathology Conference and GI Core Curriculum Conference (simulcasted with UMMC).
Hepatology Consultative Rotation (1-2 months per year)
Fellows will provide liver consultations, learn how to perform percutaneous liver endoscopies, perform inpatient endoscopy on hepatology patients. The hepatology rotation provides a broad experience in outpatient and inpatient consultation in liver diseases and management of patients with acute and chronic liver diseases. Instruction is provided in techniques of liver biopsy, interpretation of liver biopsies, and participation in hepatology rounds and conferences. The hepatology rotation includes attendance at NIH conferences: Hepatology Clinical Care Conference, Multispecialty GI Tumor Board Conference, Hepatology Pathology Conference, Hepatology Journal Club and GI/Hepatology Radiology Conference.
Outpatient Management (24 months)
Fellows participate in two outpatient continuity clinics: GI continuity clinic, which comprises one clinic every week for both the second and third year, and one hepatology clinic, which comprises one clinic every week for 6 months during the 3rd year. Fellows are directly supervised by faculty supervision. The outpatient continuity clinical experience at the NIH Clinical Center builds upon the experiences initiated during the first year at UMMC and involves the evaluation and management of patients with common GI and liver problems.
Emergency Night and Weekend Consultations
Fellows provide emergency night and weekend consultations. Emergency and after-hours procedures are supported by NIH Clinical Center endoscopy staff. Fellows rotate on-call shifts with other fellows in the program. The on-call GI fellow takes calls regarding management of inpatients, and telephone calls from outpatients. While on-call, fellows do not remain in the hospital. A faculty attending is also assigned to call and is always available for consultation. All procedures at night or on weekends are supervised directly by the attending physician.
Gastroenterology Procedural Training (24 months)
At the NIH Clinical Center, procedural training meets all board eligibility requirements and is designed to prepare fellows for academic clinical practice. At the completion of the 3-year ACGME accredited program, fellows typically graduate approximately 1000 endoscopic procedures. Fellows are closely supervised and continue to improve on their skills in upper endoscopy, flexible sigmoidoscopy, colonoscopy and polypectomy, percutaneous endoscopic gastrostomy placement, wireless capsule endoscopy, single balloon enteroscopy, esophageal pH monitoring and manometry, heater probe, BICAP and injection treatment of GI bleeding, endoscopic band ligation of esophageal varices, foreign body retrieval, and dilation of esophageal strictures. Computerized endoscopy reporting systems are used at the NIH Clinical Center.
Clinical Research Experience (16 months)
Considerable emphasis is placed on clinical research to prepare fellows for academic careers. Fellows are encouraged to participate in classes held at the NIH such as "Introduction to the Principles and Practice of Clinical Research," along with other classes offered by the Office of Clinical Research Training and Medical Education (OCRTME) and the NIH Clinical Center library. For interested fellows, the gastroenterology fellowship program also supports the opportunity for enrolling in courses towards a concomitant Master’s Degree in Clinical Research which is a collaborative program between the NIH Clinical Center and Duke University Medical Center. Clinical research projects are carried out in the inpatient and outpatient facilities of the NIH Clinical Center. Fellows will be able to develop and complete their research project(s) with a faculty mentor during their projected research time at NIH. They will also be able to participate in detailed research presentations during GI grand rounds. During the second and third years of the fellowship, the fellow will work with senior investigators on NIH-approved research protocols looking at: neuroendocrine tumors, familial gastric cancer syndromes, chronic granulomatous disease-associated inflammatory bowel disease, Zollinger-Ellison syndrome, and a variety of other GI syndromes. Twelve NIH faculty participate in the fellowship training program.
Application Information
Apply to this program through the Electronic Residency Application Service (ERAS). Two positions available per year. Applicants must be board-eligible in internal medicine prior to starting the program. This usually requires that the applicant is either currently enrolled or will have completed a three-year residency in an approved internal medicine training program within the United States.