Our program tries to attract and select the most likely candidates, and then to provide the maximal opportunity for trainees, who are interested in a career in academic gastroenterology. However, we recognize that trainees may choose to go into non-academic practice, and want to provide each fellow with three years of training centered on the six core competencies that most completely meets their own educational objectives. To this end, we continually strive to have a broad based faculty that can provide both the clinical training and mentoring in scholarship that will lead to a successful career in academic medicine, as well as the additional competencies that make a trainee more competitive for the best practice positions.
Our program has a combination of internationally recognized faculty, many senior clinicians and educators, at all medical centers, a premier Hepatology/Liver Transplant unit, a nationally recognized advanced endoscopy section, motility training, as well as strong clinical and bench research. Our NIH Training Grant (continuously funded for over 20 years) provides added opportunities for the dedicated researcher. Depth and variety of clinical experience includes Country/Regional Tertiary Trauma Center, Regional VA Medical Center, and University Tertiary Referral.
Careers in academic gastroenterology may be more balanced towards the clinician-educator or the clinician-scientist ‘tracks’ but all must have a scholarly base. To develop such career planning requires that the trainee begin thinking about that career shortly after the start of fellowship. We have will make formal contact with all accepted fellows prior to the beginning of their fellowship to discuss these issues, and highlight the negative effects of delayed choice on career options. Recognizing that change is always possible, all fellows are encouraged to make decisions about their ‘track’ (academic vs. practice) by the end of their first year of fellowship. The program directors meet with all first year fellows frequently to help them to make these choices. Although all fellows must fulfill the same core curricular elements during the first 18 months of training and have a 36 month continuity clinic, fellows heading to an academic track must utilize as much of the second 18 months of training as possible to develop a clinical or basic research scholarship base under the guidance of a faculty mentor. The mentor and project should be defined by the end of the first year. Successful application of this directive approach would allow creative career planning by the Head of the Division for potential faculty positions at the end of fellowship.
Careers in clinical practice still require a minimum of six months of dedicated research time, but second and third year electives may also be chosen that would better prepare for elements of practice. These can include: added blocks of clinics (tertiary consultative (focusing on difficult diagnostic and therapeutic management cases at the AOP, outpatient hepatology focusing on the management of chronic hepatitis), motility rotations with training in impedance technology, training in the interpretation of capsule endoscopy, training in ano-rectal pathology with a rectal surgeon, training in pediatric gastroenterology, and/or extended training in nutrition can amplify the core clinical training for a future practitioner. Research might include elements of outcomes analysis to develop skills that are better incorporated into continuous quality improvement once in practice. Topic reviews and analytic translational reviews would also be of great individual benefit. This does not mean the rigor of hypothesis driven research should not be undertaken, but the time limitations contract realistic options, particularly if choices are delayed.
To help accomplish this task we require that our fellows take part in a continuous quality improvement evaluative process of our educational enterprise. Over the past five years, multiple changes have been made in this training program, some initiated, but all contributed to, by our fellows. Not all of these changes have been successful. Examples of the latter include: attempting an outpatient month of hepatology during the year 1 (2003-2004) that turned out not to have enough educational content and delayed the development of endoscopic skills by some first year fellows; allowing clinical practice directed fellows to do pieces of research (e.g. protocol development) without completing projects; and deferring career choice to the middle of the SR2 year. We have learned from these mistakes, and modified the program. Recent positive changes in the system of education have evolved directly from our fellows input and concerns including: the development of a faculty hospitalist model at UCH, the addition of an Internal Medicine resident to the hepatology inpatient service at UCH, restructuring of Tier II specials months to include the more common ERCP procedures at DHMC and VAMC in addition to UCH/AOP, and development of a continuity endoscopy experience for practice directed fellows.
In the coming year we have implemented some new processes of evaluation that include: evaluation by non-physician personnel to assure greater validity for the Professionalism, Systems Management, Interpersonal Communication, and Patient Care competencies; inclusion of senior fellows in the curricular modification of the GI pathophysiology course and the MKSAP review for rotating IM residents to allow them to have greater opportunities to exhibit teaching expertise; and an attempt to devise a valid methodology to assess outcomes post-fellowship.
AGA Trainee Requirements (download PDF )
Goals and Objectives by Competency (download PDF)
Core Curriculum (download PDF)