The first year of fellowship is dedicated to acquiring clinical proficiency in both inpatient and outpatient aspects of Pediatric GI/Hepatology/Nutrition. The clinical activities of the first year are based at Children's Hospital Colorado, a 440-bed facility, which is the major teaching hospital for the Department of Pediatrics of the CU SOM. Children's Colorado is also the pediatric home to the NIH-supported Colorado Clinical and Translational Sciences Institute, housing the Pediatric Clinical Translational Research Center that is available to fellows and faculty to assist with performance of clinical investigations.
The GI/Hepatology/Nutrition service consults on, or is the primary attending physician for approximately 5000 inpatient visits per year and sees over 18,000 outpatient visits per year. Over a one-year period, the GI/Hepatology/Nutrition Section performs almost 5000 procedures, including approximately 2750 upper gastrointestinal endoscopies, 800 colonoscopies and flexible sigmoidoscopies, 100 liver biopsies, 50 ERCPs and other gastrointestinal procedures (motility studies, breath hydrogen analyses, esophageal pH studies, esophageal impedance, video capsule endoscopy, etc). The three first-year fellows rotate between the Inpatient Service, Consult Service, and Outpatient /Procedure Service.
The fellow performs all in-hospital consultations and supervises the care of all patients admitted to either the GI or the Liver service, under the supervision and mentorship of the attending GI or Liver physician. Emphasis is placed on physical diagnosis, developing an accurate differential diagnosis, learning the methods of evaluating and treating the child and assessing the family's needs (family-centered care). Diagnostic procedures required by these patients are performed by the fellow under the supervision of the GI or Liver attending physician. The fellow will be exposed to the full range of GI, liver, pancreatic, and nutritional problems, including acute and chronic diarrhea and colitis, vomiting disorders, esophageal and intestinal motility disorders, failure-to-thrive and nutritional problems, allergic GI diseases, inflammatory bowel disease, functional GI diseases, chronic constipation and abdominal pain, short gut syndrome, parenteral and enteral nutrition management, acute and chronic hepatitis, a variety of metabolic and genetic liver diseases, neonatal cholestasis, acute and chronic liver failure, chronic cholestatic disorders, bile duct and gall bladder disorders, acute and chronic pancreatitis, GI problems of the immunosuppressed or immunodeficient patient, and others. The fellow will learn to perform and interpret the full gamut of GI diagnostic and interventional procedures, including upper gastrointestinal endoscopy, colonoscopy and sigmoidoscopy, capsule endoscopy, polypectomy, esophageal variceal endosclerosis and ligation, esophageal pH and pH/impedence testing, duodenal intubation, paracentesis, percutaneous liver biopsy, diagnostic paracentesis, endoscopic retrograde cholangiopancreatography, pneumatic and non-pneumatic dilatation of strictures, removal of GI tract foreign bodies and percutaneous endoscopic gastrostomy tube placement. The Inpatient and Consult services range from 10-20 patients each. The Liver attending, Liver Center Team, dietitian, social worker, pharmacist and nutritional support nurse are all part of the Inpatient Liver Care Team.
While on the Outpatient/Procedures Rotation, the fellow attends four half-day clinics including urgent outpatient clinics, and multidisciplinary subspecialty clinics such as Liver Clinic, the Gastrointestinal Eosinophilic Disease Program, Intestinal Failure, IBD Referral Clinic, CF Clinic and Adolescent Obesity Clinics. The fellows are exposed to the full range of outpatient GI/ liver Nutrition disorders, and learn the appropriate and cost-effective evaluation and management of these infants and children. During the Outpatient Procedures Rotation, the fellow attends four half-day procedure block times under the direction of the attending pediatric gastroenterologist assigned to the block. Each fellow participates in a dedicated continuity clinic which begins during the second month of the first year continuing throughout their training. Fellows provide continuing care for patients evaluated in the inpatient and/or outpatient setting in this clinic. The fellows are involved in the outpatient management of home care for some of the 100-120 infants and children with complex parenteral and enteral nutritional support, including many with cystic fibrosis.
The Pediatric Liver Center at Children's Hospital Colorado, under the medical direction of Dr. Michael Narkewicz, is the regional referral center for the evaluation and care of children with acute and chronic hepatobiliary diseases. Six Pediatric Hepatologists within the Section provide consultation and ongoing care for over 800 children annually. Within this center lies the Pediatric Liver Transplant Program under the medical direction of Dr. Shikha Sundaram and the surgical direction of Dr. Michael Wachs. The Pediatric Liver Transplant Program is actively involved in the evaluation of potential candidates for transplantation, peri-transplant care, and post-transplant follow-up and performs approximately 12-16 liver transplants per year. Fellows participate in the evaluation and care of children with liver disorders and those receiving liver transplantation under the direction of the Liver Transplant/Hepatology attending physician.
First-year fellows have a four-week rotation without any inpatient or outpatient clinical responsibilities for a series of electives. During this time the fellows rotate in pathology and radiology.