The core curriculum consists of the following rotations:
1. The Mount Sinai Hospital GI consultation service
Under the guidance of two attending gastroenterologists, fellows serve as consultants to the house staff. Two fellows are on staff at all times. The fellows are responsible for directing and managing all aspects of gastrointestinal care, including endoscopic procedures. Daily work, endoscopy, and bedside rounds are all conducted under the supervision of the attending gastroenterologists.
One hour per day is designated for teaching rounds to allow fellows the opportunity for in-depth didactic instruction from the attending gastroenterologists. In addition, two days a week the fellows perform scheduled outpatient endoscopic procedures on patients referred from the GI clinic.
The Mount Sinai Hospital has 1,171 beds. Management of medical and surgical GI and liver patients is integrated in a 70-bed GI surgical subspecialties (GISS) care center. More than 20 percent of teaching service beds are occupied by patients with GI disease. Our endoscopy unit offers five procedure rooms and a full range of endoscopic procedures for children and adults. Our GI faculty practice incorporates more than 50 attending physicians, all actively involved in fellowship teaching.
2. Subspecialty rotations
Fellows rotate on four subspecialty services during the course of their fellowship:
• Inflammatory bowel disease (IBD )
• GI cancer
• Motility disorders
• Nutrition disorders
These rotations provide the fellow with the opportunity to develop an in-depth appreciation of the subspecialty areas. Each rotation utilizes a combination of inpatient and outpatient experiences to provide broad clinical exposure in each area.
Frequently a multidisciplinary approach is used, with gastroenterologists, surgeons, medical and radiation oncologists, psychologists, genetic counselors, and nutritionists playing an active role in teaching. Fellows with a particular interest in one area may choose to dedicate more time to this area through an elective block or during the research rotation.
3. The Mount Sinai Division of Liver Diseases and Transplantation Service
The liver division welcomes fellows to an intensive clinical experience, with responsibility for both inpatient and outpatient care for all forms of liver disease, including pre- and post-transplant management.
The three major areas of concentration are:
• The inpatient liver unit on the GISS Care Center
• The inpatient consult service
• A broad outpatient experience comprising pre-transplant evaluation and management, post-transplant care, general liver clinic, individual faculty office hours, and scheduled endoscopy.
4. The Bronx VA Medical Center GI Consultation Program
Fellows perform consultations and endoscopic procedures within the Bronx VA Medical Center and attend two weekly clinics in gastroenterology and hepatology. The VA has a busy outpatient endoscopy service. Fellows gain significant experience performing upper and lower endoscopies.
Inpatient consultations and attending rounds take place each day, as does instruction in all major diagnostic and therapeutic modalities. A special emphasis is placed on gastrointestinal motility training. Fellows participate in conferences as well as small group symposia with a pathologist and radiologist.
The Bronx VA Medical Center is a 247-bed teaching institution. The medical program has 70 beds. Research studies are carried out in the Alcohol Research Center and the GI Motility Laboratory, which together occupy more than 8,000 square feet of research space. Five faculty members are involved in research, teaching, and supervision.
5. GI clinic
Two GI clinic sessions take place each week in the new Center for Advanced Medicine (CAM), where a.fully electronic medical record system is in place. Each fellow maintains a weekly continuity clinic over his or her three years of fellowship.
The GI clinic is extremely busy. We see more than 200 patients a month. Training in ambulatory gastroenterology is a crucial part of the fellowship. At least three faculty members are on staff per session, allowing for significant one-on-one teaching. Over the three years, fellows become well versed in the ambulatory gastroenterology as well as the art of becoming an effective consultant. Approximately once a month, the GI clinics hold a dedicated didactic conference on the diagnosis and management of common outpatient gastrointestinal diseases.
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