Curriculum

The clinical curriculum is designed to ensure that all fellows, regardless of their eventual career interest, are trained in all aspects of inpatient and outpatient gastroenterology and hepatology. This is achieved by rotations on the following services: inpatient GI Consults, IBD, hepatology, nutrition, motility, and ambulatory clinics. A strong emphasis is placed on the appropriate indications and careful performance of endoscopic procedures under the guidance of expert teaching faculty. Each month, an academic area is chosen as the focus of the Didactic Fellows conference, with Case Conference and Journal Club centered around that theme. In most teaching environments, faculty with particular expertise in the field directly mentor the fellows. Throughout the three years, clinical responsibility is progressively tailored so that senior fellows learn to assume care and make management decisions for patients with increasingly complex diseases. The patient populations served by our institution offers a wide array of common and esoteric digestive diseases. Patient safety and quality improvement efforts are cornerstones of the fellowship program. Fellows spend approximately half of their training conducting original research under the watchful guidance of an experienced faculty mentor. Fellows acquire academic skills from their mentor, as well as Divisional, regional and national conferences. By the end of their training, fellows are well equipped to deliver excellent patient care and contribute to the fields of gastroenterology and hepatology.

The core curriculum consists of the following rotations:

1. The Mount Sinai Hospital GI Consultation Service

Under the guidance of one full-time teaching attending gastroenterologist and one voluntary teaching attending, fellows serve as consultants to the house staff on the Consult Service. 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. Each fellow on the Consult Service attends his/her GI Continuity Clinic one half-day per week.

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 and Inflammatory Bowel Disease Center incorporates more than 50 attending physicians, all actively involved in fellowship teaching.

2. Subspecialty rotations

Fellows rotate on two subspecialty services during the course of their fellowship. 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.

  • The Inflammatory bowel disease (IBD) rotation exposes fellows to patients with often extremely complex manifestations of ulcerative colitis and Crohn’s disease.  Fellows are exposed in the outpatient setting to patients seen in the multidisciplinary Inflammatory Bowel Disease Center. Emphasis is placed on understanding the surgical and medical management of these conditions, along with proper interpretation of diagnostic imaging and endoscopic studies. The psychosocial aspects of these chronic illnesses are integrated into the comprehensive and compassionate care of the patient. 
  • A month-long Selective rotation exposes fellows to experts who deal with patients at high risk of GI cancer and neuroendocrine tumors, motility disorders, and nutritional disorders.
  • A pancreaticobiliary rotation will be launched in academic year 2016-2017 for second and third year fellows to devote protected time to learning these often complex diseases. Interacting with Therapeutic Endoscopy faculty and the Advanced Endoscopy fellow, fellows will perform certain advanced procedures including dilation, stent placement and side-viewing endoscopy.

3. The Mount Sinai Division of Liver Diseases and Transplantation Service

The Division of Liver Diseases 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
  • The inpatient Liver 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.

Here is a full description of the academic activities of the Division of Liver Diseases.

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 GI Motility Laboratory. Five faculty members are involved in research, teaching, and supervision.

View a typical monthly schedule.

Conferences serve as a foundation of the teaching program. Each week the following conferences are held:

Monday

Colorectal and Esophageal Cancer Tumor Board, 5:00-6:00 pm

  • This multidisciplinary conference involves gastroenterologists, surgical oncologists, medical oncologists, radiologists and pathologists and discusses cases that require management decisions.

Tuesday

Pancreaticobiliary Tumor Board, 7:00-8:00 am

  • This multidisciplinary conference involves gastroenterologists, surgical oncologists, medical oncologists, radiologists and pathologists and discusses cases that require management decisions.

Medicine Grand Rounds, 8:30-9:30 am

  • This conference invites internal and outside leaders in internal medicine and specialties thereof to discuss the latest developments in the practice and mechanisms of medicine

Drs. Sachar-Colombel Clinical IBD Case Conference, 11:00 am-12:00 pm

  • This is a forum for fellows on the IBD service to discuss difficult cases with two world leaders in IBD.

GI Pathology/Biopsy Review Conference, 12:00-1:00 pm

  • This lunch conference is run by Dr. Noam Harpaz, Chief of the Division of GI Pathology. Using a teaching microscope, slides are reviewed from biopsies performed by fellows the week before, along with rare and instructive cases submitted by GI faculty or outside cases sent directly to the Pathology Department.

IBD Conference, 5:00-6:00 pm

  • This bi-weekly conference is a forum for internal and outside speakers to discuss the latest developments in IBD.

Research/Work-in-Progress Conference, 5:00-6:00 pm

  • This bi-weekly conference alternates with IBD Conference and is a forum for fellows and faculty to discuss their research in progress or to present new ideas for projects.

Wednesday

Dr. Jerome D. Waye Fellows Endoscopy Conference, 7:45-8:30 am

  • Dr. Waye, one of the founders of colonoscopy, spends time weekly with fellows on the GI Consult Service to discuss techniques and decision making in endoscopy

Thursday

Fellow's Conference, 7:00-8:00 am

  • This weekly conference is divided into four formats, each held once a month. A general topic of the month is chosen (eg. esophageal disease). A Didactic session is led by a faculty expert in the field. A Case Conference led by a GI fellow presents a difficult case to obtain input from all fellows and faculty in attendance. Journal Club chooses a paper on the topic that highlights important study design or biostatistical concepts and the session is supervised by faculty with expertise in clinical investigation. The fourth session is Chief’s Rounds with Dr. Bruce Sands which addresses academic skills and career advice. 

Friday

Endoscopy Conference, 7:15 – 8:00 am

  • Dr. Jerome Waye conducts this multidisciplinary case-based conference attended by gastroenterologists, surgeons, and pathologists, where interesting endoscopic cases from the week before are presented by fellows on the GI Consult and the Advanced Endoscopy services. Each case is followed by a brief literature review to provide evidence for management decisions. Surgical videos and pathology slides are often shown.

GI Grand Rounds, 8:00-9:00 am

  • This conference presents topics of general GI interest using a combination of invited outside speakers and internal faculty experts. This is also the forum for regular (approximately monthly) QI/QA conference where issues of patient safety and programmatic improvement are addressed. Approximately once every quarter, a session is held at which a GI fellow and a faculty moderator assemble a panel of faculty experts to address controversial areas of gastroenterology and hepatology.

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 300 patients a month. Fellows assume primary responsibility for patients they see in the clinic, including the coordination and follow-up of diagnostic tests. Training in ambulatory gastroenterology is a crucial part of the fellowship. Two or three faculty members are on staff per session, allowing for significant one-on-one teaching. Over the three years, fellows become well versed in ambulatory gastroenterology as well as the art of becoming an effective consultant.