Curriculum

Rotation Descriptions

We offer the following rotations to our transplant hepatology fellows:

• Pre-transplant  All patients admitted to the liver medicine inpatient service will be followed by two fellows and the service attending hepatologist, who will lead a team of assigned Internal Medicine house staff.  The typical census on the pre-transplant service ranges around 25 patients at a time.  Responsibilities include completing pre-transplant evaluations and coordinating hospital referrals with the support of the supervising attending.  All associated procedures, such as endoscopies and liver biopsies will be performed by the inpatient fellows.
• Post-transplant Fellows will attend post-transplant rounds with the transplant surgery team and learn about post-transplant management, especially the use of immunosuppression. Fellows will be expected to perform endoscopies and liver biopsies on inpatient post-transplant patients. Use of additional free time to attend transplant office hours and the daily liver pathology review is strongly encouraged.
• Outpatient By seeing patients with senior faculty in their outpatient hepatology practices, fellows learn about managing liver diseases and acquire experience in the outpatient liver transplant evaluation process and post-transplant management. Other responsibilities include conducting outpatient procedures such as endoscopy, liver biopsy, and paracentesis. Attendance at the daily liver pathology review is strongly encouraged.  Fellows will also participate in their own general hepatology continuity clinic weekly throughout the year. 
• Consult Fellows will attend to general hepatology consults requested by other inpatient services.  Cases are staffed alongside an attending hepatologist. In addition to procedures required by the consults, fellows will assist in performing outpatient procedures. Use of additional free time to attend transplant office hours and the daily liver pathology review is strongly encouraged.
• Electives and Research: Fellows will have one month of time dedicated to mentored research, and another one month for personalized electives.  Fellows are encouraged to submit their research to national meetings and prepare and submit manuscripts to peer reviewed journals.  The division funds and supports all fellows to attend the annual Liver Meeting.
• Vacation: Fellows will have four weeks of vacation during the year, taken during their outpatient, research, or elective blocks.

The following conferences take place each week:

• Recipient Review Members of the transplant team discuss the evaluation and listing of potential liver transplant recipients.
  
  
• Liver Division Lecture Series:  Didactic conferences are held twice weekly throughout the year.  The first three months of the year start with a Summer Lecture Series that covers high yield topics in hepatology.  Other conferences include journal club which is presented jointly by the hepatology attendings and fellows, updating the group on topics within their respective fields of hepatology/gastroenterology research. Hepatology fellows also  present interesting inpatient cases and/or a comprehensive review of topics pertaining to liver disease throughout the year.  Invited speakers present a variety of lectures spanning basic science, clinical, and translational interests within hepatology.
  
  
• Living Donor Liver Transplant Conference Transplant surgeons, hepatologists, and transplant coordinators present potential living donors and discuss their suitability.
  
  
• HCC Conference Multidisciplinary review of HCC cases by radiology, surgery, oncology and hepatology to review images and determine a plan of care

The following conference takes place daily:

Liver Pathology Review Daily histopathology is reviewed by Swan Thung, MD, Maria Isabel Fiel, MD, Steven Ward, MD, and the liver pathology fellows. We strongly encourage transplant hepatology fellows to attend these sessions to gain familiarity with liver biopsy interpretation. The conference is complemented by a monthly CPC review of challenging cases.

Transplant hepatology fellows will participate in the following four outpatient practice settings during their fellowship:

• Liver Fellows' Continuity Practice: Every Tuesday morning, fellows will see their own patient panel of referrals from other clinics or other institutions for a variety of liver diseases, with an emphasis on continuity of care. Fellows will also perform endoscopies on their patients during the outpatient rotation. The clinic is equipped with ancillary support to help coordinate care with all non-physician tasks. A specialized team of patient care navigators also help ensure access to care in patients prescribed anti-viral therapy for HBV and HCV.
• RMTI Faculty Transplant Practice:  During the outpatient rotation, fellows will assist in managing patients both before and after transplantation. Fellows will evaluate patients referred for transplantation and individuals referred as potential living-related donors. Fellows will learn about outpatient care of the liver transplant recipient, including management of immunosuppression, complications of immunosuppression, and recurrent disease after transplant, such as recurrent HCV.
• Outpatient Transplant Apprenticeship:  Throughout the year (except while on the Pre-Transplant Inpatient Service), fellows will join an assigned faculty member for a half-day weekly during each of their transplant office hours.  Each fellow will be assigned to apprentice with two different faculty members each for 6 months of time during their fellowship.  This apprenticeship model provides rich mentorship and continuity in post-transplant management.
• RMTI Faculty General Hepatology Practice:  During the outpatient rotation, fellows will also attend office hours with senior faculty to acquire expertise in the basic management of liver disease, including treatment of viral hepatitis, autoimmune hepatitis, primary sclerosing cholangitis, hepatocellular carcinoma, and nonalcoholic steatohepatitis. Fellows will also participate in the evaluation of abnormal liver tests.
• RMTI Liver Surgery Practice: Fellows will have the opportunity to work with our liver surgeons caring for patients with complicated hepatobiliary disease, including HCC, cholangiocarcinoma, metastatic liver tumors, and gallbladder cancer.