The clinical rotations include inpatient consults, general hepatology, transplant hepatology, motility, inflammatory bowel disease, hepatobiliary diseases, endoscopy, and clinical nutrition. In addition protected time for fellows to pursue elective study and complete the required research requirement is provided. The program is reviewed periodically and subject to modification.
Inpatient Consult Service – Mount Sinai Beth Israel, Mount Sinai Morningside and Mount West
The inpatient rotations occur at each of the three teaching hospitals including Mount Sinai Beth Israel, Mount Sinai Morningside and Mount Sinai West. The rotation teaches fellows the skills to diagnose and guide the treatment of those gastroenterology disorders that arise in the acute care setting. In addition, this rotation develops the skills to work within the multidisciplinary care team including referring doctors, radiologists, and surgical colleagues. The service is staffed by core clinical faculty and voluntary faculty who conduct daily bedside rounds with fellows and residents.
Outpatient Rotations – Mount Sinai Downtown Union Square, Mount Sinai Morningside and Mount Sinai West
Recognizing that most gastroenterologists practice outpatient medicine, the fellowship program at MSBIMW strives to train excellence in the clinical care of chronic illness and develop long-term continuity care. In each four week cycle, our fellows spend one full week of dedicated ambulatory gastroenterology training. During this time they have no inpatient responsibilities are able to focus on learning to provide high quality outpatient care. Throughout the week, fellows attend 8 half-day sessions of continuity clinic in both general gastroenterology clinic and hepatology clinic at each of the three teaching sites. Patient volume is capped to ensure quality delivery of care balanced with meeting the educational needs of our trainees. All patients are seen under the supervision of a core faculty member. During subspecialty rotations (IBD, hepatobiliary, hepatology), the trainees will spend additional outpatient time seeing patients in those practice areas. An outpatient curriculum and didactic series has been developed to ensure that all trainees are well prepared for outpatient practice.
Endoscopic Training – Mount Sinai Downtown Union Square, Mount Sinai Morningside and Mount Sinai West
Fellows will be trained in diagnostic/therapeutic upper endoscopy, diagnostic/therapeutic colonoscopy, sigmoidoscopy, percutaneous endoscopic gastrostomy tube placement, sclerotherapy, and band ligation. Our trainees vastly exceed the minimum training threshold for proficiency in endoscopic procedures. First year fellows perform all endoscopic procedures required from the inpatient consult service as well as one half-day per week of routine outpatient procedures. In the second and third year of training, a dedicated rotation is in place for outpatient endoscopic procedures. Since there is no advanced endoscopy fellowship associated with our program, all trainees spend time in their second and third years of fellowship rotating on the hepatobiliary service leading to ample opportunity to learn the basics of endoscopic ultrasound (EUS) and ERCP. All endoscopic procedures are performed under direct supervision.
Liver Transplant – The Mount Sinai Hospital
During the second year of training, the fellows will rotate for 8 weeks at The Mount Sinai Hospital main campus for their ACGE required transplant rotations. The fellows will spend 4 weeks on the inpatient pretransplant service followed by two consecutive two-week blocks of inpatient and outpatient post-transplant medicine. Dr. Charissa Chang oversees the transplant hepatology rotations at Mount Sinai.
Hepatobiliary Rotation – Mount Sinai Beth Israel, Mount Sinai Morningside and Mount Sinai West
Since there is no advanced endoscopy fellowship associated with our program, all trainees spend time in their second and third years of fellowship rotating on the hepatobiliary service. Though this is not a substitute for a formal 4th year advanced endoscopy fellowship, there is ample opportunity to learn the basics of endoscopic ultrasound (EUS) and ERCP. The purpose of this rotation is to expose fellows, in a concentrated way, to the decision-making process and advanced endoscopic procedures involved in caring for patients with acute and chronic pancreatic and hepatobiliary disorders. While the emphasis is on the cognitive component of patient care, efforts are made to involve fellows in as many procedures as possible, based on each trainee’s individual procedural skill level.
IBD Rotation – The Mount Sinai Hospital
All fellows, regardless of career interest, rotate on the IBD rotation for at least one month during their second or third year of fellowship training. This assures that fellows are exposed to the many facets of IBD. The fellows are expected to participate in all aspects of the rotation, including consultations (ambulatory and in-patient), rounds, and performance of procedures. They are expected to present a case or a review topic at IBD Conference at least once. In the ambulatory setting, the fellow works one-on-one with a member of the IBD faculty in their own office, gaining an appreciation of the complexity of these diseases.
Motility Rotation – Neurogastroenterology and Motility Center at Mount Sinai West
All fellows, regardless of career interest, are required to rotate on the Motility rotation during the second and third year of fellowship training. The major goals are to acquire knowledge of pathophysiology, clinical presentation, diagnosis, epidemiology, and therapy of gastrointestinal motility and functional disorders, as well as to learn to perform and interpret motility studies. With respect to motility studies, all trainees should have a clear understanding of the indications and potential pitfalls in the performance of motility studies and the limitations of interpretation of esophageal manometry, esophageal pH studies, radionuclide gastric emptying studies, small bowel motility, colonic transit measurements, anal sphincter manometry, and anal sphincter and pelvic floor biofeedback training.