Curriculum

The overall goals of the MSBISLW GI Fellowship training program are to provide our patients with the very best care possible while imparting a deep and nuanced understanding of the complexities of gastrointestinal diseases and conditions in our trainees. We require practice based learning and we expect our fellows to employ an evidenced based approach when investigating and evaluating their patients. We encourage our physicians to listen and communicate effectively with their patients and to exhibit professionalism at all times.

The Fellow will:

  • Gain an understanding of the anatomy, physiology and pathology of gastrointestinal and liver diseases.
  • Acquire a detailed fund of knowledge regarding the natural history, prevention, diagnosis and treatment of the major diseases of the esophagus, stomach, small intestine, colon, pancreas, gall bladder, liver and biliary tree.
  • Learn how systemic and vascular diseases manifest in the gastrointestinal tract.
  • Develop the clinical skills necessary to identify and evaluate patients with gastrointestinal, pancreatic and liver diseases.
  • Become proficient in the management of gastrointestinal and liver diseases encountered in hospitalized patients and outpatients.
  • Gain competence in a variety of procedures including diagnostic and therapeutic endoscopy, biopsies (mucosal and liver) and motility studies.
  • Have a thorough grounding in the principles, application and interpretation of imaging of the digestive tract.
  • Acquire a detailed fund of knowledge of the various classes of drugs and vaccines used in gastroenterology including sedation and sedative pharmacology.
  • Understand the importance of nutrition, malnutrition and enteral and parenteral feeding.
  • Develop skills necessary to design, conduct and evaluate research in gastroenterology.
  • Complete a research project leading to a publication in a peer-reviewed journal.
  • Adopt a critical approach to the literature pertaining to gastroenterology and hepatology.
  • Integrate health promotion, and cultural, socioeconomic, ethical, occupational, environmental, and behavioral issues with medical care.
  • Incorporate humanistic health care and patient values at all times.

Clinical Rotations
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 St. Luke’s and Mount West
The inpatient rotations occur at each of the three teaching hospitals including Mount Sinai Beth Israel, Mount Sinai St. Luke’s 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 St. Luke’s and Mount Sinai West
Recognizing that most gastroenterologists practice outpatient medicine, the fellowship program at MSBISLW 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 St. Luke’s 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 St. Luke’s 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.

 



All trainees are expected to take a scholarly approach to their education in Gastroenterology and Hepatology and recognize that non-patient care activities are fundamentally important to the fellowship education.  As such, fellows are expected to utilize textbooks, scientific literature and course syllabi to complement their training experience.  Drawing on the strengths of each clinical teaching site and our diverse clinical faculty, the fellowship has developed a robust didactic experience including grand rounds, case-conferences, journal clubs, pathology conference, board review activity, and core curriculum that are required participation. To foster a sense of unity amongst the entire fellowship program, several of our conferences including the weekly grand rounds and board review are fellowship wide activities and are teleconferenced to each of the three teaching sites.  Other activities are held at individual teaching sites which allows for local teaching culture and smaller group learning. In addition, all fellows are required to become trainee members in the New York Society of Gastroenterology (NYSGE) and to participate in the monthly fellow’s intra-city rounds, as well as the special seminars and annual course offering. The end result is a comprehensive, engaging, and dynamic teaching curriculum that encompasses the complete AGA core curriculum in Gastroenterology and Hepatology (https://gi.org/fellows-in-training/gi-training-curriculum/) and prepares fellows for certification examinations and independent practice after fellowship.

Though the list is evolving, the main core didactic sessions and conferences are listed below:

MSBISLW Gastroenterology Grand Rounds: weekly
MSBISLW Core Summer Lecture Series: July/August
MSH Gastroenterology Grand Rounds:  Weekly
MSBI Liver Conference: Weekly
MSBI Quality Improvement Conference: Monthly
MSBI Multidisciplinary Case Conference: Monthly 
MSBISLW Med-Surg Case Conference: Quarterly
MSSL Inpatient Review: Weekly
MSSL Hepatobiliary Conference: Weekly
NYSGE Intercity Fellows Rounds: Monthly
NYSGE Topical Seminars: Quarterly
NYSGE Annual Meeting and Hands on Course: Annually
App-Based Journal Club and Board Review: Continuously

Table of Fellowship Wide Didactic Sessions and Learning Opportunities  

Institution

Name

Frequency

Comments

MSBISLW

Combined Gastroenterology Grand Rounds

Weekly

Teleconferenced to all three sites of the fellowship 

MSH

Gastroenterology Grand Rounds

Weekly

Teleconferenced from MSH

MSBI

Chopped Liver Conference

Weekly

Alternates between formal didactics, journal club, pathology, and hepatobiliary radiology

MSBI

Endoscopy Quality and Improvement

Monthly

 

MSBI

Interdisciplinary IBD Case Conference

Monthly

GI, Colorectal Surgery, Radiology and Pathology

MSBISLW

Interdisciplinary Medical-Surgical Case Conference

Quarterly

General Surgery and Gastroenterology

MSSL/MSW

Inpatient Review

Weekly

Case Conference

MSSLW

Hepatobiliary Case Conference

Weekly

 

NYSGE

Intercity Fellows Night

Monthly

 

NYSGE

Special Topic Course

Quarterly

 

NYSGE

NYSGE Course

Annually

 

MSBISLW

PulseQD

Continuous

WebAb Journal Club and Board Review

MSH/MS-BISLW

Core Summer Series

July/August

Daily lectures by MSH faculty on core topic in gastroenterology; teleconferenced to all sites in the system