GI Consult Service
The GI consult service at Mount Sinai Hospital is comprised of two GI fellows and one full-time gastroenterology attending. Medical students and internal medicine residents routinely rotate on the service as well. The fellows are responsible for directing and managing all aspects of gastrointestinal care, including endoscopic procedures. Daily work, endoscopy, bedside rounds and teaching rounds are all conducted under the supervision of the GI attending. In order to facilitate teaching and learning of both endoscopy and consultative gastroenterology, endoscopy procedures are split between a dedicated Endoscopy Team and the GI Consult Team.
The 1,139 bed Mount Sinai Hospital is a high volume, high acuity quaternary-care facility located along the border of the Upper East Side and East Harlem in Manhattan. Inpatients are comprised of patients with routine medical conditions from the surrounding region, as well as complex patients transferred to Mount Sinai Hospital for quaternary care.
The Bronx VA
Fellows perform consultations and endoscopic procedures at the James J. Peters Veterans Affairs Medical Center (The Bronx VA). Additionally, the fellows attend weekly clinics in GI and Hepatology, as well as perform procedures in their busy outpatient endoscopy service. Fellows gain significant experience performing upper endoscopy and colonoscopy. Inpatient consultations and attending rounds take place each day, as does instruction in all major diagnostic and therapeutic modalities.
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.
Liver Medicine & Liver Transplant Service
The Division of Liver Diseases in partnership with the Recanati/Miller Transplantation Institute (RMTI), provides fellows a robust clinical experience, with responsibility for both inpatient and outpatient care for all forms of liver disease, including pre- and post-transplant management.
The inpatient Liver Consult service provides specialized hepatology consultations at Mount Sinai Hospital. Fellows also rotate on the pre-transplant inpatient service, providing care for patients with end stage liver disease under the direct supervision of Hepatology faculty, alongside medical residents and students. Working closely with multidisciplinary teams, Fellows take an active role in weekly liver transplant listing meetings. A broad outpatient experience is provided in the first two years of the fellowship, including rotations with general hepatology, transplant hepatology, liver surgery as well as subspecialized experiences including HCC, MASLD and viral hepatitis. During the third year of fellowship, fellows have the opportunity to maintain a dedicated longitudinal hepatology ambulatory clinic.
Fellows with a particularly strong interest in Hepatology may elect to do a 3 year combined GI/Transplant Hepatology fellowship. This novel pathway would reduce the 18 month scholarly period to 6 months, allowing fellows to proceed with their Hepatology fellowship in their 3rd year. Fellows would commit to this pathway toward the end of the 1st year of fellowship, allowing for sufficient time to explore all avenues of gastroenterology and hepatology.
Subspecialty Rotations
These rotations provide the fellow with the opportunity to develop an in-depth appreciation of subspecialty areas. 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. Novel rotations can be developed and tailored to the individual fellow’s interests.
Inflammatory Bowel Disease (IBD) Service. The inpatient IBD service provides fellows with niche training in complex manifestations of ulcerative colitis and Crohn’s disease. Working closely with world-class faculty, the emphasis is placed on understanding the surgical and medical management of these conditions, along with proper interpretation of diagnostic imaging and endoscopic studies.
Advanced Endoscopy Service. The inpatient advanced endoscopy rotation provides exposure to the management of patients with pancreaticobiliary diseases and gastrointestinal malignancies. Second and third year fellows get hands-on training in complex procedures including dilation, advanced visualization, and endoscopic mucosal resections.
Outpatient Selectives. Two months of outpatient selective rotations during the first-year exposes fellows to experts who specialize in pancreaticobiliary diseases, hereditary GI cancers, GI pathology, colorectal surgery and obesity. These selective experiences provide initial training in these subject areas and can serve as a foundation for developing a clinical niche during the 2nd and 3rd years.
GI Motility. Focused rotations with our dedicated motility faculty at Mount Sinai West provide a unique subspecialty experience. Fellows receive training in the ambulatory evaluation of patients with motility disorders, including interpretation of motility studies, and performing of novel endoscopic procedure such as BRAVO and EndoFLIP.
Nutrition. Fellows rotate with physicians and nutritionists to gain an understanding of medical nutrition. This includes the inpatient evaluation of nutritional status, nutritional management of GI disorders, and exposure to small intestinal transplanation and parental nutrition.
Additional subspecialty electives are available during the 2nd and 3rd year for fellows seeking advanced training in a particular area of clinical interest.‘Our fellows also have the unique opportunity to work with our voluntary faculty in their clinical practice locations and thus get added perspectives and training in the practice of GI and hepatology in varied environments.
Ambulatory Training: Description & Responsibilities
During the first and second year of fellowship, fellows maintain a weekly Continuity Clinic in the Center for Advanced Medicine (CAM). Preceptors consist of a core group of full-time faculty, as well as a select group of voluntary (private) faculty with a special interest in ambulatory education. Fellows assume primary responsibility for the patients they see in the practice, including initial consultation, follow up visits, interpretation of testing results, and coordination of care with other specialties. The fellows capitalize on the extensive resources allocated to ambulatory care, including social workers, nutritionists, nurses, and other staff supports (medical assistant, endoscopy liaison, insurance specialists).
To enable graduated learning and better prepare fellows for independent practice, ambulatory clinic for the 3rd year fellows is organized at the faculty practice location. This practice setting provides a novel continuity experience with a special focus on ambulatory decision making and practice management. A dedicated pre-clinic conference further supports the transition to independent practice.
Each fellow also maintains a once monthly continuity IBD Clinic located in the Feinstein Center for Inflammatory Bowel Disease. Fellows see new and established patients with complex diagnostic and management issues related to IBD. The multidisciplinary IBD Center offers a wide array of support services to patients, including dieticians, endostomal therapists, surgeons, social workers, psychologists, clinical pharmacologists, nurses and nurse practitioners, research coordinators, and administrative staff.
All above clinics have a distinct set of core preceptors who are recognized educators and ensure that the fellows are provided with adequate supervision alongside dedicated instruction.
Endoscopy Training
Endoscopy training occurs throughout the entire three year fellowship, with increasing time on outpatient endoscopy occurring during the last 18 months of the fellowship. Dedicated inpatient endoscopy rotations provide focused training and experience in endoscopic procedures on hospitalized patients. Additional rotations with the advanced endoscopy faculty provide experience in endoscopic mucosal resection, stricture dilation, and radiofrequency ablation. Fellows gain significant experience with chromoendoscopy through working with IBD faculty. Rotations at the Bronx VA provided significant training in outpatient endoscopy. During the scholarly time (2nd and 3rd year), fellows are expected to perform one day of outpatient endoscopy per week. These endoscopy sessions can occur with faculty preceptors at the hospital with high-acuity outpatients, or with full-time faculty during their scheduled sessions at the ambulatory surgical center (ASC).