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.

  1. The Mount Sinai Hospital GI Consultation Service
    The Mount Sinai Hospital Inpatient GI consult service 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 inpatient consultative gastroenterology, inpatient endoscopy procedures are split between a dedicated Endoscopy Team (AM) and the GI Consult Team (PM). 

    The 1,171 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 a diverse population with routine medical conditions from the surrounding region, as well as complex patients transferred to Mount Sinai Hospital for quaternary care. 

  2. Subspecialty Rotations
    The inpatient inflammatory bowel disease (IBD) service exposes fellows to patient with complex manifestations of ulcerative colitis and Crohn’s disease. Emphasis is placed on understanding the surgical and medical management of these conditions, along with proper interpretation of diagnostic imaging and endoscopic studies.

    Fellows maintain a dedicated once-monthly outpatient IBD continuity clinic under the supervision of dedicated IBD teaching faculty at the Susan and Leonard Feinstein IBD Center. The integrated care model incorporates cutting edge medical care, alongside nutrition and psychosocial support to provide comprehensive and compassionate care for each patient

    Hepatology training is conducted in several venues. First year fellows perform consultations on inpatients on a dedicated Hepatology consult service, while also getting exposed to Transplant and Non-Transplant Hepatology in various ambulatory practices.  Second-year fellows participate in the pre-transplant evaluation and management of inpatients with complex liver disease. Fellows participate in the multidisciplinary transplant listing meetings. During the third year, fellows maintain an outpatient continuity hepatology clinic to further enhance ambulatory hepatology training. Rotations at the Bronx VA during all three years expose fellows to inpatient and outpatient hepatology.

    The advanced endoscopy rotation provides exposure to EUS and ERCP. This rotation also provides niche training to 2nd and 3rd year fellows in complex endoscopic techniques such as endoscopic mucosal resection, stent placement and radiofrequency ablation.

    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.

    One week intensive rotations in GI Motility and Nutrition provide first year fellows with diverse multidisciplinary exposure to these important subspeciality areas. Fellows will rotate with physicians as well as allied health professionals (physical therapists, dieticians, etc) to gain a comprehensive understanding of these disorders.

    Additional subspecialty electives are available during the 2nd and 3rd year for fellows seeking advanced training in a particular area of clinical interest.

  3. Hepatology
    The Division of Liver Diseases and the Recanati/Miller Transplantation Institute provides fellows with 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.
  1. The James J. Peters Veterans Affairs Medical Center
    Fellows perform inpatient consultations and endoscopic procedures at 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.
  1. Ambulatory Training
    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, social workers, psychologists, clinical pharmacologists, nurses and nurse practitioners, research coordinators, and administrative staff.

  2. 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).

The rotation schedule is divided as follows:

First Year:

  • GI Consult Service : 16 weeks
  • VA : 10 weeks
  • IBD Service : 6 weeks
  • Liver Consults : 2 weeks
  • Subspecialty Rotations : 6 weeks
  • Selective : 6 weeks 

Second Year:

  • Scholarly Time : 18 weeks
  • GI Consult Service : 10 weeks
  • VA : 10 weeks
  • Liver: 6 weeks
  • IBD Service : 2 weeks
  • Advanced Endoscopy : 2 weeks

Third Year:

  • Scholarly Time : 42 weeks
  • VA : 4 weeks
  • Advanced Endoscopy : 2 weeks

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

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.

Wednesday

Fellow’s Core Conference, 7:30am-8:30am (see description below)

Pre-Clinic Conference, 12:30pm-1:00pm

This is a specially curated, interactive didactic session exclusively for the third year fellows prior to their weekly ambulatory clinic to discuss advanced topics related to outpatient gastroenterology and practice management.

Thursday

Fellow's Core Conference, 7:00-9:00 am

These weekly core conferences comprise of journal club, case conference, clinical guidelines conference and faculty didactics.  All conferences are precepted by faculty with specific topic-related expertise.  Clinical journal club conferences (monthly) feature discussions of high impact clinical studies and research-oriented journal clubs (quarterly) are focused on biostatistics and study design.  Case conferences are led by the fellow with a faculty preceptor, focused on interactive discussions of unique clinical cases with an emphasis on critical thinking, clinical decision making and differential diagnoses.  Didactics are presented by faculty from various disciplines, including gastroenterology, surgery, radiology, pathology, nutrition, physicial/speech therapy.   Dr. Bruce Sands conducts monthly chief rounds dedicated to academic skill development. 

Friday

Jerry Waye Endoscopy Conference, 7:15 – 8:00 am

This is the world’s longest running endoscopy conference conducted in the tradition established by Dr. Jerry Waye over 40 years ago.  This is a multidisciplinary video-based conference attended by gastroenterologists, surgeons, and pathologists, where interesting endoscopic cases are presented by the general GI Fellows and the Advanced Endoscopy Fellow.  Each case is followed by a brief literature review to provide evidence for management decisions.

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.  Once every quarter, a 2nd year GI Fellow presents a “Controversies in GI”  Grand Rounds, in which the fellow leads a discussion with a panel of faculty experts to address controversial areas of gastroenterology and hepatology

Academic Half-Days

In this novel format, the Mount Sinai Hospital GI Fellows, along with the fellows from Mount Sinai West/Morningside program, conduct an in-depth exploration of a specific topic in GI/Hepatology.  This 4 hour session includes didactics from topic experts, pathology review from Pathology faculty, Journal Club, Clinical Guidelines and/or Case Conferences.  Senior faculty members serve as facilitator to ensure broad based learning on these fundamental topics.