Our fellows are expected to develop comprehensive expertise in diagnosing and managing all forms of chronic liver disease. This includes gaining proficiency in evaluating patients for liver transplantation, as well as the full spectrum of patient selection, management, operative procedures, and postoperative care, including appropriate immunosuppression regimens. Participants gain valuable hands-on experience by observing transplant surgeries and learning from our renowned transplant surgeons.

Additionally, our fellows become adept at interpreting liver biopsies and diagnostic imaging studies— essential skills for clinical decision-making in hepatology. They are incorporated into the faculty transplant practice as apprentices and manage their own panel of general hepatology patients in the fellow’s clinic throughout the year. Our fellows also continue to receive training in endoscopic procedures, including the management of variceal bleeding. While certification in percutaneous liver biopsy is now optional per ACGME guidelines, our program includes training and hands-on experience in performing this procedure. To ensure continuous improvement throughout their training, fellows receive written performance evaluations and regular feedback. To gain familiarity with liver biopsy interpretation, we encourage fellows to attend daily liver pathology reviews and present clinical pathological case reviews. They are expected to participate in multiple weekly clinical and academic conferences.

Our curriculum also places strong emphasis on scholarly activities, as our fellows are encouraged to engage in research in collaboration with our faculty in liver medicine and surgery. Once they have started the program, fellows meet with their faculty mentors at regular intervals to facilitate project ideas and goals. They are then encouraged to submit research findings to major journals and societal meetings.

Upon successful completion of the Transplant Hepatology Fellowship at The Mount Sinai Hospital, participants are awarded a certificate recognizing their achievement. They are also qualified to pass the American Board of Internal Medicine’s certification in Transplant Hepatology.

Throughout the Transplant Hepatology Fellowship at The Mount Sinai Hospital, fellows complete a series of rotations ensuring their exposure to all areas of liver medicine and transplantation.

Pre-transplant (10 weeks)

During this rotation, you will follow all patients admitted to the liver medicine inpatient service at The Mount Sinai Hospital alongside the attending hepatologist and another fellow. Together, you will work with a team of Internal Medicine house staff. The service typically manages around 25 patients at a time including consultations on ICU patients. Under the supervision of the attending, your responsibilities include completing pre-transplant evaluations and triaging outside hospital referrals. You will also perform any inpatient endoscopic procedures on these patients.

Pre-tending (one to two weeks)

To gain even more confidence heading into independent practice, during the final weeks of the academic year, you will have the opportunity to act as the attending for the inpatient pre-transplant service. The structure includes two gastroenterology rotating fellows and a faculty hepatologist who will serve as a coach and second opinion on the clinical management you decide.  Your faculty coach will be actively observing your leadership style and teaching, providing real-time feedback. You will also be observed in delivering a teaching didactic of your choosing and format to the internal medicine residents on the team. 

Post-transplant (12 weeks)

To gain comprehensive experience in inpatient post-transplant management—particularly in the use of immunosuppression and its complications—our fellows join multidisciplinary rounds alongside our transplant surgeons, surgery fellows, transplant coordinators, pharmacists, and front-line advanced practice providers. During this time, you will perform endoscopies as needed on inpatient post-transplant patients and will review any inpatient liver biopsies with our expert liver pathology team in real time.  We strongly encourage you to take advantage of additional free time to attend office hours, observe transplants in the operating room, and participate in the daily liver pathology review.

Consult (four weeks)

During this rotation, you will provide general hepatology consultative services alongside an attending hepatologist. These cases are typically complex and interesting and include consultations for multi-visceral transplant evaluations on the cardiology and pulmonary services. You will review any inpatient liver biopsies with our expert liver pathology team in real time. You will also perform inpatient endoscopies as needed for the patients you are following.

Our Transplant Hepatology fellows participate in several outpatient practice settings during the program, each offering unique learning opportunities. The following two ambulatory clinics occur weekly throughout the fellowship experience:

Liver Fellows' Continuity Practice

Every Tuesday morning, you will maintain your own panel of patients referred from other clinics for various liver diseases and perform endoscopies. This clinic is equipped with comprehensive ancillary support, including a specialized team of patient care navigators who help ensure access for patients prescribed anti-viral therapy for hepatitis B virus (HBV) and hepatitis C virus (HCV).

Outpatient Transplant Apprenticeship

Throughout the year, except while on the Pre-Transplant Inpatient Service, you will participate in our apprenticeship program. For a half-day weekly, you will join an assigned faculty member during their transplant office hours. You will be paired with two different faculty members, each for six months, providing valuable mentorship and continuity of care experience in post-transplant management.

In addition to the above, our fellows also engage in the Outpatient Block Rotation (16 weeks). Working with senior faculty in their outpatient hepatology practices, you will continue to learn to manage liver diseases in the ambulatory setting and gain experience in both liver transplant evaluation and post-transplant management. You will learn from a wide variety of faculty and their unique approaches to our patient population to further help refine your own style, and your responsibilities will include performing outpatient procedures such as endoscopy, liver biopsy, and paracentesis. Attendance at the daily liver pathology review is strongly encouraged. There is also dedicated unscheduled time (“flex” time) each week to allow you to catch up on your own individualized learning plan. These office hours include a mixture of settings, including:

Faculty Transplant Practice

At the Recanati/Miller Transplantation Institute, you will assist in managing patients both before and after transplantation. Your responsibilities include evaluating patients for transplantation and potential living-related donors. During this rotation, you will gain expertise in outpatient care of liver transplant recipients, including management of immunosuppression, complications of immunosuppression, and recurrent disease after transplant, such as HCV.

Faculty General Hepatology Practice

At the Recanati/Miller Transplantation Institute, you will attend office hours with senior faculty to develop expertise in the basic management of liver disease. This includes treatment of viral hepatitis, autoimmune hepatitis, primary sclerosing cholangitis, hepatocellular carcinoma, and steatotic liver disease. You will also participate in the evaluation of abnormal liver tests.

Liver Surgery Practice

Alongside our liver surgeons at the Institute, you will evaluate patients with complicated hepatobiliary disease, including hepatocellular carcinoma, cholangiocarcinoma, metastatic liver tumors, and gallbladder cancer. You will also become adept at cross-sectional imaging review guided by our teaching surgeons.

Our fellows have six protected weeks set aside for mentored research and personalized elective experiences, in addition to the incorporated flex time during the outpatient rotation itself.  We support the unique academic interests of each fellow and work hard to create curricular opportunities to fill their own practice gaps and explore interests that are unique to them. At the Icahn School of Medicine at Mount Sinai, we encourage fellows to submit their research to national meetings and to prepare and submit manuscripts to peer reviewed journals. The division funds and supports all fellows to attend the annual American Association for the Study of Liver Diseases’ (AASLD) Liver Meeting.