Curriculum

Consult Service: The Consult Service rotation serves as the “core training” of the Fellowship program.  It is designed to train fellows in the practice of providing gastroenterology consultative services in both the inpatient and ambulatory care settings. The fellow is exposed to inpatient consults emanating from all services in the hospital, patient care in the ambulatory care setting, and endoscopic techniques.

In the first year of fellowship, this is the core rotation that helps to develop the fellow’s skills as a consultant and practicing gastroenterologist.  Rotations on the MSSL and MSR consult service may occur in the first, second and third year of training, with greatest emphasis in the first year.  First year fellows are expected to participate in all aspects of the rotation, including consultations (ambulatory and in-patient), rounds, and performance of procedures.

Outpatient Rotation: The outpatient rotation lasts from years 01 through 03, except during the hepatology rotation at Mount Sinai Hospital, and consisting of 3 outpatient clinics per week plus the technical procedures generated during the clinic sessions. The major goal is to become familiar with the clinical presentations and management of the range of diseases that are found in outpatients, to learn diagnostic algorithms for common GI complaints, and to become familiar with official guidelines for the management of outpatient GI diseases.

The trainee will organize the prompt and continuing evaluation and management of inpatients as they transition in the outpatient environment, including providing continuity of care, long-term disease management, and appropriate use of further diagnostic tools with progressive responsibility. The trainee will maintain a log of procedures performed, participate in division-wide practice-based improvement initiatives including the monthly, divisional Quality Assurance initiative. The trainee will learn to involve the patient as a partner in providing medical care, which is more important in the outpatient than in the inpatient environment.

In addition to the formal didactic and technical training in the program, the first-year fellow will use the outpatient experience to learn to work in a non-structured environment, which more closely reflects the post-training reality.  The trainee will gain practical knowledge of the outpatient management of gastrointestinal and hepatic diseases, including appropriate cognitive and technical evaluation and follow up.  Most of the patients will be those who were seen as inpatients in whom the care is post-acute and most will not become continuity patients.  The first year fellow will develop a log of procedures performed, participate passively in division-wide practice-based improvement initiatives, and participate actively in the monthly Quality Assurance initiative. The major goal is to develop the skills to communicate effectively with consulting and covering physicians as well as patients and their family members or other interested parties about gastrointestinal issues.  As opposed to the inpatient rotation, the fellow learns to take individual rather than team responsibility for the care of the patient

The second year fellow will hone his/her skills in outpatient management, incorporating lessons learns during the second year rotations in liver disease, motility, and hepatobiliary diseases/advanced procedures.  The second year fellow will develop a cohort of continuity patients and learn to practice with progressive independence.  In addition to prior practice-based activities, the trainees will develop a log of specific treatments in order to examine trainee-specific clinical outcomes. The trainee will become more active in the planning and execution of practice-based initiatives and QI projects.  The trainee will become more active in the planning and execution of systems-based initiatives and QI projects. The fellow also will develop intermediate and long-term relationships with patients as well as learning to act as a senior fellow, with more authority than during the first year of fellowship.

Advanced Endoscopy Rotation: The Advanced Endoscopy rotation is offered to all second and third year fellows as it facilitates the acquisition of knowledge and experience in a substantial proportion of patients with gastrointestinal disorders. It is not a substitute for a formal 4^th Year Advanced Endoscopy Fellowship.  This facilitates the ability of F-2 and F-3 trainees to perform advanced endoscopic procedures and to learn if they have the skills and genuine interest to proceed along this career path.

Advanced endoscopic techniques require a solid grounding in the fundamental aspects of general endoscopy.  First year fellows therefore do not typically perform advanced endoscopic procedures.  As a result, the Advanced Endoscopy rotation is geared towards fellows who are in their second or third years of training.  It is expected that fellows will have mastered basic EGD and colonoscopy techniques prior to embarking on advanced procedures.  The purpose of this rotation is to expose fellows, in a concentrated way, to the decision-making process involved in conducting advanced procedures, but the emphasis is on the cognitive component, and secondarily on the technical component. Efforts are made to involve fellows in as many procedures as possible, but there are no guarantees that the fellow will become proficient in any of the advanced endoscopic procedures prior to completing fellowship training.  The second year fellow participates in the advanced procedures primarily as an assistant while the third fellow year has a more direct role in performing the procedures.

IBD Rotation: All fellows, regardless of career interest, are required to rotate on the IBD rotation for at least one month during their 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: 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.

The major difference in function between years 2 and 3 is that the second year fellow will act mainly as an observer while learning the basic principles of diagnosis and management of motility disorders while the third year fellow will play a more direct role in performing diagnostic tests and therapeutic procedures.

Liver Rotation: Fellows will spend six months of the second fellowship year at The Mount Sinai Hospital and will rotate onto the four services comprising the liver service: pre-transplant, post-transplant, consults, and out-patient.

Weekly Conference Schedule

1. Monday 

• 5 PM: Combined foregut conference at Mount Sinai West (monthly – proposed)

2. Tuesday

• 8 AM: GI conference, alternating between first year fellows’ inpatient review (2), attending physicians’ and senior fellows’ case conference (1), QA conference (1), and Journal Club (1)
• 9 AM: GI clinic at Mount Sinai West
• 5 PM: Multidisciplinary hepatobiliary conference
• Wednesday
  • 1 PM: Liver Clinic at Mount Sinai West
  • Thursday
    • 8 AM: Fellows conference, alternating between attending physician’s lecture (1), case conference or board review (1), radiology or pathology conference (1), and fellows’ meeting with the PD (1)
    • 9 AM: GI clinic at MS SL
  • Friday
    • 7 AM: Endoscopy conference at Mount Sinai (remote access)

Alternating with Quarterly Combined Colorectal Conference (Quarterly)

• 8 AM: GI grand rounds at Mount Sinai (remote access)(alternating with alternating with physiology conference (1), research conference (1), nutrition conference (1) at MSSL
• 9 AM: Senior fellows’ block colonoscopy time (3 months each for the third year fellow during the second half of the academic year)
• Afternoon: Administrative/scholarly time for senior fellows