Curriculum

Curriculum

The Division of Gastroenterology and Hepatology offers a three-year, ACGME-accredited training program. Following the fellowship, trainees will be fully prepared for board-certification in gastroenterology.  Learn more:

Program Overview
Endoscopic Training
Rotations
Training Facilities
Didactic Experiences, including GI Grand Rounds

 


Program Overview

 

The gastroenterology faculty is dedicated to the goal of providing a comprehensive educational environment that fosters the professional development of fellows, thereby enabling them to become proficient gastroenterologists. While the faculty believes that clinical experience is the principal foundation of gastroenterology education, they also believe that a significant portion of the fellow’s education is achieved through lectures, conferences, teaching rounds, research, and an up-to-date comprehension of gastroenterology literature. Therefore, the gastroenterology curriculum is designed to afford fellows the opportunity to attend lectures, conferences, participate in teaching rounds, conduct research and also have sufficient time for review and study of current literature.

 

Clinical TrainingThe program also stresses the role of gastroenterologists as consultants and the need to establish the skills necessary to communicate effectively with referring physicians. Every aspect of training includes the cultivation of an attitude of skepticism and inquiry and a dedication to continuing education that will remain with the fellows throughout their professional careers. A major contributor to the enhancement of a scholarly attitude is active participation in one or more research projects, ideally followed by presentation of the work at a national meeting and publication of a paper in a peer-reviewed journal.

The field of gastroenterology has been divided into 17 areas in the Gastroenterology Core Curriculum, and into 19 core knowledge areas requiring achievement of competency as defined by the ACGME subspecialty program requirements, encompassing the breadth of knowledge and skills required for the practice of gastroenterology. These areas include not only the traditional curricular content of gastroenterology and hepatology but also associated disciplines such as nutrition, pathology, radiology, surgery, endoscopy, and research.

Fellows will provide care for patients in the hospitals’ intensive care units (including medical, cardiac, surgical, cardiothoracic, neurosurgical, and trauma units), as well as in a variety of outpatient settings where fellows will provide continuity care to ambulatory patients. Fellows will have the opportunity to participate in various subspecialty clinics, including Functional Bowel, IBD, Celiac, and Liver Transplant clinics. A rotation in pediatric gastroenterology is available through an affiliation with Children’s Hospital of Pittsburgh of UPMC.

 

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Endoscopic Training

 

Endoscopic TrainingThe faculty in the Division of Gastroenterology perform more than 12,500 procedures annually at these three facilities (including over 4,900 EGDs, 4,400 colonoscopies, 1,800 ERCPs, 850 EUSs, and 120 liver biopsies.

The hospitals’ facilities include all up-to-date general endoscopy equipment including scopes with capacity for narrow-band imaging and magnification endoscopy, ERCP and fluoroscopic equipment including sphincter manometry, cholangioscopy, electrohydraulic and laser lithotripsy; also EUS and fine needle aspiration, capsule endoscopy and radiographic equipment with digital video imaging, as well as technology to perform radiofrequency ablation, endoscopic mucosal resection, placement of advanced enteral nutrition devices, and enteral and pancreatico-biliary stenting. A full complement of support services, including anesthesiology, pathology, diagnostic and interventional radiology, surgery, and oncology are available.

Procedural experience in general endoscopic procedures (EGD, colonoscopy) and exposure to advanced procedures (ERCP, EUS) is provided.

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Rotations

 

Fellows in our program will be assigned each year to rotations consisting of 12 blocks of approximately 1 month each at Allegheny General Hospital (AGH) or West Penn Hospital (WPH). 

Typical Rotation Schedule
Below is a typical rotation schedule. Individual programs will vary, especially during the third year, according to the fellows' interests:

 

Rotation Months
Year 1  
AGH Inpatient Consults 8
AGH Lab 2
WPH Lab/Consults 1
Nutrition 1
Year 2
AGH Inpatient Consults 3
AGH Lab 1
WPH Lab/Consults 2
Inpatient Hepatology 3
Electives (Research etc.) 3
Year 3  
Elective (Research, etc.) 11
Introduction to Private Practice  1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Rotation Descriptions

  • AGH/WPH Inpatient Consult Floor  - All inpatient or emergency room consults received will be evaluated and consultative opinion rendered. Daily attending teaching rounds will be made. The team will generally consist of three fellows (a combination of two 1st and one 2nd year fellows).
     
  • AGH HepatologyThis 2nd year fellow will see all inpatients with pre- or post-liver transplant issues. Attendance at the weekly Liver Transplant clinic is required.
     
  • AGH/WPH GI Lab - The fellow will be responsible for performing all scheduled GI lab endoscopic procedures, both inpatient and outpatient.
     
  • AGH/WPH Advanced EndoscopyFellows will be responsible for performing inpatient consultations on patients who are felt to potentially require advanced therapeutic endoscopy. The fellow will also be responsible for scheduling and performing the respective procedures and providing post-procedure follow-up care.
     
  • Nutrition - The fellow will be exposed to the management of inpatient and outpatient nutritional issues under the direction of medical nutritionist, Dr. Vazquez.

  • ResearchAll fellows must complete two scholarly projects prior to the completion of their three year training. This research must consist of at least one original clinical research project, review article, or textbook chapter (which must be published, or in the form of a manuscript completed to the point of submission for publication), and may include one case report with critical review of the literature, or a similar scholarly work pre-approved by the program director.

  • PathologyFellows will participate in daily reviews of gross and microscopic pathology specimens with the Pathology attending physician.

  • RadiologyExposure to CT Body, and GI Fluoro/MRI will occur. Allowances can be made should the fellow have a specific interest in other areas of radiology (for example, nuclear medicine, interventional radiology).

  • PediatricsThis will be located at the Children’s Hospital of Pittsburgh. The rotation will consist of 2 weeks in an outpatient pediatric GI clinic.

  • Introduction to Advanced EndoscopyThis elective is designed for fellows who might have an interest in pursuing higher level training in advanced therapeutic endoscopy, or who simply wish a more concentrated but limited exposure to these techniques.

  • Outpatient EndoscopyThe North Shore Endoscopy Center (NSEC) has a high-volume, relatively fast-paced schedule of endoscopic procedures. Participation will give the fellow a closer approximation of a “private practice” model, and should serve to improve efficiency and bolster the fellow’s procedural volumes and experience. This experience will be made available only to senior (2nd and 3rd year) fellows who have already attained substantial experience with basic endoscopic procedures.

  • Private PracticeThis will be assigned to each 3rd year fellow during the early months of the academic year. The fellow will accompany a GI private practitioner through their day-to-day activities, both inpatient and outpatient, clinical and procedural, and also introduce the fellow to administrative issues not encountered elsewhere during their training. Educational focuses will include time and office management, professional billing, interpersonal communication, and practice within a healthcare system.

  • General GI Continuity ClinicFellows will attend Continuity Clinic an average of 1/2 day/week. Each fellow’s preceptor will change every 6 months to provide exposure to different styles of practice, and to help facilitate different concentrations of exposure (ie, first-year fellows will generally be assigned to a faculty member with special interest/expertise in luminal gut disease such as IBD or IBS, second years to a hepatologist, and third years to a faculty person pertinent to their chosen field of advanced training).

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Training Facilities

 

Our program's training facilities are located at our two Pittsburgh hospital campuses and in Natrona Heights, Pa.

 

Allegheny General Hospital campus (Pittsburgh's North Side)

Training facilities located on the Allegheny General Hospital campus include Allegheny General Hospital (AGH), which houses inpatient facilities and laboratories, and AGH's 

Federal northFederal North building, located a block from AGH and housing the GI Division administrative offices and outpatient clinic, specialty clinics and centers such as the Celiac Sprue, Gastroparesis and Functional Bowel clinic, and the North Shore Endoscopy Center, an ambulatory outpatient endoscopy center where second- and third-year fellows have the opportunity to rotate for hands-on endoscopic exposure.

 

West Penn Hospital campus (Pittsburgh's East End)

West Penn Hospital (WPH), in Pittsburgh's Bloomfield neighborhood, houses inpatient facilities and laboratories.

The STAR (Simulation, Teaching and Academic Research) Center, which offers state-of-the-art manikins and endoscopy protocols, is located in the WPH School of Nursing adjacent to West Penn Hospital.

 

Natrona Heights, Pa.

Allegheny Valley Hospital in Natrona Heights serves as an inpatient facility and offers a broad spectrum of programs. The Private Practice elective is conducted at this site.

 

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Didactic Experiences

 

We maintain an active schedule of teaching conferences, scheduled from 12 to 1 p.m. daily Monday through Friday. Below is a listing of educational activities that are provided.

Core Curriculum Lecture Series

This is a once- to twice-weekly series of lecture topics intended to introduce the fellows to the literature of gastroenterology and provide an understanding of the pathophysiologic basis for gastrointestinal diseases and a broad range of affiliated topics including research, ethics, and genetics. Topics cover all areas required by the GI Core Curriculum. These sessions are assigned to all the fellows in rotation. In addition, faculty and outside speakers are invited to lecture on specific topics. These conferences are scheduled throughout the academic year. A “Nuts and Bolts” series of topics is covered in July and August annually.

GI Grand Rounds

This division-wide conference for faculty and fellows occurs the third Thursday of the month, 5 to 6 p.m., for 8 months of the academic year. Invited speakers are experts from within our network and nationally renowned experts from other institutions. Attendance is mandatory for faculty and fellows.

Journal Club

On a rotating basis, one fellow per month will review all journals from a designated listing published over the last 1 to 2 months. One article is chosen for a detailed analysis, and several more that appear pertinent or interesting summarized with a 1- to 2-line synopsis of the findings. Fellows should critically discuss the article, key concepts, and clinical relevance, with special attention to research and statistical methodology.

Pathology Review

This conference is held every other month and consists of slide reviews with a brief didactic component. Faculty from the Department of Pathology serve as moderators. Topics range from colorectal neoplasia to cholestatic disorders amongst others.

GI Pathology CPC

The GI fellow will choose 3 to 4 cases with interesting pathology and present these in conjunction with the pathology resident. Pathology and Gastroenterology faculty will moderate. The fellow will prepare a brief discussion to be presented after the case and its pathology have been reviewed. This conference is held monthly.

Endo-Path CPC

On a monthly basis, the assigned fellow will select an average of 3-4 interesting endoscopic cases and their respective findings to present and discuss, review appropriate historical facts, differential diagnoses, work-up, and therapy. The focus will be on luminal gut diseases and correlation with endoscopic findings. Gastroenterology faculty will moderate.

GI - Radiology CPC

These sessions, generally held once a month in the Radiology conference room, cover interesting cases with pertinent radiographic findings and are presented by GI fellows in conjunction with residents of the Division of Radiology. Representative faculty from both GI and Radiology are present to moderate.

GI Oncology Multidisciplinary CPC

This will be held in the Cancer Center conference room. Faculty from the Department of Oncology serve as moderator. Responsibility for the case presentations rotates between various services; GI will be the assigned presenter approximately two to three times per year. This is an excellent clinicopathologic conference, with participation by GI, Oncology, Pathology, Radiation Oncology, and Surgery.

Tumor Board

Several times per year, GI fellows will participate and present at Tumor Board, incorporating teaching about GI tract malignancies into this multispecialty conference.

ERCP/EUS CPC

This series will be held monthly and presented by a senior fellow. The focus (ERCP vs EUS) will change on a rotating schedule. A review of the previous month’s ERCP or EUS cases is presented, with special emphasis on indications, findings, complications, and interpretation of cholangiograms and pancreaticograms, sonographic images and FNA/cytology results.

IBD Conference

This series of CPC-type conferences is held at 7 a.m. one Wednesday per month. Fellows and faculty will prepare cases for presentation, pertaining to patients with challenging or difficult IBD management issues. Cases presented at this multispecialty conference will be discussed by members of the divisions of Colorectal Surgery, Pathology, and Radiology.

Pancreatic Cancer Conference

This multispecialty CPC-type conference starts at 7 a.m. two Wednesdays per month in the Radiation Oncology conference room. Presentation and management of all patients diagnosed with pancreatic cancer are discussed at this series. Attendance at this conference is required of all 3rd year fellows pursuing Level 2 training in Advanced Endoscopy and is voluntary for others.

Morbidity and Mortality Conference (M&M)

Held once per month, fellows will offer brief case presentations on any GI consult team or procedure lab patient who died or sustained a complication while hospitalized. Representatives from other departments, pertinent to the case under discussion, will frequently be invited to participate to facilitate discussion. Emphasis will be placed on identification, prevention, and correction of medical errors, so as to promote quality assurance, and a culture of blame-free error reporting.

Research Conference

Held monthly, all fellows and faculty will review the status of any ongoing research projects or review articles, help prepare for presentations at national level meetings, and discuss initiation of new research interests and help develop and assist the progress of ongoing projects. A didactic curriculum covering topics pertinent to clinical research, including study design, statistical analysis, IRB submission protocol, and paper writing, will be covered.

Board Review

This activity is not part of the scheduled GI lecture series, and participation is voluntary. It is organized by the fellows and kept as a true “club” activity. The GI division will support this activity by providing pertinent and up to date board review materials for use. This series assists Fellows in preparing for the ABIM Subspecialty Examination for Gastroenterology.

Administrative GI Conference

This conference is held quarterly, and is attended by all fellows and the Program Director; all faculty are invited to attend. All issues pertinent to the Fellowship program are discussed, e.g., the program’s effectiveness in achieving its goals and objectives, evaluation of external rotations, adequacy of resources, review and revision of the curriculum, etc.

GI Division Chief Meetings

Dr. Clarke meets quarterly with all the GI fellows to offer both clinical and administrative guidance. This is an ideal forum for fellows to have direct discussion regarding Division-level administrative issues, and to pursue clinical patient-based issues that would benefit from Dr. Clarke’s expertise in IBD. Fellows should come prepared to discuss their challenging cases.

Patient Safety Series

This series consists of a combination of didactic and experiential activities the fellow will participate in, generally held monthly. These activities help to support the GI Division’s and GMEC’s endorsement of instituting a culture of patient safety, and includes activities promoting system thinking, error analysis and prevention, and systems-level improvement.

Practice Management Curriculum

ACGME guidelines now state “Fellows must receive instruction in practice management relevant to gastroenterology”. A series of didactic experiences to cover many relevant topics will occur over the course of the academic year.

Internal Medicine Chief Rounds

These multi-specialty CPC-type conferences are held one Friday per month, and are moderated by the Chief of the Department of Internal Medicine.

Medical Grand Rounds

Held every Wednesday at noon, and organized by the core Internal Medicine program. No GI divisional conferences are scheduled during this time.

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