Graduate Medical Education (GME): Gastroenterology
Stephen Wank, MD
Christopher Koh, MD MHSc
Applicants must be board eligible in internal medicine prior to starting the program. This usually requires that the applicant is either currently enrolled or will have completed a three-year residency in an approved internal medicine training program within the United States.
Structure of the Research Training Program
A. General Overview
The University of Maryland/NIH Clinical Scholars Gastroenterology Fellowship Program is an Accreditation Council for Graduate Medical Education (ACGME) accredited 3-year combined Fellowship in Gastroenterology and Hepatology. This joint fellowship program between the University of Maryland and National Institutes of Health (NIH) is designed to provide broad training in both clinical gastroenterology and hepatology and in clinical research. The first year of the fellowship is purely clinical and is centered at the University of Maryland Medical Center and Baltimore VA Medical Center (BVAMC). The second and third years are based at the world's largest clinical research complex, the NIH Clinical Center, and are predominantly focused on clinical research. The fellowship leads to board eligibility in Gastroenterology/Hepatology and is designed to prepare fellows for a career in academic clinical investigation and clinical care.
B. Training Program
The goal of the University of Maryland/NIH Clinical Scholars Gastroenterology Fellowship Program is to train clinical researchers in Gastroenterology utilizing the extensive resources of the NIH Clinical Center and faculty members of the National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK). This fellowship program provides a unique opportunity to train GI fellows to become outstanding clinical and/or translational researchers. Under the leadership of Dr. Stephen Wank, Chief of the Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, the program has a strong commitment to providing excellent training to its fellows to develop the skills necessary to become independent academic gastroenterologists.
During the first year of GI training, fellows will complete 12 months of clinical training including a continuity clinic at UMMC and BVAMC. This year is designed so that the fellow becomes proficient in all standard gastroenterological procedures (such as upper gastrointestinal endoscopy, sigmoidoscopy, colonoscopy, and polypectomy), and develops expertise in making clinical decisions involving all common gastrointestinal and liver diseases. During the second and third years, fellows will spend 100% of their time at the NIH Clinical Center, where they will complete all ACGME clinical and research requirements. While at the NIH Clinical Center, fellows will work with a faculty mentor at the NIH and actively participate in ongoing NIH clinical protocols and/or engage in translational research. The program also supports the opportunity for earning a concomitant Masters Degree in Clinical Research. Fellows will receive the training and experience to become successful clinical researchers in Gastroenterology and Hepatology.
The NIH Clinical Center has an active inpatient GI and Liver consultation service, where fellows will complete their ACGME-mandated inpatient clinical rotations during their two-year tenure. Fellows will also participate in outpatient gastroenterology and hepatology clinics that meet ACGME continuity clinic requirements. Fellows will be exposed to a broad variety of gastrointestinal and liver diseases during these rotations. Within the endoscopy unit at NIH, fellows will participate in faculty-supervised endoscopic procedures performed on patients seen in the inpatient and outpatient rotations.
C. Fellowship Structure
Year 1: Gastroenterology Consultative Rotations (approximately 9 months)
Fellows carry out inpatient consultations in gastroenterology at the University of Maryland Medical Center (UMMC) or the Baltimore VA Medical Center (BVAMC) during their first year. At UMMC, fellows are closely supervised and are trained progressively in upper endoscopy, flexible sigmoidoscopy, colonoscopy and polypectomy, percutaneous endoscopic gastrostomy placement, heater probe, bipolar circum-active probe (BICAP) and injection treatment of gastrointestinal (GI) bleeding, endoscopic band ligation of esophageal varices, foreign body retrieval, and dilation of esophageal strictures. Training is also provided in performance and interpretation of esophageal motility studies, 24 hour pH monitoring, wireless capsule endoscopy, double balloon enteroscopy, and percutaneous liver biopsy. Along with performing consultations at UMMC, fellows will also participate in
- routine and emergency GI procedures
- the outpatient clinics at UMMC, and
- the continuity clinic at BVAMC.
Year 1: Gastroenterology Subspecialty Rotations (approximately 1-2 months)
During a gastroenterology subspecialty rotation, fellows will participate in
- outpatient endoscopy at UMMC and BVAMC
- esophageal motility performance and interpretation
- esophageal 24 hour pH monitoring setup and interpretation
- wireless capsule endoscopy setup and interpretation, and
- inflammatory bowel disease consultative services.
Years 1-3: Hepatology Consultative Rotations (approximately 6 months)
The hepatology rotation provides a broad experience in outpatient and inpatient consultation in liver diseases and management of patients with acute and chronic liver diseases. Instruction is provided in techniques of liver biopsy, interpretation of liver biopsies, and participation in hepatology rounds and conferences. The hepatology rotation includes
- liver consultations at UMMC and BVAMC during the first year
- liver consultations at the NIH Clinical Center during the second and third years
- liver biopsies
- inpatient endoscopy on hepatology patients
- outpatient hepatology continuity clinic
- case presentations,
- and attendance at NIH conferences (years 2 and 3) including: Hepatology Clinical Care Conference, Multispecialty GI Tumor Board Conference, Hepatology Pathology Conference, Hepatology Journal Club and GI/Hepatology Radiology Conference.
Years 1-3: Outpatient Management
There are two outpatient continuity clinics per week for fellows, one GI clinic and one hepatology clinic, which provide extensive experience in outpatient management of common GI problems. Additional opportunities for outpatient experience are available with clinical faculty members and with research protocol patients. During the first year, all fellows follow their own patients at the UMMC and BVAMC clinics. During their second and third years, all fellows follow their own patients in the NIH Clinical Center GI and Hepatology continuity clinics. Direct faculty supervision is available at all sites.
Years 1-3: Emergency Night and Weekend Consultations
During the first year, fellows will provide emergency night and weekend consultations at UMMC and BVAMC. In the second and third years, fellows will provide emergency night and weekend consultations at the NIH Clinical Center.
Fellows rotate on-call shifts with other fellows in the program. On evenings and weekends, the on-call GI fellow takes calls regarding management of inpatients, and telephone calls from outpatients. Call assignments are more frequent in the first year then decrease in the second and third years. While on-call, fellows do not remain in the hospital.
A faculty attending is also assigned to night call and is always available for consultation. All procedures at night or on weekends are supervised directly by the attending physician. At the NIH Clinical Center, emergency and after-hours procedures are also supported by NIH Clinical Center endoscopy staff.
Years 2 and 3: NIH Clinical Center GI Consultation Service (approximately 3 months per year)
Fellows carry out inpatient consultations in gastroenterology at the NIH Clinical Center during their second and third years. Consultations occur on a daily basis under the close supervision of a full-time faculty member. The consultation service includes didactic teaching, bedside evaluation of patients on work rounds, and consult service conference rounds. Fellows participate in any GI procedures required for the patient's evaluation. Fellows also participate in presentations and conferences including: GI Case Conference, GI Research Conference, GI Grand Rounds, GI Core Curriculum Conference (simulcasted with UMMC), GI Radiology Conference, GI Pathology Conference, and CityWide GI Conference.
Years 2 and 3: GI Procedural Training
At the NIH Clinical Center, procedural training meets all board eligibility requirements and is designed to prepare fellows for academic clinical practice. At the NIH Clinical Center, fellows are closely supervised and continue to improve on their skills in upper endoscopy, flexible sigmoidoscopy, colonoscopy and polypectomy, percutaneous endoscopic gastrostomy placement, wireless capsule endoscopy, single balloon enteroscopy, esophageal pH monitoring and manometry, heater probe, BICAP and injection treatment of GI bleeding, endoscopic band ligation of esophageal varices, foreign body retrieval, and dilation of esophageal strictures. Computerized endoscopy reporting systems are used at the NIH Clinical Center.
Years 2 and 3: Clinical Research Experience (approximately 18 months)
Considerable emphasis is placed on clinical research to prepare trainees for academic careers. Fellows are encouraged to participate in classes held on the NIH Campus such as "Introduction to the Principles and Practice of Clinical Research," along with other classes offered by the Office of Clinical Research Training and Medical Education (OCRTME) and the NIH Clinical Center library. For interested fellows, the gastroenterology fellowship program also supports the opportunity for enrolling in courses towards a concomitant Masters Degree in Clinical Research which is a collaborative program between the NIH Clinical Center and Duke University Medical Center. Clinical research projects are carried out in the inpatient and outpatient facilities of the NIH Clinical Center. Fellows will be able to develop and complete their research project(s) with a faculty mentor during their projected research time at NIH. They will also have the ability to participate in detailed research presentations during GI grand rounds.
D. Clinical and Translational Research Projects
During the second and third years of the fellowship, the fellow will work with senior investigators within the NIH. Ten NIH faculty participate in the fellowship training program. Some current areas of GI clinical research include, but are not limited to
- Familial carcinoid syndrome
- Zollinger-Ellison syndrome
- Multiple endocrine neoplasia type 1
- GI graft-versus-host disease
- GI disease in chronic granulomatous disease (CGD)
- Eosinophilic GI disease
- Novel techniques for gastric acid analysis
- Novel endoscopic techniques for colonoscopy.
- Dr. Stephen A. Wank M.D., Chief, Digestive Diseases Branch
- Marc Ghany M.D., Staff Clinician, Liver Diseases Branch
- Theo Heller, MD., Tenure Track Clinical Investigator, Liver Diseases Branch
- Stephen P. James, M.D., Director, Division of Digestive Diseases and Nutrition
- Christopher Koh, M.D., M.H.Sc., Director, Gastroenterology Fellowship Program
- Sheila Kumar, M.D., M.S., Staff Clinican, Digestive Diseases Branch
- T. Jake Liang, M.D., Chief, Liver Diseases Branch
- Jose Serrano, M.D., Ph.D., Director, Liver and Biliary Programs, Division of Digestive Diseases and Nutrition
- Robert D. Shamburek, M.D., Senior Clinician, Translational Medicine Branch, NHLBI
- Michael D. Yao, M.D., Staff Clinician, Laboratory of Host Defenses, NIAID
The University of Maryland/NIH Clinical Scholars Gastroenterology Fellowship Program is a three-year gastroenterology training program accredited by the Accreditation Council for Graduate Medical Education (ACGME). This program provides excellent clinical training and research experience and upon completion, fellows are eligible to take the American Board of Internal Medicine (ABIM) certification examination in gastroenterology. The expected length of the fellowship program is three years.
Qualified candidates must be board eligible in internal medicine prior to starting the gastroenterology fellowship program. This usually requires that the applicant is either currently enrolled or will have completed a three-year residency in an approved internal medicine training program within the United States. Two positions available per year, and candidates should apply through the Electronic Residency Application Service (ERAS) which is handled through the University of Maryland Division of Gastroenterology and Hepatology and follows the annual ERAS/AAMC timeline.