Fellowship Program Directors: Stephen Wank, MD and Christopher Ko, MD, MHSc
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. 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.
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.
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 the following: 1) routine and emergency GI procedures; 2) the outpatient clinics at UMMC; and 3) the continuity clinic at BVAMC.
Year 1: Gastroenterology Subspecialty Rotations (approximately 1-2 months)
During a gastroenterology subspecialty rotation, fellows will participate in the following: 1) outpatient recovery at UMMC and BVAMC; 2) esophageal motility performance and interpretation; 3) esophageal 24 hour pH monitoring setup and interpretation; 4) wireless capsule endoscopy setup and interpretation; and 4) inflammantory bowl 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 the following: 1) liver consultations at UMMC and BVAMC during the first year; 2) liver consultations at the NIH Clinical Center during the second and third years; 3) liver biopsies; 4) inpatient endoscopy on hepatology patients; 5) outpatient hepatology continuity clinic; 6) case presentations; and 7) 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 patients with gastrointestinal or hepatologic 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. The outpatient continuity clinical experience at the NIH Clinical Center builds upon the experiences initiated during the first year at the University of Maryland and involves the evaluation and management of patients with common GI and liver problems. 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, and the GI Pathology 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 completion of the 3-year ACGME accredited program, fellows typically graduate approximately 1000 endoscopic procedures. 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. 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.
Apply to this program through the Electronic Residency Application Service (ERAS). Two positions available per year 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..