Our curriculum is carefully designed with the goal of preparing each fellow to become an expert consultant across the breadth of gastroenterology and hepatology. We’ve designed our curriculum to provide a balanced training experience encompassing the cognitive and procedural aspects of our subspecialty.
Our educational program includes hands-on experiences at the bedside as well as didactic instruction in our conferences. We have a major emphasis on scholarship, with protected time and mentorship for research in both clinical investigation and quality improvement. We recognize that a rewarding career in gastroenterology and hepatology can take many different forms; we value each fellow’s chosen career path and are committed to providing the training necessary to achieve that goal.
Our rotations are designed to provide comprehensive training in all aspects of gastroenterology and hepatology.
On this rotation, fellows work one-on-one with faculty seeing outpatient consultations covering the full spectrum of gastroenterology and hepatology. First-year fellows rotate with experienced faculty seeing general GI consults from our academic and community primary care practices, gaining experience as an outpatient consultant and as a managing subspecialist.
Upper-level fellows rotate with expert faculty seeing patients with challenging sub-subspecialty complications of:
- inflammatory bowel disease
- liver disease
- pancreaticobiliary disease
- neuromuscular disease of the GI tract
On this procedurally-focused rotation, fellows work one-on-one with expert faculty evaluating and managing patients with challenging diseases of the pancreas and biliary system. Fellows achieve substantial experience in performing ERCP, sphincterotomy and stent placement in the biliary and pancreatic ducts. Fellows also gain experience in advanced endoscopic techniques such as complex dilations, enteral stent placement, cystgastrostomy and pancreatic necrosectomy.
Because our busy endoscopic ultrasound service is involved in the evaluation of many of these patients, fellows on this rotation also gain a significant exposure to this important technology, although we believe that formal training in EUS requires an additional year of training. In collaboration with our busy bariatric surgical service, fellows also gain hands-on experience in the ever-growing field of endoscopic management of complications of these surgeries.
The GI Consult Service serves Wake Forest Baptist Medical Center, an 830-bed hospital that provides tertiary and quaternary care to a four-state area, as well as serving the citizens of Winston-Salem. Since we do not have an inpatient GI or Liver service, we see all patients with these disorders in a consultative role. The patients we see span the breadth of gastroenterology, and about one-third of these consults are for liver disorders.
The team is made up of one faculty, two fellows (one first-year fellow and one upper-level fellow), two internal medicine residents and up to two medical students. The two fellows alternate days of seeing new consults or performing procedures, which typically allows the fellow to perform procedures on a patient they performed the consult on the previous day. Residents and medical students are available to help with consults and the fellow participates in a supervisory role in their education. This structure has allowed this intensive experience to be educational and enjoyable, with time for reading and reflection.
During the second and third years of fellowship, elective rotations are offered, with the goal of meeting each fellow’s individualized training needs for his or her specific career plans. These elective opportunities range from self-designed elective experiences to established, highly structured experiences.
An example of the latter is the Transplant Hepatology Rotation at Carolinas Medical Center in Charlotte, NC. During this rotation, the fellow participates in the full transplant experience, including outpatient evaluation of chronic liver disease patients for transplant candidacy, inpatient care of acutely ill patients awaiting transplantation, operating room observation of a liver transplantation and post-operative care of transplanted patients.
Another popular elective rotation has been a significant endoscopic retrograde cholangiopancreatography (ERCP) experience with our clinical faculty at the nearby community medical center. Each fellow meets with the program director prior to each elective rotation to discuss specific plans, with the overarching goal of a tailored preparation of each fellow for their individualized future career plans.
On this rotation, fellows develop their procedural skills performing esophagogastroduodenoscopy (EGD) and colonoscopy under the direct one-on-one supervision of the GI faculty. Patients seen on this rotation are referred for ambulatory procedures, including diagnostic and therapeutic EGD, colonoscopy and flexible sigmoidoscopy for a variety of indications.
On this rotation, fellows gain experience in performing mucosal biopsy, polypectomy, endoscopic mucosal resection, esophageal dilation, variceal banding, Botox injection and Argon Plasma Coagulator treatment of AVMs under the tutelage of experienced faculty. The structure allows the fellow to review and discuss the pathology results with the attending supervising the fellow to augment the educational experience.
The research experience for fellows is made up of two components: a traditional clinical investigation project and a quality improvement project.
At the beginning of fellowship, we use a formal process to help each fellow identify a research mentor based on her or his research interests. Together with his or her mentor, each fellow will design a clinical research project, usher it through the IRB process, carry it out and collect and analyze the data. There is an expectation that each project will result in a poster presentation at the national meeting of one of our GI societies (AGA, ASGE, ACG, or AASLD) and will culminate in the submission of a manuscript for publication in one of the peer-reviewed journals of our subspecialty.
For the quality improvement project, during the first year of fellowship each fellow will gather baseline data from his or her continuity clinic or on the consult services and design an intervention for improvement in some aspect of clinical care. The intervention will be implemented during the second year of fellowship, and the data will be analyzed and presented during the third year of fellowship. It is hoped that these projects will also produce posters and publications. A total of six months of protected time is provided for each fellow for these research endeavors. Additional time for research can be elected in the third year of fellowship.
The VA Medical Center serves as a major training site for our GI Fellowship program. Although this is a comprehensive experience in gastroenterology and hepatology, including outpatient clinic evaluations and inpatient consultation, the main focus of this rotation is training in colonoscopy and EGD.
Endoscopic training begins with a state-of-the-art simulator, followed by experience with patients referred for outpatient endoscopy; these procedures are scheduled in a manner to allow first-year fellows extra time as they develop their endoscopic skills. Upper-level fellows are allowed progressive autonomy in performing procedures at this training site, meaning the fellow performs the procedure independently with the attending available through indirect supervision.
Conferences and Didactics
We have three hours of educational conferences weekly, with the explicit goals of providing the essential medical knowledge needed to become an expert consultant in gastroenterology and hepatology, preparing our fellows for success on the ABIM certifying exam, and developing the skills needed for life-long learning. Our conferences are prepared and delivered by the fellows and faculty of our section, as well as our colleagues in surgery, pathology, and radiology. The format of our conferences consists not only of a didactic presentation, but substantial time is reserved for discussion among the fellows and faculty. Because of the collegial nature and diverse training backgrounds of our fellows and faculty, spirited discussions of differing points of view are a standard feature of our conferences.