The Gastroenterology Fellowship Program at Lankenau Medical Center
provides the fellow with extensive clinical experience and interactive
When the fellow is on the clinical service he or she will serve as the
team leader, coordinating, directing and instructing students and
residents on the service. The fellow is responsible for distributing,
reviewing and evaluating all clinical work on the service. He or she is
also responsible for teaching and directing all students and residents
on the service. The clinical fellow will in turn report directly to the
attending physician on service reviewing each patient including
pertinent clinical data and x-rays with the attending physician. The
fellow is also responsible for directing and coordinating work and
teaching rounds with the attending physician.
All endoscopic procedures will be performed under the direct supervision
of an attending physician. The attending physician will be present
during each and every endoscopic procedure in its entirety. The fellow
is responsible to have an attending physician present during such
Goals and Objectives
1. Patient Care
The fellows must be able to provide care to gastroenterology patients in
the hospital that is compassionate, appropriate and effective.
Demonstrate competency in gathering essential and accurate
gastrointestinal history from patients, formulate a course of
action and convey the information in a succinct manner to the
The fellow evaluates the patient and initiates appropriate
management in a timely manner.
The fellow is available to the patient, gastroenterology staff
and attendings to address ongoing changes in patient status.
2. Medical Knowledge
The resident must demonstrate knowledge about established and
evolving practices and apply their knowledge to patient care.
To demonstrate basic knowledge in the pathophysiology of
Demonstrate awareness of the psychosocial issues as they pertain
to gastrointestinal disorders.
Demonstrate knowledge as it pertains to indications for
endoscopic procedures as well as other diagnostic studies. A
fellow must demonstrate the ability to perform essential
components of an initial history and physical with specific
attention to gastrointestinal disorders.
Be able to select and interpret appropriate laboratory data.
Be able to review appropriate radiologic studies. Be able to
perform endoscopic studies including sigmoidoscopy, upper
endoscopy, colonoscopy, and ERCP, depending on their level of
training and personal ability. Trainees need to be aware of
pharmacal dynamics of commonly used gastrointestinal
therapeutics and their complications. They need to demonstrate
competency in recognition and management of typical
3. Technical Skills
The gastroenterology fellows will be able to demonstrate proficiency in
technical skills performing various procedures including paracentesis,
liver biopsy, flexible sigmoidoscopy, colonoscopy, upper endoscopy, and
ERCP. At completion of the program they will also be to treat bleeding
esophageal varices, bleeding ulcers, perform esophageal dilatation,
placement of biliary stents, biliary sphincterotomy, esophageal
manometry, 24-hour pH tests, perform polypectomies, be able to use
electrocautery as well as heater probe and YAG Laser for ablation of
tumor and hemostatis.
4. Practice-Based Learning and improvement
The fellow must be able to investigate and evaluate their patient care
practice, appraise and assimilate scientific evidence and improve their
patient’s care practices.
The fellow must be able to use scientific data to evaluate
and manage their patients.
The fellow must facilitate learning of other health
The fellow must apply knowledge gained from journal club
discussions and other review of current data to appraise the
study design and statistical method of clinical studies on
diagnostic and therapeutic effectiveness.
5. Interpersonal and Communication Skills
The fellow must be able to demonstrate interpersonal communication
skills that result in effective information exchange in teaming with
patients, patient’s families and all personnel involved in patient care.
The fellow must demonstrate an effective relationship with other
health care professionals.
The fellow must create and sustain a therapeutic and ethically
sound relationship with patients.
The fellow must use effective listening skills and demonstrate
effective non-verbal explanatory and questioning writing skills.
The fellow must demonstrate an ability to work effectively with
others as a member of the health care team in gastroenterology.
The fellow must demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles and sensitivity to a
diverse patient population in gastroenterology.
The fellow must demonstrate adherence to professional ethical
The fellow must be willing to admit to an error in judgment.
The fellow must demonstrate a commitment to ethical principles
pertaining to confidentiality of patient information, informed
consent and business practices.
The fellow must demonstrate sensitivity and responsiveness to
patient culture, age, gender and disability.
7. System-Based Practice
The fellow must demonstrate awareness of and responsiveness to
the larger context and system of health care and the ability to
effectively call on system resources to provide care that is of
The fellow will demonstrate how their patient care and other
professional practices affect other health care professionals,
health care organizations, and the larger society and how these
elements affect their own practice.
The fellow will learn the limits of length-of-stay allowed for
various gastroenterology conditions based on managed care and
The fellow will demonstrate effective resource utilization by
reviewing it with the attending physician and practice
guidelines that do not compromise quality of care.
The fellow will demonstrate patient advocacy in dealing with
complex health systems.
The fellow will learn and show how they partner with health care
managers and providers to assess, coordinate, and improve health
care of their patients and how these activities affect the
Each fellow will conduct GI Clinic one afternoon a week. Presently, it
is Thursday from 1:00–4:00 pm. Every fellow is expected to attend Clinic
with the exception of the fellow doing a clinical rotation off campus.
Attending physicians will be available during GI Clinic for
consultation. The fellow will review the case with the attending
physician and, together, determine a course of action, select the
appropriate laboratory studies as well as endoscopic and/or Radiologic
GI Clinic is an integral part of the fellowship. The clinic provides a
longitudinal follow-up of the fellow’s own patients and provides the
opportunity to generate indicated endoscopic procedures. All procedures
are performed under the supervision of the attending physician who,
together with the fellow, determines the procedures to be performed.
It is imperative that fellows keep a logbook of all procedures. A list
of all procedures performed must be submitted to the Program Director on
a quarterly basis. This practice allows the Program Director to monitor
endoscopic progress and adjust for any deficiencies that might arise.
The logbook should include the patient’s name, medical record number,
indications for the procedure, outcome of the procedure, and
Each fellow is required to rotate at least one month a year on the Liver
Transplant Service at Thomas Jefferson University Hospital as part of
their Hepatology training. In addition, they will rotate at least one
month during their three-year fellowship at Graduate Hospital in
training for esophageal manometry. They are also encouraged to take
electives in research, both basic science and clinical, either at
Lankenau Medical Center Research Center or at another facility. In
addition, they are also encouraged to take elective outside the
institution, particularly for additional training in therapeutic
endoscopy and other gastrointestinal specialties such as pediatric
The call schedule for the fellows involves taking call every third
weekend for hospital patients and emergency room patients. This call
starts in the second year of the fellowship and goes up to and including
the third year of fellowship training. Fellows on call round on
Saturdays of each weekend and are expected to take both outpatient and
inpatient call as well as emergency room call in order to foster
experience with outpatient gastroenterology. They are expected to come
into the hospital either Saturday or Sunday if the situation calls for
it and if any endoscopic procedure is performed. These procedures are
always performed under the supervision of an attending
All consultations from the Gastroenterology Service are called into the
office of Main Line Gastroenterology. Those consults are forwarded to
the "long" fellow and subsequently distributed to other members of the
clinical team by that fellow. Each fellow doing a consult documents the
consultation in the logbook. The consult will be reviewed by the
attending physician on service at the time regardless of the specific
attending requested. This will hold true unless otherwise specified by
the attending physician on service. The consult should be performed on
the day it is called in by the fellow, resident or student and reviewed
by the attending physician on that day. The consult may be dictated,
however, a note needs to be written on the chart in lieu of a complete
dictated consult. The attending physician must also write a note
documenting the patient was seen and the consult reviewed.
The fellows need to work very closely with the residents and students
involved in the care of the patient with whom they are consulting. The
consultation should be brief and to the point and contain pertinent
history and physical findings, laboratory values, diagnostic formulation
along with recommendations. The consult should concentrate on
gastrointestinal aspects of the case and involve internal medicine
issues only as it pertains to gastrointestinal issues. Each consultation
should be accompanied by a detailed note by the attending.
The fellow, resident or student needs to write a daily note on patients
on whom they have consulted and be responsible for collating and
reviewing all appropriate lab studies and x-rays. In addition, the house
staff should be made aware of all recommendations and the case reviewed
with the appropriate house staff.
One of the gastroenterology fellows is on call each night. On average,
each fellow is on call no more than once every third night and no more
than one out of every other weekend. During a seven-day week cycle each
fellow will have at least one full 24-hour period of time off. The
fellows take call from home and come in to evaluate a patient on an as
The senior fellow is responsible for developing an on-call schedule for
all three fellows. That call schedule is made available to the attending
staff, hospital operator, Emergency Department, and Ambulatory Surgical
Center at least one month prior to the effect of the schedule. There is
always one fellow on-call each week night and each weekend. The fellows
are responsible for coordinating their schedule, avoiding any lapse in
coverage. Each fellow assigned to night call begins coverage at 5:00 pm
and ends coverage at 7:00 am after which the “long” fellows resumes
On weekends, one fellow is responsible for call from 5:00 pm Friday
until 7:00 am Monday morning. If there are any changes in the call
schedules, Dr. Mercogliano needs to be informed. The fellows should keep
a log of all calls received from patients while on call. The fellow
on-call is responsible for all Emergency Department calls as well as
hospital calls and hospital consults. They are not responsible for
outpatient calls distributed via Main Line Gastroenterology phone
service. When called by the Emergency Department or hospital for a
gastrointestinal problem, the fellow on-call is expected to evaluate,
assess and determine a plan of action regarding that patient, and, if
necessary, call the attending physician for consultation and assistance.
All endoscopic procedures are performed under the supervision of an
attending physician. If the attending physician is not called at night,
he or she must be made aware of specific problems that occurred as well
as any changes in therapy the following morning.
Moonlighting during the first year of fellowship is discouraged.
Moonlighting during the second and third year is acceptable as long as
it does not interfere with the daily clinical services or research
assignments of the fellowship. The Program Director needs to be made
aware of any moonlighting activities.
Connect with MLH
Graduate Medical Education
Main Line Health
100 East Lancaster Avenue
Wynnewood, PA 19096
For more information, call 1.866.CALL.MLH.