The Gastroenterology Fellowship Program at LMC provides fellows with extensive clinical experience and interactive patient contact. When the fellow is on the clinical service, the fellow 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. The fellow 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 with the attending physician. The fellow is also responsible for directing and coordinating work and teaching rounds with the attending physician.

Fellows have intense endoscopic training throughout all 3 years of their fellowship training. All endoscopic procedures are performed under the direct supervision of an attending physician. The attending physician must be present during every endoscopic procedure in its entirety.

Goals and objectives are as follows:

Patient care

  • Fellows must be able to provide care to gastroenterology patients in the hospital that is effective, appropriate, and compassionate
  • Demonstrate competency in gathering essential and accurate gastrointestinal history from patients, formulating a course of action and conveying the information in a succinct manner to the attending
  • Evaluate patients and initiate appropriate management in a timely fashion
  • Be available to the patient, staff and attending physicians to address ongoing changes in patient status
  • Communicate effectively with patients, attendings, co-fellows, and all providers involved with a patient's care

Medical knowledge

  • Fellows must demonstrate knowledge of established and evolving practice guidelines and apply their knowledge to patient care.
  • Demonstrate competency in recognizing and managing common and complex GI disorders, including anemia, peptic ulcer disease, complicated pancreatitis, inflammatory bowel disease, motility disorders, malnutrition
  • Demonstrate competency in recognizing and managing common and complex liver disorders, including pre and post liver transplant evaluations, decompensated cirrhosis, acute liver failure
  • Understand the pathophysiology of gastrointestinal and liver disorders.
  • Understand appropriate indications for endoscopic procedures as well as other diagnostic studies
  • Review appropriate radiographic studies and laboratory data.
  • Demonstrate knowledge of pharmacologic drugs used to manage GI and liver disease

Technical skills

  • Fellows must demonstrate proficiency in performing various endoscopic procedures including colonoscopy, upper endoscopy, push enteroscopy
  • Treatment of bleeding varices and non-variceal bleeds
  • Exposure to ERCP and sphincterotomies, stone extractions, placement of biliary stents. If a fellow completes the elective 3 months of extra ERCP training, he/she may be signed off as being proficient in ERCPs at the end of fellowship
  • Removal of foreign bodies and food impactions
  • Dilation of esophageal strictures and rings
  • Ablation of vascular lesions with argon plasma coagulation
  • Placement of PEG tubes
  • Submucosal injections using botox, tattoo ink, saline lifts for removal of large polyps

Practice-based learning and improvement

  • Fellows must be able to investigate and evaluate their patient care practice
  • Appraise and assimilate scientific evidence to improve patient care
  • Facilitate learning of other health professionals
  • Demonstrate positive utilization of feedback provided during bi-annual formal feedback sessions with fellowship leadership

Interpersonal and communication skills

  • Fellows must demonstrate interpersonal communication skills that result in effective information exchange in teaming with patients, patient's families and all providers involved in patient care
  • Demonstrate an effective relationship with other health care professionals
  • Use effective listening skills and demonstrate effective non-verbal explanatory and questioning writing skills

Professionalism

  • Fellows must demonstrate a commitment to carrying out professional responsibilities
  • Adhere to professional ethical standards.
  • Maintain confidentiality of patient information
  • Demonstrate sensitivity towards a diversity of cultures, ages, genders and disabilities

System-based practice

  • Fellows must demonstrate awareness of and responsiveness to the larger context and system of health care
  • Demonstrate effective utilization of resources
  • Advocate for the patient within complex healthcare systems