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Curriculum
The Gastroenterology fellowship at the University of Florida College of Medicine-Jacksonville is a three-year training program. There are 2 fellows per year rotating through seven core educational experiences: inpatient consults, nutrition, endoscopy ERCP and EUS, Shands Jacksonville liver consults, liver transplantation, and research. In addition, 2nd and 3rd year fellows can opt for additional elective rotations. The distribution of these educational experiences over the course of the 36-month fellowship is summarized in the following table.
| Monthly rotations in the 36 month Gastroenterology | |||||
|---|---|---|---|---|---|
| Year 1 (PGY-4) | Year 2 (PGY-5) | Year 3 (PGY-6) | |||
| Rotation | Mths | Rotation | Mths | Rotation | Mths |
| Consults | 8 | Consults | 1 | Consults | 1 |
| Nutrition | 1 | Endoscopy | 3 | Endoscopy | 2 |
| Endoscopy | 1 | Shands Jacksonville Liver | 1 | Shands Jacksonville Liver | 1 |
| Research | 1 | Research | 3 | Research | 2 |
| Liver Transplant | 1 | EUS/ERCP | 2 | EUS/ERCP | 3 |
| Liver Transplant | 1 | Liver Transplant | 1 | ||
| Elective | 1 | Electives | 2 | ||
All fellows have the same ambulatory experience. Over the course of the 3-year fellowship, each fellow has a weekly continuity clinic.
During the research and nutrition blocks fellows will also be posted to the IBD clinic to gain increased experience managing these patients.
Primary Training Rotations
I. Clinics
A. Continuity Clinic
Each fellow is assigned to weekly continuity clinics throughout the fellowship. Each clinic is supervised by a GI faculty mentor.
During the continuity clinic, the fellow is primarily responsible for the management of about 6 to 8 patients per clinic session. All patients will be seen and evaluated by the fellow who is responsible for formulating a care plan and the reviewing their findings and plan with the assigned teaching faculty member.
B. Inflammatory Bowel Disease (IBD) Clinic
IBD clinic occurs on Monday afternoon at the Emerson office and Friday afternoon at the Faculty Clinic. Here fellows, when posted to the nutrition or research rotations, will participate in the management of patients with inflammatory bowel disease. They will be under the supervision and instruction of a faculty member with expertise in inflammatory bowel disease who will also lead informal discussions of pertinent clinical and research topics. During the duration of the fellowship there will be eight months of assignment to IBD clinic.
II. Clinical Rotations
A. Inpatient consults
The inpatient consult service is located at Shands Jacksonville. Five days each week (Monday through Friday) fellows, internal medicine residents and students on the gastroenterology consult service meet with the attending physician assigned to the inpatient services. All of the patients who are hospitalized are discussed. There is a review of the pathophysiology of the medical condition, supplemented with literature pertinent to the clinical circumstances resulting. Evidence-based clinical decision-making is performed. Written consultations are reviewed. Each patient is seen and examined at the bedside.
B. Shands Jacksonville Liver Consults
Second and third year fellows are each assigned to Shands Jacksonville Liver Consult service. This rotation occurs Monday through Friday from 8 a.m. to 5 p.m. at Shands Jacksonville. On this rotation fellows perform inpatient consultations on hospitalized liver patients in Shands Jacksonville. There is a review of the pathophysiology of the medical condition supplemented with literature pertinent to the clinical circumstances resulting. Evidence-based clinical decision-making is performed. Written consultations are reviewed. Each patient is seen and examined at the bedside. All cases are reviewed with a hepatology attending from the division who is assigned to the rotation.
C. GI Laboratory Rotations: EUS/ERCP/Endoscopy
All procedures performed on patients (inpatient or outpatient) by gastroenterology fellows are conducted in the GI procedure laboratory under the direct supervision of an attending physician. These procedures include endoscopy with or without diagnostic procedures (i.e. upper endoscopy, small bowel enteroscopy, flexible sigmoidoscopy, and colonoscopy) advanced endoscopic procedures (i.e. endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasonography (EUS)), esophageal manometry and pH studies, liver biopsy and capsule endoscopy. The fellows are required to maintain a log of the procedures that they have performed. They are monitored on a yearly basis for completeness and accuracy.
Fellows in all three years rotate through the endoscopy rotation. Here an emphasis is made on the acquisition and refinement of both diagnostic and therapeutic upper and lower endoscopy. Specifically the procedures to be learned are:
- Esophagogastroduodenoscopy (EGD)
- Esophageal dilatation
- Proctoscopy
- Flexible sigmoidoscopy
- Colonoscopy
- Colonoscopy with polypectomy
- Percutaneous liver biopsy
- Percutaneous endoscopic gastrostomy (PEG)
- Biopsy of the esophagus, stomach, small bowel and colon
- Nonvariceal hemostasis (upper and lower)
- Variceal hemostasis
Second and third year fellows not only gain extra expertise in endoscopy, but also aid in the performance of EUS and ERCP. The goal of this rotation is familiarity and the ability to interpret results of the studies. It is beyond of the scope of this fellowship for fellows to attain competence to independently perform ERCP or EUS.
D. Liver transplantation
Fellows are assigned a one-month experience in liver transplantation at the Shands at UF Gainesville. All fellows are the direct supervision of Dr. David Nelson. The experience includes performance of consults, written communication with referring physicians, participation in didactic conferences and participation in the management of hospitalized transplant patients.
E. Elective rotation opportunities
During the elective rotations, the fellows may choose to rotate through radiology, pediatric gastroenterology at Nemours Children's Clinic Jacksonville, pathology, or manometry and capsule endoscopy laboratories.
III. Research Rotation
The research experience is intended to familiarize fellows with research principles and methods, and thus facilitate professional growth through self-learning and the development of critical thinking. Each fellow is paired with a faculty mentor who provides necessary guidance and direction for the experience.
There is a one-month exposure in first year, three months in second year, and two months in third year. Instruction includes introduction to statistics, research design and outcome analysis as well as critical review of literature. All fellows meet with faculty mentors, to explore research opportunities, and are monitored as to their productivity. Total Research time is 6 months with more allotted if necessary to finish worthwhile projects.
In addition to working on specific research projects there are concrete expectations for fellows in each of the three years of the fellowship. Fellows are required to have at least one peer reviewed paper accepted for publication as a requirement for graduation.
Once a mentor is assigned the fellow is expected to meet monthly with the mentor on a weekly basis during research rotations and monthly during other rotations. The mentor gives a short report of progress made at the time of the meeting to the program director.
Additional Education
Fellows are required to attend the campus-wide biostatistics and research course given on a yearly basis.
There is a monthly mandatory research conference in which fellows hear about the research projects of other faculty and fellows as well as invited guests. The fellows are expected to present their research once or twice a year.
There is an opportunity for exceptionally motivated fellows to pursue a Masters of Public Health degree through the University of Florida or the University of North Florida. Those interested should contact the program director at the earliest opportunity.
IV. Nutrition Rotation
The nutrition rotation is designed to provide the fellow with a comprehensive clinical experience in nutrition. This experience is provided in a one-month rotation during the first year of the fellowship in collaboration with nutrition services at Shands Jacksonville. An emphasis is placed on nutritional care of ill patients learning the intricacies of enteral and parenteral feeding.