Division of Gastroenterology, Hepatology & Nutrition                          -----     University of Pittsburgh School of...
Division of Gastroenterology, Hepatology and Nutrition                               University of Pittsburgh             ...
104   Institutional & Department Policies & Procedures                                     3
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Division of Gastroenterology, Hepatology and Nutrition                                                      University of ...
Division of Gastroenterology, Hepatology & Nutrition                                           University of Pittsburgh Sc...
Division of Gastroenterology, Hepatology & Nutrition                                          University of Pittsburgh Sch...
Primary Division Contact Information:Division of Gastroenterology, Hepatology and NutritionUniversity of PittsburghPUH – M...
GI FELLOWSHIP TRACKSIntroduction: The purpose of incorporating career tracks into the fellowship include:1) Defining long-...
Fellowship objectives: To learn how to become an effective clinician educator with an emphasis on learning informatics as ...
SPECIALIZED TRAININGIntroduction: The specific disciplines within gastroenterology, hepatology and nutrition support servi...
Gastroenterology Division Policies,Responsibilities and Related Information                   12
ORIENTATIONA half-day resident orientation will be held by the Graduate Medical Education (GME) office each June and July,...
DUTY HOURS, ON CALL, SCHEDULING AND TIME OFF POLICIESDuty Hour Information:All fellows are responsible for duty hour track...
Maternity & Paternity Leave Policies: Female fellows will receive six weeks off for maternity leave. Male fellows will r...
CLINICAL ACTIVITIES AND LINES OF RESPONSIBILITYResident responsibilities Related to Clinical Activities: Patient Care: Fe...
RESEARCHFellows are expected to dedicate a block of time during Year II of fellowship to their research project. Fellows w...
REQUIRED CONFERENCES:Fellows are required to attend the following conferences:Mandatory for        Conference Name        ...
EVALUATIONThe Gastroenterology Fellowship Program uses an online evaluation system for most program evaluations. Fellows w...
EVALUATIONProcedure Practicum: Direct Observation of Fellow by Supervising AttendingTwice per year (November/December and ...
The following is a sample of the Gastroenterology Fellowship Program’s direct observation evaluation form.                ...
EXTERNAL MEETING ATTENDANCE POLICYAttendance at national conferences is an important part of fellow career development. Th...
PROCEDURE LOG REQUIREMENTS TO COMPLETE GI FELLOWSHIP TRAININGThe ACGME requires fellows to complete the following number o...
POLICY FOR INPATIENT PROCEDURES IN THE GI LABAttending Expectations: Start all inpatient procedures at 7:30 am WITHOUT the...
MAGEE WOMENS HOSPITAL OFF-HOUR and WEEKEND EMERGENCY PROCEDURESTwo potential situations during which a consult would resul...
SERVICES TO ADDRESS STRESS, FATIGUE AND RELATED GI FELLOW NEEDSIf day-to-day patient care is unusually difficult or prolon...
CURRICULUM VITAE (CV)Fellows are required to update CV’s three times per year and submit them to Helen Gibson, program coo...
CERTIFICATION and LICENSURESPECIALITY CERTIFICATION:Certifying Board                                            YearMEDICA...
2002, November                    Crohn’s and Colitis Foundation of America, Patient and Family IBD Educational Conference...
ADHERENCE TO ACGME CORE COMPENTENCIESAll University of Pittsburgh’s Gastroenterology Fellowship Program clinical rotations...
GI FELLOW CURRICULUM: Rotation Goals and Responsibilities                 31
GI Hospital Service                                                Curriculum for Year I, II & III FellowsEducational Purp...
Practice-Based Learning Objectives: Become familiar with the concepts of quality improvement. Participate in conferences...
o Inflammatory bowel disease               o GI infections               o Pancreatitis               o Ischemic colitis ...
    Participate in program planning, including annual Faculty Meeting attendance, Fellow Curriculum Committee participati...
o Peptic ulcer disease              o Inflammatory bowel disease              o GI infections              o Pancreatitis ...
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  1. 1. Division of Gastroenterology, Hepatology & Nutrition ----- University of Pittsburgh School of Medicine TRAINING MANUAL for GASTROENTEROLOGY FELLOWS 2007 - 2008 Miguel D. Regueiro, MD Associate Professor of Medicine Associate Chief for Education Co-Director & Clinical Head, Inflammatory Bowel Disease Center Program Director, Gastroenterology Fellowship Program Klaus Bielefeldt, MD PhD Associate Professor of Medicine Director, GI Motility Center Associate Program Director, Gastroenterology Fellowship Program Kapil B. Chopra, MD Associate Professor of Medicine Medical Director, Comprehensive Liver program – UPMC Liver Pancreas Institute Program Director, Hepatology Fellowship Program David C. Whitcomb MD, PhD Giant Eagle Foundation Professor of Cancer Genetics Professor of Medicine, Cell Biology & Physiology and Human Genetics Chief, Division of Gastroenterology, Hepatology and Nutrition Division of Gastroenterology, Hepatology and Nutrition University of Pittsburgh School of Medicine PUH – Mezz. 2 – C Wing 200 Lothrop Street Pittsburgh, PA 15213 Phone: 412-648-9115 Fax: 412-648-9378 http://dom.pitt.edu/gi Revised 10/07 1
  2. 2. Division of Gastroenterology, Hepatology and Nutrition University of Pittsburgh GASTROENTEROLOGY FELLOWSHIP PROGRAM TABLE OF CONTENTSPAGE NUMBER DOCUMENT 4 Introduction 5 Faculty Roster 6 Fellow Roster 7 Primary Division Contact Information 8 GI Fellowship Tracks:  Physician Scientist  Clinical Investigation/Research  Informatics and Clinical Educator 10 Specialized Training:  Endoscopic Ultrasound (EUS)  Transplant Hepatology  Pancreaticobiliary  T-32 Research Opportunities 11 POLICIES, RESPONSIBILTIES AND RELATED INFORMATION 12 Orientation 13 Duty Hours, On Call, Scheduling and Time Off Policies  Duty Hour Information  Directions for Using the UPMC ROCS System  GI On Call Hours  GI and Hepatology Fellow On Call Pager Numbers  Scheduling Research Blocks  Vacation Requests  Maternity and Paternity Leave Policies  Vacation Request Form 15 Clinical Activities and Lines of Responsibility  Resident Responsibilities Related to Clinical Activities  Routine Fellow Responsibilities  Continuity Clinic  Policy to Obtain Informed Consent 16 Research:  Fellow Research Block Preference Form 17 Required Conferences 18 Evaluation  Procedure Practicum Information and Form 21 External Meeting Attendance Policy 22 Procedure Log Requirements to Complete GI Fellowship Training 23 Policy for Inpatient Procedures in the GI Lab 24 Magee Womens Hospital Off-Hour and Weekend Emergency Procedures 25 Services to address stress, Fatigue and Related GI Fellow Needs 26 Curriculum Vitae (CV) Directions 29 Adherence to ACGME Core Competencies 30 GI FELLOW CURRICULUM 31 GI Hospital Service 38 Hepatology Consultative Service 46 Hepatology Outpatient Service 54 Pancreaticobiliary Service 61 VAMC GI Service 70 Nutrition Service 77 Shadyside Hospital Service 85 Motility Service 91 GI Procedure Service 97 Research Rotation 2
  3. 3. 104 Institutional & Department Policies & Procedures 3
  4. 4. 4
  5. 5. Division of Gastroenterology, Hepatology and Nutrition University of Pittsburgh GI FELLOWSHIP PROGRAM INTRODUCTIONWelcome to the University of Pittsburgh Division of Gastroenterology, Hepatology and Nutrition and the GI Fellowship Program. The GIFellowship program seeks to select, develop and mentor young physicians in a thoughtful and scholarly manner, and we are pleasedthat you will join us for the next three years.This training manual for gastroenterology fellows will provide a basic overview of this program as well as reviews of fellow serviceresponsibilities. Additional regulatory information and documentation from recent University memos and publications is also provided.The GI Training Program at the University of Pittsburgh is becoming more selective and, consequently, more respected every year. OurDivision has a strong commitment to monitoring and evaluating the Training Program. Your comments and suggestions will bewelcomed at every opportunity.Miguel D. Regueiro, MDAssociate Professor of MedicineAssociate Chief for EducationDirector, GI Fellowship ProgramCo-Director & Clinical Head, Inflammatory Bowel Disease CenterKlaus Bielefeldt, MD PhDAssociate Professor of MedicineAssociate Program Director, GI Fellowship ProgramDirector, GI Motility Center 5
  6. 6. Division of Gastroenterology, Hepatology & Nutrition University of Pittsburgh School of MedicineFACULTY (* = SECONDARY APPOINTMENT): Steven Abo, MD Christianna Kreiss, MD Assistant Professor of Medicine - Director, GI Services at Assistant Professor of Medicine – VAMC - GI Magee Womens Hospital - GI Steven Lasky, MD Jawad Ahmad, MD Assistant Professor of Medicine – VAMC - GI Assistant Professor of Medicine - Hepatology Sacha Malin, PhD Kathryn Albers, PhD Research Associate Professor of Medicine - Research Mitchell Max, MD Leonard Baidoo, MD Research Instructor of Medicine - GI James B. McGee, MD Anthony Bauer, PhD Associate Professor of Medicine - Assistant Dean for Medical Professor of Medicine - Research Education Technology/School of Medicine - GI Jaideep Behari, MD PhD Ian McGowan, MD PhD Assistant Professor of Medicine – Hepatology & Research Associate Professor of Medicine –Magee – GI & Research Klaus Bielefeldt, MD PhD Kevin McGrath, MD Associate Professor of Medicine - Director, GI Motility Lab – Assistant Professor of Medicine - Director, GI Lab - Director, GI & Research EUS Program - GI Randall Brand, MD Satdarshan Monga, MD* Associate Professor of Medicine – GI Research Rhonda Brand, PhD* Stephen O’Keefe, MD, MSc Research Professor of Medicine - Director, Center for Intestinal Health & Brian Davis, PhD Nutrition – Nutrition & Research Associate Professor of Medicine - Research Georgios Papachristou, MD Howard Dubner, MD Assistant Professor of Medicine - GI UPMC Shadyside - GI Michael Pezzone, MD, PhD Richard Duerr, MD Assistant Professor of Medicine – GI & Research Associate Professor of Medicine - Co-Director & Genetics Mordechai Rabinovitz, MD Head, IBD Center – GI & Research Associate Profesor of Medicine - Hepatology Michael Dunn, MD Amit Raina, MD Professor of Medicine – Director, Medical Records Technology Instructor of Medicine - GI Patricia Eagon, PhD Miguel Reguiero, MD Associate Professor of Medicine - Director, Medical Student Associate Profesor of Medicine - Associate Chief for Course in Gastroenterology, Hepatology and Nutrition - Education - Co-Director & Clinical Head, IBD Center - Director, Research GI Fellowship Program - GI Kenneth Fasanella, MD Michael Sanders, MD Instructor of Medicine - GI Assistant Professor of Medicine - GI Gerald Gebhart, PhD* Robert Schoen, MD, MPH Research Professor of Medicine - Director, Gastrointestinal Cancer Toby O. Graham, MD Prevention & Treatment Center – GI & Research Associate Professor of Medicine – GI & Nutrition Obaid Shakil Shaikh, MD Julia Greer, MD PhD Associate Professor of Medicine - Director, Center for Liver Assistant Professor of Medicine - Research Diseases - Hepatology Christine Lee Gulati, MD Adam Slivka, MD, PhD Internal Medicine at Digestive Disorders Center Professor of Medicine - Associate Chief for Clinical Services - Janet Harrison, MD GI Assistant Professor of Medicine – Magee - GI Ernest Sutton, MD Refaat Hegazi, MD PhD Clinical Professor of Medicine - GI Assistant Professor of Medicine – Nutrition David Whitcomb, MD, PhD Farhad Ismail-Beigi, MD Giant Eagle Foundation Professor of Cancer Genetics – UPMC Shadyside - GI Professor of Medicine, Cell Biology & Physiology and Human Hosssam Kandil, MD PhD Genetics - Chief, Div. of Gastroenterology, Hepatology & Associate Professor of Medicine – Hepatology & Nutrition Nutrition - Director, Pancreas & Biliary Center – GI & Asif Khalid, MD Research Assistant Professor of Medicine - Chief of GI Services, VAMC Lee Weinberg, MD – GI & Research UPMC Shadyside – GI Barry Kisloff, MD Dhiraj Yadav, MD Clinical Assistant Professor of Medicine - Director, Clinical Assistant Professor of Medicine – GI Services & the Digestive Disorders Center – GI 6
  7. 7. Division of Gastroenterology, Hepatology & Nutrition University of Pittsburgh School of MedicineGASTROENTEROLOGY FELLOWS: 2007-2008Year IIIScott Cooper, MDMark Lazarev, MDJohn Lyons, MD – Chief Gastroenterology FellowJames Park, MDYear IIArthur “Tripp” Barrie, MD PhDKaren Collinson, MDCarmen Meier, MDBrian Ng, MDYear IElie Aoun, MDSandra El-Hachem, MDDavid Lo, MDShahid Malik, MDJoseph Rodemann, MDVinay Sundaram, MDHEPATOLOGY FELLOW: 2006-2007Anastasios Mavarkis, MD 7
  8. 8. Primary Division Contact Information:Division of Gastroenterology, Hepatology and NutritionUniversity of PittsburghPUH – Mezz. 2 – C Wing200 Lothrop StreetPittsburgh, PA 15213Location: Phone:Fellowship Program Director TEL: 412-648-2344 (Elaine New, scheduling secr.)Miguel D. Regueiro, MD TEL: 412-648-3372 (direct) PAGER: short range: 2276; long range: 565-0996Director, Digestive Health Programs TEL: 412-648-3232Joy Jenko Merusi, MA merusij@dom.pitt.eduFellowship Program Coordinator TEL: 412-648-9241Helen Gibson gibsonh@upmc.eduAcademic Main Number (M2) TEL: 412-648-9115Marlaine Moore, receptionist FAX: 412-648-9378Digestive Disorders Center (DDC) @ PUH TEL: 412-647-8666 or 1-866-4-GASTRO (1-866-442-7876) FAX: 412-647-6446GI Lab @ PUH TEL: 412-647-3780 FAX: 412-647-1017Center for Liver Diseases TEL: 412-647-1770 or 1-800-447-1651 FAX: 412-647-9268GI Services @ Magee Womens Hospital TEL: 412-641-2096 FAX: 412-641-2085GI Lab @ VAMC TEL : 412-688-6177 FAX : 412-688-6959 or 412-688-6942Pager 412-647-PAGE (7243)Referral Communications 412-647-7000UPMC Medical Media 412-647-5050 8
  9. 9. GI FELLOWSHIP TRACKSIntroduction: The purpose of incorporating career tracks into the fellowship include:1) Defining long-term career goals at the beginning of the fellowship.2) Providing a structured three-year training experience to allow each fellow to achieve their career goals.3) Advancing interested fellows into a third-tier, specialized training programs.The three career tracks are: physician scientist, clinical investigator/research and clinician educator/informatics. Additional masters-levelcourses may be taken as part of the training program (e.g., courses in public health, business administration and education). By thecompletion of the three-year fellowship, ALL fellows must submit at least one manuscript to a peer reviewed journal.Additionally, all fellows must give an abstract presentation at a national meeting or have a related publication or presentationopportunity approved by the fellowship program director.At the beginning of the fellowship the program director and faculty will introduce the career tracks. Within the first six months, eachfellow will meet with the program director to identify career interests. By the end of the first year, each fellow will have a structuredtemplate for the second and third years.Physician Scientist:Career Goals: To establish a career as a physician scientist in a university/academic center and become an independent principalinvestigator.Fellowship objectives: Under the supervision of a faculty mentor the fellow will be provided 18 months for bench research and 18 monthsof clinical training.Faculty responsibilities: To serve as research mentor for the fellow choosing a career as a physician scientist.Expectations at end of three year fellowship: To continue research as a post-doctoral fellow or junior faculty in an academic institutionand establish independent funding as a career scientist.Note: Although this career track is geared toward fellows with prior research experience and interest, there will be ample opportunity forfellows with little research background to enter this track. It is anticipated that fellows on this track will be supported by the (T32)Digestive Diseases Research Training Grant. Example: A fellow enters the program with extensive research experience (e.g. MD-PhDor MD with research background) and identifies a faculty mentor. By the end of the first clinical year there is a defined research projectand mentor. Eighteen months of the second and third years are spent in the lab under the supervision of the faculty mentor. Fellowsentering this track are encouraged to apply for grant support in the third year and to continue their research as junior faculty.Clinical Investigation/Research:Career Goals: To establish a career as a clinical investigator in an academic medical center.Fellowship objectives: To define a niche specialty within gastroenterology, hepatology, or nutrition and identify an area of research thatwould continue as a faculty member in an academic medical center.Faculty responsibilities: In the first six months of fellowship, selected faculty will present an overview of their research. Thesepresentations will serve as an introduction of ongoing research within the division and identify potential faculty mentors for fellows.Expectations at the end of three-year fellowship: To join a clinical academic faculty and continue clinical research within the chosenclinical subspecialty.Note: By the end of the first clinical year, there is a defined clinical research project and mentor. During the summer of the second orthird years, there will be an opportunity to participate in didactic course work that is directed by the division of general internal medicine.The second and third years will be spent completing the clinical research project and identifying a subspecialty niche. For example, afellow with an interest in GI oncology will participate in a research project in GI oncology and devote clinical time to this area.Informatics and Clinician Educator:Career Goals: To establish a career as a clinician educator with expertise in the field of medical informatics. Clinical experience in anacademic-affiliated hospital will be emphasized. 9
  10. 10. Fellowship objectives: To learn how to become an effective clinician educator with an emphasis on learning informatics as aneducational tool.Faculty responsibilities: At the beginning of fellowship, introduce the field of medical informatics and its role in clinician education.Expectations at the end of three-year fellowship: To join an academic medical center as clinical faculty dedicated to clinical educationand informatics, or to be able to incorporate education and continuing medical education into a GI practice setting.Note: At the completion of the first year, there are identified projects within the field of medical informatics. Fellows choosing this pathmay have the opportunity to supplement these experiences with didactic courses through the School of Public Health or School ofMedicine. In the second and third years, the fellow would define an education/informatics project that would be integrated with asubspecialty niche. For example, a fellow with a clinical interest in hepatology may design an informatics project that focused onclinician education of Hepatitis C. 10
  11. 11. SPECIALIZED TRAININGIntroduction: The specific disciplines within gastroenterology, hepatology and nutrition support services at UPMC are available throughspecialized training include: • Endoscopic Ultrasound; • Transplant Hepatology; and • Pancreaticobiliary.In the Division of Gastroenterology, Hepatology, and Nutrition, there are unique opportunities for fellows to gain exposure to thesedisciplines within the three-year core training program and/or as a separate third tier (fourth) year. (See specialized training outlines forspecific career objectives.) UPMC fellows with an interest and qualifications will be given preference for selection as a third tier fellow. Ifan internal candidate is not identified, the position will be offered to an external candidate. Fellows entering third tier trainingmust be board admissible or certified in gastroenterology and will be hired as a clinical instructor within the Division of Gastroenterology,Hepatology, and Nutrition.Endoscopic Ultrasound (EUS): All fellows within the three-year core fellowship will have the opportunity for exposure to EUS throughdidactic conferences. Fellows with a specific interest in pursuing a career in EUS will begin EUS research in the second and third yearsand will complete their training as a fourth-year, third tier fellow. All of the technical, "hands-on" training will take place during the fourthyear. At the end of the third tier year, fellows will have the academic and technical skills to direct an EUS program.Transplant Hepatology: All fellows within the three-year core fellowship will have exposure to at least six months of inpatient andoutpatient hepatology. Fellows with a specific interest in transplant hepatology and achieving UNOS certification will be considered for athird tier (fourth) year. Fellows interested in the third tier year will begin hepatology research in the second and third years. The third tieryear will be designed as an intensive transplant hepatology experience. Fellows chosen internally will continue research projects in thisthird tier year. At the end of the third tier year, fellows will be UNOS certified and will have the skills to participate in a liver transplantprogram.Pancreaticobiliary: Fellows interested in pancreatobiliary disease will follow a three-year core fellowship with anticipation of applyingfor a third-tier (fourth year) training position to become an expert in ERCP and to become familiar with EUS of the pancreas. Thisrotation(s) within the three-year fellowship will provide exposure and training in pancreaticobiliary disorders. As such, there will be anintroduction to ERCP, but, for advanced training, fellows will require a fourth year. Additionally, a faculty committee will decide if certainfellows merit more intensive ERCP training during the three year fellowship. These fellows will be selected by the faculty.Fellows in the pancreaticobiliary track will train in the basics of pancreatic and biliary physiology, pathophysiology, genetics, pancreaticfunction testing, pancreatobiliary radiology and surgery, as well as diagnostic and therapeutic procedures. Opportunities are alsoavailable for basic research in genetics, cell biology, molecular biology, electrophysiology, and GI oncology. In addition, fellows areencouraged to take graduate courses in clinical research and study design. A Masters in Clinical Research, Public Health, or PublicHealth Genetics represents several of the special graduate programs that can be completed through this program.Within the three-year core fellowship, all fellows will have clinical rotations on the pancreaticobiliary service (e.g. fellows may continue toelect to spend 1-3 months on the pancreaticobiliary service). All fellows will have at least one month of pancreaticobiliary clinical servicetime during their three years. Fellows interested in the third tier year will begin pancreaticobiliary research in the second and third years.The third tier year will be designed as an intensive and technically demanding pancreaticobiliary experience.T-32 Grant: Fellows interested in obtaining protected time for basic science research are eligible to participate in the University ofPittsburgh Division of Gastroenterology, Hepatology and Nutrition’s T-32 research grant. Fellows will be required to identify a researchmentor for this program. 11
  12. 12. Gastroenterology Division Policies,Responsibilities and Related Information 12
  13. 13. ORIENTATIONA half-day resident orientation will be held by the Graduate Medical Education (GME) office each June and July, and Year I fellows arerequired to attend one half-day session. Topics discussed at this general orientation will include: Ethics, autopsy and trainee fatigue.An additional half-day new gastroenterology fellow orientation program will be held in either June or July each year (typically during theafternoon following the GME office’s morning orientation session), and all Year I fellows and the chief fellow will be required to attend.Orientation topics include but are not limited to: Overview of GI fellowship program Introductions of select faculty and returning fellows Tours of key Division clinical and research areas Review of rotation schedules Financial allowance information Conference information Clinical rotation information Distribution of keys and pagers Instructions for photo ID’s and related information.Note that Year I gastroenterology fellows will be required to attend both the resident GME orientation as well as the Division’sgastroenterology fellow orientation. 13
  14. 14. DUTY HOURS, ON CALL, SCHEDULING AND TIME OFF POLICIESDuty Hour Information:All fellows are responsible for duty hour tracking through the UPMC ROCS (Resident Online Coordination System). Appropriate dutyhour compliance is mandatory for the University of Pittsburgh Gastroenterology Fellowship Program. Gastroenterology fellows areexpected to adhere to the following duty hours and on call regulations. Fellow hours will not exceed 80 hours per week. Fellows will have a minimum of 10 hours off of clinical duties between work shifts. Fellows will have at least one day out of seven per week with no work-related activities. No fellow will work more than 30 continuous hours.Any fellow duty hour violations will be noted on the GME ROCS system duty hour evaluation report. If a fellow has a violation, theprogram director will contact the fellow to inquire about the reason for the violation and to implement corrective action.Directions for using the UPMC ROCS (Resident Online Coordination System): The website for viewing and approving timesheets is available through UPMC MedTrak > http://providertrak.upmc.com. Log in using UPMC Log In and Password. Once logged into MedTrak, click the left menu link for GME ROCS. The timesheets must be approved each week between 8:00 am Friday and 12:00 midnight on Saturday. If a fellow does not sign his/her time sheet by 12:00 midnight on Saturday, a paycheck will not be issued.  If a fellow cannot sign off, notify Helen Gibson by e-mail > gibsonh@upmc.edu, and she can approve the timesheet. If Helen is not e-mailed, the time sheet will not be approved, and the fellow will not receive his/her paycheck. The system will permit only a few changes to the schedule. For now, all other changes must be made by Helen, or the fellow will need to type the changes in the comment box (i.e., and Helen will then input the new schedule information).  Fellows may change the start and/or end times of their shifts.  Helen has only listed the Tuesday morning and Medical Grand Rounds conferences for now. If a fellow does not attend one of these conferences, the fellow must inform her.  For now, Helen has entered “day off” information. Needed corrections should be reported to Helen. Moonlighting needs to be documented through the ROCS system as well. All moonlighting work must be reported to Helen in writing via e-mail.GI On Call Hours: GI on call weekday hours are 5:00 pm to 8:00 am. A minimum of two fellows will be on call over the weekend: o Weekends are split, so that each fellow will be on call for 24 hours from 8:00am on Saturday to 8:00am on Sunday with the same for Sunday. o Each fellow will cover either GI or Liver/VA. On Sunday, the GI fellow will also cover the pancreaticobiliary service. o Fellows staying past 10:00pm on weeknights will leave at 1:00pm the following day.GI and Hepatology Fellow On Call Pager Numbers: GI = 3227 Hepatology = 3299 Nutrition = 6629Scheduling Research Blocks:Fellows must notify the chief fellow of their research time requests, when the yearly schedule is determined. Once the schedule is set,there will be no changes. If a fellow needs to make a change, he/she must find coverage for the change, and then all involved fellowsmust propose their change plan to the chief fellow. The program director will have the final say regarding any conflicts.Vacation Requests: A vacation request form (see next page of this manual for a form sample) is distributed at the beginning of the fellowship year. Time off requests are considered when the fellow rotation master schedule is made. If these original time off requests change, fellows are to inform Helen Gibson and the chief fellow, in writing, at least one month before the change. Additional time off requests for vacation, conferences, etc. are to be made in writing no later than one month before the intended time off period. These requests are to be submitted to Helen Gibson and the chief fellow and are subject to approval by Dr. Regueiro. For any time off period, it is the obligation of the fellow to arrange for appropriate and approved coverage. The following fellowship program rotations permit vacation: Research, VAMC, Shadyside, Motility, Liver Outpatient and GI Procedures. 14
  15. 15. Maternity & Paternity Leave Policies: Female fellows will receive six weeks off for maternity leave. Male fellows will receive one week off for paternity leave.The following is a copy of the fellow vacation form that must be completed and given to the program coordinator per the instructions onthe previous page of this manual. FELLOW VACATION PREFERENCES FOR 2006-07 SCHEDULE FELLOW NAME: ________________________________________________ DECEMBER HOLIDAY:HOLIDAY: CHRISTMAS NEW YEARSCHOICE: VACATION PREFERENCE: (One week blocks) OMIT October 29 to November 3, 2006 (ACG); October 27 to 31, 2006 (AASLD); Mid-November to End December 22, 2006 (Second Year Medical Student Course); and May 20-25, 2006 (AGA-DDW) FIRST SECOND THIRD FOURTH CHOICE: LIFE EVENTS: (Weddings, Births, Religious Holidays) DATE, DAYS DESCRIPTIONARE YOU TAKING INTERNAL MEDICINE BOARDS? YES______ NO_____COMMENTS:________________________________________________________________________________________Please return to ASAP: Helen Gibson (gibsonh@msx.upmc.edu Division of Gastroenterology and Hepatology PUH, Mezzanine Level, C-Wing 200 Lothrop Street Pittsburgh, PA 15213 FAX: 412 383 7580 Phone: 412 648 9241 15
  16. 16. CLINICAL ACTIVITIES AND LINES OF RESPONSIBILITYResident responsibilities Related to Clinical Activities: Patient Care: Fellows’ clinical education will be emphasized over service. Rotation learning objectives describe levels of patient care for all three fellowship years, and this information may be found in the rotation curriculum sections of this manual. Level of Responsibility for Patient Management: Fellows will experience increasing levels of responsibility for patient management, as the progress successfully through the training program. Levels of responsibility for each rotation and each year level of training may be found in the curriculum sections of this manual. How Supervised and By Whom: All fellow patient care actions and responsibilities are supervised by assigned attending faculty and/ or the program director through direct observation, signing off on all procedures, fellow evaluations and direct supervision for all activities. Additional information about fellow supervision may be found in the curriculum sections of this manual.Routine Fellow Responsibilities:Gastroenterology fellows do not routinely perform ancillary services such as routine blood draws, prepping patients, starting IV’s,transporting patients, etc. If a fellow finds him/herself conducting these duties, he/she should report these activities to the programdirector for corrective action.Continuity Clinic:Fellows will participate in a continuity clinical one-half day per week during the entire 36 months of training. Fellows will work within thesame clinic during their first year. Based on interest, the fellow may rotate through other specialty clinics in six-month internals duringthe remaining two years of their training.Policy to Obtain Informed Consent:All physicians are reminded that a very detailed policy and procedure technique has been approved by the Board of the University ofPittsburgh Medical Center and its affiliated hospitals on the mechanism by which an informed consent must be obtained. You arereminded that a patient may bring legal action against any physician who performs a procedure without obtaining Informed Consent inan approved manner. Such physician can be convicted of battery if Informed Consent is not obtained in the approved fashion regardlessof the outcome of the procedure. It is therefore imperative that all physicians have a clear understanding of the mechanism by whichInformed Consent is obtained and to make sure that for each and every patient who has a procedure Informed Consent has beenobtained including a full explanation of the risks involved, benefits and alternatives. Each dictation of procedures and each procedurenote must specifically state that the patient understood all important risks and that the patient was fully capable of providing an InformedConsent to the procedure. A detailed explanation of the hospitals consent policy is on file in Dr Wald’s office. Several aspects of thisprocedure are worth reviewing.1. The definition of an Informed Consent approved by the health care services malpractice Act, Act III is defined as THE PHYSICIAN HAS INFORMED THE PATIENT.2. Informed consent must in every case include a full discussion of alternatives by the physician with the patient.3. When verbal consent is obtained, either by the telephone or direct discussion with the patient, at least two individuals must witness this consent and at least one of whom must be a nurse.4. The means of obtaining telephone or telegraph consent are quite specific as follows a. If the patient is unable to consent and the person legally responsible for providing consent for the patient (minor, mental incompetent, other) is unable to come to the Hospital to sign the consent form, telephone consent is permissible. b. This consent must be witnessed by two individuals on extensions of the same line who must sign the witness section of the consent form. c. The means of obtaining the consent (telephone number and the time obtained) should be noted on the consent form.5. Physicians are urged to use caution on the judgment of the patients capacity to provide informed consent, particularly in any situation which is clearly not an emergency. The specific wording used to describe the indications for obtaining consent from the patient’s family or legal guardian includes the very vague and broad concept that the patient may not be competent whenever “a physician or nurse has CAUSED TO DOUBT the medical capacity of the patient to consent” or to “understand the nature of the proposed treatment or procedure”. Note that this is a very broad definition where any doubt as to the patient’s capacities to fully understand the nature of the procedure or treatment requires additional consultation with the patient’s family or legal guardian. This is particularly true of patients who may show signs of encephalopathy.6. The specific responsibilities for the physician in obtaining an informed consent are rather significant. These are: a. The physician/surgeon must explain to the patient the material aspects of the nature of the proposed procedure or treatment, the risks involved, and the alternative to treatment or diagnosis. i. The physician should use layman’s terms during the explanation. ii. If a language barrier exists, a foreign language bank is available to obtain an interpreter. b. The physician will enter on the order sheet the exact wording of the procedure(s) or treatment(s) planned and the physician who will perform the procedure. c. The physician’s procedure note must reflect that the physician has discussed the proposed procedure/treatment, the risks involved, and the alternatives to treatment with the patient. 16
  17. 17. RESEARCHFellows are expected to dedicate a block of time during Year II of fellowship to their research project. Fellows will be supervised byresearch faculty during their research blocks. Fellows are expected to maintain their continuity clinic during the research blockexperience. Before the end of training, fellows must demonstrate evidence of recent research productivity through one or more of thefollowing: Publications (manuscripts or abstracts) in peer reviewed journals; and/or Abstracts presented at national subspecialty meetings.Fellows are expected to complete and submit the following form towards the end of Year I (deadline date will be assigned). This formprovides information to the Chief Fellow and fellow leadership that will be needed to assign fellow schedules for the following year. Division of Gastroenterology, Hepatology and Nutrition University of Pittsburgh GASTROENTEROLOGY FELLOWSHIP PROGRAM Fellowship Research BlocksThe fellow’s research experience within the University of Pittsburgh Gastroenterology Fellowship Program is animportant part of training. Typically, fellows average nine months of research during Year II and III offellowship training. Fellows on a research track may be selected for the Division of Gastroenterology,Hepatology and Nutrition’s NIH T32 grant and receive up to 18 months of research training.In order to provide the necessary research time, the fellow must complete this document._____________________________(Name of fellow) proposed to participate in research with_________________________________(name of faculty research mentor). The title of the project is_______________________________________________________ (title of research project), and my role inthe project will be to _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________(include brief description of research project and your role in the project).I have met with my research mentor and anticipate that I will require ________________ (complete amount oftime required, i.e., 6 months, 9 months, 1 year, etc) to complete this project. Given my mentor’s scheduleand the time it will take to receive IRB approval, I request that my research block begin on_____________________(insert date) and end on ______________________(insert date).As part of the research block I will present a brief 10 to 15 minute overview of the proposed project. At projectcompletion, I will present my data and provide a brief written review (i.e., one side of a page) and oralpresentation. These presentations will occur during the Friday GI Research Rounds conference and will becoordinated by Dr. Klaus Bielefeldt.____________________________________ ________________________Fellow Signature Date____________________________________ _________________________Research Mentor Signature Date____________________________________ _________________________Program Director Date 17
  18. 18. REQUIRED CONFERENCES:Fellows are required to attend the following conferences:Mandatory for Conference Name PIF # Description Day Time Frequency FellowsYes State-of-the-Art 13001 Core curriculum Tues. & 7:30 – 8/mo. in summer for a total of Lecture Series: Thurs. 8:30 am 16 summer programs Summer Core Curri- culum ConferenceYes Medical Grand 13001 Core curriculum Fri. 11:00 – 4/mo. Rounds 12:00 nYes GI Grand Rounds 13001 Core curriculum Wed. 5:00 – 4/mo. Sept. thru June 6:15 pmYes Tuesday Morning 13001 Core curriculum Tues. 7:30 – 1/mo. Educational 8:30 am (endoscopy confr. = Conference: Patho- 1/quarter) physiology/Clinical (incl. Endoscopy Conference)Yes Tuesday Morning 13004 Basic science Tues. 7:30 – 1/mo. or more Educational Confr.: 8:30 am Pathophysiology/ Basic ScienceYes Tuesday Morning 13010 Journal club Tues. 7:30 – 2/mo. Educational Confer- 8:30 am ence: Journal ClubYes Tuesday Morning 13013 M&M Tues. 7:30 – 1/quarter Educational Confe- 8:30 am rence: Morbidity & Mortality (M&M)Yes GI Pathology 13016 Multidisciplinary Wed. 7:30 – 1/mo. Conference clinical confr. 8:30 amYes GI Research Rounds 13007 Research Fri. 12:00 – 2/mo. 1:00 pmYes GI Motility/IBD 13016 Multidisciplinary Fri. 12:00 – 2/mo. Rounds clinical confr. 1:00 pmYes Hepatology 13016 Clinical confer- Wed. 7:30 – 4/mo. Conference & ence, journal 8:30 am 13010 club & liver pathologyFellows are required to attend the core conference series outlined on this page.The UPMC Health System offers many more conferences, and fellows are invited to any/all of these programs. Some additional non-required conferences which GI fellows regularly attend include: Hepatology Administrative & Research Meeting; Transplant Immuno-Pathology Conference, Pancreaticobiliary Conference, VMAC Liver Transplant Morbidity & Mortality Conference; Nutrition GrandRounds; VAMC Tumor Board; and the Esophageal Disorders Conference.Additional education concerning Palliative Medicine may be found at http://www.aahpm.org/cgi-bin/wkcgi/search?fastfact=1&search=1. 18
  19. 19. EVALUATIONThe Gastroenterology Fellowship Program uses an online evaluation system for most program evaluations. Fellows will be registered foraccess to www.myevaluations.com when starting the program, and fellows will be expected to complete all evaluation submissiondeadlines throughout their fellowship experience. Faculty attendings also use the myevaluations.com for fellow reviews. Automaticreminders are e-mailed to any reviewer who does not meet the submission deadlines, and these reminders continue to be sent until theevaluator completes his/her evaluations. If a reviewer ranks a comment poorly, the program director is automatically informed of thisranking, so that he may take immediate and appropriate action to improve the issue.Evaluations to be completed through the myevaluations.com program include: Fellow evaluation of faculty – completed for each rotation. Faculty evaluation of fellows – completed for each rotation. Fellow global evaluations of peers – completed semi-annually. Other medical professional and staff global evaluations of fellows – completed semi-annually.Evaluations to be complete via hardcopy forms include: Fellow evaluation of program and faculty – completed annually (June). (This is a confidential evaluation, and only aggregate scores and comments are shared with reviewing leadership. If a fellows asks for a comment to not be shared, this comment will not be shared.) Faculty evaluation of program and fellows – completed annually (June). Patient evaluations of fellows – completed annually (Spring). Procedure Practicum evaluation (i.e., direct observation) – completed semi-annually. Please see the following page for a sample of the Procedure Practicum.Fellows also take the AGA Gastroenterology Training Examination (GTE) annually (April). All fellows receive copies of their scoresdirectly with comparisons to internal and national scores of the fellows’ peers. GTE results may be used by the fellow to identify areas ofstrength and to attend to and improve lower score areas. Likewise, aggregate GTE results are used by the program director andprogram leadership to improve fellow education opportunities, conference topics and other areas based on any lower fellow GTE scores.Promotion Policy:Promotion of fellows from one year to the next is based on adequately fulfilling the goals and objectives set forth for Years I, II and III ofthe University of Pittsburgh GI Fellowship Program. All fellows must complete core competency requirements and meet the programgoals as stated in the GI Fellowship Program Training Manual. Determination of promotion will be confirmed by the Program Director atthe year-end (June) review meeting. 19
  20. 20. EVALUATIONProcedure Practicum: Direct Observation of Fellow by Supervising AttendingTwice per year (November/December and April/May), Year I and III fellows will receive a focused direct observationevaluation of procedural competency by a supervising attending. This evaluation will be performed on one upper endoscopyand one colonoscopy twice per year. Ideally, the evaluating attending is the fellow’s continuity clinic attending, and thispracticum should take place as part of a routine half day of procedures with that attending. However, the attendingevaluator may be the inpatient attending or other faculty.Given that competency develops over the three fellowship years, and certain aspects of procedural skills are learned withtime, the task being evaluated is followed by parentheses with an expectation for each year. Related to the colonoscopyprocedure, for example, insertion of scope into rectum should be achieved by all three years, whereas intubation of terminalileum is expected only of Year III fellows.At the completion of the evaluation, the attending will provide written and verbal feedback. For any areas “not competent,”the attending will discuss area(s) requiring remediation with the fellow and will repeat the evaluation at a later date afteradditional training has occurred (no more than eight weeks from original evaluation). If the fellow remains “not competent” ina certain area, further remediation and training will be provided by the program.Year III fellows are only required evaluation once (November/December). If deficiencies are identified at that time, additionaltraining will be administered by the program, and re-evaluation will occur in April.A copy of this direct observation evaluation, the Procedure Practicum, may be found on the following page. 20
  21. 21. The following is a sample of the Gastroenterology Fellowship Program’s direct observation evaluation form. See a reference and description of this form on the previous page of this manual. PROCEDURE PRACTICUM CHECKLISTFellow Name: _____________________________________ Year #: _____________Attending Evaluator: _____________________________________ Date: _____________ GENERAL TO ALL PROCEDURES: Procedure Activity Competent Not Competent Not ApplicableConsents the patient for the procedure appropriately,explaining risks, benefits and alternatives of procedure(Years I, II & III)Understands the safe and proper administration of sedation(Years I, II & III)Appropriate communication and orders given to nursing andtechnical staff (Year I, II & III)Generation of procedure report with appropriaterecommendations (Year I, II & III)Post-procedure review of findings and plan with patient andfamily/friend (Year I, II & III)Appropriate recognition of normal landmarks (e.g.,esophageal squamocolumar junction, appendiceal orifice)(Year II & III)Appropriate recognition of abnormal findings and actiontaken based on finding (Year II & III)When indicated, proper biopsy technique (Year II & III)Master scoping and patient manipulations to the degree thatpatient comfort is acceptable at the level of a beginningindependent gastroenterologist (Year II & III)When indicated, proper snare polypectomy (Year III) UPPER ENDOSCOPY Procedure Activity Competent Not Competent Not ApplicableSuccessful and safe intubation of the esophagus (Year I, II& III)Evaluation of esophagus and recognition of GE junction(Year I, II & III)Evaluation of stomach to the pylorus (Year I, II & III)Evaluation of duodenum to second portion (Year I, II & III)Appropriate retrieval of scope (Year I, II & III)Retroflexion of scope in stomach (Year II & III)Intubation of pylorus (Year II & III) COLONOSCOPY Procedure Activity Competent Not Competent Not ApplicableDigital rectal exam and insertion of scope into rectum (YearI, II & III)Passage of scope to the splenic flexure (Year I, II & III)Appropriate retrieval of scope and inspection of colon (YearI, II & III)Passage of scope to the hepatic flexure (Year II & III)Passage of scope to the cecum (Year II & III)Appropriate maneuvers utilized to reach cecum, (i.e.,pressure on abdomen, rolling patient, etc.) (Year II & III)Retroflexion of scope in rectum (Year II & III)Passage of scope to the ileum (Year III)COMMENTS: 21
  22. 22. EXTERNAL MEETING ATTENDANCE POLICYAttendance at national conferences is an important part of fellow career development. These meetings provide the opportunity topresent research, establish academic collaborations and meet thought leaders from other institutions. These meetings often includeDivision faculty as course directors, moderators or presenters and provide unique experiences for fellows.Attendance at these meetings is a privilege. Fellows not adhering to the Division’s professional and academic standards may losemeeting privileges.The following external meeting schedule is recommended for fellows:Year I Fellows  May attend one ASGE-sponsored (weekend) endoscopy course.  May attend either the ACG or AASLD meeting.Year II Fellows  May attend DDW or AASLD.  The program recommends DDW as the preferred meeting for Year II fellows.Year III Fellows  May attend one national conference.  May attend the autumn William Steinberg GI Board Review course.The program director, Dr. Regueiro, must approve requests for meeting attendance preferences different from those described above.While attending any meetings, fellows are responsible for arranging their own coverage, and this coverage plan must be approved by thechief fellow. Acceptable reasons for attending more than one meeting per year include: Presentation of research (oral presentation takes priority over poster presentation); Fellow’s research mentor indicates importance of the additional meeting for the fellow’s career, and the faculty mentor discusses this with the program director; and A fellow elects to go to more than one conference using his/her vacation time.Funding Support for Meeting Attendance: Fellow annual discretionary fund. This should be the primary funding source for GI fellow conference expenses. Fellow travel awards or grants. Fellow is responsible for his/her own award application. Research mentor funds. At the discretion of the fellow’s mentor. Program director fellowship funds or corporate grants. These allocations will be distributed at the discretion of the program director and should not be viewed as the primary funding source for fellow meeting expenses. 22
  23. 23. PROCEDURE LOG REQUIREMENTS TO COMPLETE GI FELLOWSHIP TRAININGThe ACGME requires fellows to complete the following number of procedures during the three training years. If there is no numberprovided in the following chart, this indicates that the ACGME does not require a specific number of these procedures; however, theUniversity of Pittsburgh GI Fellowship still requires fellows to conduct these procedures. Procedures Required for the Univ. of Pittsburgh GI Fellowship Program ACGME Procedure RequirementEsophagogastroduodenoscopy 130Esophageal Dilation 20Flexible Sigmoidoscopy 25Colonoscopy 140Colonoscopy with Polypectomy 30Percutaneous Liver Biopsy 20Percutaneous Endoscopic Gastrostomy 20Biopsy of the Mucosa of Esophagus, Stomach, Small Bowel & ColonGastrointestinal Motility Studies & 24-hr. pH MonitoringNonvariceal Hemostasis (upper & lower) 25 cases, including 10 active bleedersVariceal Hemostasis 20 cases, including 5 active bleedersOther Diagnostic & Therapeutic Procedures Utilizing Enteral Intubation (Enteroscopy,Ileoscopy)Moderate & Conscious SedationERCPEUSFellows are strongly encouraged to keep track of their procedures daily or weekly on their Eportfolio page. Or, the program offers anExcel program through which the fellows may track their procedures. If needed, fellows can complete hardcopy forms and may obtainthese forms from Helen Gibson, program coordinator. Please note that hardcopy procedures tracking is being phased out of thefellowship program and is not encouraged.Fellows are required to submit procedure log forms three times per year to Helen Gibson. During each of these procedure logsubmissions, fellows are required to submit: All procedures submitted since the last procedure log submission (i.e., the previous third of the year); and All procedures submitted since the start of their fellowship with a numerical total of each type of procedure. o As part of the tallied total procedure numbers, fellows are required to identify the “active bleeding” experiences for the variceal hemostatsis and nonvariceal hemostasis procedures.Dr. Regueiro, program director, will sign off on all procedure logs. 23
  24. 24. POLICY FOR INPATIENT PROCEDURES IN THE GI LABAttending Expectations: Start all inpatient procedures at 7:30 am WITHOUT the fellow (who will be at educational conferences). Eachnight, communicate the order in which the first two to three patients should be called down and whether MAC is required with the GI labnurse. MAC is NOT mandatory for every inpatient; this is at the discretion of the inpatient attending.Fellow Expectations: Fellows must consent the patient the night before and must write orders on the first two to three patients toensure that they are in the GI lab at the prespecified time (beginning at 7:30am) with working IV. Fellows must ensure that the prep isadequate and that blood products are administered (when indicated). Prior to leaving the hospital, a complete list of patients must bewritten on the GI lab sheet in order of priority (first two or three patients should match those already communicated by the attending tothe GI lab).GI Lab Expectations: The GI lab nurse will page the attending on GI/Liver the night before to discuss the first two to three patients ofthe day. The GI lab nurse will also page the Nutrition attending the night before to find out which cases will be done and will requireMAC (these will likely not start at 7:30am unless there is lab availability). The GI lab nurse will work with transport to ensure that patientsare ready and are in the room for the attending at 7:30am. The GI lab nurse will communicate with anesthesia about which patients arescheduled for MAC. The GI lab will not page the fellow between 7:30am and 8:30am Mon. through Fri. and will work directly with theinpatient attending.There will be exceptions to this policy such as emergencies coming in overnight which alter the schedule or personal emergencies thatdo not allow a start time of 7:30am, etc. In general, however, these guidelines should be followed. 24
  25. 25. MAGEE WOMENS HOSPITAL OFF-HOUR and WEEKEND EMERGENCY PROCEDURESTwo potential situations during which a consult would result in a procedure include:1. Procedure on demand (e.g., guaiac positive stool) or consult that requires non-emergent procedure: notify the Director, Dr. Abo, Monday-Friday AM 572-2253 or covering physician 641-2135.2. Consult that requires emergency procedure (see below).If procedure needs to be done emergently then:1. Move patient to ICU if not already there.2. If MAC needed and patient not intubated, contact Anesthesia for possible OR case (unlikely to be needed).3. Call Clinician on duty (this is the head nurse in the hospital who will call the GI nurse/tech to come in) either through operator 412-641-1000 or cell 412-641-2792.4. Tell Clinician on duty or nurse/tech what procedure is needed and what scopes are to be brought by the team.Contact Attending Physician:1. If attending has privileges then proceed.2. If attending does not have privileges, call the clinician on duty to obtain emergency privileges. Clinician on duty will obtain emergency privileges from the Administrator on duty.Consent for procedure must be co-signed by attending.After procedure1. Procedure notes.2. Dictate procedure into MARS.Notify Director, Dr. Abo, in AM of the procedure.Fellows may park in the Magee driveway circle or in the garage and have their tickets validated.The GI service is purely consultative at Magee, and patients are admitted to the CCM/hospitalist service. 25
  26. 26. SERVICES TO ADDRESS STRESS, FATIGUE AND RELATED GI FELLOW NEEDSIf day-to-day patient care is unusually difficult or prolonged, or if a related emergency occurs, a fellow should inform the chief fellow and/or the GI fellowship program director immediately. A fellow on a research rotation may be pulled to cover the emergency situation. If nofellows are available, a Division faculty member will provide coverage.If a fellow is unable to perform work due to stress, the program director may remove the fellow for extended rest and, if necessary,counseling. The fellow may be referred to the Resident Fellow Assistance Program (RFAP). RFAP’s phone # is (412) 647-3669.Additional information to help fellows to manage stress, fatigue and life/career issues may be found at > http://www.lifecurriculum.infoFellow Mentoring:Mentoring is important to ensure successful assimilation in the training program and enjoyment with the experience. Successfulassimilation will decrease stress and related negative factors that could inhibit graduation success.Selected Year II and Year III fellows will mentor Year I fellows for the first six months (i.e., July thru Dec.). Fellow mentors will be chosenat the discretion of the chief fellow. Fellow mentoring activities will be informal and flexible, depending on new fellows’ needs. Facultymentors will be matched to new fellows as well. At the end of Year I, fellows will also receive additional faculty research mentors. 26
  27. 27. CURRICULUM VITAE (CV)Fellows are required to update CV’s three times per year and submit them to Helen Gibson, program coordinator. A CV preparationguideline for fellows follows: University of Pittsburgh School of Medicine Division of Gastroenterology, Hepatology and Nutrition Gastroenterology Fellow Curriculum Vitae Format Guidelines List your last revision date on the front page of the CV (see page bottom). BIOGRAPHICALName: Birth Date:Home Address: Birth Place:Home Phone: Citizenship:Business Address: E-mail Address:Business Phone: Business Fax: Spouse Name: EDUCATION and TRAINING List entries in each section chronologically with the oldest information first and the newest information last.UNDERGRADUATE:Dates Attended Name & Location Degree Received Major Subject of Institution & YearGRADUATE:Dates Attended Name & Location Degree Received Major Advisor of Institution & Year & DisciplinePOSTGRADUATE:Include internships, residencies, fellowships and/or any other professional training experiences.Dates Attended Name & Location Name of Program Director of Institution & DisciplineACADEMIC:Years Inclusive Name & Location of Rank/Title Institution or Organization *Visiting prefix must be used if faculty member has been appointed pending committee review or position approval.NON-ACADEMIC:Include military or other government serviceYears Inclusive Name & Location of Rank/Title or Position Institution or Organization Revised: _____________ 27
  28. 28. CERTIFICATION and LICENSURESPECIALITY CERTIFICATION:Certifying Board YearMEDICAL or OTHER PROFESSIONAL LICENSURE:Licensing Board/State Year MEMBERSHIPS in PROFESSIONAL and SCIENTIFIC SOCIETIESOrganization Year HONORSTitle of Award Year PUBLICATIONS List the following categories separately and use the approved citation format. List entries in each section chronologically with the oldest information first and the newest information last. Refereed Articles  Refereed articles must be listed separately  Do not list articles submitted or in preparation  Publications must be numbered  Bold face your name when there are multiple authors  Use Index Medicus citation format.  List all authors. Do not use “et al”  Letters to the Editor should be included under “Other Publications” Reviews, Invited Published Papers, Proceedings of Conference and Symposia, Monographs, Books and Book Chapters Published Abstracts Other PublicationsSample Refereed Listings:1. Smith PJ, Jones WJ, Jackson AN. Name of article here with only first letter capitalized. American Journal of Gastroenterology 1993;341(1):244-5.2. Jackson AN, Samuels RR. Identification of nuclear matrix proteins. Gastroenterology 2003;256:14-27. PROFESSIONAL ACTIVITIESTEACHING:Provide a summary of courses and tutorials taught and include numbers and types of students taught, contact hours, number of lectures,etc. Provide other lectures and seminars too.Include ALL teaching and educational presentations, including Journal Club, GI Grand Rounds, Pathology Conference, web case writing/development, etc. Also include any presentations at any outside program (e.g., Division CME programs, nonprofit medical presentations(CCFA, NPF, etc.) and teaching medical school trainees. Please also include a list of exams taken.See the following examples for educational listings: 28
  29. 29. 2002, November Crohn’s and Colitis Foundation of America, Patient and Family IBD Educational Conference. Clinical Trials for the IBD patient. Sheraton Station Square, Pittsburgh.2002, December CME Symposium. University of Pittsburgh, Department of Gastroenterology, Hepatology and Nutrition GI Course, The Cutting Edge in Gastroenterology; Update in IBD Therapy. Pittsburgh, PA.2003, January Journal Club. University of Pittsburgh, Department of Gastroenteroology, Hepatology and Nutrition The Secrets of Pain. Pittsburgh, PARESEARCH:When listing funding, it is advisable to include the total dollar amount (direct plus indirect costs).Grant Role in Project & Years Source & Percentage of Effort Inclusive $ AmountCurrent Grant Support:Seminars and Invited Lectureships Related to Your Research:Fellows: The research information outlined above mostly pertains to Division faculty. Please consider the following when preparing theresearch section of your current CV:Project Mentor Dates Publications Resulting Awards Resulting from Project from ProjectLIST OF CURRENT RESEARCH INTERESTS:This can be a bullet-point list.SERVICE:University and Medical SchoolInclude committee service and chairmanships, administrative appointments and assignments.Community Activities 29
  30. 30. ADHERENCE TO ACGME CORE COMPENTENCIESAll University of Pittsburgh’s Gastroenterology Fellowship Program clinical rotations integrate the following core competencies into alleducational offerings. Gastroenterology fellows are required to obtain competence in the six areas listed below to the level expected of anew practitioner. The University of Pittsburgh defines the specific knowledge, skills, behaviors, and attitudes required, and provideseducational experiences as needed in order for gastroenterology fellows to demonstrate the following:1. Patient care that is compassionate, appropriate, and effective for the treatment of health programs and the promotion of health;2. Medical knowledge about established and evolving biomedical, clinical, and cognate sciences, as well as the application of this knowledge to patient care;3. Practice-based learning and improvement that involves the investigation and evaluation of care for their patients, and the appraisal and assimilation of scientific evidence, and improvements in patient care;4. Interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and other health professionals;5. Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to patients of diverse backgrounds; and6. Systems-based practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. 30
  31. 31. GI FELLOW CURRICULUM: Rotation Goals and Responsibilities 31
  32. 32. GI Hospital Service Curriculum for Year I, II & III FellowsEducational Purpose:The GI Hospital Service introduces the fellow to inpatient hospital management of patients with gastrointestinal diseases. During thisperiod, the fellow will have the opportunity to assess a wide variety of acute and chronic gastrointestinal conditions. The fellow willparticipate in increasing levels of management/ treatment involvement with patient needs and procedures, depending on the fellow’slevel of experience. The fellow will be expected to formulate the differential diagnosis, institute diagnostic studies and recommendtherapy. The amount of learning obtained from this rotation is directly proportional to the amount of time spent in the evaluation of thepatients.Objectives:Fellows will learn all aspects of inpatient gastrointestinal care and will display all general competencies during this experience. Minimumlevels of achievement in each competency are expected during each of the three years of fellowship training. Those meetingcompetency will receive a score of 5 in the program’s evaluation system. Fellows performing at a level better than expected for thatcompetency receive a score of 6 or 7 in the evaluation system, those at a level better than most fellows at that PGY receive an 8, andthose performing at a level deemed to be “one of the best fellows ever observed” will receive a score of 9. Fellows receiving a score of 4or below are deemed deficient in that competency; this will be brought to the attention of the program director immediately, and, ifnecessary, remediation will be implemented.The following are the goals and objectives for each competency at each level of training for the GI Hospital Service: Year I Fellow:Goal: A Year I fellow should be able to assess new patient problems, formulate and execute a treatment plan with guidance and teachbasic gastroenterology skills to medical students and other trainees. Year I fellows should begin to develop basic proceduralcompetencies in diagnostic upper endoscopy and colonoscopy.Patient Care Objectives: Perform an accurate physical examination and present information concisely with an initial assessment plan. Follow the patient’s disease course during the patient’s hospital stay. With attending consultation, formulate and execute an impression and a list of recommendations for the primary service. When indicated, consent patients for procedures and order appropriate diagnostic tests (e.g., endoscopy, radiologic tests, etc.) in conjunction with the primary/referring service. Perform with supervision the following basic gastroenterology procedures (see practicum): o Colonoscopy  By completion of Year I a fellow should be able to perform a diagnostic colonoscopy to the cecum with limited assistance. o EsophagoGastroDuodenoscopy (EGD or Upper Endoscopy)  By completion of Year I a fellow should be able to perform a diagnostic endoscopy to the second portion of the duodenum. Develop expertise in the diagnosis and management of acute and chronic inpatient gastrointestinal diseases including: o Upper & lower GI bleeding o Peptic ulcer disease o GI infections o Ischemic colitis. Learn to provide inpatient care that is safe and compassionate and to develop the ability to thoroughly and clearly educate the inpatient in the relevant areas of disease prevention, detection, progression and therapy to promote gastrointestinal health.Medical Knowledge Objectives: Attend core conferences and teaching rounds to learn the pathophysiology, epidemiology, disease management and procedure and medicine management skills for common and uncommon inpatient gastrointestinal diseases including: o Upper & lower GI bleeding o Peptic ulcer disease o GI infections o Ischemic colitis. Accumulate and begin to solve the issues that he/she encounters from other trainees, attendings and related medical professionals. Teach medical students the basics of gastroenterology and hepatology care. Achieve an average percentile score of at least 61.18on the “General” section of the in-service Gastroenterology Training Examination (GTE) exam. This score is the national average on this exam for Year I fellows. By end of Year I, pass the Internal Medicine Board Examination. 32
  33. 33. Practice-Based Learning Objectives: Become familiar with the concepts of quality improvement. Participate in conferences such as M&M, geared to the programmatic review of adverse events. Begin to review, analyze and utilize scientific evidence from the gastrointestinal literature for the management of GI patients. Learn the best practice patterns to facilitate gastroenterology care through clinic operating procedures and patient interactions.Interpersonal Communication Skill Objectives: Interview patients and family members accurately, patiently and compassionately and present information in an understandable and compassionate manner. Convey bad news compassionately and honestly. Learn to communicate effectively with staff, peers, attending gastroenterologists, referring physicians and other consultants.Professionalism Objectives: Learn to understand and demonstrate professional behavior in daily activities. Participate in professionalism-based learning activities through conferences. Learn to interact collegially with his/her peer group and other healthcare professionals. Learn to practice ethical principles with relation to patient care and confidentiality. Learn to practice appropriate interactions with pharmaceutical representatives and be unbiased in prescribing habits. Learn to be sensitive to cultural, age, gender and disability issues. Cross-cover colleagues’ services when needed and conduct this coverage carefully with appropriate feedback to responsible colleagues. Participate in program planning, including annual Faculty Meeting attendance, Fellow Curriculum Committee participation and Program Director meetings when requested.Systems-Based Practice Objectives: Attend conferences concerning healthcare system patient management and components of systems of healthcare. Achieve basic understanding of healthcare systems related to gastroenterology care and overall system activities. Learn proper documentation and billing skills to practice cost-effective care. Develop and become familiar with the e-portfolio system for personal documentation management, communication with mentors and other collaborators and related fellowship program documentation. Utilize an appropriate range of healthcare professionals to care for patients, working closely with socials services to maximize patient care and understanding the role of hospice, referring appropriately when needed. Begin involvement to understand the standard operating procedures and quality improvement initiatives within the hospital. Attend national gastroenterology conferences (e.g., ACG and endoscopy training courses). Year II Fellow:Goal: A Year II fellow should learn to assess and care for a larger volume of patients and learn and teach basic textbook and evidence-based medicine to medical students and other trainees. Year II fellows should independently perform diagnostic upper endoscopy andcolonoscopy and begin to perform therapeutic maneuvers.Patient Care Objectives: Complete a time-efficient history and physical examination. Critique the work and orders of Year I fellows. Direct the Year I fellows successfully with the appropriate level of intervention for each trainee’s skills. Complete competency-level performance of the following basic gastroenterology procedures (see practicum checklist): o Colonoscopy  By completion of Year II, master all Year I colonoscopic skill requirements. Additionally, perform endoscopic maneuvers, including snare polypectomy and begin to develop competency in control of GI bleeding: sclerotherapy and thermal coagulopathy of bleeding vessels. o Upper Endoscopy  By completion of Year II, master all Year I upper endoscopic skill requirements. Additionally, begin to develop competency in performing therapeutic maneuvers: banding and sclerosing of varices, and sclerotherapy and thermal coagulopathy of bleeding vessels. Develop clear expertise in the diagnosis and management of acute and chronic inpatient gastrointestinal diseases including: o Neuroendocrine diagnosis o Intestinal/colonic pseudobstruction o Secretory diarrheal states o Idiopathic abdominal pain o Upper & lower GI bleeding o Peptic ulcer disease 33
  34. 34. o Inflammatory bowel disease o GI infections o Pancreatitis o Ischemic colitis Present cases succinctly in a direct manner. Know the GI Hospital Service’s patients at a management level. Handle consult calls respectfully and appropriately. Teach good symptom management skills to medical students and other trainees. Provide inpatient care that is safe and compassionate and develop the ability to thoroughly and clearly educate the inpatient in the relevant areas of disease prevention, detection, progression and therapy to promote gastrointestinal health.Medical Knowledge Objectives: Begin to take a leadership role at core conferences and teaching rounds regarding the pathophysiology, epidemiology, disease management and procedures and medicine management skills for common and uncommon inpatient gastrointestinal diseases including: o Neuroendocrine diagnosis o Intestinal/colonic pseudobstruction o Secretory diarrheal states o Idiopathic abdominal pain o Upper & lower GI bleeding o Peptic ulcer disease o Inflammatory bowel disease o GI infections o Pancreatitis o Ischemic colitis Organize the team’s performance at teaching rounds. Read textbook and pertinent literature materials concerning problems encountered. Teach medical students and other trainees about GI disease states and patient management. Achieve an average percentile score of at least 62.98 on the “General” section of the in-service Gastroenterology Training Examination (GTE) exam. This score is the national average on this exam for Year II fellows.Practice-Based Learning Objectives: Participate in project groups, committees and hospital groups when requested. Participate in programmatic reviews and conferences studying adverse events. Give usable feedback to medical students and other trainees based on observation of their performance and assess improvement. Participate in problem-based quality improvement projects. Review, analyze and utilize scientific evidence from the gastrointestinal literature for the management of GI patients. Know the best practice patterns to facilitate gastroenterology care through clinic operating procedures and patient interactions.Interpersonal Communication Skill Objectives: Interview patients and family members accurately, patiently and compassionately and present information in an understandable manner. Convey bad news compassionately and honestly. Plan patient and family conferences. Counsel patients about transitioning to palliative care, when needed. Address or refer patients related to spiritual or existential issues. Communicate effectively with staff, peers, attending gastroenterologists, referring physicians and other consultants. Present cases succinctly, in a problem-based, direct manner. Learn to become a teacher of gastroenterology to junior trainees, medical students and other healthcare professionals.Professionalism Objectives: Begin to mentor medical students, other trainees and Year I fellows in professional conduct. Understand and demonstrate professional behavior in daily activities. Participate in professionalism-based learning activities through conferences. Interact collegially with his/her peer group and other healthcare professionals, including acting responsibly in the larger context of pursuing programmatic successes. Practice ethical principles with relation to patient care and confidentiality. Practice interactions with pharmaceutical representatives and be unbiased in prescribing habits. Practice sensitivity to cultural, age, gender and disability issues. Cross-cover colleagues’ services when needed and conduct this coverage carefully with appropriate feedback to responsible colleagues. 34
  35. 35.  Participate in program planning, including annual Faculty Meeting attendance, Fellow Curriculum Committee participation and Program Director meetings, when requested.Systems-Based Practice Objectives: Attend conferences concerning healthcare system patient management and components of systems of healthcare. Understand and be able to work effectively related to hospital functions within UPMC and UPP. Understand and practice proper documentation and billing skills to practice cost-effective care. Use the program’s e-portfolio system for personal documentation management, communication with mentors and other collaborators and related fellowship program documentation. Assist other trainees in the utilization of appropriate healthcare resources for the best care of the GI Hospital Service’s patients. Model appropriate interactions in multidisciplinary planning, including standard operating procedures and quality improvement initiatives. Attend national gastroenterology or hepatology conferences (e.g., DDW or AASLD). Year III Fellows:Goal: The senior-level, Year III fellow should demonstrate rapid assessment and planning skills and near-attending level care planningand management, while teaching medical students and other trainees at near to or exceeding attending level teaching. Year III fellowsshould be able to perform diagnostic and therapeutic upper endoscopy and colonoscopy procedures independently.Patient Care Objectives: Master the Year II fellow objectives. Demonstrate efficient organization of the GI Hospital Service and a working knowledge of all patients. Demonstrate near-attending level capacity for program assessment and care planning. Attain trainer level proficiency in the following gastroenterology procedures pertinent to his/her career choices: o Colonoscopy  By completion of Year III, master all Year II colonoscopic skill requirements. Additionally, be able to independently intubate the terminal ileum and begin to develop independent mastery of more advanced maneuvers, e.g., removal of large or complex polyps by saline assisted polypectomy or piecemeal resection and control of bleeding using clips or argon plasma laser coagulation. o Upper Endoscopy  By completion of Year III, master all Year II endoscopic skill requirements. Additionally, be able to pass a side viewing scope to identify the papilla or lesions difficult to observe with forward viewing scope and perform advanced maneuvers, such as placing clips on bleeding vessels or argon plasma laser coagulopathy. Secure expertise in the diagnosis and management of acute and chronic inpatient gastrointestinal diseases including: o Neuroendocrine diagnosis o Intestinal/colonic pseudobstruction o Secretory diarrheal states o Idiopathic abdominal pain o Upper & lower GI bleeding o Peptic ulcer disease o Inflammatory bowel disease o GI infections o Pancreatitis o Ischemic colitis Provide inpatient care that is safe and compassionate with the leadership ability to thoroughly and clearly educate the inpatient and all other trainees regarding relevant areas of disease prevention, detection, progression and therapy to promote gastrointestinal health.Medical Knowledge Objectives: Access and critique the medical literature regarding gastroenterology and hepatology problems encountered. Assume the trainee leadership role at core conferences and teaching rounds regarding the pathophysiology, epidemiology, disease management, procedures and medicine management skills for common and uncommon inpatient gastrointestinal diseases including o Neuroendocrine diagnosis o Intestinal/colonic pseudobstruction o Secretory diarrheal states o Idiopathic abdominal pain o Upper & lower GI bleeding 35
  36. 36. o Peptic ulcer disease o Inflammatory bowel disease o GI infections o Pancreatitis o Ischemic colitis Teach medical students, other trainees and Year I & II fellows at near-attending level. Prepare for the ABIM certifying exam throughout the year. Organize team activities in a smooth and authoritative fashion. Assist Year II fellows’ development directly at teaching conferences and indirectly at work sites. Achieve an average percentile score of at least 64.07 on the “General” section of the in-service Gastroenterology Training Examination (GTE) exam. This score is the national average on this exam for Year III fellows.Practice-Based Learning Objectives: Demonstrate mastery of Year II fellow skills and encourage participation of colleagues. Review, analyze and utilize scientific evidence from the gastrointestinal literature for the management of GI patients, taking a leadership role in guiding Year I & II fellows and sharing relevant literature reviews with them. Know and be able to succinctly communicate the best practice patterns to facilitate gastroenterology care through clinic operating procedures and patient interactions.Interpersonal Communication Skill Objectives: Interview patients and family members accurately, patiently and compassionately and present information in an understandable manner. Convey bad news compassionately and honestly. Supervise Year I & II fellows’ work related to planning patient/family conferences and patient communications/counseling. Communicate effectively as a consultant with staff, peers, attending gastroenterologists, referring physicians and other consultants and lead other trainees related to appropriate fellow-to-medical-professional communications. Present cases succinctly, in a problem-based, direct manner. Assume the role of a teacher of gastroenterology to junior trainees, medical students and other healthcare professionals.Professionalism Objectives: Demonstrate proficiency in Year II objectives. Mentor medical students, other trainees and Year I fellows in professional conduct. Assist in formal teaching exercises as requested. Assert leadership in program planning, including fellow participation in the annual Faculty/Fellow Meeting, Fellow Curriculum Committee and Conference Planning Committees.Systems-Based Practice Objectives: Attend conferences concerning healthcare system patient management and components of systems of healthcare. Assist and mentor other trainees in utilization of appropriate UPMC/UPP healthcare resources for the best care of the GI Hospital Service’s patients, including proper documentation and billing skills. Use and train others on the program’s e-portfolio system for personal documentation management, communication with mentors and other collaborators and related fellowship program documentation. Model appropriate interactions in multidisciplinary planning, including improvements related to standard operating procedures and quality improvement initiatives. Participate in hospital and national medical association committees and multidisciplinary planning groups when requested. Attend national conferences directed at career goals. Demonstrate near-attending level utilization of overall systems of care.Teaching Methods:Gastroenterology fellows participate in the GI Hospital Service during all three fellowship years. Two fellows are assigned to the GIHospital Service during all rotations. Teaching of medical students, residents and other trainees as well as appropriate interactions withother healthcare providers are important aspects of this rotation. Participating in all required conferences is mandatory, and rounding isan integral part of this experience. As fellows gain experience throughout their training, skills of organization and efficiency as well asteam leadership become increasingly important.The GI Hospital Service experience will prepare the fellow to evaluate and manage acute and chronic gastrointestinal illnesses that willbe encountered in the fellow’s future practice. This rotation will expose the fellow to a wide variety of acute abdominal inflammatoryprocesses, major gastrointestinal hemorrhages, oncological emergencies and a wide variety of gastrointestinal problems.Fellows assigned to this service will evaluate all new consults at UPMC Presbyterian and Montefiore Hospitals and will be assigned to acontinuity clinic one-half day per week. They will present new consults to the attending by the following day for routine consults and assoon as possible for emergencies. Fellows will evaluate each patient and will make initial recommendations regarding diagnostic tests 36

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