9/03 RESIDENCY REVIEW COMMITTEE FOR PEDIATRICS 515 North State Street, Suite 2000, Chicago, Illinois 60610 PROGRAM INFORMATION FORM PEDIATRIC GASTROENTEROLOGYDATE OF APPLICATION:TITLE OF PROGRAM: Stanford University Program(Use first line of program listing on the ACGME Website for core Pediatrics program to which this program is attached.New Application: ( ) Accredited Program: ( X )Pediatric Gastroenterology Program Director Full Time: YES NONAME: John Alan Kerner, MD XTitle: Director of Nutrition; Professor of PediatricsAddress: Department of Pediatric Gastroenterology and Nutrition 750 Welch Road., Suite 116 Palo Alto, CA 94304E-mail Address: email@example.com or firstname.lastname@example.orgTelephone: (650) 723-5070 Fax: (650) 498-5608The signatures of the director of the program and the chief of the department attest to the completeness and accuracy of the informationprovided on these forms.Signature - Pediatric Gastroenterology Program Director Signature - Chief of Pediatrics/Department ChairmanSPONSORING INSTITUTION: (Name the entity, i.e., the university, hospital, or foundation that has administrative responsibility for thisprogram.)Name of Sponsor: Stanford UniversityAddress: 300 Pasteur Dr., Stanford CA 94304Name of Designated Institutional Official (Typed): Martha MarshSignature:If this is not a medical school program, is there an affiliation with a medical school: YES NOIf yes, name the medical school and append a document that specifically describes the effects of these arrangements onthis program. Label this Appendix C.Name of Medical School:
2PRIMARY HOSPITAL (Hospital 1)Name: Lucile Packard Children’s Hospital at StanfordAddress: 725 Welch Road City/State/ZIP: Palo Alto/CA/94304Total number of months pediatric gastroenterology trainee is 1st year: 9-11 2nd year: 2-11 3rd year: 2-11assigned to this institution in each year of training:Chief/Chair, Department of Pediatrics: Harvey J. Cohen, MD PhDFor each participating institution provide letters of agreement specifying the administrative and organizationalrelationships which bear upon the educational program. Attach as Appendix C.OTHER PARTICIPATING INSTITUTION (Hospital 2)Name: Stanford University HospitalAddress: 300 Pasteur Drive City/State/ZIP: Stanford/CA/94305Total number of months pediatric gastroenterology trainee is 1st year 0-2 2nd year 0-2 3rd year 0-2assigned to this institution in each year of training:Distance between 2 and 1 in Miles: 0 In Minutes: 0Is this hospital used for: (check appropriate Required Elective Other?box) rotations? rotations? XChief/Chair, Department of Pediatrics: Harvey J. Cohen, MD PhDOTHER PARTICIPATING INSTITUTION (Hospital 3)Name:Address: City/State/ZIP:Total number of months pediatric gastroenterology trainee is 1st year 2nd year 3rd yearassigned to this institution in each year of training:Distance between 3 and 1 in Miles: In Minutes:Is this hospital used for: (check Required Elective Other?appropriate box) Rotations? rotations?Chief/Chair, Department of Pediatrics:
3 DURATION OF TRAININGThe program requirements which were approved by the ACGME on February 16, 1993, contain the following paragraphregarding the duration of training:Two years of progressive educational experience is required, which includes the development of procedural skills,responsibility for patient care and participation in research. Any program that extends training beyond the minimumrequirements must present clear educational rationale consonant with the Program requirements and objectives forresidency training. The program director must obtain approval of the Residency Review Committee prior toimplementation and at each subsequent review of the program. Prior to entry in the program, each resident must benotified in writing of the required length of training.If you propose or offer a program of three years duration, please provide the educational rationale below. In doing so,make reference to both the Program requirements for Pediatric Gastroenterology and the Program Requirements forSubspecialties of Pediatric ProgramsOur program is of three years duration for the following reasons:1) Three years of full-time subspecialty residency training in pediatric Gastroenterology is required by the American Board ofPediatrics for those physicians entering training on or after January 1, 1990: a) Announcement of 1990 Pediatrics Gastroenterology Examination. b) Eligibility Criteria for Certification in Pediatrics Gastroenterology2) Because the majority of pediatric subspecialists practice in academic health centers, there is a need to provide greater emphasison research training as well as to strengthen the training in clinical care. To meet the goals stated above, our program is in agreementwith the American Academy of Pediatrics statement in their newsletter for Diplomates Volume 9 (1), July 1988 that three years arenecessary to provide the proper research foundation to succeed in academic pediatrics and to allow a greater clinical exposure as well. We begin the trainee’s research experience in the first year and continue that experience for the entire period of training in order toallow for the development of research skills and to bring a project to completion (thus, we are in compliance with “Requirements For AllAccredited Pediatric Subspecialties”).3) The ACGME program requirements for residency education in Pediatric Gastroenterology effective July 2002 requirethree years of progressive educational experience that includes the development of procedural skills, responsibility forpatient care, and participation in research. To meet these requirements, our program is three years in duration. We arecurrently accredited as a three year program and all fellows are provided this information in writing prior to entry in theprogram. SUBSPECIALTY RESIDENTSPrograms making initial application should provide ONLY THE INFORMATION marked by an asterisk (*) in the topsection of the of this page:*Number of positions offered: Year 1: 2 Year 2: 2 Year 3: 1Number of positions filled: Year 1: 2 Year 2: 2 Year 3: 1*Source of salary support for % from NIH: % from other non-federal % from hospital: 20%subspecialty residents: (Add programs: 60% (usually 40%)the salaries of all no current NIH funding 1) Pediatric Research Fundsubspecialty residents and (Packard Foundation) or 100% for year 1 for 4 of the 5indicate what percent of the 2) Transplant and Tissue Fellows (Dr. Lue’s fundingtotal is supplied by each of Engineering Center of Excellence comes from his endowed Fellowship and Endowment Fund. fellowship)the following services:) 3) Paul and Yuanabi Ramsey Endowed Fellowship – Full funding for 3 years for Dr. James Lue. % from other federal % from practice-generated % from other: 20% programs: None income: Endowed Fellowship*Does the program have a funded training grant? None *If YES (until 6/30/2003) NOyes, supply the following: *If yes, supply the following:*Grant: 2 T32 *Amount: $155,000/yr. *Project Director: John Kerner, M.D.HD07397-21 7/1/98 – 6/30/03NIH: NIDDK grant ended 6/30/2003
4 CURRENT SUBSPECIALTY RESIDENTSProvide the following information regarding the current subspecialty residents in the program: Date began Name of ACGME- Name gastroenterolog accredited pediatric Date of Date of y program residency program completion Name of medical graduation completed school Lue, James 7/2006 Children’s Hospital 6/06 University of California 5/03 Los Angeles, CA @ San Francisco, CA Talisetti, Anita 7/2006 University of Illinois 6/05 M.S. Ramaiah 3/00 Chicago, IL Teaching Hospital Bangalor, India Wong, Allison 7/2005 University of California 6/05 Keck School of 5/1/02 Davis, CA Medicine University of Southern California Los Angeles, CA Mian, Sameera 7/2005 University of Nevada 6/05 St. George University 6/1/02 Reno, NV St. George’s, Grenada 7/2004 University of Illinois 6/04 University De Med Si 10/1/1998 Safta, Anca Chicago, IL Farm Carol Davila, Bucharest, Romania
4a GRADUATES OF THE PROGRAM Total number of graduates of the program in the last five years: 7Provide the following information regarding the subspecialty residents who have completed the program in the last five years. Useadditional pages as necessary, numbered 4a, 4b, etc. Include name, present location, present position, type of practice, if sub-board certification in pediatric gastroenterology has been achieved. Date completed Sub-BoardGraduates of Last 5 Years gastroenterology Present Location Present Position Type of Practice Certification program Norberto Rodriguez, M.D. 6/30/2001 University of Texas, Assistant Professor Academic Peds G-I 2003 Southwestern Director of Pediatric GI Fellowship C. Allan Pratt, M.D. 6/30/2002 Anchorage, Alaska Gastroenterologist Private Practice Peds G-I 2005 Yinka Davies, M.D. 6/30/2003 Sutter Memorial Gastroenterologist Private Practice Board Eligible Medical Center Sacramento, CA Melissa Hurwitz, M.D. 6/30/04 Stanford University Clinical Assistant Academic Board Eligible Medical Center Professor 6/30/2005 Legacy Emanuel Gastroenterologist Staff Physician Peds G-I 2005 Matthew Riley, M.D. Children’s Hospital Portland, Oregon Jacqueline Fridge, M.B., 6/30/03 Oakland Children’s Gastroenterologist/ Staff Physician/ Peds G-I 2005 Ch.B., M.B.A. Hospital Adjunct Clinical Academic Oakland, CA/ Assistant Professor Lucile Packard Children’s Hospital Phuong Christine Nguyen, 9/15/2006 California Pacific Gastroenterologist/Ad Staff Physician/ Board Eligible M.D. Medical Center junct Clinical Academic San Francisco, CA/ Instructor Stanford University Medical Center
5 PROGRAM FACULTY Program Requirements for Subspecialties of Pediatrics, IV Program Requirements Pediatric Gastroenterology, VA. PROGRAM DIRECTOR Explain how the program director meets the Program requirements with regard to: a) Board and Sub-board certification; b) demonstrated competence as a teacher and researcher; and, c) Adequate administrative experience to direct the program.a) Board and Sub-board Certification:Dr. Kerner has been a faculty member in Pediatric Gastroenterology since 1979 at Stanford University School of Medicine. He was board certified in Pediatrics in 1979. He wasboard certified in Pediatric Gastroenterology in 1990. He was recertified in Pediatric Gastroenterology in 1998 and again in 2005.b) Demonstrated Competence as a Teacher and Researcher:Dr. Kerner has received three prestigious teaching awards: a) named by the Pediatric Housestaff as the Pediatric Faculty Member Who Contributed Most to Housestaff Teaching(6/81); b) Kaiser Award for Innovative and Outstanding Contributions to Medical Education at Stanford University Medical School (6/87); c) Joseph St. Geme Education Award fromthe Western Society of Pediatric Research (1/03). Dr, Kerner was a featured speaker at the National Medical Association Meetings (8/92) and at the American Academy ofPediatrics Annual Meeting (10/92) where he taught a G-I Review and Update Course. He also taught at the Northwestern American Society for Parenteral and Enteral Nutrition(ASPEN) (10/92) and at the Arizona Chapter of ASPEN the year prior. His C.V. highlights several recent lectures at major meetings. He is also the director of the highly successfulinterdisciplinary course, “Advances in Perinatal and Pediatric Nutrition,” currently in its 18th year. He has developed a core curriculum for pediatric house staff in PediatricGastroenterology and Nutrition. His C.V. demonstrates both significant collaborative and independent research endeavors and evidence of ongoing research funding. He has alsodeveloped teaching materials for pediatric housestaff. He is the principal investigator of an NIH grant, a Nutrition Academic Award, to develop a web-based nutrition curriculum forStanford Medical Students (~$800,000 for 2000-2006). He also has current internal funding for “Aluminum Toxicity in Patients Receiving TPN”.c) Administrative ExperienceDr. Kerner directed or co-directed the Pediatric G-I program from 1979 – 1994. Since 1995 he has served as the Associate Director of the Division. He served as the director of theCalifornia Children’s Service (CCS) Designated G-I Center from 1979 – 1994. He currently chairs two committees at the Lucile Packard Children’s Hospital at Stanford – 1) Nutritionand Total Parenteral Nutrition Committee; 2) Home Health Care Committee. He has continuously participated in Quality Assurance and Quality Improvement Monitoring of thePediatric Gastroenterology Division. He currently directs the division’s teaching of both pediatric residents and medical students. Further, he currently serves as Medical Director ofthe Home Pharmacy of Lucile Packard Children’s Hospital at Stanford (LPCH). He also serves as the physician Director of the Nutrition Support Team at LPCH. If not certified by the American Board of Pediatrics Sub-board of Pediatric Gastroenterology, provide evidence of equivalent qualifications. Use an additional page numbered as page 5a to include your answer. Do not exceed one page.
B. FACULTY List below the faculty members who are direct contributors to the program, including the program director. List the gastroenterologists first. Time on gastroenterology teaching service should include the total of time spent providing instruction, supervising inpatient and outpatient experiences and supervising consultation experiences. Also include and identify any research mentors who participate in training. Duplicate this page if necessary. Time on gastroenterology teaching Certification service Location: Name Primary specialty Hospital 1, 2, 3 Hrs. per week Wks. per year Pediatrics Recertification Specify other (yr.) (yr.) board & year Pediatric Peds GI 1995 Dorsey Bass 50 - 60 48 1 1987 Gastroenterology recert. 2001 William Berquist Pediatric 50 - 60 48 1 1980 Peds GI 1990, Gastroenterology recert. 1998, 2005 Pediatric Peds GI 1990 Ken Cox 50 - 60 48 1 1977 Gastroenterology recert 1998, 2005 Pediatric Ricardo Castillo 50 - 60 48 1 1981 Peds GI 1995 Gastroenterology Pediatric Manuel Garcia 50 - 60 48 1 1995 Peds GI 2001 Gastroenterology Pediatric Melissa Hurwitz 50 - 60 48 1 2000 Gastroenterology Pediatric Peds GI 1990, John Kerner 50 - 60 48 1 1979 Gastroenterology recert. 1998, 2005 Pediatric Peds GI 1997 Eric Sibley 50 - 60 48 1 1994 2000 Gastroenterology recert 2005 American Board of Carlos Esquivel Liver Transplantation 50 - 60 48 1,2 ------ Surgery 1985 Internal Medicine Emmet Keefe Adult 2 ------ 1972 Gastroenterology Gastro-enterology 1975For each of those listed above, provide details of the individuals role in the pediatric gastroenterology training program. If not certified in pediatric gastroenterology, provide evidenceof equivalent qualifications. Specify the type of contact with the subspecialty residents, e.g., lectures, group discussions, ward rounds, laboratory supervision, patient care activities,consultations. Indicate clearly how the reported time is distributed. Include research mentors. Use additional pages as needed, numbered as 5b, 5c, etc.C. CURRICULUM VITAE 1. Attach as Appendix A the program directors full curriculum vitae and complete bibliography of articles in peer-reviewed journals. 2. For faculty members listed on the chart above, other than the program director, attach curriculum vitae using the CV format contained on the page identified as Appendix B at the end of this form and follow its instructions.Contributing Faculty MembersJohn A. Kerner, Jr., M.D. is the director of the Fellowship Training Program. Currently, Dr. Kerner is the G-I inpatient attending for 15 weeks/year as well
as an Attending in the Tuesday afternoon and the Thursday all-day Pediatric G-I clinic all year. He also covers the Wednesday Acute (Urgent) Clinic for13 weeks/year. In those roles, Dr. Kerner supervises the G-I resident(s) and pediatric house officers with patient care responsibilities and directlysupervises the G-I resident(s) for any G-I procedures. In addition, Dr. Kerner coordinates the lecture series for the G-I/Nutrition component of the NoonLecture Series for housestaff, students, and G-I residents. He leads group discussions and conducts rounds during his time on clinical service andparticipates in the G-I/Nutrition teaching for the pediatric residents’ “Morning Report” all year long. He has served as a mentor for G-I residents involvedin clinical research. He has consistently had private funding for clinical research (see his C.V.). His research interest is in the area of neonatal andchildhood nutrition and nutrition support. He has had recent grant funding from Genentech to evaluate the effect of alteplase on the clearance ofoccluded central venous catheters. He has a NIH Nutrition Academic Award (2000-2006) to develop a web-based nutrition curriculum for Stanfordmedical students. He has internal funding by LPCH to study “Potential for Aluminum Toxicity in Pediatric Patients on TPN”. He gives regular lectures tothe G-I residents and pediatric house staff on total parenteral nutrition and nutrition support issues.Ricardo O. Castillo, M.D. joined the division in 1985 as the Co-Director of Pediatric Gastroenterology and served in that capacity through 1994. he is theMedical Director of the Pediatric Small Bowel Transplant Program and Director of the Program in Intestinal Rehabilitation. He is an attending in theMonday afternoon G-I clinic all year. While serving as the inpatient attending, his clinical and teaching responsibilities are identical to Dr. Kerner’s. Heserves as Inpatient Attending on the Gastroenterology Service for 2 weeks per year and as the Liver Transplant Service Attending 15 weeks per year.He also participates in the Noon Lecture Series and Morning Report. He has served as a mentor for G-I residents pursuing basic science projects andhas an active laboratory. He has had R01 NIH Grant support in the past. His current research focus is on aspects of small bowel transplantation. Dr.Castillo is board certified in Pediatrics and in Pediatric G-I.Dorsey M. Bass, M.D. joined the division in 1990 after completing a post-doctorate research fellowship with Dr. Harry Greenberg at Stanford. He iscurrently the G-I inpatient attending for 15 weeks/year , Liver Transplant Service* attending for 5 weeks/year, as well as attending for Tuesday afternoon,Friday morning, and Friday afternoon G-I clinic all year. As the inpatient attending, his clinical and teaching responsibilities are identical to Dr. Kerner’s.He also participates in the Noon Lecture Series and Morning Report. Dr. Bass is in the process of developing an Inflammatory Bowel Center at ourhospital. He is a potential basic science mentor for G-I residents. His research interest is in the area of viral gastroenteritis. Dr. Bass is board certifiedin Pediatrics and in Pediatric G-I. He gives lectures to medical students (in Medical Microbiology) and our G-I residents on various aspects ofgastrointestinal infections.Manuel Garcia, M.D. joined the division in 1991. Currently, he is the G-I inpatient attending for 4 weeks/year. He also attends the all day Monday G-Iclinic all year. While he serves as the G-I inpatient attending, his clinical and teaching responsibilities are identical to Dr. Kerner’s. He also participatesin the Noon Lecture Series and Morning Report. He spends 75% of his time at Santa Clara Valley Medical Center (SCVMC) providing pediatric G-Iservices there. SCVMC is a affiliated hospital of Stanford University Medical Center. Dr. Garcia is board certified in Pediatrics and in Pediatric G-I.Eric Sibley, M.D., Ph.D. joined the GI division, after completion of his fellowship at Stanford, in 1996 and is associate director (research) of theFellowship Training Program. He is the GI inpatient attending for 4 weeks per year and attends in the Friday afternoon G-I clinic all year. While servingas inpatient attending, his clinical and teaching responsibilities are identical to Dr. Kerner’s. He also participates in the Noon Lecture Series and MorningReport. He is a potential basic science mentor for pediatric G-I residents. He has had steady research funding and recently was awarded a prestigiousNIH grant, “Spatiotemporal Regulation of Intestinal Gene Expression” for 2003 though 2008. Dr. Sibley is board certified in Pediatrics and in PediatricG-I. He has recently been promoted to Associate Professor with tenure (a major distinction at Stanford). Dr. Sibley regularly lectures to Stanfordmedical students and our G-I residents on G-I physiology and pathology as well as on G-I tract development.William Berquist, M.D. joined the G-I division in 1995. He currently covers the G-I inpatient services for 8 weeks/year; he covers the Liver transplantservice for an additional 12 weeks. While he is inpatient attending, his clinical and teaching responsibilities are identical to Dr. Kerner’s. Like the rest ofthe G-I faculty, he also participates in the Noon Lecture Series and Morning Report. He attends the Monday afternoon and Thursday clinics all year. Heis the Medical Director of the Ambulatory Procedure Unit where virtually all G-I procedures take place; he is also the Medical Director of Pediatric LiverTransplant. He is the principle teacher of motility disorders for the G-I residents. He gives regular lectures on motility and other procedure related topicsfor the G-I residents. He has significant NIH grant support to perform studies in Pediatric Liver Transplantation. Dr. Berquist is a potential clinicalresearch mentor for G-I residents. Additionally, he runs a support group for children with inflammatory bowel disease (and their parents) which takesplace one evening per month. The G-I resident has the opportunity to observe and participate in the support group. Dr. Berquist is board certified inPediatrics and in Pediatric G-I.Kenneth Cox, M.D. joined the G-I division as Division Chief in 1995. He serves as inpatient Liver Transplant service attending for 9 weeks/year and G-I
service attending for 3 weeks/year.. He also attends in the Monday G-I clinic all year. While serving as inpatient attending, his clinical and teachingactivities are similar to Dr. Kerner’s. He participates in the Noon Lecture Series and Morning Report. He runs the weekly G-I division conference (8 –9am) each Monday where the following are reviewed: 1) weekend phone calls; 2) current status of all G-I and Liver Inpatients as well as all active G-I/liver consults; 3) Pediatric surgical issues; 4) Quality Assurance (QA) Issues; 5) Review of the upcoming week’s admissions, clinics and procedures. Dr. Cox has had research funding in the area of family centered care and has received recent support to evaluate the role of microflora in healthychildren and patients with sclerosing cholangitis and biliary atresia. He is a potential clinical research mentor for G-I residents.He is board certified inPediatrics and in Pediatric G-I. Dr. Cox regularly lectures to the G-I residents in the area of hepatology and liver transplant.Melissa Hurwitz, M.D. joined the faculty in July 2004 as Clinical Assistant Professor in the Clinician-Educator line. She serves as an Attending in G-I Clinic onMondays all day and Tuesday afternoon all year. She serves as inpatient Liver Transplant attending for 16 weeks/year. She is board certified in Pediatrics and willbe taking the Pediatric G-I Boards in 2007. She also serves as attending in Liver Transplant Clinic and the Intestinal Transplant Clinic. Additionally, she runs a G-Iclinic at SCVMC on Wednesdays all year when she is not inpatient liver transplant attending. She is involved in actively teaching the G-I residents, including Fridaynoon lectures (most recently on Autoimmune Hepatitis).Drs. Berquist, Castillo, Cox, and Hurwitz regularly rotate through both the Liver Transplant Clinic and Small Bowel Transplant Clinic and are directly involved inteaching our G-I residents in these clinics.Carlos Esquivel, M.D. is the Director of Adult and Pediatric Liver and Small Bowel Transplant Programs. He covers the surgical component of theTransplant program approximately 16 weeks per year. When on service, he rounds at least daily with the transplant surgery team and the pediatrichepatologist on service (the G-I resident also attends these rounds when covering the Liver Transplant service). He runs the monthly Morbidity andMortality Conference for the Division of Transplantation. He is actively involved in bench research, and has had extensive research funding. He is apotential mentor for G-I residents.Emmet Keefe, M.D. is the Medical Director, Adult Liver Transplant Program, former Adult G-I fellowship director, and former president of the AmericanGastroenterologic Association (AGA). Dr. Keefe has a number of currently funded research studies primarily in the area of the treatment of chronic hepatitis C. Heis a potential clinical research mentor for the G-I resident.* The “Liver Transplant Service” now includes the Small Bowel Transplant Service as well.Inpatient Ward Rounds:As seen above, our service is split into two services – Gastroenterology (including consults) and Transplant (including Liver and Small Bowel Transplants). One G-I resident isalways assigned to each service. The G-I resident always has a faculty attending on each service. Our faculty vary in their inpatient responsibilities (described above). During wardrounds, each faculty member spends anywhere from 2-4 hours reviewing patients, examining patients and going over plans with the subspecialty residents and the house staff.Outpatient Care:Faculty work closely with and directly supervise the subspecialty residents in the outpatient setting (clinics). The subspecialty resident takes a history and physical, examines thepatient then presents the case to the faculty member. The faculty member reviews the consultations and the established follow-up visit with the subspecialty resident. The facultymember meets with the patient and family in conjunction with the subspecialty resident and they devise a treatment plan. Every patient seen on an outpatient basis in our clinics oracute care area are reviewed personally by the faculty member. Long-term parenteral and enteral nutrition support patients are currently being seen in the regular gastroenterologyclinics. Plans are underway to localize complex home TPN patients into a separate regular clinic day (or days).Research:Dr. Sibley has the role of overseeing, in general, the mentoring process of our subspecialty residents and makes certain that they are progressing along in doing their researchactivities. Dr. Sibley recommends appropriate mentors either inside our division or mentors who are a part of the long-time NIH-supported Digestive Disease Center or those whohave significant other G-I related research support.
The research mentors meet with the residents at first to help develop the research project. Once the project has been researched and the plan for it developed, it is presented infront of the entire faculty and subspecialty residents for their critique. After the projects are submitted and approved by the institutional research board, they are representedperiodically (at least every three months) to the faculty and subspecialty residents as progress reports.When the data are ready for presentation, it is brought before the entire division for their evaluation and criticism. This process is repeated until the manuscript developed from theresearch is submitted for publication. This entire process may involve multiple presentations before our faculty and other research fellows.
PROGRAM FACULTY (Continued) 6D. PROGRAM STAFF: RELATED SPECIALISTS (working with pediatric gastroenterology) at participating hospitals: Complete the following chart using the name of the primary staff member involved. It is understood that certification is not available in all of the disciplines listed below. Faculty hours reported should be only for hours CONTRIBUTED TO THIS PROGRAM. Use 40 hours per week as the full time equivalent. Numbers of additional faculty in each field should be entered in the last column. (If adult specialists cover pediatric subspecialties, enclose name or number in parentheses.) Sub-certification/ Faculty participation Discipline Name Recertification in training program Hospital 1, 2 or 3 No. of other faculty Year of Hours Weeks Name of certification/ per per Sub-board recertification week year Neo- Neonatology David Stevenson, M.D. natology 1979/2004 2 48 1 15 Pediatric Hematology/Oncology Michael Link, M.D. Heme/Onc 1980 2 48 1 8 Pediatric Allergy/Immunology Richard Moss, M.D. All/Imm 1981 1 48 1 2 Genetics Eugene Hoyme, M.D. Med Gen 1984 1 48 1 4 Pediatric Infectious Diseases Ann Arvin, M.D. 2 48 1 8 American Pediatric Surgery Craig Albanese, M.D. Board of 1992 5 48 1 5 Surgery American Pediatric Anesthesiology Anita Honkanen, M.D. Board of 1996 5 48 1 13 Anesthe- siology Anatomic Pediatric Pathology Richard Sibley, M.D. Pathology 1975 5 48 2 0 Pediatric Radiology Richard Barth, M.D. Ped Rad 1995 5 48 1 6 Child & Child Psychiatry and/or Psychology Richard Shaw, M.D. Adoles 1993/indef. 5 48 1 5 Psych Pediatric Nutrition John Kerner, M.D. G-I & 1990/2005 10 48 1 1 Nutrition American Other: (specify) Carlos Esquivel, M.D. Board of 1985/1995 10 48 1,2 3 Transplantation Surgery Surgery Pediatric Lorry Frankel, M.D. Critical 1990/2005 5 48 1 7 Pediatric Critical Care Care Medicine
If any of the above are not housed predominantly in the primary hospital, provide specific details of their availability to the program. Include on a page numbered 6a.All of these individuals are available to the Pediatric Gastroenterology training program on a daily basis, 40 hours per week. The training program has a formal arrangementwith Pediatric Surgery (monthly conference), Transplant Surgery (twice weekly Liver Transplant Clinic; weekly Small Bowel Transplant Clinic; daily rounds), PediatricPathology (weekly Liver Transplant conference; monthly G-I conference), and Pediatric Radiology (monthly conference). The other specialists’ contributions are madethrough consultation, teaching on the wards, and Pediatric clinical and research conferences.D. PROGRAM STAFF: OTHER ANCILLARY STAFF List only the numbers of those who work in the pediatric gastroenterology training program: Hospital 1 Hospital 2 Hospital 3 Nurse specialists and/or physician extenders in gastroenterology 10.4 Pediatric social workers 2 Pediatric nutritionists 7 Other (specify): Child Psychologist 1 Oromotor Therapist 1 Nursing Assistant 1 Developmental Specialist 1Describe the involvement of the staff in each of these categories in the pediatric gastroenterology program:1. Nurse Specialists/Physician Extenders (Pediatric Nurse Practitioners):Three nurse practitioners work full-time for pediatric gastroenterology – Kathy Cox, P.N.P., Pat Frost, P.N.P. and Kaylie Nguyen, P.N.P. They enable the G-I service to seeadditional patients both in the G-I clinics at LPCH and at various outreach clinics including: Eureka, Ukiah, Stockton, Monterey, and Santa Cruz. They see patients, bothnew and return, and present them to G-I Attendings to come up with plans for diagnosis and management. They then become the front-line person handling all follow-upissues for their own patients.Three nurses are serving as Pediatric Liver and Small Bowel Transplant coordinators – Carmela Alviar, R.N., Deb Stricharz, R.N. and Marcia Kreisl, R.N. They are bothinvolved in seeing all liver and small bowel transplant outpatients at LPCH and at various outreach clinics in Oakland, Fresno, Sacramento, Portland, OR, as well asTacoma, WA, Honolulu, Hawaii, Albuquerque, NM, and Anchorage, AK. They coordinate all clinical care for these patients. They are also involved in evaluating patients forpossible transplantation, both in the inpatient and outpatient areas. They teach the families prior to transplantation what to expect after transplantation and help coordinatecare both in and out of the hospital. The G-I resident learns what their roles are and interact with them as part of the transplantation team. Two nurse practitioners, JenniferNielson, R.N., P.N.P., manage a subset of inpatient transplant patients—usually re-admitted transplant patients and patients being evaluated for transplantation. They takecall on weekends, rounding in-house each day and then taking phone calls from home. They take pressure and responsibility off of busy pediatric residents and G-Iresidents. Sarah Iverson, M.S., PA-C handles all “fresh” transplant patients (i.e., transplant patients immediately post-op). She acts as their primary caregiver Mondaythrough Friday and every third weekend (alternating with 2 “adult” physician assistants). The G-I resident, while on the transplant rotation, rounds with Sarah and is taughtimmediate post-op transplantation care from her and the transplant surgeons.
7a1.4 FTE of nursing is devoted full-time to the Pediatric G-I service. Denise Lehman, R.N. directly performs all breath hydrogen tests and coordinates any outpatient or dayhospital activities – D-xylose testing, Golytely therapy for constipation, Alteplase treatment of central line occlusion and mechanical complications with gastrostomy tubes.Denise is responsible for coordinating all tests (x-rays, nuclear medicine, CT, G-I procedures, stool collections, etc.) scheduled in G-I clinic and is primarily responsible forfollowing up on all lab work drawn in G-I clinic. She works on authorizations required by insurance companies for future outpatient procedures and inpatient admissions. Sheserves as the “first-line” for all phone calls from patients or parents of G-I patients. She does all of the extensive paperwork required for all patients covered by CaliforniaChildren’s Services (C.C.S.) as we are a designated C.C.S. Center for Pediatric G-I/Nutrition. Many of these patients need extensive supplies for home enteral orparenteral nutrition. Denise runs a support group for children with inflammatory bowel disease and their parents. The group is co-run by Dr. William Berquist and meets at7pm once per month.2. Pediatric Social Workers:Two social workers are devoted to the Pediatric G-I service – Chris Dong, M.S.W. and Robin Newman, M.S.W. Chris is the one dedicated social worker for pediatric liverand small bowel transplant patients. Robin is dedicated to G-I patients. They both are available by pager to see patients in all our LPCH clinics. Both are available toprovide inpatient consultation for pediatric G-I patients. When they are not available (nights, weekends, vacation, illness), the hospital provides social service coverage 24hours a day, 7 days per week. Both Chris and Robin have played active roles in care conferences for complex G-I and liver patients in both the outpatient and inpatientareas. Their mental health worker expertise is highly valued by the entire G-I service. These two positions are funded by LPCH.Our two social workers help the patients and their families and teach the G-I residents about the social, physical, and psychological needs of the patients and their families.They work with the families to teach them how to deal with the stresses created by their child’s illness show the subspecialty residents how social workers extend the carephysicians provide. Subspecialty residents learn how to utilize the social worker to improve the quality of patient care both in the hospital and at home.3. Pediatric Nutritionists:The nutritionists teach the G-I residents techniques of nutritional assessment and the use of different types of specialized feedings. They teach techniques for enteral andparenteral nutrition and how to establish patients on both TPN and enteral feedings in the hospital and at home. They explain to the subspecialty residents transitionaltechniques to convert from TPN to tube feedings. Complications for both routes of feeding are reviewed. Nancy Baugh, R.D, is the primary nutritionist providing routine consultation to the LPCH G-I Clinics. She brings more than 20 years of nutrition support team experienceto her consults. Tanya Wapensky, R.D., is the lead nutritionist for our inpatient transplant patients. She covers the ICU, and 2 general wards (3E, 3W). Grace Shih, R.D., is the lead nutritionist for G-I inpatients. She covers 2 general wards (3S, 3N).Other key nutritionists with whom the G-I resident interacts are: Julie Matel, R.D., is the lead nutritionist for inpatient and all outpatient clinics for cystic fibrosis (CF) patients. Lisa Schultz, R.D., is the lead nutritionist for the use of the ketogenic diet, for all cardiac patients (CVICU, cardiology patients on 3W and in the IICU). She also coversour intermediate care nursery (IICN). Olivia Mayer, R.D., is the lead nutritionist for the NICU. Monica Holt, R.D. is the lead nutritionist for diabetes (inpatient and outpatient), inpatient metabolic patients, renal and infant development clinic, and high risk obstetricalinpatients.In 1994, LPCH established a formal Nutrition Support Team. All LPCH inpatients requiring parenteral nutrition are seen on initiation of parenteral nutrition and followed atleast weekly. The team includes all of the above named nutritionists. The medical director of the team is Dr. John Kerner. The team’s other two key members are RobertPoole, Pharm.D., Director of Pharmacy at LPCH and Colleen Nespor, R.N., a nutrition support nurse. The team is nationally recognized for its excellence and isresponsible for numerous publications including the first published “Clinical Pathway for Pediatric Parenteral Nutrition” published in Nutrition in Clinical Practice in 1997. Theteam makes formal rounds once per week on all new parenteral nutrition patients and any ongoing patients where there are questions or concerns. The Pediatric G-Isubspecialty resident attends these rounds while on the “Nutrition” rotation and other times when able.
All these nutritionists are funded by LPCH.4. Child Psychologist:Michelle Brown, Ph.D. is available to all the G-I clinics and the inpatient service for G-I consultations. She is a key member of the Child Psychiatry liaison service. Shouldthe patient require intensive psychiatry support, the child is admitted to the “Comprehensive Care” Unit at LPCH South (El Camino Hospital in Mountain View, CA) whereLPCH has a special unit. That hospital is approximately 20 minutes away from LPCH.5. Oromotor Therapist:Marianna Thorn, O.T. provides consultation both for the G-I clinics and inpatient units. She has been very active in working with our physicians, nurses, and nutritionists inpreparing appropriate, detailed care plans for complex patients with feeding disorders.6. Nursing Assistant:One nursing assistant is assigned to us for the entire time of the eight half-days of clinic; he/she “checks in” patients, obtaining heights, weights, and head circumference(plotting them out on appropriate graphs), and vital signs where appropriate. She also assists in obtaining and sending off appropriate stool, urine, and blood studies.7. Developmental Specialist:Karen Wayman, M.A. is the division’s developmental specialist. She sees patients both in the outpatient clinic and the inpatient units. She is heavily involved in researchstudies assessing neurodevelopmental outcome, particularly of liver transplant patients. She has an endowed position funded by the Lucile Packard Foundation.
8 FACILITIES AND SERVICES Program Requirements Pediatric Gastroenterology, IVIndicate the availability of the following: Hospital 1 Hospital 2 Hospital 3 Facility/Service Yes No Yes No Yes No Space in an ambulatory setting for optimal evaluation and X care of patients An inpatient area with pediatric and related services (including surgery and psychiatry) staffed by pediatric residents and X faculty Support services including radiology laboratory, nuclear X X medicine and pathology X Pediatric intensive care unit Number of beds in PICU 24 ** Neonatal intensive care unit X Number of beds in NICU 40* Access to gastrointestinal function laboratory capable of measuring intestinal absorptive function, esophageal X physiology and pancreatic function and nutritional parameters in pediatrics patients Flexible endoscopy facilities X XProvide an explanation if NO is indicated for any of the above facilities and/or services across all hospitals:*There are also 29 additional beds for the Intermediate Intensive Care Nursery.**There are also 10 additional beds in the Intermediate ICU.+The Lucile Packard Children’s Hospital at Stanford (LPCH), is a separately licensed entity but physically is attached to Stanford University Hospital. It is a regional andtertiary care facility providing all pediatric medical and surgical services associated with Stanford University Medical Center (which encompasses LPCH – Hospital 1 andStanford University Hospital – Hospital 2).** LPCH utilizes some of Stanford University Hospital’s facilities including Nuclear Medicine, Fluoroscopy rooms for ERCP’s and balloon dilatations, CT and MRI scanning,the Operating Rooms and Surgical Pathology.
9 PATIENT DATAProvide the following information for the most recent 12-month period. Inclusive dates: FROM (mm/dd/yy): 09/01/04 TO (mm/dd/yy): 08/31/05 INPATIENT 1. Total number of admissions for whom the pediatric gastroenterology service assumed 562 major clinical responsibility: a. Average daily census of patients on the pediatric gastroenterology service 11.2 If ADC is less than six, please explain how residents have an adequate exposure to inpatients on a page numbered 8a. b. Number of new patients admitted each year (“new” refers to those who are 197 being seen by the gastroenterologists for the first time): c. Average length of stay of patients on the pediatric gastroenterology service: 10.3 days 2. Number of consultations by pediatric gastroenterologists on other inpatients: 309 a. Are consultations provided to the NICU? YES X NO If yes, how many? 51 b. Are consultations provided to the PICU? YES X NO If yes, how many? 24
AMBULATORY PEDIATRIC GASTROENTEROLOGY EXPERIENCE FOR ALL YEARS OF TRAINING Duration of Number of Number of Number of Average Average Faculty Name of Experience Experience Sessions Per New Patients Return Number Number Supervision Hospital/Other Setting Identifier (in wks/yr) Week Per Per Patients Per Other Trainees Teaching Resident Resident resident Per Session Attendings Per Session Per Session Per SessionG-I Clinic at LPCH (Monday all day; Tuesday P.M.; Thursday all Yday; Friday all day) 48-52 1-4 0-2 3-6 0-3 2-4G-I “Urgent” Clinic at LPCH (Wednesday P.M.) 48-52 2x/month * 4 0 0-1 1 YLiverTransplant Clinic at LPCH (Monday and Thursday P.M.) 48-52 0- 2 0-1 ** 3-4 0-2 2 YSmall Bowel Transplant Clinic (Wednesday P.M.) 48-52 0-1 0-1 1 YOptional Outreach Clinic – Chico (Wednesday/Thursday) 12 4-5 5-6 1 YOptional Outreach Clinic – Santa Clara Valley Medical Center Y(Wednesday P.M., Thursday A.M., Friday A.M.) 48-52 2 2-3 1Optional Outreach Clinic – Santa Cruz (All day) 12 1 5-7 1 YOptional Outreach Clinic – Monterey (1/2 day) 12 1 3-4 1 YOptional Outreach Clinic – Eureka (All day) 4 4-5 5-6 1 YOptional Outreach Clinic – Liver Transplant – Oakland (1/2 day), YFresno (1/2 day) 3-5 * Primarily for Y N 1st yr G-I Residents1. If the experience is in a private office, provide full details, including name and credentials of supervisor, numbers and types of patients, degree of resident responsibility for their care, frequency of attendance at office, how director monitors the experience and resident performance. Include as pages 10a, 10b, etc.2. Explain how the residents have the opportunity to provide outpatient care for patients whom they treated on the inpatient service. See page 17, #3. Outpatient Experiences; sections b. and d. ** G-I residents are assigned to “New Evaluation” Liver Transplant patients whenever possible. The G-I residents are expected to attend at least one G-I outreach clinic and one liver transplant outreach clinic to appreciate the role of our faculty and the role of our G-I colleagues at liver transplant outreach clinics.
11 12-MONTH SUMMARY: OUTPATIENT CLINICS/INPATIENT SERVICESDuring the same 12-month period as used on page 9, how many pediatric patients with the following gastroenterology problemswere: a) seen in the ambulatory settings; b) were admitted to and/or consulted on by the pediatric gastroenterologists at theprimary hospital? PROGRAMS MAKING NEW APPLICATION SHOULD COMPLETE ONLY THE COLUMNS MARKED BY ANASTERISK ( * ). Inclusive Dates: FROM (mm/dd/yy): 09/01/2004 TO (mm/dd/yy): 08/31/2005 Gastroenterology Outpatients Inpatients problems Number of Number seen by Inpatient service Consultations patients* subspecialty residents No. on No. seen by No. of No. seen by gastro subspecialty consults* subspecialty service* residents residents 1. Growth failure and malnutrition 3392 69 74 74 42 42 2. Malabsorption (celiac disease, cystic 1322 24 67 67 10 10 fibrosis, pancreatic insufficiency, etc.) 3. Gastrointestinal allergy 27 15 2 2 1 1 4. Peptic ulcer disease 3 0 0 0 0 0 5. Jaundice 89 22 16 16 13 13 6. Liver failure (including evaluation and 560 23 126 126 20 20 follow-up care of patient requiring liver transplantation) 7. Digestive tract anomalies 469 19 35 35 41 41 8. Chronic inflammatory bowel disease 134 44 6 6 1 1 9. Functional bowel disorders 91 3 15 15 4 4 10. Gastrointestinal problems in the 0 0 2 2 3 3 immune-compromised host 11. Vomiting (including 2056 77 47 47 64 64 gastroesophageal reflux) 12. Acute and chronic abdominal pain 783 41 30 30 20 20 13. Acute and chronic diarrhea 340 16 8 8 13 13 14. Constipation (including 1896 49 7 7 8 8 Hirshsprung disease) 15. Gastrointestinal bleeding 199 25 30 30 27 27 16. Gastrointestinal infections 300 5 52 52 5 5 17. Motility disorders 484 1 2 2 2 2 18. Infectious and metabolic liver diseases 474 28 28 28 29 29 19. Pancreatitis 63 1 15 15 3 3 12A
LIST OF DIAGNOSESList 150 CONSECUTIVE admissions and/or consultations from the general pediatric service to the gastroenterology serviceduring the same 12-month period as used on the previous pages. Use additional pages as necessary. Submit a separate list foreach hospital that provides required rotations. Number all additional pages in sequence as 12a, 12b, etc. Hospital: Inclusive dates during which these FROM (mm/dd/yy): TO (mm/dd/yy): admissions/consultations occurred: 12/01/2005 04/10/2006 PATIENT ID NUMBER OF DAYS IN HOSPITAL GASTROENTEROLOGIC DIAGNOSIS NUMBER AGE 1869484-4 6M 9 FEEDING INTOLERANCE 6203940-9 16Y 4 S/P SB TRANSPLANT; FEVER/SEPSIS 6087522-6 14Y 7 ABDOMINAL PAIN; UPJ OBSTRUCTION 6184478-3 5Y 6 RETROPERITONEAL MASS; ALAGILLE SYNDROME 4003465-4 11M 7 METABOLIC LIVER DISEASE 4005179-9 1M 10 ABDOMINAL DISTENSION/ANAL STENOSIS 4005176-5 1M 10 ABDOMINAL DISTENSION/ANAL STENOSIS 4004589-0 9M 29 GROWTH FAILURE/MALNUTRITION/GT EVAL 1764310-7 4Y 4 CHRONIC ABDOMINAL PAIN 6010196-1 14Y 4 ABDOMINAL PAIN 6264408-3 2Y 17 INTESTINAL PSEUDOOBSTRUCTION; FEVER/SEPSIS 1798508-6 15M 77 ADENOVIRUS ENTERITIS; WISKOTT ALDRICH 4001138-9 10Y 115 RECURRENT EMESIS; ALL 4002678-3 3M 10 BAFK; ASCITES 4003312-8 7M 8 BAFK; GROWTH FAILURE 6257192-2 5Y GI BLEEDING 6201521-9 5Y 1 GI POLYPS; S/P POLYPECTOMY 1893316-8 8M 108 SHORT BOWEL SYNDROME; ESLD; GI BLEED 1900714-5 7Y 55 S/P LIVER TRANSPLANT; FEVER/NEUT; LYMPHOMA 6289167-6 2Y 6 S/P LIVER TRANSPLANT; FEVER; GI BLEED 1800969-6 3Y METABOLIC DS; TRANSAMINITIS 4005697-0 2M 8 MALROTATION S/P LADDS; CHYLOUS ASCITES 4000614-0 2M VOMITING/GER 12B
PATIENT ID NUMBER OF DAYS IN HOSPITAL GASTROENTEROLOGIC DIAGNOSISNUMBER AGE1873614-0 15M MALROTATION S/P LADDS; VOMITING4000677-7 2M HEMANGIOENDOTHELIOMA; GROWTH FAILURE6096089-5 9Y 10 GI BLEEDING1875917-5 9M 9 HEMANGIOENDOTHELIOMA; GROWTH FAILURE6194535-8 7Y 1 S/P LIVER BIOPSY; TRANSAMINITIS1874868-1 6Y 8 PANCREAS DIVISUM6092451-1 9Y CF; GROWTH FAILURE4001292-4 2M CONGENITAL HT.DS; GROWTH FAILURE6098299-8 10Y 7 IMMUNODEFICIENCY; TRANSAMINITIS6198082-7 10Y JRA; DERMATOMYOSITIS; PANCREATITIS4006214-3 1Y 6 CAUSTIC INGESTION6054317-0 12Y GERD6102727-2 12Y 5 GI BLEEDING6258209-3 17Y 1 METABOLIC LIVER DS; S/P LIVER BIOPSY1878635-0 6M 4 DOWN SYNDROME; GROWTH FAILURE4003533-9 7M 4 LIVER FAILURE; TRANSPLANT EVALUATION6090287-1 13Y 4 CROHN’S DISEASE4004967-8 5Y 3 GI BLEEDING; TRANSPLANT (LIVER) EVAL1899849-2 3M GERD; EX 27 WEEK PREMIE6243602-7 3Y 8 S/P LIVER TRANSPLANT; SEVERE CONSTIPATION4006814-0 2M ARTHROGRYPOSIS; TRANSAMINITIS4005420-7 1M S/P NEC; FEEDING INTERLOANCE1802664-1 1Y 4 GI DYSMOTILITY4006865-2 8M 22 LIVER FAILURE1848781-9 5Y GI DYSMOTILITY6264408-3 2Y 9 INTERTINAL PSEUDOOBSTRUCTION; FEVER/SEPSIS1772429-5 2Y 4 GI BLEEDING; S/P LIVER TRANSPLANT1878438-9 12Y CONSTIPATION6271311-0 2Y GI BLEEDING; ALL 12C
PATIENT ID NUMBER OF DAYS IN HOSPITAL GASTROENTEROLOGIC DIAGNOSISNUMBER AGE6247121-4 5Y S/P LIVER TRANSPLANT; HCC1926186-6 17Y 1 GASTRIC FOREIGN BODY4003465-4 10M 7 METABOLIC LIVER DISEASE6212885-5 5Y 2 S/P LIVER TRANSPLANT; GI BLEEDING4007172-2 1Y GI BLEEDING6064629-6 18Y GERD/VOMITING; UPPER GI BLEED4001292-4 2M CONGENITAL HT.DS; GROWTH FAILURE6098299-8 10Y 7 IMMUNODEFICIENCY; TRANSAMINITIS6198082-7 10Y JRA; DERMATOMYOSITIS; PANCREATITIS4006214-3 1Y 6 CAUSTIC INGESTION6054317-0 12Y GERD6102727-2 12Y 5 GI BLEEDING6258209-3 17Y 1 METABOLIC LIVER DS; S/P LIVER BIOPSY1878635-0 6M 4 DOWN SYNDROME; GROWTH FAILURE4003533-9 7M 4 LIVER FAILURE; TRANSPLANT EVALUATION6090287-1 13Y 4 CROHN’S DISEASE4004967-8 5Y 3 GI BLEEDING; TRANSPLANT (LIVER) EVAL1899849-2 3M GERD; EX 27 WEEK PREMIE6243602-7 3Y 8 S/P LIVER TRANSPLANT; SEVERE CONSTIPATION4006814-0 2M ARTHROGRYPOSIS; TRANSAMINITIS4005420-7 1M S/P NEC; FEEDING INTERLOANCE1802664-1 1Y 4 GI DYSMOTILITY4006865-2 8M 22 LIVER FAILURE1848781-9 5Y GI DYSMOTILITY6264408-3 2Y 9 INTERTINAL PSEUDOOBSTRUCTION; FEVER/SEPSIS1772429-5 2Y 4 GI BLEEDING; S/P LIVER TRANSPLANT1878438-9 12Y CONSTIPATION6271311-0 2Y GI BLEEDING; ALL
12D PATIENT ID NUMBER OF DAYS IN HOSPITAL GASTROENTEROLOGIC DIAGNOSISNUMBER AGE6247121-4 5Y S/P LIVER TRANSPLANT; HCC1926186-6 17Y 1 GASTRIC FOREIGN BODY4003465-4 10M 7 METABOLIC LIVER DISEASE6212885-5 5Y 2 S/P LIVER TRANSPLANT; GI BLEEDING4007172-2 1Y GI BLEEDING6064629-6 18Y GERD/VOMITING; UPPER GI BLEED6288309-5 3Y 8 SHORT BOWEL SYNDROME; FEVER/SEPSIS1869473-7 8M 1 INTESTINAL LYMPHOANGIOENDOTHELIOMA1772429-5 2Y 13 S/P LIVER TRANSPLANT; GI BLEEDING6249764-9 2Y CHOLESTASIS4007790-1 9M 7 GI BLEED; INTESTINAL LYMPHOANGIOENDOTHELIOMA6067526-1 11Y GERD; ESOPHAGEAL FOREIGN BODY4006968-4 2W BOWEL PERFORATION; NEONATAL CHOLESTASIS1751160-1 6Y PROTEIN LOSING ENTEROPATHY4007786-9 4M 150 BAFK; ASCITES4005076-7 18M 5 LIVER FAILURE; FEVER/SEPSIS6288449-9 2Y WISKOTT ALDRICH; INTESTINAL GVHD6245742-9 3Y 6 INTESTINAL LYMPHANGIECTASIA1875917-5 10M 12 HEMANGIOENDOTHELIOMA; CONSTIPATION1835169-2 1Y CONGENITAL CARDIAC DS; CHOLESTASIS4007953-3 8M 5 SHORT BOWEL SYNDROME; ESLD1772429-5 2Y 2 S/P LIVER TRANSPLANT; GI BLEEDING4008611-8 4Y 90 LIVER FAILURE1848781-9 5Y GI DYSMOTILITY; GERD4002748-4 3M 7 GERD; GROWTH FAILURE1751571-9 2Y 6 HYPOALBUMINEMIA6123767-3 8Y 1 CHRONIA DIARRHEA4008952-6 1Y 2 ESOPHAGEAL FOREIGN BODY4007152-4 1M CONGENITAL CARDIAC DS; GERD 12E
PATIENT ID NUMBER OF DAYS IN HOSPITAL GASTROENTEROLOGIC DIAGNOSIS NUMBER AGE1827254-2 9Y CHRONIC BLOODY DIARRHEA; IBD1755262-1 2Y 3 SHORT BOWEL SYNDROME; DEHYDRATION4011760-8 6Y 3 LIVER FAILURE4008264-6 15Y 2 ABDOMINAL PAIN; CHRONIC PANCREATITIS6075611-1 10Y 6 PANCREATIC DUCT STRICTURE4010637-9 2W HYPERTRIGLYCERIDEMIA4007261-3 17Y HEART FAILURE/LIVER FAILURE4011914-1 11M 19 AUTOIMMUNE HEPATITIS1895993-2 15Y 1 SHORT BOWEL SYNDROME; S/P LIVER BIOPSY1792904-3 5Y 1 GI BLEEDING1892695-6 7M 8 SHORT BOWEL SYNDROME; FEEDING INTOLERANCE1881562-1 9M GROWTH FAILURE4013091-6 1D GI BLEEDING; TRANSAMINITIS4012397-8 1W CYSTIC FIBROSIS; SHORT BOWEL SYNDROME4009379-1 5Y 3 INTESTINAL PSEUDOOBSTRUCTION; UTI6178565-5 6Y 2 CITRULLINEMIA; S/P LIVER TX; TRANSAMINITIS4012110-5 1Y COCCIDIOMYCOSIS; GROWTH FAILURE4008730-6 2M PIERRE ROBIN; MALNUTRITION/GROWTH FAILURE1809292-4 2W CONGENITAL CARDIAC DS; TRANSAMINITIS4001084-5 1Y 4 GROWTH FAILURE/MALNUTRITION4012253-3 5M 3 GERD; DEHYDRATION4013438-9 14Y ABDOMINAL PAIN6092451-1 10Y CYSTIC FIBROSIS; C.DIFFICILE COLITIS4013817-4 3D GI BLEEDING; GASTRIC ULCER1937492-5 15Y MIXED CONNECTIVE TISSUE DS; GI DYSMOTILITY
12G PATIENT ID NUMBER OF DAYS IN HOSPITAL GASTROENTEROLOGIC DIAGNOSISNUMBER AGE ABBREVIATIONS USED 1 BAFK = BILIARY ATRESIA FAILED KASAI 2 ESLD = END STAGE LIVER DISEASE 3 DS = DISEASE 4 CA = CARCINOMA 5 UPJ = URETEEROPELVIC JUNCTION 6 GT = GASTROSTOMY TUBE 7 S/P = STATIS-POST 8 CF = CYSTIC FIBROSIS 9 SB = SMALL BOWEL 10 TX = TRANSPLANT 11 GER = GASTROESOPHAGEAL REFLUX 12 GERD = GASTROESOPHAGEAL REFLUX DISEASE 13 NEC = NECROTIZING ENTEROCOLITIS 14 HT = HEART 15 HCC = HEPATOCELLULAR CARCINOMA 16 ALL = ACUTE LYMPHOBLASTIC LEUKEMIA 17 GVHD = GRAFT VS. HOST DISEASE 18 SMA = SPINAL MUSCULAR ATROPHY 19 IBD = INFLAMMATORY BOWEL DISEASE
SKILL OBJECTIVES Program Requirements Pediatric Gastroenterology, II.C 13Indicate whether or not the program provides experience in each of the following procedures. Use the same 12-month period as indicated on the previous pages. For proceduresnot performed at any of the participating hospitals, provide an explanation on a page numbered 13a. PROGRAMS MAKING NEW APPLICATION COMPLETE ONLY THECOLUMN MARKED "NUMBER PERFORMED ON SERVICE(S)" FOR EACH HOSPITAL. Inclusive Dates: FROM (mm/dd/yy): 09/01/2004 TO (mm/dd/yy): 08/31/2005 Hospital 1 Hospital 2 Hospital 3 Number Total # Number Total # Number Total # performed performed by performed performed by performed performed by on subspecialty on subspecialty on subspecialty service(s) residents service(s) residents service(s) residents 1. Colonoscopy 127 95 2. Diagnostic upper panendoscopy 402 228 3. Establishment and maintenance of patients on enteral/parenteral 45 45 nutrition (including nutritional assessment) 4. Sigmoidoscopy (rigid and flexible) 47 15 5. Paracentesis 54 54 6. Percutaneous liver biopsy 65 43 7. Rectal biopsy 4 3 8. Small bowel biopsy 175 94 9. Anorectal manometry 90 6 10. Breath hydrogen analysis 28 0 11. Dilatation of esophagus 26 11 12. Endoscopic retrograde cholangiopancreoscopy (ERCP) 11 2 13.Therapeutic upper pandendoscopy (sclerosis of esophageal varices) 70 23 14. Esophageal manometry 3 1 15. Pancreatic stimulation test 7 2 16. Esophageal pH monitoring 44 12 17. Placement of percutaneous gastrostomy 10 21 14
CONTENT OF TRAINING PROGRAMComplete the following chart by providing the duration of the activities specified below for each year of the training program. Answers should be provided as indicated, i.e., inmonths, in weeks, or in other appropriate time periods. Through June 2006: First Year Second Year Third Year (if offered) 1. Clinical training 10 months 2 months 2 months Monday through Thursday Nights Monday through Thursday Nights Monday through Thursday Frequency of night call * while on service and every 4th while on service and every 4th Nights while on service and weekend weekend every 4th weekend 5 per week 5 per week 5 per week Number of clinical rounds 7 per week if on call during week 7 per week if on call during week 7 per week if on call during and weekend and weekend week and weekend 2. Research training and experience 1 Month 9 months 9 months Frequency of night call * Every 4th weekend Every 4th weekend Every 4th weekend* Evening call is taken from home 14A
Starting July 2007: First Year Second Year Third Year (if offered)1. Clinical training 8.5 months 2.5 months 2.5 months Monday through Thursday Nights Monday through Thursday Nights Monday through Thursday Frequency of night call * when on Transplant Service and when on Transplant Service and Nights when on Transplant every 6th weekend every 6th weekend Service and every 6th weekend 5 per week 5 per week 5 per week Number of clinical rounds 7 per week if on call during week 7 per week if on call during week 7 per week if on call during and weekend and weekend week and weekend2. Research training and experience 2.5 Months 8.5 months 8.5 months Frequency of night call * Every 6th weekend Every 6th weekend Every 6th weekend * Evening call is taken from home
15 CONFERENCES Program Requirements Pediatric Gastroenterology, II.DList regular subspecialty and interdepartmental conferences, rounds, etc., that are a part of the pediatric gastroenterology training program. Identify the INSTITUTION by using the corresponding number as it appears on the first and second pages of this form. Indicate thefrequency, e.g., weekly, monthly, etc., and whether conference attendance is required (R) or optional (O). Person(s) responsible for conducting Hospital 1, Conference R, O Frequency conference 2, or 3 Pediatric G-I & Liver Meeting: review of all inpatients/admissions/procedures, R Weekly Ken Cox, M.D. 1 Q/A issues, fellowship program issues 2 (attached Liver Pathology Rounds O* Weekly Richard Sibley, M.D. to Hospital 1) nd Allison Wong, M.D. (2 Year Fellow) Pediatric G-I Pathology Rounds R Monthly 2 Terri Longacre, M.D. (Path) Pediatric G-I/Peds Surgery/Radiology Sameera Mian, M.D. (2nd Year Fellow) R Monthly 1 Conference Richard Barth, M.D. (Peds Radiology) Pediatric G-I Journal Club/JPGN R Monthly Eric Sibley, M.D. 1 Editorial Board Meeting Difficult Case Discussions R* Monthy Anca Safta, M.D. (3rd year fellow) 1 Nutrition Support Team Rounds O+ Weekly John Kerner, M.D. 1 Pediatric Liver Transplant Selection/ Outpatient Review/Inpatient Review O* Weekly William Berquist, M.D. 1 Board Review/Research Updates/ Anca Safta, M.D. (3rd Year Fellow) National Meeting Updates/Case R Weekly 1 John Kerner, M.D. Discussions Pediatric Morning Report O ** Daily Pediatric Chief Residents 1 Noon Pediatric Lecture Series O ** Daily Pediatric Chief Residents 1 Combined Basic Science/Clinical G-I Journal Club O ++ Weekly Anson Lowe, M.D. 2 Adult G-I Clinical Conference O ++ Weekly Lauren Gerson, M.D. 2 Pediatric Grand Rounds O ** Weekly Bert Glader, M.D. 1 Once Q 2-3 Mel Heyman, M.D. (based at Pediatric G-I Gut Club-Peds G-I R Months University of California, San Off site Lectures for all Bay Area Pediatric G-I Francisco) Transplantation Medicine Morbidity/ Mortality Conference O* Q. month Carlos Esquivel, M.D. 2 Gastroenterology Inpt. Rounds R Daily G-I Service Attending 1 Liver Transplant Inpt. Rounds R* Daily Liver Service Attending 1*Required when on Liver Transplant Service ++Required when fellow has to present+Required when on Nutrition Support Service **Required for any Lectures, Morning Reports, or Case Discussions where G-I, Liver, or Nutrition issues are discussed. 15aDescribe how subspecialty residents participate in these activities:
A variety of conferences encompassing various clinical and research aspects of pediatric gastroenterology are open to G-I residents on an optional or required basis. Active as opposed to passive participation is encouraged at all such conferences. Presentations of cases as well as discussion of patient problems is a skill which is nurtured in all trainees. For the Monday morning meeting, the pediatric G-I resident is required to present and discuss the current status of all G-I and Liver Transplant inpatients and all consults following the weekends he/she is “on call” . The third year G-I Resident coordinates the weekly Friday conference. The second year residents coordinate Pediatric G-I Pathology and G-I/Surgery/Radiology Conferences. The third year resident coordinates the “Difficult Case” Conference. The G-I residents rotate in sequence, in presenting articles at Pediatric G-I journal club. The G-I Resident presents at least one lecture/year at the Pediatric Resident’s Noon lecture Series. The G-I resident presents at least 2 times/year at Adult G-I journal club or at the Adult G-I Clinical Conference. The G-I resident is also required in the second and third year to provide regular updates on the status of their research at the Friday noon conference.What are the attendance requirements for subspecialty residents? What mechanisms are (will be) used to ensure trainee attendance atrequired conferences? To what degree is faculty attendance expected? Is this monitored? All pediatric gastroenterology resident trainees are expected to attend the required conferences. For those conferences other than Monday morning Pediatric G-I and Liver Meeting and G-I service and Liver Service Inpatient Rounds, attendance is taken. Likewise, faculty support of these conferences is expected. Sign-in sheets are retained for many of these conferences and reviewed on a semi-annual basis.