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Gastroenterology, Hepatology and Nutrition
Fellowship
Overview
The University of Colorado Denver (UCD) offers a three-year fellowship training program in the field of Pediatric Gastroenterology, Hepatology and Nutrition. The Program is run by the Section of Pediatric Gastroenterology, Hepatology and Nutrition of the University of Colorado School of Medicine. Dr. Michael R. Narkewicz is the director of the Fellowship Training Program. The Program has been fully accredited in Pediatric Gastroenterology by the Residency Review Committee of ACGME since the specialty was first recognized by ACGME in December 1994. Starting with recruitment for fellowships beginning in 2008, our pediatric gastroenterology fellowship training program will participate in the National Resident Match Program (NRMP). Beginning with 2009 recruitment, we will participate in the Electronic Residency Application Service (ERAS) program for fellowship applicants.
The goals of this program are to prepare the fellow for a career in academic medicine, with strong emphasis on excellence in clinical care, teaching and productive and independent research. The first year of the fellowship is devoted primarily to clinical training, education and experience, and the second and third years are devoted to research activities with continued training in the outpatient and continuity aspects of the field. Because of the strong academic and research activities of the Section of Pediatric Gastroenterology, Hepatology and Nutrition, the fellow will be exposed to a stimulating environment in one of the top Children's Hospitals in the U.S.
Two fellows are accepted into the Program each year. Fellows have more than ample opportunity to see a wide breadth of GI/liver/nutritional disorders and to perfect skills in all the procedures necessary for the Pediatric Gastroenterologist. Normal physiology of the gastrointestinal tract and the pathophysiology, cellular and molecular events that underlie various disease processes, as well as clinical pharmacology and biotechnology, are stressed throughout the fellowship. Strong emphasis is placed on the scientific basis of disease and evidence-based disease management.
Note: Please see our fellowship curriculum for further information.
Clinical Training
The first year of fellowship is dedicated to acquiring clinical proficiency in both inpatient and outpatient aspects of Pediatric GI/Hepatology/Nutrition. The clinical activities of the first year are based primarily at The Children's Hospital, a 235-bed facility which is the major teaching hospital for the Department of Pediatrics of the University of Colorado Denver. The Children's Hospital is also home to an NIH-supported Pediatric General Clinical Research Center that is available to fellows and faculty to assist with performance of clinical investigations. The GI/Hepatology/Nutrition service consults on, or is the primary attending physician for, 800-900 inpatients per year, and sees approximately 4,000 outpatient visits per year. Over a one-year period, the GI/Hepatology/Nutrition Section performs approximately 600 upper gastrointestinal endoscopies, 250 colonoscopies and flexible sigmoidoscopies, 90 liver biopsies, 20 small bowel biopsies and 250 other gastrointestinal procedures (motility studies, breath hydrogen analyses, ERCP, esophageal pH studies, esophageal impedance, video endoscopy, etc).
Both first-year fellows share the inpatient experience over the entire year, rotating admitting responsibilities. While on the admitting service, the fellow will see all in-hospital consultations and supervise the care of all patients admitted to the GI/Hepatology/Nutrition service, under the supervision and mentorship of the Attending GI physician. Emphasis is placed on developing an accurate differential diagnosis, learning the methods of evaluating and treating the child and taking care of the family's needs. Diagnostic procedures required by these patients will be performed by the fellow under the supervision of the GI attending physician. The fellow will be exposed to a full range of GI, liver, pancreatic and nutritional problems, including acute and chronic diarrhea and colitis, vomiting disorders, esophageal and intestinal motility disorders, failure to thrive and nutritional problems, allergic GI diseases, inflammatory bowel disease, functional GI diseases, chronic constipation and abdominal pain, short gut syndrome, parenteral and enteral nutrition management, acute and chronic hepatitis, a variety of metabolic and genetic liver diseases, acute and chronic liver failure, cholestatic disorders, bile duct diseases, acute and chronic pancreatitis, GI problems of the immunosuppressed or immuno-deficient patient and others. The fellow will also learn to perform the full gamut of GI diagnostic procedures, including upper gastrointestinal endoscopy, colonoscopy and sigmoidoscopy, polypectomy, esophageal manometry, esophageal variceal endosclerosis and ligation, esophageal pH testing, duodenal intubation and pancreatic function testing, capsule duodenal biopsies, anorectal manometry, percutaneous liver biopsy, diagnostic paracentesis, endoscopic retrograde cholangiopancreatography, pneumatic and non-pneumatic dilatation of strictures, removal of GI tract foreign bodies and percutaneous endoscopic gastrostomy tube placement. The inpatient Gastroenterology/Hepatology/ Nutrition service ranges from 8 to 15 patients at any given time, and the procedure volume approximates 10 procedures per week. During the first year, the fellow will participate in care of children undergoing liver transplantation. The GI attending, Liver Center Team, dietitian, social worker and nutritional support nurse are all part of the Inpatient Care Team.
Both first-year fellows also share a rich outpatient experience. While on the outpatient service, they will attend several of the scheduled half-day clinics of the Section, be available for emergency and urgent outpatient consultation and participate in phone triage. A GI/Hepatology/Nutrition faculty member designated as the Outpatient Attending works closely with the fellow. The clinics include the Pediatric Liver Center clinic on Monday and Thursday mornings, GI clinics on Wednesday, Thursday and Friday mornings and outreach clinics on Monday afternoons or Thursdays. The fellows are exposed to the full range of outpatient GI/Hepatology/Nutrition disorders, and learn the appropriate and cost-effective evaluation of these infants and children. The fellows will perform any GI procedures generated by outpatients seen by the fellow, under the direction of the patient's attending physician. The outpatient fellow will attend at least two half-day procedure block times and is responsible for the performance of the procedure during that block under direction of the attending pediatric gastroenterologist assigned to the block. Each fellow participates in a dedicated continuity clinic which begins during the second half of the first year. Continuing care of patients evaluated in the inpatient and/or outpatient service will be followed by the fellow in this clinic. Finally, the fellows are involved in the outpatient management of home care for 100-120 infants and children with complex parenteral and enteral nutritional support, including many with cystic fibrosis.
The University of Colorado Denver has an active liver transplantation program, the pediatric component being based at The Children's Hospital since 1990. The Pediatric Liver Center is under the direction of Dr. Michael Narkewicz, together with Dr. Frederick Karrer of the Department of Surgery, and is actively involved in the evaluation of potential candidates for transplantation, peritransplant inpatient care and post-transplant follow-up of all children. The Pediatric Liver Center is also the regional referral center for the evaluation and care of children with a variety of acute and chronic hepatobiliary diseases. Fellows participate in the evaluation and care of children with liver disorders and those receiving liver transplantation under the direction of the Liver Center Team attending physician.
During the first year fellows will be relieved of both inpatient and outpatient clinical responsibilities for a duration of four consecutive weeks. During this time the fellow will rotate in the pathology and radiology departments and utilize develop research interests. In the spring of their first year, the fellow will present research interests to the Scholarly Oversight Committee for advice and approval. The Oversight committee will monitor the fellow's progress routinely over the next two years, and advise the program director of the fellows progress.
Research Training
The second and third years of training are devoted to research training (either clinical investigation or laboratory research) which will be carried out primarily in the laboratories and facilities of the University of Colorado Denver and The Children's Hospital. During the first year of fellowship, the fellow will meet with each of the Pediatric Gastroenterology/Hepatology/Nutrition faculty and other researchers at the Health Sciences Center, and in conjunction with the Director of Fellowship Training, will determine if clinical or laboratory investigation will be the track chosen by the fellow, and with which laboratory investigator or clinical investigator he/she will work. The Department of Pediatrics at UCD has a formal educational program in clinical investigation and outcomes research, in conjunction with the Clinical Sciences Program (see website for details: http://www.uchsc.edu/clinicalscience/). Fellows will complete the Department-sponsored program as a requirement of the American Board of Pediatrics (ABP) and the Accreditation Council for Graduate Medical Education (ACGME). Fellows choosing the clinical investigation track will have the option to participate in further training in the Clinical Sciences Program (Masters and PhD programs are available). Responsibilities on the inpatient services are curtailed during these years in order to provide protected time for full pursuance of research training. All second-year fellows choosing the basic research track will attend the Introduction to Cellular and Molecular Biology course offered during July/August at UCDHSC. Research opportunities are numerous, including both basic and clinical investigation, under the mentorship of one of the Pediatric GI/ Hepatology/Nutrition faculty or another mentor of the School of Medicine. The GI/Hepatology/Nutrition Fellowship is an NIH-funded training program in pediatric gastroenterology, hepatology and nutrition, and works closely with the NIH-supported Clinical Nutrition Research Unit of the School of Medicine. In these Centers, there are a large number of NIH-supported investigators studying basic and clinical areas. In addition, the Clinical Translational Research Center at The Children's Hospital provides study design, biostatistical, bioinformatics, nursing, financial and scientific support for clinical investigation. During the second and third year of training, the fellow will continue to attend one half-day continuity clinic per week, the teaching conferences of the Section and rotate on the inpatient service for 2-4 weeks per year, but are otherwise dedicated to the research training.
Currently, the GI/Hepatology/Nutrition Section research is funded through more than ten National Institutes of Health grants awarded to Drs. Sokol, Narkewicz, Mack, Hoffenberg, Krebs and Hill, and funding from other sources (e.g., Cystic Fibrosis Foundation and pharmaceutical industry). A bibliography of recent publications is available on the following web page: http://www.uchsc.edu/peds/subs/gihepnut/pubs/.
Teaching Activities
The Section has designed the following series of teaching conferences to assist in the training of fellows and housestaff:
- Fellows' Rounds are held on Tuesday morning, during which the fellows present interesting patients to the entire group for discussion focused on patient management.
- Wednesday afternoon conference (4 p.m.) alternates weekly between GI radiology, GI pathology, and research conference and journal club. This is followed at 5 p. m. with a clinical topic conference. Faculty, guest faculty and fellows present various state of the art lectures on GI/Hepatology or Nutrition topics. Fellows present 1-3 times per year. Emphasis is placed on the fellow's acquisition of skills needed to deliver effective lectures and improve their teaching skills for their future careers.
- Pediatric GI/Surgery Conference: This monthly conference is run by both the GI and Pediatric Surgery Fellows and is held at TCH on the fourth Friday morning of the month. Each fellow will present 2 formal lectures each year on topics relevant to both GI and Surgery. Emphasis is placed on presentation and teaching skills.
- A citywide GI Grand Rounds for pediatric gastroenterology is held at the University on the first Friday morning of each month. A combined pediatric GI/Hepatology/Nutrition and Pediatric Surgery conference is held at TCH on the fourth Friday morning of the month. The fellow reviews and teaches basic GI/Hepatology physiology under the direction of the senior GI fellow and supervised by at least one faculty member.
- A GI physiology lecture series is under the direction of the senior GI fellow. The fellows review and teach basic GI/Hepatology physiology under the direction of the senior GI fellow and supervised by at least one faculty member.
- There are other weekly conferences run by the Center for Human Nutrition and the Hepatobiliary Research Center, in addition to Pediatric Grand Rounds.
- Finally, weekly meetings are held to review all Liver Center patients and monthly meetings to review Home Nutritional Support patients and Inflammatory Bowel Disease patients.
Support Staff
Support Staff in the Section includes a full-time Nutritional Support and IBD Nurse Specialist, two GI disease Nurse Coordinators, a Liver Center Nurse Coordinator, a GI/Hepatology dietitian, a GI/Hepatology Social Worker, three GI procedures nurses and secretarial staff, as well as Liver Transplant Coordinators.
Salary
Salaries are guaranteed by the University of Colorado Denver and paid at the PL-IV level with standard dental and medical insurance benefits for the fellow and family, and disability and life insurance. Funds are available for travel to one or two medical conferences per year, and for books/journals.
Night Call
Weekend call for fellows is divided among the fellows and averages every fourth weekend for the first-year fellows, and every sixth weekend for the second- and third-year fellows. Weeknight call is shared by first-year fellows. Fellows are supervised by a designated GI/Liver/Nutrition attending.
Fellowship Application
We are now registered with ERAS (The Electronic
Residency Application Service). Please login to ERAS, complete the Common Application Form, and attach the following supporting documentation:
- Current CV
- Personal Statement outlining the reasons for choosing this specialty, and applicant’s career plans
- At least two (2) but no more than four (4) Letters of Recommendation from physicians familiar with the applicant, one of which should be from the applicant’s residency program director
- USMLE/ECFMG scores
- A wallet-size photo
Interviews are conducted in groups of no more than five applicants at a time. Recruitment interviews will tentatively occur between late January and mid-April, although this is subject to change. Applicants selected for a personal interview will be contacted by the fellowship program coordinator:
Cindy Wyman
Business Administrative Coordinator and Fellowship Program Coordinator
Pediatric Gastroenterology, Hepatology & Nutrition
The Children's Hospital
13123 East 16th Avenue, B-290
Aurora, Colorado 80045
Tel: 720-777-5420
Fax: 720-777-7277
E-mail: Wyman.Cynthia@tchden.org
For additional questions, please contact:
Michael R. Narkewicz, MD
Director of Fellowship Training Program
Pediatric Gastroenterology, Hepatology & Nutrition
The Children's Hospital
13123 East 16th Avenue, B-290
Aurora, Colorado 80045
Tel: 720-777-6669
E-mail: Narkewicz.Michael@tchden.org
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