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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 Denver School of Medicine. Dr. Michael R. Narkewicz is the Director of the Fellowship Training Program. The Program has been continuously fully accredited in Pediatric Gastroenterology by the Residency Review Committee of ACGME since the specialty was first recognized by ACGME in December 1994. To better meet the needs of applicants, our pediatric gastroenterology fellowship training program participates in the National Resident Match Program (NRMP) and 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 pediatrics, with a 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 primarily 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 and research Universities in the U.S.
Two first year fellows are accepted into the Program each year. Fellows are exposed to a wide breadth of GI/liver/nutritional disorders and receive expert training in order to perfect skills in all procedures necessary for the Pediatric Gastroenterologist. Normal physiology and development 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, evidence-based disease management, instituting best practices and quality improvement, and refining clinical judgment, teaching, and interpersonal skills.
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 at TCH, a 270-bed facility, which is the major teaching hospital for the Department of Pediatrics of the University of Colorado Denver. TCH is also the pediatric home to the NIH-supported Colorado Clinical andTranslational Sciences Institute, housing the Pediatric Clinical Translational 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 over 8,000 outpatient visits per year. Over a one-year period, the GI/Hepatology/Nutrition Section performs over 3,000 procedures, including approximately 1,000 upper gastrointestinal endoscopies, 300 colonoscopies and flexible sigmoidoscopies, 90 liver biopsies, 20 small bowel biopsies and other gastrointestinal procedures (motility studies, breath hydrogen analyses, ERCP, esophageal pH studies, esophageal impedance, video capsule endoscopy, etc).
The two first-year fellows rotate between the Inpatient GI Service and Outpatient Clinics and procedures. While on the Inpatient Rotation, the fellow performs all in-hospital consultations and supervises 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 physical diagnosis, developing an accurate differential diagnosis, learning the methods of evaluating and treating the child and assessing and addressing the family's needs (family-centered care). 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 the 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, neonatal cholestasis, acute and chronic liver failure, chronic cholestatic disorders, bile duct and gall bladder disorders, acute and chronic pancreatitis, GI problems of the immunosuppressed or immunodeficient patient, and others. The fellow will learn to perform and interpret the full gamut of GI diagnostic and interventional procedures, including upper gastrointestinal endoscopy, colonoscopy and sigmoidoscopy, capsule endoscopy, polypectomy, esophageal variceal endosclerosis and ligation, esophageal pH and pH/impedence testing, duodenal intubation, paracentesis, 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. During the first year, the fellow will participate in care of children undergoing liver transplantation. The Transplant Hepatology Attending, Liver Center Team, dietitian, social worker, pharmacist and nutritional support nurse are all part of the Inpatient Care Team.
While on the Outpatient Rotation, the fellow will attend approximately 4 scheduled half-day clinics of the Section, approximately 2 urgent outpatient clinics, one continuity clinic, 3 half-days in the GI Procedure Unit, and participate in phone triage. A GI/Hepatology/Nutrition faculty member designated as the Outpatient Attending works closely with the fellow. The clinics available include the Pediatric Liver Center clinic on Monday and Thursday mornings, GI clinics Tuesday, Wednesday, Thursday, and Friday mornings and Monday, Wednesday, and Thursday afternoons, and various local satellite clinics. Multidisciplinary subspecialty clinics include the Pediatric Liver Center, Gastrointestinal Eosinophilic Disease Program, Intestinal Failure, and Adolescent Obesity Clinics. The fellows are exposed to the full range of outpatient GI/Hepatology/Nutrition disorders, and learn the appropriate and cost-effective evaluation and management of these infants and children. During the Outpatient Rotation, the fellow will attend two or three half-day procedure block times under direction of the attending pediatric gastroenterologist assigned to the block. Each fellow participates in a dedicated continuity clinic which begins during the second month of the first year continuing throughout their training. Fellows provide continuing care for patients evaluated in the inpatient and/or outpatient setting in this clinic. The fellows are involved in the outpatient management of home care for some of the 100-120 infants and children with complex parenteral and enteral nutritional support, including many with cystic fibrosis.
UCD and TCH have an active pediatric liver transplantation program. The Pediatric Liver Center, under the medical direction of Dr. Michael Narkewicz and the surgical direction of Dr. Frederick (Fritz) Karrer of the Department of Surgery, is actively involved in the evaluation of potential candidates for transplantation, peritransplant care, and post-transplant follow-up of all children. The Pediatric Liver Center is the regional referral center for the evaluation and care of children with acute and chronic hepatobiliary diseases. Five Pediatric Hepatologists within the Section provide consultation and ongoing care for these children. Fellows participate in the evaluation and care of children with liver disorders and those receiving liver transplantation under the direction of the Liver Transplant/ Hepatology attending physician.
First-year fellows also have a four-week rotation without any inpatient or outpatient clinical responsibilities for a series of electives. During this time the fellows rotate in the pathology and radiology departments in the morning and in the Exploring Research Opportunities Rotation during the afternoon. Working with the Program Director and Section Chief, a research plan for the fellow’s second and third years will be developed during the first year. In the spring of their first year, the fellow will present his or her research plans to the Scholarly Oversight Committee for advice and approval. The Oversight committee will systematically monitor the fellow's progress during the next two years, assuring appropriate progress and success of the fellow.
Research Training
The second and third years of training are primarily devoted to research training (either clinical, translational, or basic research) which will be carried out in the laboratories and facilities of the UCD and TCH. Responsibilities on the inpatient services are minimized during years 2 and 3 in order to provide protected time for research training. During the first year of fellowship, the fellow will meet with each of the Pediatric Gastroenterology/Hepatology/Nutrition faculty and other appropriate researchers at UCD, and, in conjunction with the Director of Fellowship Training and the Section Chief, will choose a mentor and a field of study. The Department of Pediatrics at UCD has a formal core educational program in Ethics, Professionalism, Statistics, Evidence-Based Medicine and Quality Improvement for all fellows that begins in the first year of fellowship. For fellows who elect to pursue Clinical and Translational Research, we encourage completion of a Masters in Clinical Sciences through the Clinical Sciences Program (see website for details: http://www.uchsc.edu/clinicalscience/). Basic research trainees are encouraged to participate in appropriate didactic course work as well as mentored laboratory research. All second-year fellows choosing the basic research track attend the Introduction to Cellular and Molecular Biology course offered during July at UCD. Research opportunities are numerous, 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 Mucosal Inflammation Program and Clinical Nutrition Research Unit at UCD. In these Centers, there are a large number of NIH-supported investigators studying basic and clinical areas. In addition, the Colorado Clinical and Translational Sciences Institute at UCD, in conjunction with the Clinical Translational Research Center at TCH, provides training in clinical and translational research, and provides assistance with study design, biostatistics, bioinformatics, research nursing, and financial and scientific support for clinical investigation. During the second and third years 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. The GI/Hepatology/Nutrition Section is also an active Clinical Center in 5 national research consortia studying childhood liver diseases, bringing many clinical research opportunities for fellows.
Currently, the GI/Hepatology/Nutrition Section research is funded by more than $3 million per year in grant support including ten NIH grants awarded to Drs. Sokol, Narkewicz, Furuta, Mack, Hoffenberg, Krebs, and Colgan, and funding from other sources (e.g., Cystic Fibrosis Foundation, American Liver 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 is active in the following teaching conferences that play an important role 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 evidenced-based patient management.
- Outpatient-Directed Topic Conference is held on alternate Tuesday mornings approximately 6 months a year. This conference is focused on a directed outpatient management topic and is presented by the fellows with an attending mentor.
- Morbidity and Mortality Conference is held Tuesday morning every other month.
- Wednesday afternoon conference (4 p.m.) alternates weekly between GI radiology, GI pathology, research conference, and journal club. Second- and third-year fellows present research in progress at the research conference once a year. At 5 p.m., there is a clinical topic conference. Faculty, guest faculty, and fellows present various state-of-the-art lectures on GI/Hepatology or Nutrition topics. Fellows present 1-2 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 presents 1 formal lecture each year on topics relevant to both GI and Surgery. Emphasis is placed on presentation and teaching skills.
- A citywide GI Grand Rounds for gastroenterology is held on Thursday evenings 8-10 times per year.
- A GI physiology lecture series is under the direction of the senior GI fellows with a faculty mentor. The fellows review and teach basic GI/Hepatology physiology under the direction of the senior GI fellow and are supervised by at least one faculty member.
- There are other weekly conferences run by the Mucosal Inflammation Program, the Center for Human Nutrition, and the Adult Gastroenterology Program, in addition to Pediatric Grand Rounds. Numerous other lectures and presentations are available across the Anschutz Medical Campus.
- Weekly multidisciplinary care meetings are held to review all Liver Center patients, Gastrointestinal Eosinophilic Disease Program patients, and biweekly meetings for Intestinal Failure and Inflammatory Bowel Disease patients.
Support Staff
Support Staff in the Section includes a full-time Nutrition Support/IBD Nurse Specialist, 6 GI Nurses, 2 Liver Care Nurses, 3 GI/Hepatology dietitians, 2 GI/Hepatology Social Workers, 3 GI procedures nurses and administrative assistant staff, as well as Liver Transplant Coordinators.
Salary
Salaries are guaranteed by UCD 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
Curriculum Vitae (CV)
- Personal Statement of 1-2 pages outlining the reasons for choosing this specialty, and the 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-sized photo
Interviews are conducted in Denver in groups of no more than three applicants at a time. Recruitment interviews will tentatively occur between January and mid-April, although this is subject to change. Applicants selected for a personal interview will be contacted by the fellowship program coordinator:
Kimberly Lilienthal
Program Assistant-Fellowship Program Coordinator
Department of Gastroenterology, Hepatology and Nutrition
The Children's Hospital
13123 East 16th Avenue, B-290
Aurora, Colorado 80045
Tel: 720-777-2738
Fax: 720-777-7277
E-mail: lilienthal.kimberly@tchden.org
For additional questions, please contact:
Michael R. Narkewicz, MD
Director of Fellowship Training Program
Pediatric Gastroenterology, Hepatology and 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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