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Clinical Gastroenterology Pathway

The three-year Case Western Reserve University/University Hospitals Cleveland Medical Center Clinical Gastroenterology Pathway is available to physicians who have completed three years of residency in internal medicine and wish to prepare for a career in gastroenterology in an academic environment or practice. Emphasis is placed on the analytical evaluation of gastrointestinal diseases and the practice of clinical gastroenterology. The program's flexibility allows fellows to develop skills and knowledge in accord with their individual interests and career goals.

Clinical Gastroenterology Fellowship Program Goals

The goal of the Clinical Gastroenterology Fellowship Program is to train outstanding internists in the fundamentals of gastroenterology based on the knowledge of physiology, biochemistry and pharmacology of the digestive system. Some of the ways in which these disciplines are applied to the diseases treated by a gastroenterologist include:

  • Gastrointestinal endoscopy
  • Gastrointestinal oncology and surgery
  • Hepatology
  • Inflammatory bowel disorders
  • Nutrition

The Clinical Gastroenterology Fellowship Program stresses a broad understanding of pathology and the use of procedures and diagnostic tests in consultation and management of these gastrointestinal disorders.

Gastroenterology Fellowship Program Training

Training includes extensive experience and supervision in the following areas:

  • Colonoscopy
  • Enteral and parenteral alimentation
  • Esophageal dilatation
  • Gastric and pancreatic biliary secretory tests
  • Gastrointestinal motility studies
  • Liver and mucosal biopsies
  • Upper endoscopy
  • Colonoscopic polypectomy

Fellows are supervised in the indications for and interpretation of endoscopic and radiographic procedures, including endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography. The program aims to develop skills required to analyze clinical problems critically, based on fundamental scientific information.

Ambulatory Clinic Experience

Outpatient ambulatory clinics provide all fellows with a weekly experience at both UH Cleveland Medical Center and the Louis Stokes Cleveland VA Medical Center, each with an assigned faculty advisor. Two new patients with four to six follow-up patients are usually seen by a fellow at each clinic, allowing involvement in continuity of care for many chronic digestive and liver disorders that are typically not encountered in the inpatient setting.

Specialized Hepatitis C Clinic

When rotating at the Louis Stokes Cleveland VA Medical Center, fellows in the Clinical Gastroenterology Fellowship Program staff a clinic to see urgent outpatient consultations and attend a Hepatitis C Clinic.

Focused Training in Liver Disease and IBD

The Clinical Gastroenterology Fellowship Program provides focused training in the outpatient management of liver disease and inflammatory bowel disease. Each of these specialized experiences complements the more traditional fellowship curriculum.

Emergency and Weekend On-Call Schedule

The on-call schedule covers both institutions with fellows supervised by faculty. This schedule provides an outstanding experience in the emergency care of a wide variety of gastrointestinal problems, including:

  • Ascending cholangitis
  • Foreign body removal
  • Intestinal obstruction
  • Management of acute abdominal emergencies
  • Upper and lower gastrointestinal bleeding

Fellows are on-call approximately every 12th night.

Documented Procedures Record/Logbook

All fellows in the Clinical Gastroenterology Fellowship Program are expected to keep a documented record of all procedures they perform (HIPAA-compliant record). This is required to show that they have performed a sufficient number of procedures to achieve competence as defined by the American Society for Gastrointestinal Endoscopy (ASGE) Standards of Training Committee.

Logbooks will specify date of procedure, type of procedure, therapy given (if any) and name of supervising attending. Fellows are expected to attest that they have truthfully performed the documented procedures.

Monitoring and Evaluation Process

All fellows in the Clinical Gastroenterology Fellowship Program will be monitored and evaluated by an endoscopic training and competency assessment/evaluation process. The monitoring and evaluation process will be performed by evaluating attendings at regular time intervals throughout the course of the three-year fellowship.

These evaluation forms will detail all aspects of endoscopy, both technical and cognitive. There will be opportunity for face-to-face discussions and feedback between fellows and evaluating attendings throughout the three-year fellowship. In addition, a subset of procedures will be formally evaluated by faculty members using a standard template.