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Gastroenterology And Hepatology Fellowship

Gastroenterology and Hepatology Training

During the program, fellows receive training in the cognitive aspects of consultative gastroenterology and hepatology, in gastrointestinal endoscopy and liver biopsies, and have opportunities for research. Fellows also have an opportunity to spend six months in laboratory-based or clinical research. An amalgamation of these clinical, procedural and research experiences provides the foundation for a career in academic medicine, as well as in scholarly clinical practice.

The role of the gastrointestinal specialist has been modified with the changes in health care delivery and the advent of managed care. We are cognizant of these changes and we have designed our program to be sufficiently flexible to meet the needs of our trainees and to allow for future success.

This includes the creation of the dual pathway training option where a trainee will be board-eligible in both gastroenterology and transplant hepatology in only three years. 

Complex problems in gastroenterology often require a team approach. We have excellent collaborative relations with GI and liver transplant surgeons, diagnostic and therapeutic radiologists, and GI pathologists who interact with us regularly in the care of our patients and in our research efforts. As a result of this team approach, we are proud to offer the newly ACGME-approved dual pathway training in our fellowship. This is an exciting opportunity for those interested in being board-eligible in both gastroenterology and transplant hepatology. This combined program is designed to be completed in three years rather than as separate programs spanning four years. Saint Louis University has an active abdominal transplantation program.

A Supportive Environment

Our teaching hospitals provide fellows with experience treating both common medical conditions seen in community settings and complex cases treated at a major academic tertiary care referral center. Our teaching faculty are an enthusiastic and skilled group of educators, including many who are listed on St. Louis's Best Doctors List. Our faculty and staff are known to be approachable, friendly, and supportive.

Fellows are regularly instructed at the bedside by dedicated clinical educators who provide a truly diverse and varied experience. Fellows develop excellent clinical and patient management skills that allow them to become outstanding physicians in any environment. The program fosters self-governance and ownership of the educational experience by the fellows, encouraging self-directed, lifelong learning.

Fellowship Clinical Services

During the first year of training, fellows rotate on the gastroenterology service at SSM Health Saint Louis University Hospital and John J. Cochran Veterans Hospital. Fellows become proficient in basic endoscopic procedures. Here is a yearly breakdown:

First Year
  • GI  Service at SSM Health Saint Louis University Hospital and  John J. Cochran Veterans Hospital
  • Proficient in basic endoscopic procedures including:
  • Upper endoscopy 
  • Colonoscopy
  • Endoscopic biopsy 
  • Polypectomy
  • Esophageal dilation 
  • Endoscopic hemostasis
  • Percutaneous endoscopic gastrostomy 
  • Second and Third Year 
  • Liver service 
  • Pancreatiocobiliary service
  • SLU clinics
  • Endoscopy
  • John J. Cochran Veterans Hospital 
  • If a trainee has an interest in completing the dual pathway for gastroenterology and transplant hepatology, they may apply in their first year to begin on the adjusted pathway during their second year. These trainees will have the same robust gastroenterology experiences with the following transplant hepatology-specific experiences:

  • Outpatient rotations with transplant surgery, pediatrics
  • Pathology
  • Participation in liver biopsies
  • Participation in liver procurement
  • Elective Options
  • Gastrointestinal radiology 
  • Pathology 
  • Pediatric and adolescent gastroenterology 
  • Advance endoscopy 
  • Hepatology 
  • Liver transplantation 
  • Colorectal surgery 
  • Academic leadership/teaching/QI project
  • Fellowship Research

    Each fellow is expected to complete a research project of clinical or basic science interest. The goal of the research component of the fellowship is to train physicians and basic scientists who want to pursue a career in academic medicine. The program develops independence under the direction of a mentor.

    A major emphasis of the experience is teaching the skills necessary to perform research and win peer-reviewed funding in our current competitive climate. The research process includes experience in literature review, study design, budgeting, peer review, IRB approval, data collection, statistical analysis, and submission of an abstract for society presentation and publication in a peer-reviewed journal. In addition to the support of the teaching faculty, the fellowship program provides research support consisting of clinical research assistants, computer programming for data analysis, and graphics and audio/visual support for presentations.

    Each fellow must also present their research at our annual year-end research conferences. Fellows are also encouraged to present the results of their research experiences at an annual national meeting, such as those sponsored by the American Gastroenterological Association, the American Association for the Study of Liver Diseases or the American College of Gastroenterology. 

    Current research activities include: 

  • Investigation into the mechanisms of hepatic fibrogenesis 
  • Mechanism of lipotoxic liver injury (NASH) 
  • Gene regulation of hepatic collagen synthesis
  • Regulation of hepatic stellate cell activation
  • Effects of Kupffer cell products on hepatic stellate cells
  • Role of oxidative stress in hepatic injury
  • Mechanisms of inflammation and fibrosis in the pancreas
  • Intracellular signaling in stellate cell
  • Correlation of hepatic steatosis among cohabitants - NASH and pharmacology
  • Effect of food-reintroduction timing post-scope
  • Endoscopy for abnormal imaging
  • Training Goals

    The goal of training in the second and third years is for fellows to develop specific skills in keeping with their career goals. Someone interested in general gastroenterology practice might be involved in all clinical areas. Someone interested in a research-oriented academic career would place an emphasis on research. And subspecialty residents interested in a career in academic clinical hepatology might do extensive work in the liver clinic, with the liver transplant service, and with several clinical research projects. The flexibility of the curriculum in the second and third years allows our fellows to tailor their training according to their career choices.

    Transplant Hepatology

    Our ACGME-accredited transplant hepatology fellowship is designed for trainees who have already completed their gastroenterology training. Building on the prior training allows this one-year fellowship to deepen the trainee's knowledge while challenging them with additional skills and procedures. Our program's goal is to create well-rounded gastroenterologists capable of meeting 21st-century needs in a collaborative approach with their patients, other services and the medical system.

    If you have any questions please reach out and let us know. 

    New! Clinical Research Fellowship

    Beginning in the 2023-2024 Academic Year, the Division of Gastroenterology and Hepatology at Saint Louis University will be offering a one-year, non-ACGME Clinical Research Fellowship.

    This full-time, exempt position will report to and work closely with Division Director Wing-Kin Syn, M.D.. This is a bespoke one-year clinical research fellowship, with potential for extension, focusing on NAFLD with a mixture of research and clinical training. The breakdown will be as follows:

  • 50% (six months) of translational research in NAFLD and liver fibrosis with administrative time
  • 50% (six months) of clinical practice in GI Division (NAFLD liver) training with exposure to GI Fellow continuity clinic (ambulatory clinics; inpatient where appropriate))
  • It will suit trainees or junior faculty who intend to pursue a career as a GI/hepatology physician-researcher or physician-scientist. This blended research and clinical practice fellowship is designed to marry the clinical and research components of the field to enhance patient care.

    For more information, please reach out to wing-kin.Syn@slucare.Ssmhealth.Com

    Application Process

    You may apply for one of our four GI fellowship positions through the Electronic Residency Application Service (ERAS). We accept applications July 1-31 for each interview season. We review applications in early August and invite applicants to interview from late August-October. All of our positions will be filled through the National Residency Match Program (NRMP). We sponsor both H-1B1 and J-1 visas. All application requirements are listed with ERAS.

    Research 

    The Division of Gastroenterology and Hepatology at Saint Louis University fosters research from the lab to patient treatment. As a leading research center, we are continually engaged in multicenter clinical trials allowing us to offer our patients access to the latest advances in clinical care. Our physicians specialize in diagnosing and treating liver diseases that range from the evaluation of fatty liver to hepatitis B to management of severe, complicated, end-stage liver disease awaiting transplantation.

    To learn about our clinical trials, please call the Gastroenterology and Hepatology Clinical Studies Unit at 314-977-9400 to speak with a research coordinator.

    View Current Clinical Trials

    As an alumna of Saint Louis University School of Medicine's Gastroenterology Fellowship program, I am intimately familiar with the rigors and rewards of training here. Our program's goal is to create well-rounded gastroenterologists capable of meeting 21st-century needs in a collaborative approach with their patients, other services, and the medical system. Fellows focus on clinical outpatient experiences, inpatient services, research and special populations. The fellowship program is positioned to grow with trainees and their interests with our talented faculty and staff facilitating their instruction. Please check out some of the information about our dual pathway fellowships. If you have any questions please don't hesitate to reach out. 

    Jennifer Palagiri, M.D.Assistant ProfessorProgram Directorjennifer.Palagiri@health.Slu.Edu

    Alex Befeler, M.D. HepatologistProfessor; Medical Director of Liver Transplantation; Program Director, Transplant Hepatologyalex.Befeler@health.Slu.Edu

    Antonio Cheesman Rocca, M.D.Assistant ProfessorAssociate Program Directorantonio.Cheesmanrocca@health.Slu.Edu Kamran Qureshi, M.D. Associate ProfessorAssociate Program Directorkamran.Qureshi@health.Slu.Edu Laura Robinson, M.A.Program Coordinatorlaura.Robinson@health.Slu.Edu

    What Is Gastroenterology?

    According to the American College of Gastroenterology, Gastroenterology is the study of the normal function and diseases of the esophagus, stomach, small intestine, colon and rectum, pancreas, gallbladder, bile ducts and liver.

    A gastroenterologist needs to have a detailed understanding of the normal physiology of all the above mentioned organs as well as motility through the intestines and gastrointestinal tract in order to maintain a healthy digestion, absorption of nutrients,  removal of waste and metabolic processes.

    A gastroenterologist also needs to have a clear understanding of ailments affecting the organs of the gastrointestinal system like:

  • peptic ulcer disease
  • gastric cancers
  • esophageal cancers
  • achalasia
  • Barret's esophagus
  • colon polyps
  • colon and bowel cancers
  • pancreatitis
  • pancreatic cancers
  • cholecystitis
  • biliary tract disease
  • gallbladder stones and cancer
  • hepatitis
  • gastroesophageal reflux
  • colitis
  • nutritional problems and malabsorption,
  • Irritable Bowel Syndrome (IBS)
  • a host of other disease conditions
  • Training

    A Gastroenterologist must first complete a three-year Internal Medicine residency. He or she is then eligible for additional specialized training (fellowship) in Gastroenterology for two to three years. This means a total of 5-6 years of additional specialized education after medical school.

    The fellowship is a hands-on intense and rigorous programme that gives the opportunity to the trainee to learn directly from nationally recognized experts and work to get a detailed understanding of gastrointestinal diseases.

    Starting from evaluation of patients to caring for them in the office as well as in the hospital is part of the training. Training involves learning endoscopy (upper endoscopy, sigmoidoscopy, and colonoscopy), endoscopic biliary examination (endoscopic retrograde cholangiopancreatography or ERCP), endoscopic mucosal resection or EMR, endoscopic ultrasound (EUS) etc.

    Along with endoscopy they are also trained in performing advanced endoscopic procedures such as polypectomy, esophageal and intestinal dilation and hemostasis. They are taught how to interpret imaging and pathology results in order to make appropriate recommendations to treat conditions.

    The fellowship is overseen by national societies like the American Board of Internal Medicine, the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy.

    After completion of the fellowship the gastroenterologists are qualified to take the Gastroenterology board certification test administered by the American Board of Internal Medicine. Once they have successfully completed this examination they are "Board Certified."

    Renewal of certification

    Gastroenterologists renew their board certification through the American Board of Internal Medicine (ABIM) via the Maintenance of Certification (MOC) program.

    For this gastroenterologists need to schedule, take and pass the secure ABIM Gastroenterology Maintenance of Certification Examination as well as earn 100 points in Self-Evaluation of Medical Knowledge and Self-Evaluation of Practice Performance.

    In the latter test they are needed to earn a minimum of 20 points of medical knowledge and 20 points of practice performance. The remaining 60 points may be from either medical knowledge, practice performance or both.

    The ABIM Gastroenterology Maintenance of Certification Examination evaluates the knowledge and clinical judgment in relevant areas of practice. Exam questions are developed by a team of gastroenterologists in practice and in academic medicine. The computer-based examination is offered twice a year – in spring and fall.

    Sources
  • http://s3.Gi.Org/patients/ccrk/WhatIsAGastro.Pdf
  • https://www.Abim.Org/
  • http://www.Questdiagnostics.Com/hcp/intguide/Gastro.Pdf
  • https://www.Ficci.In/api/home
  • Further Reading

    Division Of Pediatric Gastroenterology, Hepatology And Nutrition

    The Division of Pediatric Gastroenterology, Hepatology and Nutrition at Baylor College of Medicine consists of 45 faculty members and a support staff of 86 all dedicated to outstanding and compassionate patient care through evidence-based and expert practice achieved though research and education.

    Expert state-of-the-art clinical care is provided for the entire range of diseases within Pediatric Gastroenterology, Hepatology, Nutrition, Pancreatology and Transplant Medicine focused in three hospital-based campuses – The Texas Medical Center, The West Campus and The Woodlands and multiple community based specialty centers. In 2019, the team conducted over 27,000 outpatient clinic visits, 3,700 endoscopic procedures (including 425 advanced procedures) and managed an in-patient hospital census of 20 to 40 patients. Multiple subspecialty clinical programs exist within the division including; aerodigestive diseases, celiac disease, eosinophilic gastrointestinal diseases, hepatology and liver transplantation, inflammatory bowel diseases, intestinal rehabilitation, neurogastroenterology and motility, pancreaticobiliary disease and viral hepatitis.

    In addition, to the breadth and depth of the clinical care provided by the division of Pediatric Gastroenterology, Hepatology and Nutrition, the division has a strong tradition of academic and research excellence.

    Clinical research activities include over 200 IRB approved protocols covering the spectrum of types of clinical research including randomized controlled trials, prospective observational studies, translational research, multi-centered database studies, expanded access protocols and various retrospective analyses. Clinical research is supported by a team of five highly skilled clinical research coordinators. Active collaboration in pharmaceutical supported studies brings novel therapies to the care of patients cared for by the division. A recently renovated basic and translational research facility houses state-of-the-art molecular investigations of biliary atresia, fatty liver disease, immune function, malnutrition and motility to name only a few of the active areas of investigation. The division is supported by numerous grants (including 1 T32, 2 U01, 3 K23, 1 K08 and 1 R03 awards from the NIH). The academic productivity of the division is highlighted by the publication of 84 peer-reviewed manuscripts in 2019.

    Educational activities are critical to the successful completion of the mission of the Division of Pediatric Gastroenterology, Hepatology and Nutrition. Our team is involved in a wide range of educational programs with learners at all levels including medical students, residents, fellows and our clinical colleagues. Innovative approaches including the train-the-trainer program in endoscopy are characteristic of the divisions educational endeavors. A major training focus for the division is our Gastroenterology, Hepatology and Nutrition Fellowship along with our Pediatric Liver Transplant Medicine Fellowship. Innovative approaches to education exist in both of these programs including newly developed research training tracks. Advanced clinical skills (e.G. Advanced endoscopic procedures, inflammatory bowel diseases and neurogastroenterology /motility) may also be acquired in unique instructor level training programs.

    Learn more about the Gastroenterology, Hepatology and Nutrition division at Texas Children's Hospital.






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