Gastroenterology Fellowship

Fellowship Program for 2009-2010 Academic Year:
 
The fellowship program at the McGaw Medical Center of Northwestern University includes three hospitals: Northwestern Memorial Hospital (NMH), VA Chicago Healthcare System-Lakeside Division (VACHS-LS) and the Rehabilitation Institute of Chicago (RIC). The program is designed to cover three years. The aim is to provide a broad range of experiences in both clinical and investigative gastroenterology. Matriculating fellows are expected to be well prepared for future careers in either academic or practice settings. Two to three fellows are accepted each year in the three year general GI program.
 
The facilities at NMH and VACHCS-LS are outstanding. Northwestern Memorial Hospital has state of the art GI endoscopy procedure rooms, inpatient and outpatient facilities, conference facilities and a "filmless" radiology system that utilizes digitalized imaging for all procedures. The NMH, VA, RIC and medical school facilities are within a three-block radius in the Streeterville area two blocks east of Michigan Avenue's "magnificent mile."
 
The divisions of gastroenterology and hepatology  are fortunate in having fulltime faculty clinical investigators with interests and expertise in several major areas of digestive disease. These areas include gastroesophageal reflux disease, esophageal motor disorders, gastrointestinal motility, viral hepatitis, liver transplantation, chronic liver disease, colon cancer, peptic ulcer disease, inflammatory bowel disease, pancreaticobiliary disease, advanced endoscopy, clinical trials and outcomes research. Active clinical and/or basic science research efforts exist in these areas. 
 
Teaching is an integral part of the fellowship program at Northwestern. Fellows learn through clinical rotations, outpatient clinics and numerous education conferences that are listed below. The faculty is fully committed to providing their fellows an outstanding training experience.
 
1. Gastroenterology and Hepatology Faculty
 
Peter Kahrilas MD
Gilbert H. Marquardt Professor of Medicine
Chief, Division of Gastroenterology 
Academic Interests: Esophageal disorders, Gastroesophageal reflux disease, Oropharyngeal dysphagia
 
Jill Addesa, MD
Assistant Professor of Medicine
Academic Interest:  General Gastroenterology
 
Rameez Alasadi, MD
Assistant Professor of Medicine
Academic Interests: Endoscopic Ultrasound, Interventional Endoscopy
 
Alfred Baker, MD
Professor of Medicine
Academic Interests: Hepatology, Liver Transplantation
 
David Barch, MD
Associate Professor of Medicine
Associate Chief of Staff for Research and Development, VACHCS-LS 
Academic Interests: Basic science colon cancer
 
Terrence Barrett, MD
Associate Professor of Medicine
Academic Interests: Basic science investigations in inflammatory bowel disease and gut immunology
 
Andres Blei, MD
Professor of Medicine
Medical Director of Hepatology at NMH
Academic Interests: Portal hypertension and Hepatic Encephalopathy, Liver Transplantation, Clinical and Basic science
 
Alan Buchman, MD
Associate Professor of Medicine
Medical Director of Inflammatory Bowel Disease
Academic Interests: Inflammatory Bowel Disease, Nutrition, Clinical Trials
 
Rosario Ferreira, MD
Assistant Professor of Medicine
Academic Interests: Health Services Research in Colon Cancer 
 
Steven Flamm, MD
Associate Professor of Medicine
Director, Hepatology Clinical Practice
Academic Interests: Hepatitis, Liver Transplantation, Clinical trials
 
Richard Green, MD
Chief, Divison of Hepatology
Associate Professor of Medicine
Chief of Gastroenterology, VACHCS-LS
Academic Interests: Hepatology Basic Science Investigations
 
Ikuo Hirano, MD
Associate Professor of Medicine
Director, Gastroenterology Fellowship Program
Academic Interests: Swallowing and Motility Disorders
 
Colin Howden, MD
Professor of Medicine
Director, Gastroenterology Clinical Trials 
Academic Interests: Helicobacter pylori, Peptic diseases, Non-ulcer dyspepsia
 
Michael Jones, MD
Associate Professor of Medicine
Director, GI Endoscopy Laboratory
Academic Interests: Gastroparesis, Dyspepsia, Irritable Bowel syndrome
 
Thomas, Lee, MD
Instructor of Medicine
Academic Interests: Interventional endoscopy, ERCP, Gastroesophageal reflux disease, endoscopic therapy for reflux disease
 
Patrick Lynch, MD
Assistant Professor of Medicine
Academic Interests: Clinical Hepatology, Liver Transplantation
 
John A. Martin, MD
Associate Professor of Medicine
Interventional Endoscopy
 
John Pandolfino, MD
Assistant Professor of Medicine
Academic Interests: Gastroesophageal reflux disease, Motility Disorders
 
Mary Rinella, MD
Assistant Professor of Medicine
Academic Interest:  Clinical Hepatology
 
Christian Stevoff, MD
Assistant Professor of Medicine
Director, Gastroenterology Clinical Practice
Academic Interests: Colon cancer, General Gastroenterology
 
Arvydas Vanagunas, MD
Professor of Medicine
Chief, Patterson Firm
Academic Interests: Endoscopic Ultrasound, General Gastroenterology, Medical Education
 
2. Gastroenterology Fellows
 
Joseph Ahn, MD
Aaron Benson, MD
Jason Cisler, MD
Greg Cote, MD
Anne Henkel, MD
Christian Jackson, MD
Sean Koppe, MD
Brant Lutsi, MD
Eva Sotil, MD
Ramsey Umar, MD
 
3. Call Schedule
 
First year fellows will take call on a Q5-6 week basis. The schedule will be as follows:
 
First year: 9 weeks 
Second year: 6 weeks 
Third year: 6 weeks 

First year fellows will not be on call until 8/1/02. 
 
4. Core Clinical Curriculum
 
12-14 months general GI (6-8 mos VA, 4-6 mos NMH)
4-6 months Hepatology/Transplant
3-6 months Pancreaticobiliary/Interventional/Endoscopic Ultrasound
4-6 months outpatient endoscopy 
1-2 months nutrition/inflammatory bowel disease 
12-16 months Research block for research fellows
 
5. Fellow Teaching Conferences
 
A weekly fellows teaching conference is held on Wednesday mornings. These are didactic sessions. All conferences with the exception of pathology will be held in the GI conference room on the 4th floor of Galter (Galter 4-133)or in room 14018A at 676 N. St. Clair St., 14th floor. Path conference will be held in the pathology conference room on the 7th floor of Galter (Galter 7-514). These conferences are mandatory for all fellows.
 
a. Swallowing and Motility conference, Dr. Hirano 7:30 - 8:30, first Wed every other month alternating with Inflammatory Bowel Disease conference, Drs. Barrett and Buchman
b. Patholophysiology conference, Dr. Craig 7:30-8:30, second Wed 
c. Pancreaticobiliary conference, Dr. Alasadi, third Wed every other month alternating with Hepatology conference, Dr. Baker
d. Pathology conference, Dr. Sam Rao/Dr. Hirano, 7 am - 8 am, fourth Wed 
e. Fellows meetings Dr. Hirano, fifth Wed 7:30 - 8:30 
 
6. Summer Lecture Series
 
To run in lieu of the Wednesday Fellows conferences, July-September.  These will be held in the GI conference room Galter 4-133, 7:30-8:30 am
 
Topic: 
 
GI Emergencies: Acute GI Bleeding A. Vanagunas
GI Emergencies: Esophageal Emergencies and Strictures I. Hirano
Gastroesophageal Reflux Disease P. Kahrilas
Malabsorption/Nutrition A. Buchman
Interpretation of LFTs A. Baker
Inflammatory Bowel Disease T. Barrett
Complications of Chronic Liver Disease A. Blei
Pancreaticobiliary Emergencies R. Alasadi
Colon Cancer Screening/Surveillance R. Ferriera
Basic Science for the GI Fellow R. Green
Complications of GI Endoscopy J.Addesa
Ulcer and Non-Ulcer Dyspepsia C. Howden
Liver Transplantation P. Lynch
Intestinal Obstruction and PseudoObstruction J. Pandolfino/A. Nagle
Viral Hepatitis A to G S. Flamm
Techniques of Colonoscopy and Polypectomy C. Stevoff
 
7. Weekly Division Conferences
 
a. NW GI Oncology Patient Management Conference. Tuesdays at 3-4 pm. Feinberg 3-523
b. Gastroenterology Education Conference. Thursdays 7:30 - 8:30 am. 676 N. St. Clair St., Room 14018A, 14th floor.   Includes journal club, lectures by visiting professors, research presentations and State of the Art presentations.
c. Medical-Surgical Gastroenterology Conference. Thursdays 5 - 6 pm. Galter 7-302. Case presentations by surgical residents and gastroenterology fellows with discussions focused on management issues. 
d. NW Hepatology Research Conference. Fridays at 7:30-8:30 am. Galter 17th floor Transplant Conference room
 
8. Other Conferences


a. University of Chicago-Northwestern Combined GI Conference. Quarterly meeting held on Thursday evenings 5-6 pm. Location alternates between UC and NU.
b. NU Medical Grand Rounds are held on Friday afternoons from 12 noon until 1 pm.
c. The Chicago Society for Gastroenterology holds monthly dinner meetings on Wednesday evenings. There is no membership fee for fellows. In addition, one meeting in November is dedicated to fellow presentations of interesting cases from each of the Chicago GI programs. Second or third year fellows will be expected to present at this meeting.
d. Digestive Disease Week is the annual meeting of the American Gastroenterological Association. The meeting is held in May of each year. Second and third year fellows typically attend this meeting.
e. Other.  Additional national conferences and meetings on outcomes research, endoscopy techniques, biliary disease etc are available to second and third year fellows depending upon academic interests of the fellow and the discretion of the program director.
 
9. NMH General GI
 
The NMH General GI rotation is the major educational experience for fellows in clinical Gastroenterology covering the pathophysiology, evaluation and management of common and uncommon GI diseases. Common presentations and disorders include upper and lower gastrointestinal hemorrhage, peptic ulcer disease, acute abdominal pain, dysmotility syndromes, dysphagia, ischemic bowel, diverticulitis, bowel obstruction, pancreaticobiliary disease, diarrhea, nausea/vomiting, inflammatory bowel disease and gastrointestinal cancers. Teaching is achieved through a combination of didactic case-based attending rounds, bedside walk rounds, primary review of radiology and pathology examinations and performance of supervised endoscopic procedures.
 
NMH GI fellows are expected to see all consults on the day the consult is received. Consultation notes should be written prior to presentation to the attending of the month on rounds. Follow up notes should be written on a daily basis on active patients. Consultations seen by medical residents must also be seen by the GI fellow although a separate note is not necessary in most instances. Separate notes by the fellow or attending are required for notes by medical students.
 
Prerounding on active NMH consultations is expected prior to the first scheduled inpatient procedure.
 
In general, the first year NMH fellow is responsible for performing procedures on inpatient consultations. All procedures are fully supervised by an attending physician. A dedicated procedure attending is available to cover both morning and afternoon procedures (see Attachment). Procedures for the following day need to be booked by the inpatient fellow through the scheduling clerks in the GI lab front office. It is important that inpatient procedures be booked as closely together as possible to allow effective utilization of the covering inpatient attending.
 
10. Hepatology/Liver Transplantation
 
The Hepatology/Liver Transplantation rotation covers both inpatient and outpatient issues related to liver disease. The goal of the rotation is to provide an understanding of the pathophysiology, evaluation and management of liver diseases including viral hepatitis, alcoholic liver disease, acute liver failure, cirrhosis, portal hypertension and hepatoma. Aspects of liver transplantation including preoperative assessment, management of critical patients awaiting transplantation and evaluation of post transplant complications and immunosuppression are covered. The rotation involves inpatient consultations, primary coverage of pretransplant patients and participation in both pre and post transplantation liver outpatient clinics.
 
11. VA General GI
 
The VA GI service runs in a similar manner to NMH. The inpatient caseload tends to be lighter but the outpatient endoscopy schedule is significantly busier. Fellows are responsible for performing endoscopic procedures on both the outpatients and inpatients with supervision by VA staff physicians.
 
12. Outpatient GI Experience
 
The goal of the outpatient experience for GI fellows is the acquisition of knowledge and experiences that will allow them to serve as skilled consultants. Emphasis is placed on the diagnosis and management of common disease states including peptic ulcer disease, gastroesophageal reflux disease, irritable bowel syndrome, inflammatory bowel disease, chronic abdominal pain, non ulcer dyspepsia, chronic diarrhea, Barrett's esophagus and colorectal cancer. Teaching is achieved through supervision by an ambulatory attending and through reading of articles covering topics relevant to the practice of outpatient Gastroenterology.
 
The outpatient GI experience consists of ambulatory clinic sessions held at both the Lakeside VA and Northwestern Memorial Faculty Foundation. The VA experience is a weekly, morning clinic session. Each first, second and third year fellow will follow his/her own panel of patients. The fellow will be responsible for evaluating the patient, discussing the case with the supervising attending and writing a visit note in the VA computer (DHCP). 
 
Second and third year GI fellows attend outpatient GI clinic with selected GI attendings. In addition, a hepatology clinic runs on Wednesday afternoons at the VA. 
Second and third year fellows participate in an outpatient endoscopy rotation. During this rotation, fellows are responsible for the supervised performance of assigned outpatient endoscopic procedures at both Northwestern Memorial Hospital and the Lakeside VA medical center. Advanced procedures in endoscopic ultrasound, endoscopic dilation, botulinum toxin injection, stent placement and endoscopic coagulation techniques are also available during this rotation.
 
13. Endoscopic Training
 
During the course of the three year fellowship, fellows are expected to become competent in upper endoscopy, colonoscopy, flexible sigmoidoscopy, hemostasis of upper and lower GI hemorrhage, variceal band ligation, esophageal dilatation, percutaneous endoscopic gastrostomy, endoscopic retrograde cholangiopancreaticogram (ERCP) and percutaneous liver biopsy. The number of procedures recommended by the American Society of Gastrointestinal Endoscopy (ASGE) is listed in the fellowship manual. Traditionally, the number of procedures actually performed by fellows graduating from the Northwestern program has far exceeded the ASGE requirements. Procedural competency is assessed by supervising attendings, the head of endoscopy and the head of interventional endoscopy. Fellows are required to track the numbers of procedures performed on spreadsheets available through personal computers or palm pilots.
 
14. Teaching Responsibilities
 
Fellows are expected to participate in the education of housestaff and medical students during rotations on the NMH and VA General GI services. Teaching and supervision is a critical component of the fellowship program. Fellows are strongly encouraged to obtain appropriate references pertaining to interesting cases on the service and to distribute these to the consultation team.
 
In addition, fellows are responsible for presentations at the Medical-Surgical Gastroenterology Conference. This conference runs from September through the remainder of the academic year. Presented topics are expected to be well researched and up to date. In addition, second and third year fellows are expected to present their research projects at the Gastroenterology Education Conference. All fellows will be responsible for one "State of the Art" lecture per year as part of the Gastroenterology Education Conference.
 
15. Research 
 
Toward the end of the first year of fellowship, research fellows are expected to identify a mentor with whom they will work on a research project during their second and third years. Research time in the second year is greater than in the third year so that data collected in the second year can be analyzed, written up and presented at national meetings in the third year. Fellows who are identified as having strong investigative interests upon acceptance to the program or early in the first year will be assigned a substantially greater proportion of research rotations during both the second and third years. 
 
At least one abstract and paper are expected per fellow. A partial list of areas of faculty interest is stated under each faculty member's name in item 1. In addition to an $750 yearly academic allowance, fellows who present at a national GI conference will receive an additional $500 to help cover travel expenses. Additional financial support is available at the discretion of the research mentor and fellowship program director.
 
16. Fellow Meetings
 
The fellowship director will hold regular meetings with the fellows. General meetings will be held on a quarterly basis with all fellows on Wednesday mornings. In addition, the fellowship director will formally meet with each fellow on an individual basis every 6 months. Additional meetings can be arranged with the fellowship director by calling the fellowship coordinator at 695-0182.
 
17. Medicine and Gastroenterology Boards
 
First year fellows will be taking medicine boardsAugust 19-20, 2003. GI specialty boards are taken after completion of the third year. The Wednesday morning fellow conferences are designed to teach fellows material that is important for the board examination.
 
18. Vacation
 
Fellows will receive 3 weeks of paid vacation per annum. Vacations are not permitted in June. Fellows are required to notify the fellowship coordinator in writing (email preferred: skuipers2@nmff.org) of vacation requests at least 4 weeks in advance. The time must be approved by the fellowship director and coordinator. The second or third year fellows will cover first year fellows on NMH and VA services (maximum of 2 weeks are allowed during these services). The VA clinic scheduling coordinator must be notified 4 months in advance to allow for rescheduling of patients. If this is not done, it will be the responsibility of the fellow to contact and rebook the scheduled patients. In addition, fellows with clinic at NMFF must notify Elyse Stuart, RN in writing or email (estuart@nmff.org) of any vacation plans at least 2 months prior to their vacation date. Vacation time cannot be accrued and carried over to the following year of training.
 
When on vacation or attending scientific meetings, coverage must be arranged for fellows on services other than research elective. Vacation maybe taken during endoscopy block time but the coverage should be arranged with the attendings on endoscopy block on an individual basis (in some cases, the endoscopy block may be either cancelled or covered by the attending).
 
19. Moonlighting
 
Moonlighting is not permitted in the first year of fellowship due to the high demands of clinical service and the intensive learning curve that characterizes that period of time.  Moonlighting is also strongly discouraged during the second and third years of fellowship.  Northwestern fellowship stipends have been substantially increased  to decrease the financial burdens of its trainees.  Any moonlighting that does occur must not violate the RRC regulations on duty hours listed below:
 
a) Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-hours call activities, conferences, and patient care.
 
b) Fellows must be provided with one day in seven free from all educational and clinical responsibilities, averaged over a four-week period.  One day is defined as on continuous 24-hour period free from all clinical, educational and administrative activities.
 
c) Continuous on-site duty must be limited to 24 consecutive hours with an additional six hours available for clinical and educational activities.
 
Any fellow found in violation of these regulations as a result of moonlighting activity will be subject to disciplinary action.  In addition, moonlighting activity that interferes with a fellow's performance or time commitments during clinical rotations is unacceptable and grounds for disciplinary action.  Moonlighting activities will be monitored and documented on a semiannual basis by the fellowship director.
 
20. Fellow Evaluation
 
The attending of the record at both the VA and NMH will submit a written evaluation of each fellow. The GI  faculty meet on a monthly basis to discuss and evaluate the fellows according to the guidelines of the ABIM. The fellowship director will summarize the faculty evaluations and meet individually with each fellow to review his/her evaluation ever six months.  Yearly evaluation will incorporate evaluations by the Fellowship Director, Director of the Endoscopy Unit, Director of Therapeutic Endoscopy and Chiefs of the Divisions of Gastroenterology and Hepatology as well as the attending evaluations from specific rotations. Separate evaluations will be submitted on the American Board of Internal Medicine (ABIM) Annual Training Evaluation Forms administered through the Department of Medicine.  The faculty and ABIM fellow evaluations may be reviewed at any time by contacting the fellowship coordinator (5-0182) for an appointment.  In addition, the forms are reviewed on a semiannual basis during regularly-scheduled evaluation sessions with the program director.
 
Endoscopic skills of GI fellows are reviewed on a semiannual basis.  A committee on GI fellow endoscopic proficiency consists of the manager of the GI endoscopy lab, medical director of the GI endoscopy lab, director of interventional gastroenterology, fellowship program director, and faculty who rotate on the fellow endoscopy blocks. ASGE endoscopy assessment forms are incorporated into the annual GI fellow review process.
 
21. Applying for the Fellowship
 
Applications for fellowship positions beginning July 2006 can be downloaded by clicking:
Fellowship Application
or by writing the fellowship coordinator:
 
Sandy Kuipers, GI Fellowship Program Coordinator
Division of Gastroenterology
676 North St. Clair St, Suite #1400
Chicago, IL 60611-2951
skuipers2@nmff.org
(312) 695-0182