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Gastroenterology/Hepatology

Education

Postdoctoral Fellowship

As a Fellow in Pediatric Gastroenterology/Hepatology, you will be involved in an educational process that will emphasize not only high quality clinical care, but significant involvement in basic research.

Fellows enter the program after completing three years of residency in pediatrics and are expected to commit three or more years to our postdoctoral program. One candidate is accepted into the program each year for combined clinical and research training. Research activities are supported, in large part, by training grants from the National Institutes of Health.

The program is designed so that postdoctoral fellows experience a continuum of learning in both the clinical gastroenterology/hepatology and research over three years. This continuity of patient care is absolutely essential for children who have chronic illnesses and require long term therapy. Similarly, the complexity of contemporary research, both clinical and basic, requires the progressive acquisition of research skills and sufficient time to become familiar with and expert in research technologies. Consequently, the Pediatric Gastroenterology/Hepatology Program allows intense clinical experience during all three years as well as an early introduction to either laboratory or patient oriented research in the first year of the program.

Clinical Experience

Fellows participate in the diagnosis and management of patients on the pediatric inpatient service, pediatric ICU, neonatal ICU and pediatric specialty center.

Fellows participate in outpatient GI/Hepatology clinics under the supervision of the faculty. This clinical training allows the Fellows to gain experience and competency in managing common pediatric gastrointestinal, liver and nutritional problems. (Competencies: patient care, medical knowledge, practice-based learning improvement, professionalism).

Fellows receive extensive training in diagnostic workup (including endoscopy, colonoscopy, pH probe studies and liver biopsy), as well as therapeutic endoscopy including sclerotherapy, band ligation, foreign body removal and polypectomy.

Research Experience

Fellows spend a minimum of two years in research activities, with many fellows extending the period of research training to three years. Extending the period of research experience provides fellows with additional time for course work and, more importantly, allows them to become involved in more challenging and technically demanding research projects. It is our perspective that the acquisition of high quality research skills is fundamental to a viable long-term career in academic medicine. We have assembled a group of preceptors for research training which is broad based and encompasses the highest level of contemporary techniques. The Yale University School of Medicine is unique in having outstanding investigators with expertise in a broad range of biomedical disciplines relevant to research.

The choice of a particular preceptor and project is the most important decision facing each fellow. Because it is the philosophy of the program that preceptors should be chosen by trainees rather than assigned, each fellow is provided with extensive help in the form of information, advice and time to make a careful and deliberate selection of preceptor and project. During the first three months of fellowship, each trainee will have many opportunities to meet with the faculty whose research programs are of possible interest to them.

Teaching Conferences

Pediatric GI/Hepatology Conferences are held weekly. Joint teaching conferences with Pediatric Pathology are held monthly as are Radiology conferences. Journal club meetings are held in addition to topical conferences.

Conference Topics

Gut

• Oropharyngeal & Esophageal Disorders
• GI Bleeding (major points covered in Pathophys; here, focus on logistic aspects of management and show pediatric cases)
• Foreign Bodies & Toxic Ingestions
• GERD
• Allergic Enteropathies
• Celiac Disease
• Gastritis
• Abdominal Pain & Dyspepsia: Functional and Non-functional Disorders
• IBS
• IBD (can be split up into several parts, or this may serve as an introduction)
• Perianal Disease
• Polyposis
• Hirshsprungs, Intestinal Neuronal Dysplasias, and other Motility Disorders
• Constipation
• Gastrointestinal Infections &' Bacterial Overgrowth
• Short Bowel Syndrome
• Pediatric Ostomy Management
• Pediatric Diarrhea
• Pediatric Endoscopy 1: Indications & Considerations
• Pediatric Endoscopy 2: Normal & Pathologic Findings
• Anomolies of the GI tract (may also be covered in Radiology conference)

Hepatobiliary/Pancreatic

• Cholestasis (emphasis on the newborn period and TPN-associated cholestasis)
• Biliary atresia
• Fulminant Hepatitis
• Viral Hepatitis in Children I (Intro to the hepatotrophic viruses, then hepB (also Rx & prognosis, hepD)
• Viral Hepatitis in Children II (hepC (also Rx & prognosis), then hepE)
• Autoimmune & Drug-Induced Hepatitis
• Metabolic Liver Disease
• NAFLD
• Indications for liver biopsy and considerations
• Pediatric liver transplantation
• Portal hypertension (may already be covered in the Pathophys lectures)
• CF: Nutrition, Pancreatic Insufficiency, and Liver Disease
• Pancreatitis

Nutrition

• Malnutrition
• TPN

2005 Mid-conference Schedule

For more information, please contact:

Resident Elective - Rotation in Pediatric Gastroenterology

Goals & Activities

Goal 1: Gain experience and competency in managing common pediatric gastrointestinal, liver and nutritional problems. (Competencies: patient care, medical knowledge, practice-based learning improvement, professionalism)

Objectives: At the end of the elective, the resident should be able to

• recognize and manage the infant/child with functional constipation/encopresis, gastroesophageal reflux, chronic nonspecific diarrhea (Toddler's diarrhea), and functional abdominal pain.
• critically assess information to remain up-to-date in the management of these patients.

Goal 2: Interact effectively as a primary care physician with pediatric gastroenterologists. (Competencies: patient care, medical knowledge, practice-based learning improvement)

Objectives: At the end of the elective, the resident should be able to:

• recognize and initiate the evaluation of more complex GI disorders (malabsorption/chronic diarrhea [celiac disease], inflammatory bowel disease, infant/child with jaundice, hepatitis, malnutrition).
• recognize the appropriate time for consultation or referral of patients with GI disorders.
• understand the basic diagnostic tests available for the diagnosis of the patient with gastrointestinal, liver and nutritional disorders.
• understand the basic concepts of enteral and parenteral nutrition.

Goal 3: Recognize resources available for the care of patients with GI, liver and nutritional disorders. (Competencies: practice-based learning improvement, systems-based practice, interpersonal and communication skills)

Objectives: At the end of the elective the resident should be able to:

• list the educational and informational resources available to physicians and patients related to specific GI disorders.
• co-ordinate care with physician extenders.

Average Number of Inpatients/Consults per day: 3 - 5

Number of Clinics per week: 3 (Tuesday, Thursday and Friday mornings)

Major Activities:

• Daily rounds with the attending physician and follow-up care coordination with physician extenders.
• Participation in outpatient clinics. Friday AM clinics with Dr. Escalera in the community.
• See and follow-up of inpatients and consult patients on the floor.
• Attend endoscopy sessions (Tuesday PM) if interested.

Night & Weekend Call Responsibilities: None related to elective.

For more information please contact:

Dinesh Pashankar, M.D.
408 FMP, Tel: 785-4649

Medical Student Elective - Rotation in Gastroenterology

Goals & Activities

Goals:

• To learn to evaluate pediatric patients in clinics (involves taking history, physical examination, considering a differential diagnosis and management plan)
• To learn about common pediatric gastrointestinal problems such as gastroesophageal reflux, constipation, abdominal pain, jaundice.
• To learn about inpatient management of children with gastrointestinal disease.

Number of Clinics Per Week: 3 (Tuesday, Thursday and Friday mornings)

Major Activities:

• Daily inpatient rounds with Sue Johnson, NP and attending physician.
• Participation in outpatient clinics.
• Attend endoscopy sessions (Tuesday PM).
• Attend departmental morning and noon conferences, and division conference (Monday 3 PM)
• Complete suggested reading of enclosed articles and GI topics in Clerkship book.

For more information please contact:

Dinesh Pashankar, M.D.
408 FMP, Tel: 785-4649