Primary training is conducted at the University of Cincinnati Medical Center (UCMC) and the Cincinnati Veterans Administration Medical Center (VAMC). UCMC serves as the principal city hospital and is the only major academic referral center for the Tristate region (Ohio, Indiana and Kentucky). Trainees gain experience with managing a full spectrum of patients with gastrointestinal and liver diseases. In addition, UCMC is a major pancreas center (including islet cell transplantation) and has a vibrant liver transplant program (performing over 100 transplants per year). The Cincinnati VA services a large population of military veterans in the region. These two centers provide fellows with broad exposure to a wide array of patients and illnesses, thereby assuring a truly diverse clinical experience.
Fellows train under the supervision of experienced Digestive Disease faculty from the University of Cincinnati Medical Center (UCMC) and the Cincinnati Veterans Administration Medical Center (VAMC). Attending physicians are responsible for providing guidance and education during the rotation. Consultation teams also include residents and medical students rotating on the services. Fellows are expected to actively participate in the training of these junior colleagues.
The following inpatient and ambulatory services form the core of fellowship training:
- Gastroenterology and hepatology inpatient service
- Gastroenterology consult service
- Hepatology consult service
- Cincinnati VA gastroenterology / hepatology consult service
- Interventional endoscopy
- Clinical research
- Ambulatory gastroenterology clinics
- Ambulatory liver clinics
The University of Cincinnati Medical Center GI Inpatient Service is comprised of a full medical team that cares for patients with digestive disorders admitted to the medical service. This rotation affords fellows the opportunity to function in a role that is similar to an academic faculty member. Mornings are spent rounding with the service attending and medical team. Fellows are expected to formulate diagnostic and treatment plans for patients and to assist with the supervision and teaching of the house staff and medical students. In order to maintain continuity of care, the fellow performs procedures on those patients admitted to the service.
On the gastroenterology consult service, fellows generally spend mornings performing endoscopic procedures under faculty supervision. Procedures are performed on inpatients seen in consultation as well as those referred from the outpatient clinics. Consult service rounds generally occur in the afternoon. Fellows are expected to independently evaluate each consult, summarize the pertinent history and physical findings and formulate an appropriate diagnostic and therapeutic plan.
Through rotations on the University Hospital liver consult service, fellows are intensively trained in the evaluation and management of patients with liver disorders, including pre and post-liver transplantation. Fellows participate in inpatient and outpatient liver consultations, perform all endoscopic procedures on liver patients (including liver biopsies), provide guidance to the house staff in the management of inpatients, and actively participate in the weekly liver transplant selection committee.
Rotations at the Cincinnati VA Medical Center provide additional endoscopic experience and clinical training in gastroenterology, hepatology, and pancreatic disorders.
First- and second-year fellows participate in one half-day gastrointestinal and one half-day liver clinic each week. Fellows are assigned to specific clinics for a minimum of one year to ensure continuity of care and exposure to longitudinal disease processes. Each trainees is responsible for their own panel of outpatients. In their third year of training, fellows have the option of selecting six-month elective ambulatory clinic opportunities in inflammatory bowel disease, liver transplant, and/or women’s health. All clinics are staffed by one of our Digestive Disease faculty.
The two principal gastroenterology clinics are located at the University of Cincinnati Medical Center and at the Cincinnati VA Medical Center. Fellows will encounter diverse populations of patients with a variety of acid-peptic, motility, functional, neoplastic, and inflammatory disorders of the intestinal tract, as well as pancreaticobiliary diseases.
The two principal liver clinics are located at the University of Cincinnati Medical Center and at the Cincinnati VA Medical Center. Fellows will gain experience managing infectious, autoimmune, metabolic, and neoplastic disorders of the hepatobiliary system, as well as complications of cirrhosis.
All fellows have the opportunity to participate in one month rotations through the multidisciplinary pancreas clinic located at the University of Cincinnati Medical Center.
Elective Ambulatory Clinics
Third year fellows may elect to spend a minimum of 6 months in one of the following ambulatory clinics: Inflammatory Bowel Disease (UCMC), Liver Transplant (pre- or post-; UCMC), and/or Women’s Health (at the nearby Midtown satellite location).
A variety of regularly scheduled conferences allow for the in-depth discussion of particular cases and topics; the exchange of ideas among internists, surgeons and pediatricians caring for patients with digestive diseases; and the presentation of scholarly information on clinical problems in gastroenterology. The regularly scheduled conferences include:
GI and Liver Pathology Conferences
These are monthly interdepartmental conference attended by members of the Department of Pathology and the Division of Digestive Diseases. The conference provides an outstanding forum for correlating the clinical and pathologic aspects of gastrointestinal and liver disorders.
Medical/Pediatric Clinical Conference
This conference is held on a monthly basis in conjunction with faculty and fellows from the Division of Gastroenterology and Nutrition at Cincinnati Children's Hospital Medical Center. Selected cases are presented by adult and pediatric GI fellows, followed by a short discussion of the topic with group participation. This conference provides the GI fellow with exposure to the presentation and management of gastrointestinal diseases in pediatric populations.
GI Physiology/Pathophysiology Conference
This conference, which is held on a monthly basis, reviews GI physiology and pathophysiology and is presented by a fellow and a faculty mentor from the division of digestive diseases and the division of pediatric gastroenterology and nutrition at Cincinnati Children’s. Cases are provided as "unknowns" and discussed in the format of a CPC. Controversial topics may be presented in a "point-counterpoint” format.
GI Journal Club
A monthly GI journal club reviews recently published articles of clinical relevance. Participants include GI faculty and fellows.
A research conference for faculty and fellows of the division of digestive diseases is held monthly. Preliminary data from research-in-progress are presented by the GI faculty or fellows. Outside speakers with research interests in gastroenterology or hepatology also are invited to present.
GI Summer Emergency Lecture Series
For the first two months of the year, fellows receive weekly lectures on topics of general and immediate clinical relevance. Sample topics include introduction to gastrointestinal endoscopy, conscious sedation, gastrointestinal hemorrhage, fulminant hepatic failure and clinical study design.
Clinical Topics Conference
On a monthly basis, the GI faculty presents formal lectures on topics of clinical relevance within their areas of expertise to the fellows and rotating residents and students.
Clinical Case Conference
This "working conference" provides a format for the presentation and discussion of difficult diagnostic or management problems by faculty and fellows.
Run by a faculty radiologist, this conference serves as a monthly forum to correlated clinical and radiology findings and to develop an understanding of how to read and interpret radiological studies.
The fellows meet with the GI training program director on a monthly basis to consider various programmatic issues. Outside speakers are invited to present non-traditional topics of interest to the trainees and to stimulate roundtable discussions. Sample topics include medical ethics, death and dying, disability insurance and asset protection, the impaired physician, coding and practice management, legal issues and risk management.
Selected conferences throughout the year cover additional topics relevant to fellowship training, including, nutrition, morbidity and mortality, hepatobiliary tumor board, and liver transplantation. Additional conferences are given by nationally recognized gastroenterologists and hepatologists on an ad hoc basis.