First-Year Program for GI Fellows
At Cincinnati Childen's Hospital Medical Center, the first-year fellows in the Division of Gastroenterology, Hepatology and Nutrition immerse themselves in clinical pediatric gastroenterology, hepatology and nutrition, making a base for future learning.
Fellows spend three separate months each on:
- Gastroenterology inpatient ("lumen") service
- Hepatology inpatient ("liver") service
- Gastroenterology consult service
- Research or clinical electives
During the first year, fellows also work with assigned faculty members in treating outpatients in the Pediatric Gastroenterology Center and in learning endoscopic and other procedural skills in the care of both inpatients and outpatients.
Rounds and Inpatient Care
Our GI fellows assume primary responsibility (with faculty supervision) for the work-up and management of all patients and consultations to the service, as well as supervision of rotating residents and students.
Rounds are made daily by faculty, fellows and residents, nurse practitioners, and inpatient nursing staff on all inpatients, generally in the patients' rooms, because family-centered care is emphasized at Cincinnati Children's. During this time, new patients are presented, clinical progress is reviewed, plans for patient care are developed and informal teaching takes place.
Because all of the division's inpatients are cared for by a single PL-2 resident team, lumen and liver rounds are held successively during the morning. Rounds on consult patients are made by a separate consult attending and fellow. Sign-out rounds, particularly to review the most ill patients, are held in the late afternoon or early evening.
Call
First-year fellows take overnight call from home in rotation. Responsibilities include evening / nighttime admissions, emergency procedures and parent phone calls. On-service attendings provide backup.
Weekends are covered by fellows from all three years. Two fellows are on call: one each for the lumen / consult service and the liver service, with each responsible for parent calls for half of the weekend. The on-call experience is arranged to be in compliance with requirements of the Accreditation Council for Graduate Medical Education (ACGME) for work hours.
Outpatient Experience
First year fellows spend one-half day per week evaluating patients in an outpatient setting. Every year, each fellow has three-month rotations in four different faculty members' outpatient clinics, providing fellows the opportunity to see a wide variety of clinical problems as well as to learn a variety of styles. Fellows are expected to participate in further evaluation, such as endoscopy, of the patients that they see.
Procedure Experience
GI fellows participate in specialty evaluation and treatment of inpatients and outpatients through diagnostic and therapeutic endoscopies, suction rectal biopsies and liver biopsies that are performed on a routine or emergency basis.
Electives
During the first year, GI fellows have the opportunity to have up to three one-month electives, including research electives and clinical electives.
Research electives
The first elective is a rotation in a basic science laboratory to learn the approaches and vocabulary of bench research that are integral to modern medicine. This elective provides an opportunity to "taste" the laboratory before a two-year commitment.
Clinical electives
The second elective month is used for a clinical research or an outcomes research experience. It is expected that the fellow will again have an in-depth tutorial experience but may also develop a short (e.g., retrospective) project. During the third elective month, fellows take a clinical elective.
Choosing a Research Project
One purpose of the research elective months is to allow fellows to develop a research focus in the area of their intended career path. Besides working on a laboratory-based or clinical research project, fellows have the opportunity to interview potential mentors for their two-year research training experience from among faculty both inside and outside of the division.
Concept sheet. Fellows are required to propose a hypothesis-based research project in the area of basic science, patient-oriented, or outcomes research, in the form of a 2-3 page concept sheet before the final quarter of their first year of fellowship.
This concept sheet, which is to be reviewed by the mentor prior to submission to the Education Council, includes:
- Title of the proposal
- Mentor: a faculty member with significant extramural funding in the general area of the proposed research (usually an NIH R01 grant or the equivalent, but other funding in which the mentor is a PI will be considered)
- Hypothesis to be tested
- Significance to pediatric gastroenterology
- Relevant background information, intellectual and physical resources available locally
- Specific research plan (specific aims), including outcome parameters, sample size and statistical plan, and / or laboratory assay endpoints as appropriate
- References
- Coursework to be taken (if any) and its relevance
- Timeline for completion of the project
- Brief statement about career goals: "Where do you see yourself in 5 years?"
- Brief statement regarding your commitments to other academic activities including scientific projects, chapters and reviews, etc.
- Source of proposed funding for this project: training grant or other
- An NIH biosketch for both the mentor and trainee
- Tentative roster of the proposed Scholarship Oversight Committee (SOC) that will review research progress at least twice a year
- A brief statement from the proposed mentor indicating his / her commitment to help refine and interpret this project and meet with you on a regular basis. If relevant resources or reagents beyond that indicated in the proposal will be provided by the mentor or the mentor's laboratory, these should be indicated. The number of other trainees for which the mentor will be responsible during the time of the proposed project should be included.
These proposals are reviewed by the division's Education Council for suitability for the fellows' career development. Subsequently, each fellow creates a unique Scholarship Oversight Committee to help design and monitor their academic program.
