The 3-year combined Fellowship in Gastroenterology and Hepatology at the University of Maryland and National Institutes of Health (NIH) is designed to provide broad training in both clinical gastroenterology and hepatology and in clinical research. The first year of the fellowship is purely clinical and is centered at the University of Maryland Medical Center and Baltimore VA Medical Center (BVAMC). The second and third years are based at the NIH Clinical Center and are predominantly focused on clinical research. The fellowship leads to board eligibility in Gastroenterology and is designed to prepare fellows for a career in academic clinical investigation and clinical care.
The NIH component of the fellowship program is supervised by Stephen Wank, MD, a tenured Senior Clinical Investigator and Chief of the Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Nine NIH gastroenterologists, including Dr. Wank, participate in the NIH portion of the program. For more information at the NIH web site, click here.
In the first year fellows carry out inpatient consultations in gastroenterology at the University of Maryland Medical Center, Baltimore VAMC, and Union Memorial Hospital on a daily basis, under the close supervision of a full-time faculty member. Fellows usually will supervise medical residents and/or students doing a GI subspecialty rotation. The consultation service includes didactic teaching and bedside evaluation of patients on work rounds. Fellows participate in any GI procedures required for the patient's evaluation.
At the NIH fellows carry out inpatient consultations in gastroenterology at the NIH Clinical Center, a fully functioning 234 bed research hospital with additional extensive day hospital and outpatient areas. The NIH Clinical Center is the nation's largest hospital devoted to clinical research and has both patient care areas and considerable laboratory space and research support facilities.
The hepatology rotations at the University of Maryland provide a comprehensive experience in outpatient and inpatient consultation in liver diseases, management of patients with acute and chronic liver diseases, evaluation of patients for liver transplantation, and consultative services for patients pre and post liver transplantation. Instruction is provided in techniques of liver biopsy, interpretation of liver biopsies, and participation in hepatology/transplantation rounds and conferences.
At the NIH, hepatology rotations provide a truly unique experience. In addition to providing inpatient consultative services at the Clinical Center, fellows are directly responsible for the care of liver patients admitted for clinical protocols of the Liver Diseases Branch. Most protocols focus around the treatment of viral hepatitis or steatohepatitis and the fellow manages the patients and performs all necessary liver biopsies. Weekly formal liver rounds and liver pathology conferences are held with world-renowned hepatologists and hepatopathologists and provide superior training in hepatology and exposure to the design and implementation of clinical trials.
Year 1 – Two outpatient continuity clinics are held for fellows, one at University Hospital and one at the Baltimore VAMC, with a total of approximately 4,650 patient visits (3,500 VA, 1,150 UMMS). This provides fellows with extensive experience in outpatient management of common gastrointestinal problems.
Years 2 and 3 – GI continuity clinic is held in the NIH Clinical Center. Some fellows return to University Hospital for their continuity outpatient experience. In addition, hepatology clinics are held two times per week; however, fellows attend only when patients they have seen in consultation during inpatient months are seen in follow-up, or if patients involved in protocols in other departments require outpatient liver consultation.
Approximately 9,000 procedures are performed annually in the Division of Gastroenterology at the University of Maryland and Baltimore VAMC. There are three combined inpatient/outpatient endoscopy facilities, two in the University Hospital and one at the Baltimore VAMC. Fellows are closely supervised and are trained progressively in upper endoscopy, flexible sigmoidoscopy, colonoscopy and polypectomy, percutaneous endoscopic gastrostomy placement, treatment of GI bleeding, endoscopic band ligation of esophageal varices, foreign body retrieval, and dilation of esophageal strictures. Training is also provided in performance and interpretation of esophageal motility studies, 24 hour pH monitoring, wireless capsule endoscopy, balloon enteroscopy, and percutaneous liver biopsy. Procedural training meets all board eligibility requirements and is designed to prepare fellows for clinical practice. Computerized endoscopy reporting systems are used at each hospital.
The NIH Clinical Center houses a fully functional endoscopy unit with the capability to perform all standard endoscopic procedures, including wireless capsule endoscopy. ERCP and EUS are not performed at the NIH. During their two years at NIH, fellows return to the Baltimore VAMC each month for a dedicated endoscopic procedure day.
Considerable emphasis is placed on clinical research to prepare trainees for careers in academic medicine and clinical research.
The Digestive Diseases Branch at the National Institutes of Health is uniquely positioned to provide a robust research experience. The facilities of the NIH Clinical Center are second to none and world experts in numerous areas are available for collaboration. Pioneering research takes place every day at the NIH and patients with conditions that most only read about in textbooks become commonplace.
Major areas of current study within gastroenterology and hepatology include familial carcinoid tumors, GI peptides and their receptors, non-invasive methods of performing gastric acid analysis, hepatitis B/C/D, nonalcoholic fatty liver disease, GI manifestations in hyper-IgE syndromes and Behcet's disease, mucosal immunology, and the use of mesenchymal stem cells in Inflammatory Bowel Disease.
During the first year, the GI fellow on evening and weekend call takes calls regarding management of inpatients, emergency room patients, and telephone calls from outpatients. Fellows take call in rotation with other fellows in the program. Fellows do not remain in the hospital while on call, although a call room is available if needed for overnight stay. On weekends, work rounds are conducted with an attending.
A faculty attending is also assigned to night call and is always available for consultation. All procedures at night or on weekends are supervised directly by the attending physician.
At the NIH, fellows provide evening and weekend call for urgent consultations and procedures. Call is taken from home, and weekend rounds are conducted as needed.
Emphasis is placed on day-to-day feedback to fellows on individual cases and procedures. In addition, attendings provide formal written and informal feedback at the end of the rotation for each fellow. Written evaluations are available for review by the fellow and are discussed with the program director at least every six months. Likewise, fellows provide written confidential evaluations of each faculty member and of the training program. The fellow has ample opportunity for discussion with the program director throughout the training period.
In addition to the minimal requirements above, emphasis is placed on mentoring trainees by individual faculty members regarding research projects, didactic presentations, and long-range career goals.
Applications to this program are handled through the University of Maryland Division of Gastroenterology and Hepatology. For information on the application process, click here.