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Gastroenterology/Hepatology

Postdoctoral Fellowship

Overview

The overarching goal of the post-doctoral fellowship program in Pediatric Gastroenterology/Hepatology at Yale is to equip the subspecialty resident with the clinical and research skills to become independent and productive academic pediatric gastroenterologists. Yale University has a prestigious pediatric gastroenterology fellowship training program. Yale fellowship training program in pediatric gastroenterology was first established in 1988 by Dr. Frederick Suchy and since then the Yale University School of Medicine has pioneered the training of academic scholars. NIH support was first obtained in 1990 with training focused on developmental gastroenterology first with Dr Frederick Suchy as the PI (1990-1996), then with Dr Susan Moyer as the PI (1996-2002). Former fellows have gone on to hold positions of Section Chief, director of pediatric liver center, and residency program director in medical schools and hospitals across the country as well as becoming independent NIH-funded investigators. Our fellowship program remains highly competitive. This is a 3-year program that enrolls one fellow/year. It ranks among the top training programs in US for placing fellows in academic positions. All of the fellows in the program participate in bench or patient-oriented research during years 2 and 3 and they are supported by two separate NIDDK-funded Institutional Training Grants in Investigative Gastroenterology (DK070171) and Investigative Hepatology (DK07356). The training environment and program is highly developed, exposing trainees to the full spectrum of pediatric gastrointestinal diseases while maintaining the strong tradition of providing outstanding opportunities for research training.

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. We accept one candidate into the program each year for combined clinical and research training. Research activities are supported, in large part, by training grants from NIH/NIDDK mentioned above.

The program is designed so that postdoctoral fellows experience a continuum of learning in both the clinical gastroenterology/hepatology and research over three years. Throughout the training we emphasize importance of continuity of patient care 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 represents some of the most outstanding investigators with expertise in a broad range of biomedical disciplines relevant to pediatric GI/ hepatology 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.

Our previous fellows have been productive in research and have a high likelihood of progressing to academic careers as exemplified by these publications (name of training fellow highlighted):

• Del Valle, A, Jones BF, Harrison LM, Chadderdon RC, Cappello M. Isolation and molecular cloning of a secreted hookworm platelet inhibitor from adult Ancylostoma caninum. Mol Biochem Parasitol, 2003. 129(2): p. 167-77.
• Denson, LA, Sturm E, Echevarria W, Zimmerman TL, Makishima M, Mangelsdorf DJ, Karpen SJ. The orphan nuclear receptor, shp, mediates bile acid-induced inhibition of the rat bile acid transporter, ntcp. Gastroenterology, 2001. 121(1): p. 140-7.
• Echevarria, W, Leite MF, Guerra MT, Zipfel WR, Nathanson MH. Regulation of calcium signals in the nucleus by a nucleoplasmic reticulum. Nat Cell Biol, 2003. 5(5): p. 440-6.
• Husain, SZ, Prasad P, Grant WM, Kolodecik TR, Nathanson MH, Gorelick FS. The ryanodine receptor mediates early zymogen activation in pancreatitis. Proc Natl Acad Sci USA, 2005. 102(40): p. 14386-91.
• Leite, MF, Thrower EC, Echevarria W, Koulen P, Hirata K, Bennett AM, Ehrlich BE., Nuclear and cytosolic calcium are regulated independently. Proc Natl Acad Sci USA, 2003. 100(5): p. 2975-80.
• Sehgal, S, Guerra MT, Kruglov EA, Wang J, Nathanson MH. Protein 4.1N does not interact with the inositol 1,4,5-trisphosphate receptor in an epithelial cell line. Cell Calcium, 2005. 38(5): p. 469-80.

Scholarship Oversight Committee

A formal Scholarship Oversight Committee (SOC) is established to mentor and guide each fellow. SOC is composed of 3 individuals i.e., the primary mentor supervising the trainee's scholarly activity, a mentor or mentors for the trainee's clinical and general career development, and a mentor or mentors with expertise in the particular area of scholarship that is being pursued by the trainee. The specific goals of SOC are:

• To meet with the fellow at least 2 times a year. If there are concerns with the fellow's progress, meetings are expected to occur more frequently.
• Complete evaluation/progress reports after each meeting to assess progress and detail accomplishments.
• Review and approve the proposed research plan for first year fellows.
• Attend the Thursday morning conferences to hear their fellow's presentations.
• Evaluate fellow's written product of scholarly activity.

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:

2008 Didactic Conference Schedule

Pediatric GI/Hepatology works closely with the Section of Digestive Diseases, Internal Medicine. In addition to our weekly conferences, combined conferences between the Sections are held twice weekly.

Resident Elective

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.

Medical Student Elective

Goals & Activities:

Goals:

• Learn to evaluate pediatric patients in clinics (involves taking history, physical examination, considering a differential diagnosis and management plan)
• Learn about common pediatric gastrointestinal problems such as gastroesophageal reflux, constipation, abdominal pain, jaundice.
• 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 regarding postdoctoral fellowship, please contact: