CLINICAL OPPORTUNITIES
Overview
The clinical experience is a strength of our program. Skills are learned through continued exposure to a wide range of conditions that characterize our specialty. Fellows gain mastery through increasing responsibility over the course of the training program. Graduates from our program are confident they can care for patients in any setting: routine office visits, complicated hospitalized patients, and difficult procedures.
Inpatient
Our inpatient service is very busy and fast paced, which can be tiring but fulfilling. We ensure our fellows are always well supported and not overwhelmed. We expect that our first year fellows run the inpatient service with direct supervision and support from the attending on-call. As fellows advance, they assume increased responsibility. By the time our fellows graduate, we expect they are the primary team leader with the attending in a supporting role.
- The day starts with pre-rounding and signout from the overnight nursing and resident team
- The inpatient team generally begins rounds at 9:00 am
- Throughout the day the GI fellow is managing the inpatient service including performing urgent/emergency procedures, completing consults from other services, fielding phone calls from community providers and emergency departments
- After typical business hours, the on-call service fellow takes home call, triaging questions from parents, the emergency department, and community providers.
- First year: approximately 25 weeks of inpatient service
- Second year: approximately 12 weeks of inpatient service
- Third year: approximately 8 weeks of inpatient service
- Weekday call starts on Monday morning at 8:00 am and ends on Friday afternoon at 5:00 pm
- Weekend call starts on Friday afternoon at 5:00 pm and ends on Monday morning at 8:00 am
Outpatient
Among the unique qualities of our program is strong outpatient experience. Fellows see patients two-half days per week, where they are assigned new patients who they follow throughout their training. Though there is always appropriate supervision, the fellow is the primary provider for their patients, not the attending. Fellows are expected to take full ownership of their patients, follow up test results, manage disease exacerbation and questions or concerns from families. There is true continuity in our continuity clinic. Building rapport and long-term relationships with patients and their families is cited by our fellows as among the most gratifying components of their fellowship experience.
- Each fellow attends two, half-day continuity clinics per week
- Fellows precept with an attending for all patients
Procedures
We have a busy endoscopy unit with ample opportunity for fellows to become proficient long before they graduate. Fellows are routinely exposed to the following procedures: upper endoscopy, colonoscopy, foreign body removal, polypectomy, esophageal dilation, percutaneous endoscopy gastrostomy placement, rectal suction biopsy, Bravo capsule placement for reflux monitoring, and wireless capsule endoscopy placement for small bowel imaging. Other procedures include 24-hour multichannel intraluminal impedance monitoring, g-tube maintenance and trouble-shooting, and hydrogen breath testing interpretation. Fellows graduate from our program with confidence in their procedural skills.
- When off-service, fellows generally scope one day per week according to a fellow-organized calendar
- When on-service, fellows are responsible for all inpatient, consult, and emergency cases
Conferences
Our fellowship program is dedicated to teaching. We encourage active learning through case-based discussions, journal clubs, board reviews sessions, and didactics. We ensure our fellows have protected time dedicated to their education outside of their clinical responsibilities. We also recognize that to be an excellent gastroenterologist requires a strong foundation and continuing education in general pediatrics. To that end, we encourage attendance at the many educational opportunities provided by the stellar Brown Pediatric Residency Program including daily morning report and noon conference and monthly Morbidity and Mortality.
Pediatric GI Conferences:
- Monday: Pathology Conference. Review cases and slides from previous weeks endoscopy.
- Tuesday: Pediatric Morbidity and Mortality
- Wednesday: IBD conference. Discuss active IBD cases focusing on diagnosis and management.
- Thursday (8-9 am): GI potpourri including Journal Club, State of the Art attending lectures, Interesting Case Conference, or Adult GI Grand Rounds.
- Thursday (9-10 am): Inpatient Conference. Discuss all consult and GI-service admissions.
- Friday: Pediatric Grand Rounds. Weekly presentations by invited guest speakers distinguished in their field directed towards faculty, fellows, and residents.
Multidisciplinary Conferences:
- GI-Radiology Conference (1 time per quarter)
- GI-Surg Conference (2 times per year)
- GI-Allergy Conference (2 times per year)
- GI-NICU (2 times per year)