Pediatric Gastroenterology Fellowship Curriculum & Rotations

Broad clinical competence also includes the ability to perform gastroenterological tests and procedures safely and to interpret these results accurately. Procedures include the following:

• Colonoscopy
• Upper endoscopy
• Stricture dilation
• Sigmoidoscopy
• Banding of esophageal varices
• Endoscopic therapeutic injection
• Hemostasis
• Polypectomies
• Liver biopsies
• Paracentesis
• pH probes (interpretation only)

The written guidelines are communicated and provided by the Department of Pediatrics and University of Michigan Health, at large, based on accreditation guidelines for hospitals (HCFA). The Division of Pediatric Gastroenterology complies with The University of Michigan Graduate Medical Education supervision policy.

• The attending physician faculty evaluates, assesses and decides on a treatment plan for all patients admitted to the gastroenterology service on a daily basis.
• He or she provides daily notes. The frequency of the written notes for patients under consultation varies depending on the complexity of the problem and the need for regular advice. This policy is followed whether a fellow is rotating on the in-patient service or not.
• The fellow’s responsibility is to evaluate the patient first prior to the attending physician.
• In addition, it is the fellow’s responsibility to immediately notify the attending physician of all new admissions, requests for consults, and significant worsening of a patient's status.
• Similarly, in the outpatient service the attending physician evaluates all patients once the fellow has evaluated the patient and has delineated their own management plan.
• All contacts with the attending faculty provide the opportunity for discussion of the clinical picture, social issues, or recent reports of the literature relevant to the current patient context.
• Urgent consultation is offered to all areas of the hospital 24 hours a day, 7 days a week.

During inpatient rotations, fellows are responsible for all patients admitted to the Pediatric Gastroenterology Service. The number of patients the fellows follow is variable, but generally are five to ten patients on the service. Fellows are supervised by the Pediatric GI attending on service. All patients are seen on the same day of admission.

The Pediatric GI service rounds with advanced practice providers and patients/families daily. Rounding with the primary inpatient GI team takes one-two hours per day depending on the census.

During these patient-family centered rounds, each patient’s progress, physical examination, and treatment plans are discussed. If possible, the treatment plan is discussed in the context of a teaching experience where pathophysiology and current medical advances are brought into the discussion of treatment decisions. Fellows are closely involved in medical decision making and all patients interactions.

Fellows are responsible for the evaluation and follow-up care of the patients seen in the ambulatory setting. This includes the original evaluation, follow-up letters and calls to the family and physicians, inquiries regarding laboratory tests, involvement with gastrointestinal testing, and interpretation and viewing of radiological studies. 

Once the patient is evaluated, the history and physical examination are presented to the gastroenterology attending who then reviews or expands the history with the patient and examines important areas pertinent to the presenting complaint. A discussion of the differential diagnosis, clinical management, and final plan takes place either in the staff room or in the examination room with the family. In year 2 and later, the fellow discusses the clinical impression and management plan with the family with the attending present.

Fellows evaluate consultations from other services and follow these patients’ progress as part of continuing management of the particular gastrointestinal problem. Consultations are seen within 24 hours of request. A curriculum on common consultation topics supplements this learning opportunity.

Continuity of patient care is assured by the assignment of new patients to the fellow currently on the inpatient gastroenterology service. The fellow is involved in all treatment decisions as long as the patients are hospitalized, and is encouraged to enroll the patient in their continuity clinic. This decision is made prior to the fellow rotating off service or as the patient is discharged while under their care. Appropriate clinic scheduling to their continuity clinic is part of discharge planning.

Fellows are scheduled for continuity clinic one-half day per week. New patients are scheduled in the fellows' continuity clinic each week and return to the fellow’s clinic as necessary.

Trainees are expected to demonstrate their interest in and ability to both critically reading manuscripts and teach individuals (medical students and house staff) in small group settings. Communication skills for scientific presentations and preparation of teaching materials for didactic presentations also are emphasized. Upon completion of their three year training, all trainees should be competent to be sub-board eligible and complete the pediatric gastroenterology specialty certification in a timely manner.

• Outpatient: Fellows have one-half day per week of general pediatric gastroenterology clinic with their own outpatient population and all associated outpatient care for those patients. Approximately once a month, fellows also have a half day of urgent clinic.
• Inpatient: Fellows follow gastroenterology patients on both our inpatient service and separate consult service in C.S. Mott Hospital for a total of about 8 months. Service time is generally divided into 2 to 4 week blocks to promote continuity of patient care. Weekends are divided evenly among all fellows. When on service, the fellow is responsible for care of patients admitted to the GI service, ER and outpatient after hour calls. The consult fellow is responsible for all inpatient consults during regular operating hours.
• Call: Fellows will take call while on the inpatient service at C.S. Mott Children’s Hospital. This consists of home call both during the week and on weekends (there is a separate rotation for each). The fellow is required to return to the hospital for emergency procedures, patients with a changing clinical course, and critically ill admissions. Pediatric residents provide in-house night time inpatient coverage for non-acute issues.
• Procedures: The on service fellow is responsible for all inpatient procedures. Fellows will have 3-4 outpatient procedure days per month while not on service.
• Research: The Pediatric Gastroenterology faculty will work with each fellow to identify a clinical or basic science research project and mentor for years 2 and 3. The research project mentor may include members of the Pediatric GI division, as well as members of the Departments of Surgery, Internal Medicine, Physiology, Anatomy and Cell Biology, and the School of Public Health. A supervisory committee will be formed to evaluate each fellow’s research project.
• Teaching: Fellows will receive both formal and informal teaching from the Pediatric Gastroenterology faculty. Fellows have a prominent role in resident and medical student education.

• Outpatient: Fellows have one-half day per week of general pediatric gastroenterology clinic with their own outpatient population as well as continued involvement with the urgent clinic.
• Inpatient: 4-6 weeks on service with description and call as described above. 4 weeks of the consult service.
• Procedures: Outpatient procedure days continue throughout fellowship. Generally, fellows do 2-5 days per month depending on service obligations and scheduling.
• Research: The fellow begins more focused work on their clinical or basic science research project.
• Teaching: Fellows continue to receive both formal and informal teaching from the Pediatric Gastroenterology faculty. Fellows continue to have a prominent role in resident and medical student education.

• Outpatient: Fellows have one-half day per week of general pediatric gastroenterology clinic with their own outpatient population as well as continued involvement with the urgent clinic.
• Inpatient: 4-6 weeks on service with description and call as described above. 4 weeks of the consult service. During this time, the trainees are given a great deal more responsibility for patient care.
• Procedures: Outpatient procedure days continue throughout fellowship. Generally, fellows do 2-5 days per month depending on service obligations and scheduling.
• Research: During the first part of year 3, fellows complete their research projects with the goal of submitting one or more manuscripts for publication prior to completion of fellowship training.
• Teaching: Fellows continue to receive both formal and informal teaching from Pediatric Gastroenterology faculty. They are expected to provide more teaching including giving talks to the general pediatric residents on specific pediatric gastroenterology topics.