Gastroenterology, Hepatology and Nutrition

Pediatric Gastroenterology and Nutrition Fellowship

Overview and mission

The primary goal of the program is to train academic pediatric gastroenterologists. We define academic gastroenterologists as those who are excellent clinicians encompassing skills in broad aspects of evaluation, diagnosis and management of primary and secondary diseases of the gastrointestinal tract and who are active in advancing the field by participating in research and/or education.

The Fellowship Training Program in Pediatric Gastroenterology (GI) is a three-year program designed to offer a strong clinical and research experience and to prepare the trainee to qualify for the subspecialty boards in Pediatric Gastroenterology and Nutrition.

The first year of the program is devoted principally to clinical training, with both inpatient and outpatient activities and participation in an active consult service. The second and third years of the program are devoted primarily to laboratory and/or clinical research. In some cases, an additional year may be added for training in clinical nutrition.

Nutrition fellowship or training

An independent three-year Nutrition fellowship is available. For those applicants interested in pursuing a traditional GI fellowship with additional Nutrition training, a combined four-year program is available. This program requires admission to each individual program and is comprised of the GI clinical year, a Nutrition clinical year and then the two-year research experience with a project that spans both fields.

Fellowship training program director

Elizabeth Rand, MD
Gastroenterology Fellowship Training Program
Division of Gastroenterology, Hepatology and Nutrition
The Children's Hospital of Philadelphia
34th Street and Civic Center Boulevard
Philadelphia, PA 19104-4399
215-590-3247 Email Dr. Rand.

Division chief

David Piccoli, MD
Division of Gastroenterology, Hepatology and Nutrition
The Children's Hospital of Philadelphia
34th Street and Civic Center Boulevard
Philadelphia, PA 19104-4399
215-590-2762
Email Dr. Piccoli.

Unique information about the program

Specific information by years and/or rotation

First year

Inpatient service

Goals: As described in the guidelines provided by the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN), the fellow should become competent in rendering age-appropriate inpatient care from evaluation to discharge of a broad range of gastrointestinal diseases, including intestinal mucosal diseases, motility disorders, hepatobiliary diseases, pancreatic disorders and functional problems from mouth to anus. Furthermore, the fellow should become competent in the performance of diagnostic and therapeutic invasive procedures. The fellow should learn to evaluate and ameliorate the psychosocial impact of disease, utilize available ancillary services and deliver cost efficient care.

Objectives: The fellow will participate, with supervision from attending physicians, in all aspects of the care of patients of all ages hospitalized under the GI service at Children's Hospital. This care includes initial evaluation, formulation of differential diagnosis and evaluation, participation in diagnostic procedures, interpretation of laboratory, radiologic, pathologic and other testing, treatment and discharge planning. The fellow will perform daily duties as described in the Fellows Handbook. The fellow will also participate in teaching residents and students on rounds and at the bedside. The fellow will attend all teaching conferences.

Outpatient service

Goals: As described in the NASPGHAN guidelines, the fellow should become competent in rendering age-appropriate outpatient care from evaluation through long-term follow up or discharge from clinic as indicated for each disease process. The fellow should provide care to patients with a broad range of gastrointestinal diseases including intestinal mucosal diseases, motility disorders, hepatobiliary diseases, pancreatic disorders and functional problems from mouth to anus. Additionally, the fellow should learn to evaluate and ameliorate the psychosocial impact of disease, utilize available ancillary services and deliver cost efficient care.

Objectives: The fellow will, with supervision from attending physicians, organize outpatient evaluation, diagnostic procedures and treatment, including hospital admissions as necessary. The fellow will perform history and examination, review of outside data and present cases to the attending physician as per the Fellows Handbook. The fellow will generate a clinic note and dictate a letter to the referring physician.

Consult service

Goals: The fellow should become proficient in the evaluation of primary and secondary gastrointestinal signs and symptoms in infants and children with non-GI disease. This includes primary GI diseases in those patients with extraintestinal presentations and secondary GI diseases in patients with known non-GI diseases. The fellow should be able to perform a complete history and examination and review any prior medical evaluation and testing. Formulations and recommendations must be reviewed with the supervising attending physician and then communicated to the referring team and placed in the patient record in a timely and respectful fashion.

Objectives: The fellow will evaluate all patients as requested by any primary service at the Hospital. The fellow will present cases, write notes and communicate with the primary service as per the Fellows Handbook. The fellow will attend and make presentations in rotation at all teaching conferences.

Procedure service

Goals: The fellow should become increasingly proficient in the performance of various GI invasive procedures including patient assessment, sedation, procedural techniques and post-procedure monitoring and management. The fellow will ultimately develop skills to become independently proficient in diagnostic procedures such as upper and lower endoscopy, rectal suction biopsy, liver biopsy and manometry. The fellow will gain experience in therapeutic procedures including esophageal dilation, sclerotherapy, banding and polypectomy.

Objectives: The fellow will review charts of scheduled outpatient procedures daily, will participate in the consent process, conscious sedation, the procedure, post-procedure management, communication with patients and families and generation of reports.

Additional rotations

Goals: The major goal of these rotations is to provide additional experience and insight into other specialties important to the evaluation and treatment of children with GI disorders, particularly Nutrition, Radiology and Pathology. The fellow will attend Continuity Clinic and participate in teaching conferences as allowed by the selective schedule.

Objectives:

Night and weekend call

Goals: The goal of night and weekend call is to provide the fellow with experience in the telephone triage of patients with acute changes in new or chronic illness and to provide training in cross-covering inpatients.

Objectives: The fellow will obtain sign-out information from the inpatient and/or consult fellow as applicable prior to taking on-call responsibilities. Responsibilities are described in the Fellows Handbook.

First-year clinical rotations

Second and third years

Research experience

Goals: Each fellow will undertake a specific project or projects — under the guidance of a clinical mentor — with the goal of significant participation in research. This is one of the requirements of the American Board of Pediatrics for certification in Pediatric Gastroenterology, the NASPGHAN guidelines and our program goal to produce graduates who will become academic gastroenterologists. The division chief and program director will assist each fellow in the selection of an appropriate project and mentor.

Objectives: The specific objectives of each project will vary greatly depending on the project selected and the mentor chosen. The long-term goal is for each fellow to submit at least one manuscript describing their research experience to a peer-reviewed journal for publication. The fellow will attend project specific conferences and the standard clinical GI conferences.

Outpatient service

Goals: See First year, Outpatient service

Objectives: See First year, Outpatient service

Night and weekend call

Goals: See First year, Night and weekend call

Objectives: See First year, Night and weekend call

 

Reviewed by: Elizabeth Rand, MD
Updated: September 2013

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To schedule or change an appointment, please call

215-590-3630

For other questions or information, please call

267-426-2270