About the Program
Mission
Provide a comprehensive educational experience that allows trainees to develop into independent physicians and academicians who will practice with the highest quality standards, abide by patient-centered ethical principles, and become community leaders who will advance the fields of gastroenterology and hepatology.
Contact
Please contact us about questions you may have regarding your application to the program and interview.
Program Highlights
- Advanced training in the full spectrum of general gastroenterology and hepatology.
- Specialized training in GI/hepatology diagnosis and management in a diverse population of patients in a variety of clinical settings.
- Opportunity to gain endoscopic procedural proficiency, including training using endoscopic simulation.
- Development of research skills in clinical and/or translational research.
- Training in academic skills such as abstract and manuscript preparation, PowerPoint and oral presentation skills, development of research ideas and research protocols, and writing a grant proposal.
- A diverse faculty with expertise in all subspecialties of gastroenterology and hepatology.
- A full array of regular educational conferences encompassing GI pathology, GI radiology, clinicopathological conference, GI grand rounds, etc.
Clinical Training
The curriculum for the Gastroenterology and Hepatology Fellowship is based upon AGA/ACG guidelines and is consistent with ACGME requirements. Clinical training includes patient care, procedures, sub-specialty rotations, didactic training (see Conferences) and teaching opportunities.
Patient Care
A comprehensive inpatient and outpatient clinical experience is offered by the Kirk Kerkorian School of Medicine at UNLV fellowship program. Fellows on the gastroenterology hospital service will act as first assistants to the faculty and will encounter numerous clinical scenarios that form the backbone of the patient care experience. GI fellows will function in a junior faculty role, directly supervising and guiding medical residents on the team, together with the attending faculty. Fellows will personally conduct or supervise all gastrointestinal and hepatology consultations while on the inpatient service and perform procedures on hospitalized patients. Rotations in several hospital-based specialty areas, including nutrition and liver transplantation, will round out the fellow experience.
Throughout the three-year fellowship, trainees will participate in a weekly core continuity clinic which, in later years, includes rotations in several subspecialty clinics (e.g., hepatobiliary disease, pancreas, IBD).
Procedures
All procedures are performed under the direct supervision of School of Medicine faculty or adjunct clinical faculty gastroenterologists. Procedural training will include upper endoscopy, esophageal dilatation, esophageal and anorectal manometry, esophageal pH readings, small bowel enteroscopy, capsule enteroscopy, percutaneous endoscopic gastrostomy placement, colonoscopy and endoscopic retrograde cholangiopancreatography and endoscopic ultrasound.
Fellows will become proficient with all current therapeutic modalities, including polypectomy, electrocautery, argon plasma coagulation, hemoclip application, variceal banding and various stenting procedures. Trainees may elect to pursue additional experience with gastrointestinal motility, the dynamic assessment of pancreatic, hepatobiliary and gastrointestinal function and other procedures.
Sub-specialty Rotations
Several rotations are available during which fellows in their second and third years of training may gain further expertise within sub-specialties in gastroenterology such as hepatology, inflammatory bowel disease, clinical research and advanced procedures. Formal extra-year training fellowships within these sub-specialties are currently not available at the School of Medicine.
Teaching Opportunities
There is ample opportunity for fellows to teach Kirk Kerkorian School of Medicine at UNLV students, visiting students from other medical schools and medical residents through bedside instruction, teaching rounds and formal didactic lectures. Fellows will receive instruction on effective presentation skills and regular feedback will be provided after presentations.
Fellowship Rotations
General Gastroenterology Inpatient Service
This service represents the bulk of the first year of fellowship experience and includes the "bread and butter" of gastroenterology and hepatology. The overall educational goal of this rotation is to develop consultative skills in the evaluation, diagnosis and management of the hospitalized patient with GI disease with a focus on a cost-effective and ethical approach. The fellow will function as the primary consultant for residents, interns, and medical students and will coordinate all aspects of care. This rotation also includes the breadth of experience in emergency endoscopy such as acute GI bleeding.
Transplant Hepatology Inpatient Service
The overall goal of this rotation is for fellows to gain exposure to the evaluation and management of pre- and post-liver transplant patients. The fellow will function as a consultant on the liver transplant team, working in concert with transplant surgeons, transplant hepatology faculty, social workers, care coordinators as well as other trainees. Fellows will be exposed to all aspects of liver transplant care including complications of chronic liver disease, fundamentals of liver transplant evaluation, management of fulminant hepatic failure, and post-transplant complications requiring hospitalization. At present, there is no liver transplant program in the state of Nevada. Therefore, the School of Medicine has partnered with Loma Linda University to allow fellows in the second or third year of training to participate in a one-month rotation on the liver transplant service in Loma Linda, CA.
Hepatology Consultation Service
Currently, general hepatology consultation is incorporated into the general gastroenterology inpatient consultative services. Specialized training in general inpatient hepatology will be accomplished by working closely with the faculty on teaching rounds with consultative support by the affiliated hepatology faculty.
Endoscopy Training
Fellows will experience a wide array of both inpatient and outpatient endoscopy within the framework of the rotations described herein. All procedures conducted by fellows will occur under direct supervision of faculty. Fellows shall maintain a log of all cases they perform during their fellowship. Besides becoming proficient in all basic procedures and therapeutic techniques, fellows will learn how to properly assess patient risk for conscious sedation, communicate with anesthesia colleagues on the use of deep sedation and how to communicate risks to the patient and other caregivers.
Third-year fellows will have the opportunity to participate in therapeutic ERCP, EUS as well as other advanced procedures such as radiofrequency ablation, placement of self-expandable metallic stents, endoscopic tumor ablation and endoscopic mucosal resection. However, proficiency in these advanced procedures and techniques with the goal of obtaining credentialing should be accomplished via completion of a fourth year advanced fellowship in therapeutic endoscopy.
Clinical Nutrition Service
The objective of this rotation is to become familiar with the various modes and indications for nutritional support in hospitalized patients. During the second or third year, fellows will participate in a one month rotation co-sponsored by the Nutrition Service at the primary educational site. Fellows are expected to become adept at identifying patients with protein calorie malnutrition, assessing initial patient caloric requirements and monitoring ongoing needs, gain expertise in the appropriate use of both enteral and parenteral feeding and recognize complications of these therapies. This experience will encompass a wide variety of clinical settings such as medical and surgical ICU, neurosurgical ICU, burn unit and trauma ICU. Additional outpatient nutrition education will allow trainees to participate in intestinal rehabilitation, obesity clinics, and bariatric surgery clinics.
Motility
All fellows have the opportunity to learn how to conduct and interpret esophageal manometry testing as part of their clinical rotations and by participation in a joint motility case presentation conference. This will be accomplished at two locations in Las Vegas under the supervision of the School of Medicine and adjunct faculty with expertise in motility disorders.
Research
Fellows will engage in independent research under the supervision of mentoring faculty. Dedicated research blocks of 2-3 months occur in the second and third year of fellowship. Trainees are expected to generate research ideas, develop protocols, seek grant support where necessary, and obtain IRB approval for their projects. All fellows will learn how to successfully complete a research project, including data acquisition, result interpretation, statistical analysis, abstract development with the goal of presenting their work and regional and national meetings and manuscript publication. The fellowship program focuses primarily on conducting clinical research; however, the ambitious fellow may pursue translational and/or basic research opportunities through collaborations with other departments within the University of Nevada. Research experience is a fundamental aspect of the fellowship and trainees should learn how to critique and interpret the published medical literature, which is among the key skills that distinguish a gastroenterology leader from the merely competent
Conferences
Clinicopathological Conference
Fellows conduct a 15-20 minute case presentation with relevant imaging and pathology with a primary goal of developing a broad differential diagnosis, and ensuring a cost-effective, expedient GI-directed work-up. Common clinical dilemmas are discussed and debated among fellows and faculty. A brief literature review is provided to gain additional expert knowledge in the topic presented. This conference includes a thorough review of morbidity and mortality issues encountered during routine practice.
Gastroenterology Survivors Guide Series
A series of lectures are provided to fellows at the beginning of the academic year to help prepare them for the most commonly encountered issues during consultative practice. Both university and adjunct faculty participate in this educational series.
GI Radiology and GI Pathology Conferences
Bi-weekly conferences that occur during the general inpatient consultative service. Selected cases highlighting basic or unusual radiologic and pathologic findings are presented informally with radiology and pathology experts. Fellows will reach a deeper understanding of how to interpret test results and correlate them into clinical care.
Board Review Conference
A weekly board review conference based on ACG/AGA curricula.
Gastroenterology Journal Club
A journal club is held monthly. Articles are selected by faculty around a theme, and presented in a critical fashion by the fellows. Topics are rotated month to month.
Tumor Board
A specialized conference that fellows can attend to gain additional experience in the multidisciplinary approach to GI and liver cancers.
GI Grand Rounds
A one-hour seminar open to the larger Las Vegas GI community in which faculty, fellows and guest speakers disseminate their expertise on a multitude of cutting edge topics that reflect upon local patient care and also reflect national and international trends in medicine.
Application Information
Two or three fellows are selected per year based upon applicant pool and clinical need. Applications must be received through the Electronic Residency Application Service (ERAS). The application requires the following information:
- Official medical school transcripts
- Official test transcripts for all applicable examinations (USMLE, LMCC, COMLEX, NBOME, FMGEMS, FLEX or NBME)
- Three letters of recommendation, including one from the internal medicine program director
- A curriculum vitae
- A personal statement
- A valid ECFMG certificate (if you graduated from medical school outside of the United States)
- A photograph
Fellow appointments are made through the Gastroenterology Subspecialty Match Program, sponsored by the National Resident Matching Program Specialty Matching Services (SMS). All candidates must register through the SMS. Fellowship candidate interviews are conducted on selected dates during September and October.
Current Fellows
Medical School: University of South Carolina School of Medicine
Medical School: University of Pittsburgh School of Medicine
Medical School: St. George's University School of Medicine
Medical School: Virginia Commonwealth University School of Medicine
Medical School: Rutgers New Jersey Medical School
Medical School: University of Utah School of Medicine