General Gastroenterology and Hepatology 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 the University of Arizona to allow fellows in the second or third year of training to participate in a one-month rotation on the liver transplant service in Tucson, AZ.
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 hepatology faculty on teaching rounds.
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.
All fellows have the opportunity to learn how to conduct and interpret esophageal manometry testing during a one-month rotation in motility. 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.
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