Curriculum and Program Design

Our fellows must accomplish competency goals over 3 years by completing the specific objectives set forth in our curricular experiences and rotations. 

Consult Service (12 months)

The GI Fellows provide daily consult service for all the Harlem Hospital in patient services. The fellows cover nights and weekends as well. Call is taken from home.  The consult fellow will either directly see and evaluate the patient or supervise the resident on The GI Elective Rotation, who would be given the opportunity to see the patient first. The fellow, with/ or without the resident, will formulate the plan prior to presentation to the attending. All cases are presented to the attending on rounds, which are held daily.  The fellow – resident team will follow the patient’s progress.  Issues related to medical knowledge, patient care, systems based practice, as well as practice based learning and improvement will be discussed with the resident and fellow using the Socratic Method.

Endoscopy Service (11 months)

Endoscopy is performed daily in the endoscopy unit of the Ambulatory care unit. GI performs procedures 3.5 days weekly. Surgery performs procedure one day per week- Thursdays. The endoscopy unit can provide all standard diagnostic and therapeutic procedures.  It is the goal of the Endoscopy rotation for the fellow to learn the indications, contraindications, as well as the risks, benefits, and alternatives for the procedures they perform.   Also, the fellow will at the end of 3 years be an independent general endoscopist able to perform esophagogastroduodenoscopy (EGD), esophageal dilatation, colonoscopy, techniques of hemostasis, percutaneous endoscopic gastrostomy (PEG) placement, and liver biopsy.  The fellow will have had experience reading basic capsule endoscopies. It is an equally important goal for the fellow to know and understand the ethical issues surrounding the obtaining of informed consent and the performance of endoscopy in special populations that may not be able to advocate for themselves, including patients who are demented, developmentally delayed, or active substance abusers.  The fellows must also understand the importance of pre-procedure preparation of the patient and post procedure closure with the patient.

General GI Clinic (6 months) - Longitudinal Experience

GI clinic occurs every Thursday throughout the three years of fellowship. Fellows attend this clinic even when on rotation at Columbia. They attend this clinic all three years. The fellow will gain experience and develop expertise in the diagnosis and management of gastrointestinal disorders as they occur in an outpatient setting.  In this venue the fellow will experience the natural history of gastrointestinal diseases.  The fellows and residents will also learn to negotiate and improve systems issues involved in trying to secure care for their patients with multiple disease states and limited resources. 

Hepatology Curriculum (6 months)

The Hepatology Curriculum is a blended experience that includes:

Liver Clinic (3 months) – Longitudinal Experience

All fellows participate in the half day a week Hepatology clinic on Monday afternoons. Although all liver disease is seen in clinic the majority of the patients have viral hepatitis and in particular Hepatitis C.  The first year fellow sees most of the patients who present with non-specific complaints such as abnormal liver enzymes.  The second year fellow sees all patients who are identified as having NAFLD, viral Hepatitis B or C. In this way that fellow gains experience treating their own cohort which they carry through the third year of fellowship. This also provides more continuity of care for the patients as they have one identifiable provider for the duration of this very arduous therapy.

Liver Transplant Rotation (2 months)

In their third year fellows spend 2 months at Columbia where they learn the fundamentals of transplant hepatology. Also, since CPMC is a tertiary care hospital, the fellow gains broader experience seeing some of the more rare cholestatic and inherited liver diseases.

Biliary/Advanced Endoscopy (1 month)

Lastly, the third year fellow spends one month at Columbia on their advanced endoscopy service. Here the fellow will build on the exposure to advanced techniques seen in the first 2 years at Harlem and observe application of those techniques in the evaluation of the hepatobiliary system including ERCP and EUS. The fellow will also have significant exposure to techniques of deep enteroscopy.

Motility Curriculum

The second year fellow performs the majority of the motility tests. The fellow will learn to identify the proper candidates for motility exams.  They will understand the indications, contraindications, and complications of motility studies. They will understand the different modalities used in motility studies.  They will understand the pathophysiology of motility disorders.  They will learn to perform and interpret motility exams. 

Nutrition (1 month)

The third year fellow spends one month on Columbia’s Nutrition Support consult service. Although the concentrated nutrition experience occurs at CUMC during the fellows third year the foundation for the understanding and diagnosis of malnutrition occurs in the first two years.  Fellows learn nutrition assessment, enteral and parenteral formula selection, and PEG placement techniques prior to their one month Columbia experience.

Conference Curriculum

To provide fellows with the didactic experience that they need to broaden and deepen their clinical understanding of the complexity of gastrointestinal disease. The conference curriculum combines passive learning through presentations made by Division attendings and outside speakers with active learning, with fellows developing their own presentations. The discipline of conference preparation encourages self-study, which is at the heart of acquiring medical knowledge.

Research Curriculum (6 months)

The goal of the research rotation is for the fellow to understand how to critically review the medical literature and relate it to observations he or she has made on their own patients.   The fellow should learn how to formulate a hypothesis and design a study. The fellow should also gain a greater understanding of the use of biostatistics and epidemiology in the design and conduct of medical research.