Clinical training

The Advanced Endoscopy Fellowship provides intense endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) training with the goal of developing future leaders in the field.

Exposure to other advanced procedures, such as endoscopic mucosal resection (EMR), is available based on the needs of individual fellows and existing opportunities.

Use of an animal lab and simulation-based training allows rapid acquisition of basic skills and enhanced exposure to new and advanced techniques. A complete text and video library is available to augment teaching.

Upon completion of the Advanced Endoscopy Fellowship, you should be able to:

• Use EUS and ERCP to diagnose and manage patients with a variety of gastrointestinal disorders
• Identify the unique features of dedicated echoendoscopes, catheter probes, and EUS and ERCP accessories
• Identify normal EUS anatomy
• Establish the T, N, and M stage for luminal tumors and pancreatic cancer
• Differentiate the various types of cystic pancreatic tumors
• Identify the utility of EUS for evaluating patients with chronic pancreatitis, including autoimmune pancreatitis
• Differentiate the various subepithelial mass lesions
• Assess the N stage for lung cancer
• Integrate EUS into the care of patients with inflammatory bowel disease
• Demonstrate proper technique for EUS-guided biopsy (FNA, Trucut)
• Recognize the technical aspects and role of interventional EUS and ERCP procedures, including but not limited to stone retrieval, cyst drainage, pseudocyst drainage, celiac plexus block and neurolysis, duodenal and other luminal stenting, ampullectomy, biliary stent placement, and cholangioscopy
• Begin the process of overseeing and teaching these skills and techniques to gastroenterology fellows
• Integrate proper reimbursement and billing into your practice

Rotation schedule

The Advanced Endoscopy fellow is typically assigned to:

• 80 percent time doing EUS, ERCP, and other advanced procedures
• 10 percent time for research
• 10 percent time for clinical service

Clinical service is necessary to cover a portion of the fellow's salary and other costs. It may predominantly consist of general gastroenterology consultations.

Didactic training

In addition to hands-on performance of techniques, the curriculum includes a series of didactic lectures. These lectures are provided by the EUS and ERCP staff, other gastroenterology and non-gastroenterology physicians who use these techniques, radiologists, oncologists, and advanced fellows.

Conferences

Along with the weekly gastroenterology divisional and research conferences, there are separate endoscopy conferences, a gastroenterology divisional Endoscopy Group Meeting, and a monthly Gastroenterology Research Group meeting. As an advanced fellow, you are responsible for presenting at several of these forums and coordinating intermittent advanced endoscopy meetings.

Research training

Regular and structured meetings are held between fellows and identified mentors to design and conduct research protocols. Fellows also work with other Division of Gastroenterology and Hepatology members with diverse skills and investigative backgrounds. Research projects are further developed and implemented in one of our varied gastroenterology subspecialty clinics and interest groups.

It is anticipated that each research project will generate results and information suitable for publication in a major gastroenterology subspecialty journal. Manuscripts are expected. These may include a major subject review, case report (limited to one), or a retrospective review.

Development of abstracts for at least two of the major national gastroenterology meetings — Digestive Disease Week and the American College of Gastroenterology annual meeting — also is anticipated.

Teaching opportunities

Opportunities are available for teaching rotating gastroenterology fellows in the endoscopy suites as well as residents and fellows during conferences.

Evaluation

To ensure you gain proficiency and develop the corresponding technical skills, your performance is monitored throughout the Advanced Endoscopy Fellowship. You are formally evaluated by your supervising faculty member after completing each clinical rotation, and you will then meet with the program director to review these evaluations. In addition, you regularly evaluate the faculty to ensure your educational goals are being met.