Mission

The Gastroenterology Fellowship Training Program at Henry Ford Providence Southfield Hospital, part of Michigan State University College of Human Medicine, is designed to set the highest standard for excellence in training. The purpose of this training program is to develop successful practicing gastroenterologists with excellent clinical knowledge and procedural skill. The fellows who complete this program will:

1. Demonstrate competency in the field of Gastroenterology and Hepatology.
2. Be capable of pursuing careers in academic medicine and clinical practice.
3. Possess habits of life-long learning that will continue to enhance their knowledge, skills, and professionalism.

Introduction

The training manual and curriculum is developed for the use of the gastroenterology fellows and teaching faculty at Henry Ford Providence Southfield Hospital. The training manual will outline a variety of overall aspects of the program and provide curriculum goals and objectives for each level of the program. The curriculum for each rotation is included. These are structured around the six Accreditation Council of Graduate Medical Education (ACGME) core competencies and the Entrustable Professional Activities (EPAs) outlined by the American Association for the Study of Liver Diseases (AASLD), American College of Gastroenterology (ACG), American Gastroenterological Association (AGA), American Neurogastroenterology and Motility Society (ANMS), and American Society for Gastrointestinal Endoscopy (ASGE).

Gastroenterology Consultation Service

We cover five total GI services across the three sites. The consult service is a busy, procedure-rich service. All procedures are supervised by faculty. The fellows have access to the on-site simulation lab at the Southfield campus. Fellows also have one half-day of fellows clinic 1-2 times per month in addition to one half-day of clinic per week with an attending.

Conferences

We participate in the following conferences:

• Core Curriculum Conference Weekly
• GI Radiology Conference Monthly
• GI Pathology Conference Monthly
• Research Meeting Quarterly
• GI Journal Club Monthly
• GI Morbidity and Mortality Conference Quarterly
• Internal Medicine Resident Conference Monthly

Our gastroenterology fellows have formal instruction, clinical experience and opportunities to acquire expertise in the prevention, evaluation, and management of the areas listed below. Specific subjects required are listed for each rotation throughout this manual:

• Acid peptic disorders of the gastrointestinal tract
• Functional disorders of the GI tract
• Motility disorders of the GI tract
• Acute and chronic liver diseases
• Complications of Cirrhosis
• Biliary Disorders
• Acute and chronic pancreatic diseases
• Gastrointestinal infections
• Non-infectious luminal GI diseases
• Gastrointestinal and hepatic neoplastic disease
• Diseases of nutrient assimilation

Procedural Curriculum

Gastroenterology fellows are provided opportunities to gain competency in a variety of gastrointestinal procedures. A skilled preceptor is present to teach and supervise each procedure. The fellow documents the procedure in a procedure log. The fellow's log includes the procedure performed, the indication and outcomes of the procedure, the patient's diagnosis and the supervising physician(s). The fellow must demonstrate competency of the following procedures, including, but not limited to:

• Biopsy of the mucosa of the esophagus, stomach, small bowel, and colon
• Capsule endoscopy
• Colonoscopy with polypectomy
• Conscious sedation
• Esophageal dilation
• Esophagogastroduodenoscopy
• Nonvariceal hemostasis including actively bleeding
• Other diagnostic and therapeutic procedures utilizing enteral intubation
• Percutaneous endoscopic gastrostomy tube placement
• Retrieval of foreign bodies from the esophagus
• Variceal hemostasis including actively bleeding patients

The 2017 ASGE guidelines recommending the minimum number of procedures to begin to assess competency are followed and are listed below:

We follow the 2017 ASGE guidelines which outline the following objective performance components to be evaluated during assessment of endoscopy competence:

• Reviews patient records/x-ray films
• Identifies potential risk factors
• Understands indications/contraindications
• Believes findings will influence management
• Obtains proper informed consent
• Uses appropriate sedation 
• Intubates GI tract with good technique
• Correctly identifies landmarks
• Conducts thorough examination
• Detects and identifies all pathologic conditions
• Completes the examination within a reasonable period 
• Obtains tissue sample properly 
• Performs therapeutic maneuvers successfully/effectively
• Recognizes and manages procedure-related adverse events
• Prepares an accurate report
• Plans correct management and disposition
• Discusses findings with patient/family and other healthcare providers
• Arranges proper follow-up, review of pathologic findings, and case outcome

Academic Opportunities & Professional Development

Abundant opportunities exist for scholarly activity. Mentors are established for fellows based on their interests and future goals to provide guidance on scholarly work, research or educational projects, and career planning. Fellows will be expected to complete at least one substantial scholarly project.