Inflammatory Bowel Disease Fellowship
University of Pennsylvania Perelman School of Medicine
Gary R. Lichtentstein, MD Professor of Medicine Director, IBD Center Director, Advanced IBD Fellowship
James Lewis, MD, MSCE Professor of Medicine & Epidemiology Senior Scholar, CCEB Associate Director, IBD Center Associate Director, Advanced IBD Fellowship
The inflammatory bowel diseases, including Crohn’s disease, ulcerative colitis, and microscopic colitis, constitute an increasingly specialized area of gastroenterology. Across the country, a small number of programs have initiated non-ACGME certified sub-specialized training for individuals interested in pursuing this field of clinical care and research. The University of Pennsylvania has ideal clinical and research facilities to provide specialized training in the care of patients with inflammatory bowel diseases and conducting clinical research relevant to these same conditions.
· Scope of training: The intended scope of training includes all areas pertaining to the diagnosis and treatment of patients with inflammatory bowel disease, as well as clinical research pertaining to causation, epidemiology, diagnosis, prognosis, and management of these diseases.
· Length of training: The Inflammatory Bowel Disease Fellowship will last twelve months.
· Number of training positions available per year: One trainee position is available per year.
· List of program faculty from the Gastroenterology Division:
o Faten N. Aberra, MD, MSCE
o Meenakshi Bewtra, MD, MPH
o James D. Lewis, MD, MSCE
o Gary R. Lichtenstein, MD
o Mark T. Osterman, MD, MSCE
o Farzana Rashid, MD
o Gary D Wu, MD
o Jesse Green, MD
o Vesselin Tomov, MD, PhD
o Frank Scott, MD
o Nabeel Khan, MD
o Jan Michael Klapproth, MD
o Robert Stein, MD
· List of Associated Faculty from other Departments and Divisions:
o Franz Fogt, MD - Pathology
o Emma Furth, MD – Pathology
o Marc Levine, MD – Radiology
o Stephen Rubesin, MD- Radiology
o Najjia Mahmoud, MD – Colorectal Surgery
o Joshua I. S. Bleier, MD- Colorectal Surgery
o Cater Paulson, MD- Colorectal Surgery
o Cary Arons, MD- Colorectal Surgery
o Nicole M. Saur, MD- Colorectal Surgery
o Skandan Shanmugan, MD- Colorectal Surgery
· Description of the activities of the fellow: The fellow will commit approximately 50% of their time to clinical activities and 50% to research. Overall, 4 days per week on average is dedicated to training and 1 day a week (50% endoscopy and 50% clinic) is dedicated to divisional activity. Clinical time will include two half-day sessions of outpatient office visits each week under the supervision of the GI faculty at either Pearlman Center for Advanced Medicine or Penn Presbyterian Medical Center. The fellow will be expected to complete two half-day sessions of unsupervised endoscopy or outpatient clinical sessions each week at the discretion of the Gastroenterology Division Chief. The fellow will complete one half-day endoscopy session each week under the supervision of the faculty. The fellow will spend four weeks as inpatient attending on the luminal Gastroenterology consultation service at either the Hospital of the University of Pennsylvania or Penn Presbyterian Medical Center. The fellow will not take night call or weekend call other than during the four weeks of attending on the consultation service. The remaining 50-60% of the time will be dedicated to clinical research activities and didactic sessions.
· Didactic Sessions: The fellow will be expected to attend the following weekly didactic sessions: 1) Inflammatory Bowel Disease Journal Club and Research Conference – This weekly meeting reviews clinical articles relevant to inflammatory bowel diseases, reviews ongoing research within the IBD Program, and discusses difficult cases. The fellow will be expected to present once every 2 months at the meeting, either in the format of a journal club or presenting their ongoing research. 2) Gastroenterology Division Clinical Case Conference and Grand Rounds – This weekly conference includes presentation of challenging cases and lectures germane to Gastroenterologists. If desired, the fellow may also attend the weekly Gastroenterology Division Clinical Journal Club.
· Description of basic science and/or clinical research requirements and opportunities: Fellows are expected to participate in a supervised clinical or translational research project pertaining to inflammatory bowel disease. These may include retrospective studies as well as prospective studies of an observational nature or clinical trials. These activities will be directly supervised by one of the GI faculty. The fellow will be guided through the process of obtaining human studies approvals and in the structuring of the research and writing of the protocol. Fellows will also receive instruction on methods of data collection and appropriate analysis. It is anticipated that each fellow will complete a manuscript describing their independent research in a manner suitable for publication. It is anticipated that fellows will spend at least 40% of their time working with their mentor in clinical research training.
· Vacation time: The IBD Fellow will have three weeks of vacation during the one year of training.
· Describe the topics, techniques, etc. that will be taught and how: Topics pertaining to etiology and pathogenesis will be taught in the context of clinical care, as well as in the context of the didactic sessions. Areas related to clinical care that pertain directly to the management of patient but are outside the field of gastroenterology, such as pathology and radiology, will be incorporated into clinical activities and conferences. Particulars of diagnosis and management issues as well as pharmacotherapy and decisions relating to surgery will be conveyed in the routine course of managing both inpatients (as noted above) and outpatients primarily. In addition to the IBD Journal Club, a core curriculum of classic articles germane to the field will be provided for the fellow. Fellows will receive direct supervision to inform them of diagnostic and therapeutic procedures relevant to the care of patients with IBD, including appropriate implementation of surveillance colonoscopy in screening for dysplasia, recognition of abnormal findings in the setting of IBD, and gradation of disease severity.
· Specific educational goals and objectives for the Fellow:
To learn appropriate methods and collection of data in support of a diagnosis of Crohn’s Disease or Ulcerative Colitis.
To learn appropriate uses of medical and surgical therapies targeted for these diseases.
To learn appropriate preventative measures used in the treatment of these conditions and complications of therapies.
To learn the essentials of clinical investigation relevant to clinically-oriented questions in Inflammatory Bowel Disease and relevant to translation of basic pathophysiology to patient-oriented research.
To learn to identify finding relevant to diagnosis and management of IBD in the course of endoscopic procedures.
Pre-requisites for Program:
Completion of training in Internal Medicine
Completion of Gastroenterology Training Program
License to Practice Medicine in Pennsylvania (application may be pending)
Appropriate Visa requirements if non-U.S. citizen (ECFMG)
Applicants will be expected to have completed an ABIM certified three-year training program in Gastroenterology prior to beginning their IBD Fellowship. For those applying from outside the United States, completion of equivalent post-graduate training in Gastroenterology is acceptable. Selection criteria will be based on the following: 1) Demonstrated interest in an academic career in IBD; 2) Demonstrated interest in clinical/translational research in IBD; 3) Excellence in clinical care.
The application process will involve a personal statement, three letters of recommendation, as well as an interview for a subset of applicants. Selection of applicants will be conducted by the Fellowship Program Directors, with the assistance and input of the Division Chief and the other IBD faculty from the GI Division.
The fellow will meet with Dr. Lewis and/or Dr. Lichtenstein quarterly to review their progress.
Metrics for Determination of Competence and Successful Completion of Fellowship
At the completion of training, the IBD fellow will be evaluated by the Program Directors to assess competence in the clinical care of patients with IBD. The following metrics will be used to assure sufficient exposure to a wide breadth of complex patient scenarios.
· Completion of a minimum of 10 surveillance colonoscopies in patients with IBD
· Completion of a minimum of 10 pouch endoscopies in patients with IBD
· Participation in the care of a minimum of 10 patients initiating biologic therapies for IBD
· Participation in the care of a minimum of 10 patients initiating non-biologic disease modifying therapies such as azathioprine or methotrexate for IBD
· Participation in the completion of a minimum of 10 outpatient consultations for second opinion regarding the management of IBD
The Fellow will be given the title of Instructor in the Department of Medicine.
Salary will be commensurate with level of training.