Due to Hurricane IKE, we will not be taking applications for 2010.
We will not be in the ERAS Match program in 2010. 
We are currently trying to update ERAS with this information.

The University of Texas Medical Branch Division of Gastroenterology and Hepatology joined the national effort in participating in the Match process for applicants who will start their fellowship in 2009-2012.

If you have any questions, please contact the GI Fellowship Program Coordinator.

Natha Nuckols
GI Fellowship Program Coordinator
University of Texas Medical Branch
301 University Boulevard
Galveston , TX 77555-0764
(409) 772-1501

Overview

Mission and Objectives

The mission of the GI Fellowship Program at UTMB is to train academic gastroenterologists for leadership positions in the specialty. To this end, the fellowship is heavily weighted to providing the overall cognitive and technical skills required for a meaningful career in academic gastroenterology. We recognize the importance of clinical training and take great pride in offering our trainees an exciting educational experience with state of the art procedural components. Our curriculum is designed to provide trainees the opportunity to acquire the cognitive information, procedural skills, professional attitudes and practical experience in the specialty of gastroenterology.

Overall Structure and Organization

The GI fellowship program consists of three years of training. The first year is almost exclusively focused on clinical training in gastroenterology and hepatology. Years 2-3, focus on refining clinical expertise in specific areas of GI (sub-subspecialty) and developing the scholarly foundation for an academic career in Gastroenterology

The following graph summarizes the approximate distribution of time spent in each of these areas over the three-year training period. It should be noted that much of this experience is obtained on an on-going basis throughout the year but the approximate total time per year is estimated in this table. Gastrointestinal pathology and radiology are incorporated into the training program throughout.

Recognizing that academic gastroenterology may include a diversity of career paths, training in the second and third year is individualized to meet the goals and aspirations of the trainee. Fellows will meet with program director Dr. Sellin during their first year to develop a curriculum that may consist of:

• Basic Research

• Masters in Clinical Science

• Clinical Research/Scholarly activities

We aim to provide opportunities for the development of a wide spectrum of scientific scholars ranging from a fundamental emphasis on molecular biology and basic pathogenic mechanisms to clinical or epidemiologically based investigations. Several instructional tools will be used to achieve these aims including relatively formalized formats for didactic courses, coordination of individualized training and transition to junior faculty positions.

A. First Year

The first year of fellowship is focused on developing the arts and crafts of a clinical gastroenterologist and consultant. The GI service generally has two first year fellows simultaneously while the hepatology service has one fellow. These are consultant services. No inpatient GI.

B. Years Two and Three

1. Basic Research Training

The basic research training pathway is intended for training and development of future clinician scientists who are most interested in research on the underlying mechanisms of digestive disorders. They will learn to utilize state-of-the-art investigative and educational techniques under the mentorship of one or more active established investigators. The training program will include the following key elements:

• Acquisition of a core of knowledge in GI and liver biology and pathobiology with further rigorous emphasis on a focused area of interest, including

• Design and completion of a mentored research project, which includes rigorous training on methods needed to test a specific research hypotheses

• Training and experience in manuscript and grant writing

• Development of intellectual curiosity, research integrity and collegial attitudes in a mentored environment

The expected outcome is a competitive clinician-scientist with the expertise to identify and investigate fundamental biological questions related to causes and treatment of digestive diseases.

Examples of recent research projects:

• Experimental endoscopic approaches to GERD therapy
• Colonic motility in a rat model of IBS
• Neonatal inflammation and stress induced alterations of neuromuscular regulation of colonic motor activity
• Microspectroscopy increasing the accuracy of measurement of hepatic fibrosis in patients with hepatitis C
• Pathophysiological mechanisms of visceral hyperalgesia in IBS patients
• Intestinal pacing and gastric motility
• Toll receptor expression in human intestinal myofibroblasts
• Colonic myofibroblasts and inflammation
• Mechanisms of ERCP-induced pancreatitis
• HCV and alcohol induced cytotoxicity involves synergistic reactive oxygen production and mitochondrial depolarization
• Botulinum toxin for gastrointestinal disorders: therapy and mechanisms

2. Masters in Clinical Science Track

The Clinical Science Track is intended for fellows interested in clinical and translational research. The objective is to train future clinical and translational investigators in gastroenterology who are skilled in patient-oriented or health services research. The degree is awarded by the Graduate School of Biomedical Sciences (GSBS). The curriculum includes required courses in statistics and epidemiology and additional electives that may include basic science courses offered by the GSBS. The required master’s thesis includes completion of an original research project mentored by an experienced investigator in gastroenterology or a related scientific field. Admission requirements of the GSBS must be met. (See Clinical Science website www.gsbs.utmb.edu )

The Clinical Science Master’s Program offers two tracks:

• The Clinical Investigation Track emphasizes laboratory-based patient-oriented research. Facilities of UTMB’s General Clinical Research Center (GCRC) are available for studies of basic disease mechanisms in humans and for clinical trials. Students in this track are may be expected to gain a strong understanding of basic science principles and laboratory methods as related to their area of research interest.

• The Health Services Research Track emphasizes research methods used for assessing and improving the delivery of effective and cost efficient health care. These may include epidemiologic methods for the study of groups of individuals or use of existing databases of health-related information.

An application to the GSBS and the Clinical Science Program is usually submitted early in the first year of the GI fellowship (deadline April 1). Most required and elective courses are completed during the second fellowship year, during which clinical responsibilities are limited (e.g. one weekly clinic or endoscopy session). The master’s thesis project is usually completed and approved early in the third year prior to graduation from the GSBS.

Combining a GI fellowship with this degree program is an effective and efficient means of educating young, motivated clinicians to become clinical and translational investigators in gastroenterology. There is a great need for physician scientists with this training and career orientation at many academic medical centers. Pursuit of a PhD in Clinical Science is also possible, and would require identification of a source of support for an additional year in the graduate program. UTMB also offers the MPH degree for residents and fellows interested in public health practice.

Examples of recent master’s thesis topics :

• Increased vascular endothelial growth factor and hypoxia inducible factor-1α transcription in gastric sporadic acquired angiodysplasias Long-term Survival after Transjugular Intrahepatic Portosystemic Shunt (TIPS) for Refractory Ascites and Recurrent Variceal Bleed.
• Experimental endoscopic approaches to GERD therapy.
• Neonatal inflammation and stress induced alterations of neuromuscular regulation of colonic motor activity.
• Microspectroscopy increasing the accuracy of measurement of hepatic fibrosis in patients with hepatitis C.
• Pathophysiological Mechanisms of Visceral Hyperalgesia in IBS patients.
• Intestinal pacing and gastric motility.
• Toll Receptor Expression in Human Intestinal Myofibroblasts .
• Role of Endoscopic Simulators in Training.
• Mechanisms of ERCP-induced Pancreatitis.
• HCV and Alcohol induced Cytotoxicity Involves Synergistic Reactive Oxygen and
• Effect of Race and Ethnicity on Perceptions of Inflammatory Bowel Disease.
• Comparing the Response Rate of an Accelerated Vaccination Schedule Using a Combination Hepatitis A and B Vaccine (Twinrix®) in populations with and without Hepatitis C.
• Role of EUS FNA in pancreatic cystic lesions.
• Botulinum toxin for gastrointestinal disorders: therapy and mechanisms.
• Investigating the feasibility of using capsule esophagoscopy as an initial screening method to detect esophageal varices in patients without prior screening.
• Increased vascular endothelial growth factor and hypoxia inducible factor-1α transcription in gastric sporadic acquired angiodysplasias
• Associations among Susceptibility Factors in Patients with Porphyria Cutanea Tarda.
• Role of Immunosuppressives in Lymphocytopenia in Inflammatory Bowel Disease.

3. Clinical Scholar Track

Trainees may elect to pursue a non-degree track that would involve significant scholarly activity in a focused area of gastroenterology. Presently such training is available in Inflammatory Bowel Disease. Given the establishment of a Liver Transplant Service, we expect that a similar program would be available in that area. A detailed plan of education training will be developed in correlation with the training director.

C. Third year Sub-subspecialty Tracks.

In the third year, there are focused rotations in specific sub-specialty aspects of IBD including

1) Luminal Rotation

• The Luminal Rotation has two major components: a) Inflammatory Bowel Disease and b) GI Motility. The rotation is supervised by faculty with specific expertise in these areas and involves primarily outpatient clinics and procedures.

• IBD. The IBD component involves 3-4 half days of clinic and endoscopy. The emphasis is placed on understanding the clinical challenges in managing these complex diseases, the rational use of biologics and Immunosuppressives, and the endoscopic spectrum of UC and Crohn’s disease.

• Motility. To achieve this goal, fellows will interview patients presenting for manometry and other procedures, observe and participate in catheter placement and recording as appropriate, and interpret, including the written report, a minimum of 4 studies of each variety during a one-month experience.

• Become familiar with and acquire experience in data acquisition and interpretation of: Esophageal, Anorectal, Ambulatory pH, and Hydrogen Breath Testing

• Fellows will attend the weekly Tuesday afternoon motility conference, during which studies from the previous week are reviewed and discussed. This conference convenes weekly at 1:30 PM and may extend to 4:00 PM.

• Clinical training will include attending one motility clinic per week and the Clinic for Swallowing Disorders, currently meeting on the 2 nd and 4 th Thursdays of each month.

• Other possible clinical experiences: barium swallow/modified barium swallows, pelvic floor problems, Fiber optic Endoscopic Evaluation of Swallowing (Speech-Path), and Scintigraphy (Nuclear Medicine).

2) Pancreaticobiliary Service

Goals and Objectives

The Pancreaticobiliary Service is an inpatient rotation for the advanced fellows. Evaluation and management of complex patients with pancreatic disease or disorders of the biliary tract are handled by this team.

Specific learning objectives:

During the rotation the trainee should develop and understanding of:

1. The complexity of disorders involving the pancreas or biliary tree

2. The assessment of patients with diseases of the pancreas or biliary tree

3. The indication and scope of use for endoscopic and radiological procedures for diagnostic and therapeutic interventions including endoscopic retrograde pancreatography(ERCP)

4. The principles of management of these patients, including unique metabolic and nutritional consequences of the diseases

5. Observation of and participation in performance of ERCP, sphicterotomy and stone removal, endoscopic biliary and pancreatic drainage

Further details of our curriculum of the training program can be found on our Home web site.