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.
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.
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
- Evaluation of US vs CT as the initial screening modality for HCC in patients with HCV and cirrhosis
- 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
- Metolazone in diuretic refractory ascites
- Myofibroblasts and the colonic epithelial stem cell niche
- Pathophysiology of IBD symptoms in experimental models of inflammation
- Prospective camparison of treatment of porphyria cutanea tarda by phlebotomy or low-dose hydroxychloroquine
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
- 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.
- Metolazone in diurectic refractory ascites
- Comparison of the efficacy and safety of Phlebotomy and hydroxychloroquine in the treatment of porphyria cutanea tarda: A prospective study
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.
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:
- The complexity of disorders involving the pancreas or biliary tree
- The assessment of patients with diseases of the pancreas or biliary tree
- The indication and scope of use for endoscopic and radiological procedures for diagnostic and therapeutic interventions including endoscopic retrograde pancreatography(ERCP)
- The principles of management of these patients, including unique metabolic and nutritional consequences of the diseases
- Observation of and participation in performance of ERCP, sphicterotomy and stone removal, endoscopic biliary and pancreatic drainage