Gastroenterology

  • Angleton Danbury Campus

Specific Learning Objectives in Core Hepatology Program

Fellows will acquire expertise in:

  • The evaluation of abnormal liver enzymes
  • The assessment and therapy of jaundice
  • The assessment and therapy of acute and chronic liver disease including alcoholic, drug-induced, autoimmune, viral, cholestatic, and metabolic liver diseases
  • The evaluation and therapy of complications of liver disease including portal hypertension, ascites, hepatic encephalopathy
  • The diagnosis and management of hepatobiliary neoplasms
  • The diagnosis and management of biliary tract stones
  • The assessment and therapy of hepatobiliary manifestations of HIV disease
  • The approach to surgical risks in patients with liver disease
  • Liver biopsy techniques
  • The assessment and endoscopic therapy of gastrointestinal bleeding (i.e. sclerotherapy or vanceal banding) in patients with liver disease.

Required Procedural Skills

The trainee must acquire competence in the performance of the following procedure in addition to understanding their indications, contraindications, limitations, complications, and interpretation:

  1. Performance of percutaneous liver biopsy: minimum 20
  2. Diagnostic and therapeutic paracentesis: minimum 20

Method of Teaching

Sites of hepatology learning are the inpatient wards of the UTMB hospital, including the internal medicine, pediatric, psychiatric, geriatric, surgical, obstetrics, family medicine, and neurology services, and the Texas Department of Criminal Justice (TDCJ) hospital. Additional hepatology training occurs in the outpatient clinics of the UTMB Hospital, the TDCJ hospital, the GIM- Maroon Team and the Surgical Liver Transplant Service.

For the inpatient experience, there is one hepatology attending who is the primary teacher for the fellow during that month. Additional input to the development of the fellow comes from the weekly clinical case conference, pathology conference and radiology conference. It is routine that the hepatology team reviews all liver biopsies from patients on the hepatology service with an expert in hepatic histopathology. Each new consultation is seen under the personal guidance and review of the hepatology attending at the bedside and at all sites of primary information (i.e. radiology, pathology). The historical information, physical exam findings and laboratory data from the case are reviewed in light of both recent and time-honored literature and personal experience of the attending. A thorough assessment and plan are agreed upon and proper communication to the primary attending physicians and the patient and his/her family is emphasized.

The hepatology fellow is involved in providing care in the weekly outpatient TDCJ gastroenterology clinic that is populated by roughly 50% of hepatology patients. There is further hepatology experience in the UTMB outpatient fellows' gastroenterology clinics that are supervised by divisional attendings on a monthly basis. The principles of cost effective assessment and rational use of diagnostic test and therapies are emphasized especially in the outpatient environment.

The fellow is expected to teach as well as learn. There is an extensive curriculum file in the gastroenterology library and there are individual computers for each fellow and textbooks of hepatology in the fellows' office for the purpose of literature review and consolidation of knowledge concerning cases seen in various clinical settings.

Method of Evaluation

Faculty observe the fellow's skill and competence in history taking, physical exam, judgment, and consulting skills for an entire month by daily rounding with the fellow and meeting to discuss in-depth problems or unusual cases. Technical competence in endoscopy and liver biopsies is observed first hand by the attending in the Endoscopy Unit as well as the Hepatology attending. Communication skill, attitude and behavior are assessed through close association through the month. At the end of the month, the hepatology faculty member completes a numerical ranking form and supplies extra comments for the ultimate assessment of the fellow by the Chief of Gastroenterology. The fellows also assess the Hepatology rotation and the faculty attending. The evaluation process is described more fully in the previous section on Method of Evaluation under Gastroenterology Consult Rotation.