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PGY 1

PGY-1 Fellows:

First year fellows are accepted within the National Residency Matching Program. The fellow is assigned to the Gastroenterology Service at one of the participating training institutions. He or she is under the supervision of the Chair of the Department, the Program Director, full time faculty, and supervising fellows.

The goal of the first year is to acquire diagnostic, therapeutic and prognostic skills through participation in direct patient care in supervised inpatient and outpatient settings. A typical year includes:

  1. Four months on the Out Patient Clinics / Endoscopy (VA/Tulane)
  2. Four months on the In Patient Consult Service/ Endoscopy(Tulane/UMCNO)
  3. Two months on the Hepatology service (Tulane)
  4. Two months on Tulane backup/ Research.
  5. Four weeks of vacation (incorporated into the monthly schedules)
General Knowledge

The first-year fellows obtains knowledge related to the presenting manifestations, natural history, complications, pathophysiology, differential diagnosis, and appropriate diagnostic and management plans for the most common diseases and conditions in the practice of the specialty. This includes diseases and conditions seen in ambulatory patients, emergency departments, regular hospital services and intensive care units. The intern develops proficiency in the interpretation of diagnostic studies used in the evaluation of common diseases in the specialty. First year fellow also acquire knowledge about the indications, limitations, complications and cost effectiveness of common diagnostic tests and procedures. The first year fellow obtains knowledge of the therapeutic indications used for the management of the common diseases in the specialty. In this year fellows are given the opportunity (through didactics and self directed learning, and teaching residents and students) to relate pathophysiology to the disease processes of luminal GI and hepatology.

Ambulatory Clinics

First year fellows are taught the essentials of the GI history and physical exam, as well as differential diagnosis and management. They learn to build upon the base knowledge of internal medicine to develop the skills of a gastroenterologist.

Charity Clinic  (UMCNO)

The first year fellow participates with faculty in the evaluation and treatment of patients seen in the UMCNO ambulatory care clinics. GI fellows maintain their own continuity clinic one half day per week. This is considered a general GI/hepatology clinic. With faculty supervision, these fellows obtain histories and physicals from each patient, order indicated laboratory and diagnostic studies treat diagnosed digestive and liver disease, and counsel patients regarding their health and disease. Fellows see at least one, but not more than four new patients per clinic. Fellows see not less than two, but not more than four established patients per clinic. The clinic is staffed with faculty preceptors at a ratio of 1 preceptor per 2 first year fellows.

Out-Patient Clinics  Dedicated Luminal GI or Hepatology (VA, Tulane Hospital)

The first year fellow participates with faculty supervision in VA clinics which are general GI (including hepatology) as well as a dedicated hepatology clinic. The first year fellow also participates in subspecialty clinics at Tulane which cover general GI, inflammatory bowel disease, motility disorders, and hepatology. Assigment to hepatology and subspecialty GI clinics at Tulane will vary between fellows in a single year, but all fellows will have received the same clinic exposure by the end of the program. All first year fellows will have the same exposure in that year to VA general GI clinics.

In-Patient Consult Service  (Tulane Hospital, UMCNO)

The first year fellow is taught the essentials of the GI consultation, building upon the knowledge acquired in internal medicine training and learning to direct focus towards GI disease.

The first year fellow serves as the supervising fellow in performing consults on inpatients on the wards and the ICU, as well as those admitted patients in the ER, unless they are paired with a more senior fellow, who would assume this role . This includes:

  1. Directly supervising interns, medical fellows and medical students in:
    1. Obtaining a history and physical on all patients
    2. Writing orders for patients if authorized by the admitting service
    3. Advising on a management plan as well as indicated laboratory and diagnostic studies
  2. Fellows also continue to increase their knowledge of the indications, contra-indications, risks and benefits, and interpretation of diagnostic procedures. They learn how to perform procedures commiserate with their level of training (vida infra). (see Endoscopy service, below)
     
  3. Leading and organizing a GI consult service. This responsibility includes:
    1. Supervising all intern and medical student ward activities
    2. Organizing work and teaching rounds
    3. Providing evaluation and feedback for each member of the ward team.
  4. Urgent consults will be seen within the hour. Non urgent consults will be seen that day or within 24 hours of the consult request.
GI Endoscopy Service

First year GI fellows typically have no or very little hands-on experience with endoscopic procedures on entering the program, despite some familiarity with the indications for endoscopy. In the first year they will learn the essential cognitive and practical principles of endoscopic diagnosis and management.

First year GI fellows will primarily perform esophagogastroscopy (EGD, including foreign body removal, hemostasis of bleeding, variceal ligation, stricture dilation and diagnostic biopsy) and colonoscopy (including hemostasis of bleeding, decompression of Ogilvy’s syndrome, polypectomy and diagnostic biopsy) while on call. They will be assisted as needed by second or third year GI fellows on home backup call with them during the first month. They will not perform supervised ERCP or EUS in the first year. First year fellows will always perform procedures under the direct supervision of GI faculty who are in the room at all times. Basic competency in EGD and colonoscopy is expected by the end of the first year, with competency in associated diagnostic and therapeutic procedures to develop over the next two years.