The second-year fellow is expected to expand the fundamental knowledge obtained in the first year of training. Specifically, knowledge on the diagnosis and treatment of less common diseases is acquired during the second year. By the beginning of the second year, the fellows should have performed enough procedures and/or patient encounters to begin to demonstrate mastery of each. During the second year, the fellow improves mastery of these skills.
Second-year fellows are expected to continue to develop interpersonal skills, leadership, self-reflection and improvement, an understanding of systems of care, clinical education and ethical and professional refinement.
The second-year fellow continues the clinic rotations established in the first year of training. As experienced GI fellows they are expected to use the knowledge and skills acquired in the first year to diagnose and treat outpatients, as well as to act as a resource for first year fellows, residents and students.
Fellow maintain their own continuity clinic one half day per week, and serve as the primary GI care provider for these patients. With faculty supervision, second year fellows augment their understanding of ambulatory management of gastrointestinal and liver disease. Fellows continue to hone their skills in obtaining histories and physicals, ordering indicated laboratory and diagnostic studies, treating diagnosed digestive and liver disease, and counseling 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 three, but not more than four established patients per clinic. The clinic is staffed with faculty preceptors at a ratio of one preceptor per two second year fellows. While in the clinic, fellows are responsible for obtaining histories and physicals and consulting with supervising staff physicians in the management of the patient’s disease.
The second year fellow participates with faculty supervision in VA clinics which are general GI (including hepatology) as well as a dedicated hepatology clinic. The second 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.
The second year fellow assigned to consult services at Tulane Hospital or University Hospital will continue the learning process started in the first year, but due to his/her added experience will act as a resource to junior house staff as well as first year fellows, taking a greater leadership role.
The second 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. This includes:
Assignment to the Consult Service is designed to expose fellows to patients that are suspected of or who have documented acute and/or chronic disease of the digestive tract and through this exposure to educate fellows about:
The second year fellow will add to his/her knowledge and skills in the care of patients with advanced liver disease. Liver disease has become an increasingly important component of the practice of Gastroenterology. This increase reflects both an improvement in the recognition of patients with liver disease and significant advances in therapy. The novel and effective therapies for viral hepatitis and the improvement in survival of orthotopic liver transplants have increased the need for clinicians with expertise of liver disease.
Training in management of these patients is essential for all gastroenterologists, although practitioners providing the bulk of transplant hepatology care may require additional training beyond that offered in a typical gastroenterology training program (level-3, Transplant Hepatology).
The Tulane program provides level 1 training as per guidelines of the AGA (American Gastroenterological Association) Task Force on training in Hepatology. This includes education in a broad range of knowledge of the physiology of the liver and biliary system and a thorough knowledge for the diagnosis and management of patients with hepatobiliary disease.
The goals and objectives on the liver service are achieved by lectures, conferences, seminars and exposure to inpatients and outpatients with hepatobiliary disease, including those pre-transplant and post-transplant. The specific goals and objectives are outlined below:
In addition to Tulane Hospital endoscopy duties, all second and third year fellows are assigned to outpatient and inpatient endoscopy at University Hospital. These procedures are mostly performed in the DTD unit, but may be done in the emergency room or intensive care unit. Procedures which will be performed are 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). ERCP, EUS and esophageal stenting are not routinely done by second year fellows, but may if no third year fellow is available. Second year fellows will always perform procedures under the direct supervision of GI faculty who are in the room at all times. Competency in basic EGD and colonoscopy should already be established by the beginning of the second year, with expectation of further development of the basic skills as well as the additional diagnostic and therapeutic maneuvers described above.
Second year fellows take home call for GI or hepatology emergencies at Tulane Medical Center and (on alternate weekends) University Hospital GI emergencies. They will round daily with on call faculty on inpatients being followed by the GI Consult service at Tulane University Medical Center wards AND either TATU (Tulane Abdominal Transplant Unit) or UMCNO (alternate weekend responsibilities). All fellows of any year will contact staff with new consults for review and decision making consultation.