The University of Massachusetts Medical School offers a fully accredited three year training program to selected applicants interested in the study of digestive disease, nutrition and liver disease. The fellowships program draws upon the resources of three affiliated campuses: UMassMemorial Medical Center - University Campus, and UMassMemorial Medical Center - Memorial Campus, and St. Vincent’s Hospital.
The fellowship provides an opportunity to learn about and care for patients with a wide spectrum of disease including inflammatory bowel disease, motility disorders, nutrition, acute and chronic liver disease, biliary disease, pancreatic disease, and liver transplantation. Broad endoscopic training is provided with conventional and novel endoscopic modalities, as well as access to a variety of research opportunities.
Statement of General Philosophy and Principles
The training program is based on the supposition that Fellows-in-Training are mature and responsible physicians. As such, they are to be treated by the senior staff and faculty as junior colleagues in the discipline of Internal Medicine and the subspecialty discipline of Gastroenterology. It is also presupposed that the trainees are capable and willing to accept a share of the responsibility for their own education.
The goal of the faculty is to convey, by example and by didactic teaching, a comprehensive, thoughtful, analytical approach to the whole patient. All humane and competent physicians must take the time to view the patient as a whole and come to understand the particular illness with which the patient presents in the broad social and cultural context of that patient's prior and current experiences. This requires a broad base of knowledge in general Internal Medicine with emphasis on the underlying scientific principles of physiology, pathophysiology, immunology and other relevant biomedical disciplines. The teaching and learning of these underlying principles of basic science and particularly of pathophysiology and rational therapeutics are central to all good medical education. Nowhere is this more true than in the disciplines of gastroenterology and hepatology.
Clinical Practice and Learning
We believe that each patient presents a unique opportunity for thoughtful diagnosis and individualized treatment plans. This requires careful history taking, interpreting laboratory and radiologic data, as well as effective communication to assist with coordination of care. Through both inpatient and outpatient experiences, fellows will hone clinical skills and judgment in multiple areas of gastroenterology, hepatology, and therapeutic endoscopy.
In Gastroenterology and Hepatology, as in many other medical subspecialties, there are specialized technical procedures with which practitioners of the specialties must develop technical competence. A goal of this training program is to assure that all Fellows will have had the endoscopic and other experiences required by the American Board of Internal Medicine and the subspecialty Board of Gastroenterology. However, the learning and performance of technical procedures, important as they are, are not to be viewed as ends in themselves, nor to be of primary importance in the overall training of Fellows in digestive disease. Rather they should be viewed as tools in the modern armamentarium of gastroenterologists for the diagnosis and treatment of patients. It is essential that considerations and discussion be given to the indications, the contraindications, the costs, the benefits, the limitations and risks of special procedures. Discussions of these aspects are equally as important as performance of the procedure themselves.
Experience in Related Disciplines
The Fellowship experience is intended to be well-rounded and to include learning opportunities beyond the evaluation and treatment of adult patients with gastrointestinal and liver diseases. Experience in clinical nutrition, pediatric gastroenterology-hepatology, liver transplantation, intestinal surgery, radiology, and pathology are additional goals. This is not to say that the GI Fellow will themselves be competent in all these areas, but rather that they will have had exposure to specialists in these areas and will have some experience in these areas to provide the necessary perspective concerning their potential and limitations. Through research endeavors, trainees will have the opportunity to interact with scientists with special expertise in the areas of GI and liver physiology, biochemistry, and quantitative health sciences.
Research and Quality Improvement Projects
An essential part of the Fellowship is to provide the opportunity, the time and resources, for scholarly and investigative activity to be carried out by all trainees during their fellowship experience. Serious participation in such activities, with the presentation of the fruits of the Fellow's labors at seminars and regional and perhaps national medical and scientific meetings, is expected. Such research and scholarly activities will occupy a minimum of 6 months of the thirty-six months of the standard fellowship and will include the development of a specific, written and orally presented proposal, performance of the research, gathering and analysis of data, and organized presentation of results ideally as a presentation and/or manuscripts.
Each trainee will work with a faculty member who will serve as preceptor for the research experience. This faculty member may be a member of the Division of Gastroenterology, another Division of the Department of Medicine, or a member of some other Department. Fellows with definite interest in academic careers will have the option of spending additional time primarily doing research. The goal is to tailor a flexible experience to the needs and interests of the trainee insofar as possible. Research rotations are intended to be times when the primary and major responsibility of the Fellow is to carry out a meaningful research project. The research activity can range from clinical bedside investigation to more basic bench-type research. The University of Massachusetts Medical School offers an advanced degree program called the Millenium MD/PhD Program in which qualified candidates can obtain a PhD degree during their residency or fellowship with an additional three years. The emphasis of this time would be spent on thesis work with less coursework than in a traditional PhD program.
In addition, we require fellows to identify a QI project during the second year that often becomes the focus of the fellow’s research project.
Conference and Seminars
As part of the fellowship training program, it is expected that trainees participate in a variety of educational conferences. These include Journal Club, Pathology Review, Morbidity and Mortality, Guidelines Conference, Pancreaticobiliary Conference, Research Conference, Radiology Conference, and joint GI-Surgery Case Conference. These activities are important for Fellows to develop the knowledge and ability to read bio-medical literature critically and to present effectively, both in small and larger group.