summary | philosophy | clinical practice | research | conferences
The University of Massachusetts Medical School offers a comprehensive training program to selected applicants interested in the study of digestive disease and nutrition.
The overall goal of this training program is to assist seriously committed physicians, who are board-eligible or certified in General Internal Medicine, to develop attitudes, knowledge and skills needed for them and to become outstanding scholars, practitioners and investigators in the field of adult gastroenterology, hepatology, and clinical nutrition. There are currently three fellowship openings per year.
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 major share of the responsibility for their own educations.
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, biochemistry, 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 digestive disease and nutrition.
Practice as clinical research: We believe that each patient represents an opportunity for diagnosis and therapeusis that is, in some sense, unique. Therefore each patient encounter is an instance and opportunity for carrying out clinical investigation. This mandates the careful gathering of information about the patient, e.g., from the history, physical examination, laboratory studies, special procedures, etc., and the careful recording of effects of therapeutic interventions.
Role of procedures: 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 doing 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. Discussion of all 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 not only opportunities to see and participate in 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 had some direct experience in these areas to provide the necessary perspective concerning their potential and limitations. It is also intended that trainees will have contact with the physicians and basic scientists whose special expertise is in the areas of GI and liver physiology, biochemistry, and pharmacology.
Another 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 12-14 months of the thirty-six months of the standard fellowship and will include the development of a specific, written and orally presented proposal (in the form of a small grant application), performance of the research, gathering and analysis of data, and organized presentation of results in suitable reports and manuscripts.
Each trainee will work with a senior 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 up to 20 months 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. Consideration for a combined gastroenterology/hepatology program is available for those who are interested in further study and research in hepatology. Medicine residents who show an early interest and ability in research can pursue short-tracking into a research gastroenterology track beginning after their second year of medicine residency. The University of Massachusetts Medical School is developing an advanced degree program called MMPP (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.
It is expected that the Fellow will work as diligently during this time and put forth a similar quantity of efforts as at all other times of the Fellowship experience. The specific projects to be worked on may often be ongoing research projects being carried out by the Division of Gastroenterology. In some instances, a Fellow or small group of Fellows may initiate a new research project. It is recognized that, particularly for clinical studies, a period of one year may be insufficient time for most meaningful studies to come to completion. Thus, the ideal research training experience in Gastroenterology should allow, for at least some fellows, a greater amount of time than the 12 months outlined above.
Conferences and seminars
As part of the Fellowship Training Program, it is expected that trainees will have regular and active participation in journal club, in clinical digestive disease conferences, in research seminars and other scientific and medical conferences. These activities are important to assure that Fellows will develop the abilities to read bio-medical literature critically and to speak effectively, both in small and larger groups.
Wendy J. Rickert
David R. Cave, MD, PhD
GI Fellowship Program Director
Phone: (508) 856-8399