Introduction
The dramatic and accelerating developments in gastrointestinal endoscopy have increased the demands for structured post-graduate training. Traditional training in endoscopy takes place during the 1-2 years of a traditional three year fellowship in gastroenterology. This type of training provides a good foundation for the skills of upper GI endoscopy and colonoscopy.
However, the increasing need for training dedicated to ERCP and the recent introduction of a large number of advanced endoscopic techniques has lead to the development of third tier fellowships dedicated to advanced endoscopy. These fellowships usually take place following the completion of a gastroenterology fellowship.
Endoscopic fellowships may be focused on a single procedure such as ERCP or based more broadly on the discipline of endoscopy. The later approach may be more appropriate for the training of academic endoscopists and may require a two year period of training. This type of fellowship would include more than training in ERCP and other advanced endoscopy such as EUS and laser. It might also include training in statistics, epidemiology, trial planning, and grant writing.
Program Directors:
| William Brugge, M.D. Co Director, BWH/MGH Advanced Endoscopy Fellowship Director, GI Endoscopy Massachussets General Hospital |
David L. Carr-Locke, M.D. Co Director, BWH/MGH Advanced Endoscopy Fellowship Director, Endoscopy Institute Brigham and Women's Hospital |
Judy Aukstikalnis Fellowship Coordinator jaukstikalnis@partners.org |
Philosophy of the Advanced Endoscopy Fellowship
The endoscopy faculty at BWH and MGH have joined together to develop a comprehensive and joint fellowship in advanced endoscopy. The primary purpose of the program is to provide an outstanding training program in advanced endoscopy. The key feature of the program will be the ability to provide a wide experience in advanced endoscopy by combining the endoscopic experience and facilities for use by the advanced endoscopy fellows. The fellows will be able to accumulate a large experience in ERCP and EUS since more than 2000 of these procedures are performed each year. Laser therapy, PDT, and stent placement are also performed in large numbers at both institutions. The fellows will have the ability to use this extensive experience by rotating between each institution and accumulating data for clinical trials.
The second key feature of the program is to support the fellows in academic endoscopy training. In addition to the training in the performance of procedures, the faculty will provide experience and training in endoscopic research. This will consist of accumulating experience in developing new techniques, planning trials, and analyzing data. The fellowship can be designed to fit the needs of the fellow by using a wide variety of training experience. There are several important affiliated institutions and facilities that can be used by the faculty and fellows in the advanced endoscopy fellowship. The most important resource is the Harvard School of Public Health that offers a variety of programs for the training in clinical research. At BWH and the Harvard Medical School the Center for Minimally Invasive Therapy offers research facilities, funding for research, and a rich program in procedural therapy. At MGH, CIMIT (Center for Innovative Minimally Invasive Treatment) provides a funding program for faculty and fellows. CIPR (Center for Imaging Pharmaceutical Research) has laboratory facilities at MGH East for imaging research. Finally the Wellman Laser Center is a large facility concentrating on a wide range of research in the use of lasers for imaging and treatment. A Harvard Clinical Scholar program recently been added.
One of the most important research experiences for the advanced endoscopy fellow will be the development and use of large databases that will span the experience at both institutions. It is hoped that the fellow will be an active participant in these research efforts and will provide an opportunity for the two institutions to collaborate. In addition to the first hand experience in endoscopic trials, the fellows will be able to use their time to obtain formal training in clinical research. This may take place at MGH or BWH in a series of institutional lectures and courses or in a formal program at the Harvard School of Public Health.
It is anticipated that the graduates of this program will be the best trained gastroenterology/endoscopy fellows in the United States. They will become leaders in the field.
MGH-BWH Faculty
All Advanced Endoscopy faculty have academic appointments at Harvard Medical School and are members of the Gastroenterology divisions at MGH or BWH. They also participate in the training of gastroenterology fellows.
MGH Faculty
William R. Brugge, M.D., Director of GI Endoscopy since 1998, has extensive experience in ERCP, having performed the procedure in academic centers since 1980. Since 1992, he has pursued endoscopic ultrasound as a scientific technique, clinical tool, and a means of understanding pancreatic diseases . He is directing a large multi-center study of the role of EUS in the diagnosis of cystic neoplasms of the pancreas.
Robert H. Schapiro, M.D., Director Emeritus of GI Endoscopy, was one of the pioneers in ERCP in the United States. He has performed ERCP at MGH for the past 30 years and accumulated an unprecedented experience in malignant and non-malignant diseases of the pancreatic-biliary system.
Peter B. Kelsey, M.D. has accumulated an extensive experience in therapeutic endoscopy at MGH, focusing on ERCP. He has recently pioneered a new technique in ERCP, cholangioscopy. This technique brings a wide range of diagnostic and therapeutic tools into the pancreatic-biliary tree. Recently, he has developed a Digital Atlas of Video Education (DAVE) website, an important new educational tool for endoscopy.
Brenna C. Bounds, M.D. has been a faculty member of the Advanced Endoscopy Group since 2000. She is interested in the use of EUS and ERCP to diagnose and manage pseudocysts of the pancreas. Recently she has participated in the development of the DAVE site with Dr. Kelsey. In 2006 she has assumed responsibility for directing endoscopic education for traditional GI fellows.
David Forcione, M.D. has been a faculty member of the Advanced Endoscopy Group at MGH since 2004. David uses his skills in ERCP and EUS to evaluate and treat patients with pancreatic-biliary diseases.
BWH Faculty
David Carr-Locke, M.D . Director of Endoscopy Institute is an internationally recognized figure in the endoscopy of pancreatic-biliary diseases. He has published and presented extensively on therapeutic ERCP in benign and malignant diseases.
John Saltzman, M.D ., is the Director of the Endoscopy Center at BWH. He has developed a broad experience in endoscopic ultrasound and GI bleeding at the University of Massachusetts before coming to BWH in 1998.
John Poneros, M.D. is a faculty member of the Advanced Endoscopy Group at BWH. He was trained in the joint fellowship and has published on the role of OCT in the evaluation of Barrett's Esophagus.
Chris Thompson, M.D . is a faculty member in the Advanced Endoscopy Group at BWH. Chris has established himself as an innovator and investigator in therapeutic endoscopy. His research in transgastric endoscopy has been presented at national and international meetings.
Linda Lee, M.D. is the Medical Director of Women's GI Health at BWH, Her clinical research interests include pancreatico-biliary diseases.
Facilities
MGH Endoscopy Unit
The MGH Endoscopy Unit moved to its new facilities in the Blake building at MGH in June 1997. The 10,000 square foot state-of-the-art facility features procedure rooms dedicated to ERCP, EUS, and laser (PDT). More than 28,000 procedures are performed yearly, including 800 ERCPs, 800 EUS examinations, and 200 laser treatments. The unit features a large conference room that is connected to 4 procedure rooms and the MGH auditorium. Faculty and fellow offices are adjacent to the unit. A new outpatient endoscopy unit in Charles River Plaza opened in 2005.
BWH Endoscopy Center
The Endoscopy Center provides a wide range of diagnostic and therapeutic procedures in a large multi-disciplinary procedure facility. ERCP, EUS, laser treatments are offered to inpatients and outpatients from BWH, Harvard Pilgrim Health Center, and Dana Farber Cancer Center. More than 10,000 procedures are performed annually, including 800 ERCPs and 250 EUS exams. A conference room provides audio-video connections to the procedure rooms and the BWH auditorium.
Rotational Schedule
The fellows will rotate every 3 months between MGH and BWH. At each institution, the fellow will focus on the primary endoscopic technique of their choice and supplemented with some experience in other procedures. Although the fellows' primary focus will be the development of their endoscopic skills, the fellows will be encouraged to begin exploring areas of research interest.
At the conclusion of each three month rotation, the fellows will meet with the faculty and review the three month rotation and plan for the next one. The fellows will be encouraged to interact with the other fellows and faculty in clinical trials planning and database development. The rotations will continue at three month intervals.
Application Process
Applicants should have completed an academic gastroenterology fellowship within 5 years of the application process. Fellows should have a strong interest in an academic career. Preference will be given to applicants who have had experience in clinical research. Applications can be requested from Judy Aukstikalnis (Academic assistant to W.R. Brugge, M.D.), Blake 482 B-1, GI Unit, MGH, jaukstikalnis@partners.org, or are available online (Word Document). Three letters of recommendation are required. Deadline for submitting the application is December 15th.
BWH/MGH Advanced Endoscopy Fellowship Graduates
| 1996-1997 | Daniel M. Quirk, M.D., M.P.H Clinical Assistant Professor of Medicine Brown Medical School Director of Endoscopy Ultrasonography Rhode Island Hospital Providence, Rhode Island |
| 1997-1998 | James Shawn Mallery, M.D. Assistant Professor University of Minnesota Hennepin County Medical Center, Minneapolis, MN |
| 1998-1999 | Steven Brandwein, M.D. Medical Director Comprehensive Liver, Pancreas, and Biliary Center Danbury Hospital, Danbury, CT |
| 1998-1999 | Peter M. Rosenberg, M.D. Staff Physician St. John's Health Center UCLA Santa Monica Medical Center Santa Monica, CA |
| 1999-2000 | Brenna C. Bounds, M.D. Assistant Professor in Medicine Harvard Medical School Associate Physician Massachusetts General Hospital, Boston, MA |
| 1999-2002 | Brian C. Jacobson, M.D. Assistant Professor of Medicine Boston University School of Medicine Director of Endoscopic Ultrasonography Associate Director Endoscopy Services Boston University Medical Center, Boston, MA |
| 2000-2001 | James J. Farrell, M.D. Director, Endoscopic Ultrasound UCLA Medical Center, Santa Monica, CA |
| 2000-2001 | Salim Al-Shalabi, M.D. Private Practice San Ramon, California |
| 2001-2002 | John Poneros, M.D. Assistant Professor of Medicine Harvard Medical School Associate Physician Brigham and WomenÕs Hospital, Boston, MA |
| 2002-2003 | Christopher Thompson, M.D. Assistant Professor of Medicine Harvard Medical School Associate Physician Brigham and WomenÕs Hospital, Boston, MA |
| 2002-2003 | Jennifer Telford, M.D. Clinical Assistant Professor University of British Columbia Vancouver, BC Canada |
| 2003-2004 | Seng-Ian Gan, M.D. Assistant Professor of Medicine Tufts School of Medicine Associate Physician New England Medical Center, Boston, MA |
| 2003-2004 | David Forcione, M.D. Instructor in Medicine Harvard Medical School Associate Physician Massachusetts General Hospital, Boston, MA |
| 2005-2006 | Richard Kwon, M.D. Clinical Lecturer, Department of Internal Medicine A. Alfred Taubman Health Care Center University of Michigan, Ann Arbor, MI |
| 2004-2006 | Linda S. Lee, M.D. Assistant Professor in Medicine Harvard Medical School Medical Director of WomenÕs GI Health Brigham and WomenÕs Hospital, Boston, MA |
| 2005-2006 | Tony Yusuf, M.D. Associate Physician SUNY Downstate Medical Center Brooklyn, NY |
| 2006-2007 | Bhavani Moparty, M.D. Faculty Physician Baylor University Medical Center Dallas, TX |
| 2006-2007 | Kunal Jajoo, M.D. Assistant Professor of Medicine Weill Cornell Medical College of Cornell University Associate Physician Division of Gastroenterology New York Presbyterian Hospital |
| 2006-2007 | Michael Piesman, M.D. Staff Gastroenterologist Instructor in Medicine, University of Texas San Antonio School of Medicine San Antonio, TX Gastroenterology Service Brooke Army Medical Center Ft. Sam Houston, TX |
