Introduction
The training program in Gastroenterology at the Massachusetts General Hospital is aimed at instruction in the clinical and investigative aspects of gastrointestinal and hepatic disease. It is designed to provide reasonable flexibility to meet the needs of each Fellow and to take into account his/her past training experience. The major objective is to provide intensive and individualized training for candidates who plan to pursue a career in academic gastroenterology with a significant commitment to research. Individuals are required to spend three years in Fellowship training, although typically more time may be needed to enable a Fellow to become adequately prepared as an independent productive academician. Appointments are made on an annual basis.
Application Process
We currently participate in the Eras and the MATCH programs. The application process and all the materials should be processed through the appropriate programs. Visit Eras website at http://www.aamc.org/students/erasfellow/start.htm.
Fellowship Information
|
Program Staff Major Clinical Activities Educational Activities Endoscopy and Clinical Procedures |
Research Activities Center for the Study of IBD (CSIBD) Academic Title Faculty |
Program Staff
 Andrea Reid, MDProgram Director Gastroenterology Fellowship |
 Daniel K. Podolsky, MDChief Gastrointestinal Unit |
 Scott Snapper, Md Ph.D.Research Director Gastroenterology Fellowship |
 Brenna Bounds, MDEndoscopy Training Director Gastroenterology Fellowship |
Mariane Leonard Fellowship Coordinator mleonard1@partners.org |
Major Clinical Activities
GI Inpatient Services
Fellows gain clinical experience by functioning as consultants in gastroenterology on the medical and specialty services. Their recommendations on inpatient consultations are reviewed with a clinician of the Gastrointestinal Unit who is assigned as the Attending for a given three-week block. In addition to serving as the primary gastroenterology consultant to the Bigelow teaching service, Fellows participate in the evaluation and management of patients on the Ellison in close relationship with the senior staff. They also perform basic endoscopic procedures under the supervision of attending staff on patients seen in consultation. Fellows also have the opportunity to gain a substantial experience in hepatology and liver transplantation by rotations on the Liver Service, in which they work closely with members of the GI Unit involved in this program. Through these activities, Fellows gain an in-depth experience in both common and uncommon problems in gastroenterology. The year's experience is divided into the general GI service (9 mos) and the liver service (3 mos).
GI Conferences and Outpatient Clinics
Attending rounds with the Fellows are generally held daily. Each Tuesday morning from 8 to 9 am Gastroenterology Grand Rounds is held. Lectures are presented by staff or outside speakers, or cases selected in advance are presented formally by Fellows and discussed. A GI Fellows' "clinic" (ambulatory practice) is held weekly throughout the year for consultation, follow-up and longitudinal care of outpatients. In the second year, the general GI outpatient clinic is complemented by participation in a second more specialized clinic matched for the trainee's specific interest. A staff mentor provides supervision and instruction in management of outpatients. Didactic instruction in GI Pathology with review of pathology slides by a pathologist is accomplished at weekly sessions. A free ranging conference with the Chief of the GI Unit, Dr. Podolsky, is also held on a weekly basis. In addition to the comprehensive clinical experience available at the MGH, Fellows have the opportunity to undertake elective clinical rotations at the Brigham and Women's Hospital, a partner institution with the MGH and another major teaching affiliate of the Harvard Medical School.
Liver Service
As noted above, because of growing clinical demand and the need for specialized care of patients with acute and chronic liver disease, a dedicated inpatient Liver Service rotation has been developed. Each Fellow spends a total of three months during the first fellowship year on this service. The Fellow works with a Liver Service Attending, with whom rounds take place on a daily basis. New patients are presented, and rounding on active inpatients follows. This rotation also provides a forum for other activities relevant to hepatology. In addition, each Fellow participates in an outpatient Liver Clinic under the supervision of a staff hepatologist ½ day every other week.
A Typical Schedule of Educational Activities for First Year Fellows:
Monday
1:00 Outpatient Liver Clinic4:00 Attending Rounds
Tuesday
7:15 Liver Biliary Pancreas Center Interdisciplinary Rounds8:00 GI Grand Rounds
11:00 GI Research Seminar
4:00 Attending Rounds
7:30 Interhospital GI Rounds (Monthly)
Wednesday
11:00 Research Journal Club 1:00 GI Ambulatory Clinic (2 Fellows)4:00 Attending Rounds
Thursday
8:00 Medical Grand Rounds9:00 GI Ambulatory Clinic (2 Fellows)
12:15 GI Clinical Journal Club
4:00 Attending Rounds
Friday
8:00 Ellison Rounds (Case Conference)8:00 Transplantation Rounds (Liver Rotation Fellowship)
12:15 IBD Clinical Rounds
4:00 Attending Rounds
Description of Educational Activities and Conferences
The following applies to all three years of training, unless otherwise indicated.
GI Unit Research Seminar - Each Tuesday afternoon a seminar is held from 4:30p.m. dealing with basic science as well as investigative aspects of GI disease. Speakers from Boston and other parts of the country are invited to participate in this series of seminars. Research Fellows also present their research activities.
GI Clinical Journal Club - A Clinical Journal Club is held every Thursday from 12:15 to 1:00 p.m. Fellows participate and take turns in presenting a review of pertinent and selective publications dealing with clinical aspects of gastroenterology.
Basic Science Research Journal Club - This Journal Club is held Wednesdays from 4:00 to 5:00 p.m. It is intended for Research Fellows and staff. It generally involves an in-depth review of a pertinent scientific topic. Typically, the discussion encompasses basic advances in molecular biology, cell biology and biochemistry. - For second and third year fellows attendance is required.
Work-in-Progress - Approximately every third week Work-in-Progress presentations are held in place of Basic Science Research Journal Club. Generally two members of the GI Unit, (research fellows or staff) summarize their most current work in an informal setting, sharing their results and hypotheses with other investigators within the GI Unit and benefiting from their suggestions. - For second and third year fellows attendance is required.
Ellison Rounds - This lively conference is held in the GI Unit Library on Friday mornings from 8:00-9:00 a.m. Discussion focuses on interesting cases from the "private" service and is led in rotation by GI attending physicians.
Liver-Biliary-Pancreas Center Rounds - These rounds have been initiated by the Liver-Biliary-Pancreas Center, which include members of the GI Unit, and Departments of Surgery, Radiology, Pediatrics and Pathology and which coordinate interdisciplinary approaches to patients with complex disorders in which of the liver, biliary tract and pancreas.
IBD Clinical Forum - Weekly rounds held on Friday at 12:15 p.m. in which management of patients with IBD including those newly seen in the Clinical IBD Center, are discussed.
GI Pathology Conference - Fellows meet weekly with a member of the GI Pathology Unit to review pathology of specimens from GI patients. - First year fellows only.
Transplantation Rounds - Review of all liver transplantation patients (pre- operative and post-operative management) is conducted in formal rounds weekly. GI Fellows, while on liver transplantation service, also participate in daily work-rounds of the transplantation team. - First year fellows only
GI Motility Conferences - A series of lectures at the beginning of the year are given covering motility pathophysiology and testing of the entire gastrointestinal tract. Review sessions are held with the motility staff every three weeks to review motility studies including esophageal manometry, 24 pH testing, gastroduodenal manometry, and anorectal motility. - First year fellows only.
Monthly Interhospital GI Rounds - These Rounds rotate among the major GI teaching services in Boston and take place one evening per month during 8 months of the year. The goal is to present the most unusual and challenging patients seen during the past year at each institution, provide informed reviews of relevant literature, and share insights in patient management.
CPC and Medical Grand Rounds - The Fellows are invited to attend the weekly Medical Grand Rounds held each Thursday at 8:00 A.M. and weekly Clinical-Pathological Conference held at 12:00 noon every Wednesday.
Introduction to Clinical GI: during July and August - Twice weekly conferences conducted by the GI Unit faculty cover approaches to diagnosis and management of the spectrum of GI disorders. - First year fellows only.
GI Unit/Center for the Study of Inflammatory Bowel Disease (CSIBD) Molecular Biology Course - This series of lectures is given on Monday, Wednesday and Friday mornings throughout the summer and provides an intensive overview of basic molecular biology, biochemistry and cell biology, with emphasis on practical applications and geared to provide a foundation for fellows entering their research training. - First year fellows only
Harvard Medical School Gastrointestinal Pathophysiology Course - Instruction is given by members of the GI Unit at the Harvard Medical School for second year students every fall. In selected cases, Fellows may be invited to participate in the instruction during the course.
Annual Post Graduate Course in Gastroenterology - Each spring a week-long course is given through the auspices of the Harvard Medical School's Department of Continuing Education. The course faculty are from MassachusettsGeneral Hospital, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center. The Fellows are encouraged to attend these sessions and may also be asked to participate in case presentations in this course.
Chief's Rounds - Weekly meeting with Dr. Podolsky to discuss a variety of topics including new advances in Gastroenterology and a broad range of career development issues.
Endoscopy and Special Clinical Procedures
During the clinical training period, each Fellow receives extensive experience in the techniques of liver biopsy, sigmoidoscopy, esophagogastro/duodenoscopy (control of bleeding, banding, dilation, percutaneous endoscopic gastrostomy), and colonoscopy (polypectomy and control of bleeding). Training in endoscopic procedures is obtained within the facilities of the GI Endoscopy Unit directed by Dr. William Brugge. Currently, more than 20,000 endoscopic procedures are performed each year in this unit, ranging from diagnostic upper and lower studies (esophagogastroduodenoscopy and colonoscopy) to highly advanced diagnostic interventional and therapeutic modalities (endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, optical coherence tomography, photodynamic therapy, video capsule endoscopy of the small intestine) reflecting the role of the MGH GI Unit in the care of patients in the local community and as a major regional, national and international referral center for problems requiring consultation and endoscopic expertise. Fellows acquire a substantial experience by performing procedures on patients they have evaluated in both the in-patient and out-patient settings. Fellows carry out these procedures under the direct supervision of an attending staff physician and receive in-depth instruction on the variety of techniques used in modern gastroenterology.
Research Activities
Participation by Fellows in research activities of the GI Unit depends on the Fellow's, past experience and interests. In general, when a Fellow participates in research of a basic nature, it is done during the second year and beyond. However, it is possible to initiate clinical or clinical investigative projects during the first year of fellowship. The following is a partial listing of the areas and projects being pursued by various members of the GI Unit.
Clinical Research Projects
- Natural history and epidemiology of viral hepatitis
- Antiviral treatment of hepatitis C and hepatitis B
- Studies of the immunological changes in acute and chronic liver disease
- Clinical studies of acute and chronic hepatitis
- Outcomes studies in endoscopy and liver transplantation
- Serologic markers of malignancy
- Endoscopic studies involving photodynamic therapy, optical coherence tomography, endoscopic ultrasound and fine-needle aspiration, cholangioscopy, and others
- Clinical studies of inflammatory bowel disease
- Immunosuppressive and biologic response modifies therapy in inflammatory bowel disease
- Oral tolerance in inflammatory bowel disease
- Novel therapeutic agents in inflammatory bowel disease Clinical studies of inflammatory bowel disease
- Application of decision analysis to Gastroenterology, including management of biliary tract disease, diagnostic strategies to gastrointestinal malignancy and gastrointestinal bleeding
- Role of abnormal motility and visceral hypersensitivity in functional bowel disease
- Therapeutic trials in functional bowel disease
- Chemoprevention of colorectal polyps
- Liver transplantation/organ allocation
- Markov analysis of GI cancer screening modalities
Laboratory Research Projects
Regulation of intestinal epithelial cell growth
- Role of transforming growth factors in intestinal epithelial cells
- Expression and molecular cloning of peptide growth factors
- Molecular cloning and characterization of cell adherence molecules
- Interaction of epithelial cells and lymphocytes
- Molecular biology of trefoil factors
- Functional studies of tight junction proteins
Gut-CNS peptide hormones
- Regulation of somatostatin expression
- Molecular cloning of trk receptors
- Mechanisms of leptin action
Molecular biologic studies of gene regulation and gene expression of gastrin, HDC, galanin and related peptides
- Determination of cis regulatory elements
- Isolation and characterization of transacting regulatory factors
- Use of transgenic models to define molecular basis of organ specific gene expression
- Use of targeted gene deletion ("gene knockout") to establish molecular models for characterization of functional biology of the GI tract
Mucosal Immunology
- Signalling pathways of lymphocyte activation
- Cloning and functional characterization of chemokines and chemokine receptors
- Molecular cloning of signaling molecules in NF-KB activation
- Toll-like receptors
Inflammatory bowel disease
- Regulation of growth factors and cytokines in IBD
- Molecular basis of barrier function alteration in IBD
- Studies on mechanisms of innate immunity and mucosal-bacterial interaction
- Development of innovative models through gene deletion and transgenic approaches
- Vascular adhesion molecules
- Delineation of cytokine effects in intestinal mucosa
- Characterization of immune models of IBD established through gene knockout
Malignancy and transformation
- Oncogenes; suppressor genes
- Longitudinal study of colon cancer oncogenes -their activation and expression
- Basic studies of metastasis
- Study of wnt signalling pathways
- Clinical and basic studies of hepatocellular carcinoma
- Role of cyclin D1 in neuroendocrine cell neoplasm
- Role of the met protooncogene in gastric and hepatic malignancy
- Immunology of colorectal cancer
- Transgenic models of gastric, and colonic tumors
- Role of Hepatitis C structural protein in hepatocellular neoplasm
- Angiogenesis and tumor genesis
Viral hepatitis - immunology, cell biology and molecular biology
- Monoclonal antibodies in diagnosis of hepatitis B (HBV) and non-A, non-B
- HBV-DNA detection in circulating lymphocytes and liver
- Studies of HBV-integration into hepatocyte DNA and factors influencing HBV-DNA transcription, translation and expression
- Relation of HBV infection and hepato-cellular carcinoma (HCC)
- Molecular mechanisms of HCV replication
Stem cells and developmental biology
Center For the Study of Inflammatory Bowel Disease (CSIBD)
In conjunction with collaborators at the New England Regional Primate Research Center, the MGH established the CSIBD several years ago as the newest of the NIH designated Digestive Disease Research Centers. The goal of this center, directed by Dr. Podolsky and anchored in the MGH GI Unit, is to promote the study of basic processes relevant to understanding the pathogenesis of IBD. Center investigators include faculty in many laboratories and departments (e.g., molecular genetics, membrane biology, arthritis, immunology, pathology) studying such basic problems as epithelial-lymphocyte interactions, regulation of MHC gene expression, lymphocyte homing molecules and mechanisms of neutrophil and macrophage activation. The Center supports an intramural pilot grant program and core laboratory support services as well as a comprehensive program of training and research seminars geared to promote new collaborative interactions. GI fellows are encouraged to participate in these activities during their research training and benefit from access to a broad spectrum of expertise.
Academic Title
In general, each Fellow will be given an appointment as Clinical and Research Fellow in Medicine at the Massachusetts General Hospital and Research Fellow in Medicine at the Harvard Medical School.
Faculty
CHIEF:
Daniel K. Podolsky, M.D.
