Gastroenterology Fellowship
Gastroenterology Fellowship at Massachusetts General Hospital - a leading educator of future researcher-practitioners.
The fellowship training program in Gastroenterology at the Massachusetts General Hospital prepares physicians to become future leaders in academic gastroenterology and hepatology. The program is designed to provide a structured yet individualized training experience to meet the needs of each fellow, Fellows are provided broad didactic and mentored instruction in both the clinical and investigative aspects of gastrointestinal and hepatic disease. Fellows are expected to conduct in-depth, mentored research and scholarship in either the clinical or basic sciences relevant to gastroenterology. Individuals are required to spend a minimum of three years in fellowship training, although training may be extended to enable a fellow to become adequately prepared as an independent productive academician.
Program Staff
Andrew T. Chan, MD, MPH
Program Director
Gastroenterology Training Program
Bruce E. Sands, MD
Acting Chief
Gastrointestinal Unit
Scott Snapper, MD, Ph.D.
Research Director
Gastroenterology Fellowship
Brenna Bounds, MD
Endoscopy Training Director
Gastroenterology Fellowship
Mariane Leonard
Fellowship Coordinator
mleonard1@partners.org
Formal attending and teaching rounds take place twice daily. In addition,a series of didactic lectures are offered throughout the week. Each Monday, a senior pathologist meets with the fellows to review the pathology from cases the Fellows have evaluated. Each Tuesday morning, Gastroenterology Grand Rounds is held which forms the basis of a core curriculum for fellows while updating staff about new areas within GI. Lectures are presented by MGH faculty, or outside speakers. Several times a year, Fellows will also formally present clinical cases for discussion. Each quarter, we invite visiting professors to the MGH to present Grand Rounds and meet our fellows for lunch. In Grand Rounds, we also hold quarterly sessions with our nursing staff for a formal “morbidity and mortality report”and to review quality measures. Each Tuesday, a lunchtime lecture is held which includes topics in biliary-pancreas disease; case discussions of liver disease; GI pathophysiology; Boards Review; and didactic review of GI pathology. Each Wednesday, a lunchtime conference is held which includes a presentation of cases to a senior clinician or clinical journal club. Each Thursday, a fellows-only conference with the Chief of the GI Unit is held at lunchtime. In this session, the Chief discusses interesting clinical cases, career development, the field of gastroenterology, etc. Each Friday morning, fellows attend a presentation of interesting cases by physicians in the GI Unit, Surgery, Radiology, Oncology, etc. On Fridays, an Inflammatory Bowel Disease lunchtime case conference is held which includes a formal presentation of an IBD case, as well as a more informal discussion of patients seen by fellows or faculty in the hospital or outpatient clinic.
Each month, fellows attend Boston Interhospital Rounds which are held at different hospitals around the city. In these rounds, fellows from all the Boston-area training programs present the most interesting cases seen at their hospital. For first year fellows, in the month of July and August, an introduction to clinical gastroenterology is led by an expert faculty member each Monday and Thursday mornings. Beginning September, a lecture series on GI motility as well as practical sessions reading manometry tracings is held on Thursday mornings.
Finally, conferences focused on research are held throughout the year. These include a weekly research seminar in which scientists from throughout the Harvard Medical community are invited to discuss their research, a weekly research journal club, and a monthly clinical research interest group in which clinical research present their ongoing projects for discussion.
A Typical Week’s Schedule of Educational Activities for First Year Fellows:
Monday
7:15 AM Pathology Slide Rounds
8:00 AM Podolsky Service Attending Rounds
1:00 PM Outpatient Liver Clinic
2:00 PM Liver Service Attending Rounds
4:00 PM Podolsky Service Attending Rounds
Tuesday
7:15 AM Liver Biliary Pancreas Center Interdisciplinary Rounds
8:00 AM GI Grand Rounds
9:00 AM Podolsky Service Attending Rounds
9:00 AM GI Fellows Clinic (2 fellows)
12:15 PM Fellows Teaching Conference
2:00 PM Liver Service Attending Rounds
4:00 PM Podolsky Service Attending Rounds
4:00 PM GI Research Seminar
7:30 PM Interhospital GI Rounds (Monthly)
Wednesday
8:00 AM Podolsky Service Attending Rounds
8:30 AM Transplant Rounds (Liver Rotation)
11:00 AM Research Journal Club / Works in Progress
12:15 PM Clinical Journal Club / Schapiro Rounds
2:00 PM Liver Service Attending Rounds
4:00 PM Podolsky Service Attending Rounds
5:00 PM Clinical Research Interest Group (monthly)
Thursday
7:00 AM Motility Reading (every 3 weeks)
8:00 AM Podolsky Service Attending Rounds
8:00 AM Medical Grand Rounds
9:00 AM GI Fellows Clinic (2 Fellows)
12:15 PM Chief’s Rounds2:00 PM Liver Service Attending Rounds
4:00 PM Podolsky Service Attending Rounds
Friday
8:00 AM Ellison Rounds (Case Conference)
9:00 AM Podolsky Service Attending Rounds
8:00 AM Transplantation Rounds (Liver Rotation)
12:15 PM IBD Clinical Rounds
2:00 PM Liver Service Attending Rounds
4:00 PM Podolsky Service Attending Rounds
Description of Educational Activities and Conferences
Pathology Slide Rounds: This is a weekly, hands-on teaching session reviewing the pathology specimens from cases seen on the Podolsky or Liver Service with a senior GI pathologist.
GI Grand Rounds: This is our weekly core curriculum conference. Speakers include local physicians and researchers presenting either reviews of clinical oriented topics or the latest in clinical research in GI. Several times a year, Visiting Professors from across the U.S. are invited to present in this forum. Approximately every six weeks, fellows formally present their most interesting cases to the faculty.
Tuesday Teaching Conferences: A weekly lunchtime conference includes case discussions of biliary-pancreas disease, liver disease, transplant hepatology, GI pathophysiology, Boards Review, nutrition, and GI pathology.
Wednesday Teaching Conferences/Clinical Journal Club: These weekly lunchtime conferences include Clinical Journal Club, which is a discussion of the research methodology and findings from both recent GI research as well as “classic” papers in GI. Once a month, in lieu of journal club, Dr. Robert Schapiro, a senior clinician leads a case discussion.
Ellison Rounds: This lively, multidisciplinary conference is held weekly to provide a forum to present interesting cases seen by the attending gastroenterologists, surgeons, oncologists, and radiologists.
Liver-Biliary-Pancreas Rounds: These weekly rounds include members of the GI Unit, and Departments of Surgery, Radiology, Pediatrics and Pathology and focuses on interdisciplinary approaches to patients with complex disorders of the liver, biliary tract, and pancreas.
IBD Clinical Forum: A weekly lunchtime conference focused on the multidisciplinary management of patients with IBD including those newly seen in the Clinical IBD Center. A formal case presentation also occurs once a week.
Transplantation Rounds: A 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.
GI Motility Conferences: A series of lectures throughout 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.
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.
Introduction to Clinical GI: During July and August, a twice weekly conference conducted by the GI Unit faculty covers approaches to diagnosis and management of the spectrum of GI disorders.
Clinical Pathological Conference and Medical Grand Rounds: The Fellows are invited to attend the weekly Medical Grand Rounds and the weekly Clinical-Pathological Conference which forms the basis of the Clinical Pathological Conference published weekly in the New England Journal of Medicine.
GI Unit Research Seminar: A weekly seminar discussing the latest research in basic science related to GI disease. Speakers from Boston and other parts of the country are invited to participate. Research Fellows also present their research activities.
GI Unit Basic Science Research Journal Club: A weekly journal club discussing the latest basic and translational science studies.
GI Unit Clinical Research Interest Group: A monthly dinner conference in which all faculty and fellows who engage in clinical research in the GI unit meet to discuss works in progress and present research findings.
GI Unit/Center for the Study of Inflammatory Bowel Disease (CSIBD) Molecular Biology Course: This series of lectures occurs throughout the summer and provides an intensive overview of basic molecular biology, biochemistry and cell biology, with emphasis on practical applications. This course provides a broad foundation for fellows entering basic research training.
Annual Post Graduate Course in Gastroenterology: A week-long course reviewing current concepts in GI is sponsored through the auspices of the Harvard Medical School's Department of Continuing Education. The course faculty include attendings from MGH,, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center. Fellows are encouraged to attend these sessions.
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 substantial experience by performing procedures on patients they have evaluated in both the in-patient and out-patient settings. In the first month of fellowship, fellows receive a structured training experience with three expert faculty endoscopists. After the first month, fellows perfomprocedures under the direct supervision of all attending staff physicians and receive in-depth instruction on the variety of techniques used in modern gastroenterology.
Faculty
ACTING CHIEF:
Bruce E. Sands, M.D., M.S.
- Diane Abraczinskas, M.D.
- Bernard Aserkoff, M.D.
- Brenna Bounds, M.D.
- William Brugge, M.D.
- Cheryl Bunker, M.D.
- Andrew Chan, M.D., M.P.H.
- Daniel Chung, M.D.
- Raymond Chung, M.D.
- Jules Dienstag, M.D.
- Wolfram Goessling, M.D.
- Stephen Goldfinger, M.D.
- Lee Kaplan M.D.., Ph.D.
- Chin Hur M.D., M.P.H.
- Peter Kelsey, M.D.
- Myles Keroack, M.D.
- Braden Kuo, M.D.
- Barbara Nath, M.D.
- Norman Nishioka, M.D.
- Daniel Pratt, M.D.
- Bruce Sands, M.D., M.S.
- Robert Schapiro, M.D.
- Scott Snapper, M.D., Ph.D
- Michael Thiim, M.D.
- Debra Weinstein, M.D.
- Ramnik Xavier, M.D.
- Vijay Yajnik, M.D. , Ph.D.
GI Inpatient Services
First year fellows will spend time on two services in the first year: the Podolsky General GI Teaching Service (nine months) and the Liver Service (three months).
- The Podolsky Service. In their first year, fellows gain clinical experience as consultants in gastroenterology on the inpatient medical and specialty services. Their work is directly supervised and reviewed by a Gastrointestinal Unit teaching attending physician. During the rotation, the sole responsibility of the teaching attending is the supervision of the fellows’ consults and care of GI service inpatients without any other competing obligations or other patient care responsibilities. Teaching attending rounds are held twice a day, in the morning and late afternoon. Fellows will receive training in basic endoscopic procedures (upper endoscopy and colonoscopy) under the supervision of attending staff for the patients they evaluate in consultation. Because MGH is a leading tertiary care hospital in New England as well as a primary care facility for the Boston area, Fellows will gain in-depth exposure to both common and uncommon problems in gastroenterology.
- Liver Service. Because of the increasing need for specialized care for patients with chronic liver disease, fellows will rotate through a dedicated hepatology service. This service is staffed by leading transplant hepatology attendings and offers fellows an opportunity to gain a substantial experience in hepatology and liver transplantation. Teaching attending rounds are held once a day.
GI Outpatient Services
In their first year, fellows will have a ½ day of ambulatory continuity clinic every other week alternating with an ambulatory clinic dedicated to liver patients. The fellows’ clinics provide initial consultations as well as long-term longitudinal care of patients with GI and hepatology problems. The fellows’ clinic is staffed by a senior outpatient GI attending while the Liver Clinic is staffed by attending hepatologists. After the first year, fellows will have a dedicated ½ day of ambulatory continuity clinic weekly.
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.
GI Electives
In the second year of fellowship, fellows will complete two months of elective blocks in specialty areas in gastroenterology. These include electives in GI oncology, high risk cancer genetics clinic, inflammatory bowel disease clinic, cholestatic liver disease clinic, motility, GI oncology, GI radiology, GI pathology, video capsule endoscopy, and nutrition. In the third year of fellowships, each Fellow will complete a one month elective block which is specially designed to meet their clinical interests.
Participation by fellows in research activities of the GI Unit depends on the fellow's past experience and interests. In general, a fellow participates in research during the second year and beyond. However, it is possible to initiate investigative projects during the first year of fellowship. Fellows who intend to pursue clinical investigation will often enroll in a ten-week intensive introduction to clinical research methodology held at the Harvard School of Public Health (HSPH) in the beginning of their second year. For appropriate fellows, additional course work may be taken which culminates in a Masters in Public Health from HSPH or a Masters Degree in Clinical Science from Harvard Medical School.
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 modifier therapy in inflammatory bowel disease
- Oral tolerance in inflammatory bowel disease
- Novel therapeutic agents in inflammatory bowel disease and 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
- Epidemiology of GI disease, including cancers
- Novel endoscopic techniques
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
- -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 cancer
- Transgenic models of gastric, and colonic tumors
- Role of Hepatitis C structural protein in hepatocellular neoplasm
- Angiogenesis and tumorigenesis
- 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. Ramnik Xavier 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.
Please address questions regarding applications to Mariane Leonard at mleonard1@partners.org.
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