Fellowships

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Gastroenterology Fellowship at Massachusetts General Hospital

The Gastroenterology Fellowship Program at the Massachusetts General Hospital provides a rigorous foundation in patient care, research, and teaching for talented individuals committed to careers in academic gastroenterology.

OVERVIEW

The Massachusetts General Hospital (MGH) Gastroenterology (GI) Fellowship is an ACGME-accredited program offering outstanding clinical and research training for future leaders in academic gastroenterology. As a leading center of clinical excellence, we offer highly specialized care as a tertiary referral center as well as routine treatment for common gastrointestinal problems. Our commitment to excellence in patient care also forms the basis for our outstanding programs in basic science, clinical and translational research. Moreover, with established relationships with leading scientists in the Harvard and MIT communities, our fellows benefit from training or collaboration beyond our Division.

The MGH has a long and storied history of training leaders in gastroenterology. In the 1940s and 1950s, Dr. Chester M. Jones, an internationally renowned clinician, led the clinical activities in gastroenterology at the MGH, with a strong focus on esophageal and gastric motility. In the mid 1950s, the then-Chief of Medicine, Walter Bauer, introduced the Clinical Unit system and in 1957, he appointed Kurt J. Isselbacher to develop and head the Gastrointestinal Unit. In succeeding Dr. Jones, the central focus of this GI unit was shifted to bring scientific rigor to the study of gastroenterology. In the 32 years that Dr. Isselbacher led the division and the training program, the MGH became recognized for its scientific accomplishments and, more importantly, its success in training GI academicians. The more than 180 alumni of this GI Unit from that period include more than 40 individuals who have gone on to head academic divisions (31), departments of medicine and pediatrics (4), biochemistry, cell biology, anatomy and pharmacology, and include presidents of the ASCI (2), the AGA (5) and the AASLD (4). Most importantly, this program produced scores of productive investigators and educators.

In 1989, Dr. Daniel K. Podolsky, himself a graduate of this training program, was appointed as the third Chief of the MGH GI Unit and served in that role until 2008. During that nearly 20-year period, the GI Unit underwent a steady expansion of its research, clinical and training programs. The unit developed a broad array of clinical services encompassing outstanding general gastroenterology, a Crohn’s and Colitis Center, and a Liver Center, including liver transplantation services and comprehensive endoscopic services. Clinical volume of outpatient and inpatient care as well as endoscopic procedures grew nearly 10-fold.

In parallel with the development of the clinical services, the GI Unit research programs underwent significant expansion with the increase from two NIH investigators to more than 17 NIH-funded investigators, as well as an additional 12 faculty funded by other grant mechanisms. In 1990, the Center for the Study of Inflammatory Bowel Disease (CSIBD), a comprehensive digestive disease center funded by the NIH, was established. Over the ensuing years, the GI Unit and CSIBD gained international recognition for the important contributions by its investigators advancing understanding of the basic mechanisms underlying inflammatory bowel diseases. In addition to the many investigators within the GI Unit, the Center included participation of more than 60 other investigators from other departments within the MGH and other Harvard-affiliated institutions. Together with the Crohn’s and Colitis Center, these efforts established the MGH GI Unit as among the most eminent IBD Centers.

During this period, the full-time faculty grew from 6 to 44. Growth in clinical and research programs was associated with expanded gastroenterology fellowship and postdoctoral research fellowship activities as well as development of advanced fellowship training. The MGH GI fellowship expanded over time from two to four fellows per year and became among the most highly competitive in the country. In addition, advanced fellowships were established in interventional endoscopy, hepatology and inflammatory bowel disease, which also rapidly attracted the very best trainees seeking advanced training experience.

More than 70 fellows received GI fellowship training while Dr. Podolsky was Chief of the Unit. Of these, a great majority are pursuing careers in academic medicine with the majority remaining active in peer review funded research. These include 10 professors, 13 associate professors, 18 assistant professors, and 14 instructors at medical schools or research institutions in the United States. Nine former fellows are pursuing clinical practice outside academia and two have positions in industry. Five are now division chiefs. In addition, more than 150 postdoctoral research fellows received training in laboratories of the MGH GI Unit. These fellows were from 16 countries and include five professors and five department chairmen.

Important scientific contributions have been made in a broad array of fields, including basic mechanisms of intestinal mucosal immune response, epithelial biology, innate immunity, viral hepatitis, energy balance, GI hormone-gene regulation and GI tumorigenesis. In addition to robust programs of basic laboratory research, the GI Unit developed expanded clinical and translational research efforts. These included key roles in clinical trials defining better therapeutics for inflammatory bowel disease, anti-viral therapy for chronic hepatitis C, health services research, evaluation of new diagnostic modalities, and health disparities as well as endoscopic ultrasound and new endoscopic techniques. Research funding increased approximately 14-fold during this period.

When Dr. Podolsky left MGH in July 2008 to become President of the University of Texas Southwestern Medical Center at Dallas, Dr. Bruce Sands, a senior member of the GI faculty and graduate of the MGH training program, succeeded him in an interim capacity. In May 2010, Dr. Sands became the Chief of the Henry D. Janowitz Division of Gastroenterology at Mount Sinai Medical Center.

In January 2010, Dr. Ramnik Xavier, who trained in internal medicine and gastroenterology at MGH, assumed the position of Chief of the Division of Gastroenterology, becoming only the fourth person to hold this position. Dr. Xavier is Kurt Isselbacher Chair in Medicine at Harvard Medical School, Senior Associate Member of the Broad Institute of MIT and Harvard University, Director of the CSIBD and a senior investigator in the Center for Computational and Integrative Biology at MGH.

Andrew T. Chan, MD, MPH
Program Director
Gastroenterology Training Program

Ramnik J. Xavier, MD, PhD
Chief
Division of Gastroenterology

  • Applicants must be enrolled in or have completed an American Council of Graduate Medical Education-accredited internal medicine residency.

  • Applicants must document successful completion of USMLE Step III by the time of appointment (beginning of fellowship). In rare circumstances, LMCC/MCCQUE and COMLEX examinations may be substituted.

  • Applicants interested in entering the American Board of Internal Medicine (ABIM) Research Pathway (“short-track”) must have the support of their current internal medicine residency program director. The applicant must notify the ABIM of their intention to pursue such training by Spring of their PGY-2 year of residency. All ABIM Research Pathway applicants must satisfactorily complete 24 months of accredited categorical ACGME internal medicine training, which includes a minimum of 20 months of direct patient care responsibility.

An overview of our training program by year:

YEAR ONE

  • Podolsky Service (general GI) inpatient service (9 months)
  • Liver Service (transplant hepatology) inpatient service (3 months)
  • Ambulatory clinic (½ day every other week)
  • Ambulatory liver clinic (½ day every other week)
  • Endoscopy (longitudinal)

YEAR TWO

  • Clinical electives (2 months)

  • Ambulatory clinic (½ day per week)
  • Endoscopy (longitudinal – 1.5 months)
  • Mentored research / research didactic training

YEAR THREE

  • Clinical electives (1 month)
  • Ambulatory clinic (½ day per week)
  • Endoscopy (longitudinal – 1.5 months)
  • Mentored research / research didactic training

YEAR FOUR (optional)

  • Ambulatory clinic (½ day per week)
  • Endoscopy (longitudinal – 1.5 months)
  • Mentored research / research didactic training

OVERVIEW

Our clinical curriculum encompasses a minimum of 18 months of rigorous work in all aspects of digestive diseases. Our training program also affords opportunities for fellows to develop as clinical teachers for their colleagues, medical residents and Harvard medical students. Fellows are offered broad exposure to specific clinical areas, including:

  • esophageal and swallowing disorders
  • gastrointestinal oncology
  • inflammatory bowel disease
  • liver disease
  • transplant hepatology
  • biliary-pancreatic disease
  • interventional endoscopy
  • motility
  • neurogastroenterology

FACILITIES
All clinical training occurs on the main MGH campus located in the heart of Boston. MGH is the third oldest general hospital in the United States and the oldest and largest hospital in New England. The hospital is consistently ranked among the top five hospitals in the nation by U.S. News and World Report. The main hospital is a 900-bed medical center wth more than 47,000 admissions annually. Clinical activities in gastroenterology are largely focused in our 17,000-square-foot endoscopy and clinic facility in the main hospital, as well as a 13,000-square-foot endoscopy and clinic facility in Charles River Plaza, an adjacent outpatient building. Currently, more than 20,000 endoscopic procedures are performed each year in our endoscopy units, 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.

INPATIENT EXPERIENCE
The Podolsky Service (nine months): In their first year, fellows gain clinical experience as consultants in gastroenterology on the inpatient service. Their work is directly supervised and reviewed by a GI teaching attending physician. 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 (three months): Because of the increasing need for specialized care for patients with chronic liver disease, fellows will rotate through a dedicated inpatient hepatology service. This service is staffed by leading transplant hepatology attendings and offers fellows an opportunity to gain substantial experience in hepatology and liver transplantation.


OUTPATIENT EXPERIENCE
In their first year, fellows will have a ½ day of ambulatory continuity clinic every week, which includes dedicated sessions to the care of patients with liver disease (Liver Clinic). 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. Beyond the first year, fellows will continue to have a ½ day of ambulatory continuity clinic every week running longitudinally during their mentored research time. Specific clinic sessions focused on the care of patients with liver disease or inflammatory bowel disease is also offered by request. Each clinic session is staffed with a 1:1 or 1:2 ratio of attending to fellows to maximize teaching and supervision.

GI ENDOSCOPY
Each fellow receives instruction and 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). In the first year, fellows primarily provide endoscopy for the inpatients they evaluate in consultation. Beyond the first year, fellows will have an aggregate of 1.5 months per year of endoscopy running longitudinally during their mentored research time. During this session, the fellow can expect to perform upper and lower endoscopies on their ambulatory outpatients, selected inpatients, as well as patient directly referred to them for outpatient endoscopies.

GI SPECIALTY 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, obesity medicine, 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.

LONGITUDINAL DIDACTIC ACTIVITIES
Formal attending and teaching rounds take place twice daily. In addition, a series of didactic lectures are offered throughout the week. A partial listing of conferences includes:

GI Grand Rounds
This is our weekly core curriculum conference. Speakers include local physicians and researchers presenting either reviews of clinically 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.

Biliary-Pancreas Conference
A monthly lunchtime conference includes case discussions of biliary-pancreas disease presented by our interventional endoscopy faculty.

Liver Case Conference
A monthly lunchtime conference with case discussions of liver cases presented by our hepatologists.

Transplant Hepatology Conference
A monthly lunchtime multidisciplinary conference reviewing pertinent topics in liver transplantation.

GI Pathophysiology Conference
A monthly lunchtime conference led by senior GI faculty integrating clinical medicine with basic GI pathophysiology.

Nutrition Conference
A series of six lectures over the course of the year reviewing basics of nutritional assessment, enteral and parenteral feeding, and nutritional issues in patients with complex GI disorders, including liver disease and inflammatory bowel disease.

Clinical Journal Club
A weekly discussion of the research methodology and findings from both recent GI research as well as “classic” papers in GI.

Schapiro Rounds
A monthly lunchtime conference led by
Dr. Robert Schapiro, a senior clinician, to discuss challenging clinical cases, particularly in relation to general gastroenterology and advanced endoscopy.

Master Clinician Breakfast
A monthly breakfast conference led by Dr. Jules Dienstag, a senior clinician, to discuss challenging clinical cases, particularly in relation to hepatology.

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 Division, and Departments of Surgery, Radiology, Pediatrics and Pathology to focus 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 new patients evaluated in the Clinical IBD Center.  A formal case presentation also occurs once a week.

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.

Radiology Rounds
A monthly conference with Dr. Joseph Simeone, a
senior radiologist reviewing cases with interesting and challenging radiological studies.

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 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. 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 basic 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.

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.

EVALUATIONS
After each rotation, each faculty member evaluates each fellow according to the six ACGME core competencies of patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and system-based practice. All faculty members meet with fellows individually for verbal feedback and evaluation. For endoscopy, technical competence is also evaluated through specifically designed evaluation forms, practicums,
a simulator laboratory, and an annual skills assessment program. At the end of year fellowship year, an aggregate evaluation of a fellow’s clinical progress is conducted through a faculty committee on clinical competency.

DUTY HOURS
We adhere fully to ACGME common program requirements for resident and fellow duty hours. We conduct ongoing monitoring of duty hours to ensure compliance.

MOONLIGHTING
Fellows are not permitted to moonlight in their first year of fellowship. After the first year, moonlighting is permitted with approval of the Program Director if it is judged not to interfere with the ability of the fellow to achieve the goals and objectives of the educational program. Moonlighting must also adhere to the ACGME common program requirements for fellow duty hours.

OVERVIEW
Generally, fellows begin their mentored research after completion of 2 months of electives in the second year of fellowship. Over the course of their research time, fellows are fully “protected” from clinical responsibilities except for a ½ day per week of continuity clinic and ½ day per week of endoscopy. Generally, there is no overnight call or weekend call during research time. Some fellows do elect to do additional endoscopy sessions on some weekends, but this is not required.

Our research curriculum involves hands-on mentored research training that offers fellows a range of scientific approaches relevant to digestive disease-related research. All fellows are required to conduct at least 18 months of in-depth mentored research and scholarship in either the clinical or basic sciences relevant to gastroenterology. However, research training may often extend beyond 18 months to develop the necessary scientific foundation to enable the committed trainee to establish a successful program of independent investigation.

Fellows have an opportunity to gain expertise in several disciplines as a foundation for digestive disease-related research, including:

  • epidemiology and biostatistics
  • outcomes research/decision analysis
  • clinical and intervention trials
  • computational biology
  • molecular biology
  • cell biology
  • systems biology
  • chemistry
  • biochemistry
  • immunology
  • developmental biology
  • genetics
  • engineering

FACILITIES
MGH has an annual research budget exceeding $550 million, the largest hospital-based research program in the United States. MGH’s research program spans more than 20 clinical departments and centers across the hospital. Aside from the main hospital, dedicated research space is committed at a 400,000-square-foot facility at the Charlestown Navy Yard and a 260,000-square-foot facility at the Simches Research Building immediately adjacent to the main hospital. The GI Division has nearly 20,000 square feet of space committed for research. Moreover, additional space is available through the expansion of research programs of the broader faculty of the training program, most notably in the context of new multidisciplinary research centers in Genetics, Integrative and Computational Biology, Systems Biology and Stem Cell/Regenerative medicine, and the Center for the Study of Inflammatory Bowel Disease (CSIBD). The CSIBD is an NIDDK Digestive Disease Center directed by Dr. Xavier that promotes studies of basic mechanisms contributing to the pathogenesis of inflammatory bowel diseases. The Center has fostered research through a highly productive base of established and new investigators focused on molecular biology, immunology and epithelial cell biology.

MENTORS
The GI Division has more than 47 faculty that may serve as potential mentors in clinical or basic research. Many faculty are leading investigators in a range of GI research areas. Learn more about our team.

An important feature in the organization of our research experience is the integration of other basic and clinical research programs beyond gastroenterology. The training program encompasses faculty from several basic science departments (Biology, Molecular Biology, Genetics, Cell Biology, Systems Biology, Regenerative Medicine, Stem Cell Biology, Computational and Integrative Biology) as well as other laboratories in the Renal, Infectious Disease, Cardiac, Endocrinology, and Pediatric GI Units of the MGH. For clinical, epidemiological, and translational research, faculty from other clinical departments, as well as the Harvard School of Public Health, Broad Institute, and the Harvard Catalyst program are integrated. The research base has been broadened to be able to provide trainees diverse opportunities to apply cutting edge research methodology for digestive disease research. Thus, the training program is uniquely able to provide trainees access to the most powerful approaches for the strongest possible research foundation which will sustain a program of independent investigation.

BASIC SCIENCE TRAINING
Laboratory research training is enhanced by the active participation of fellows in a rich program of didactic courses, seminars and journal clubs as well as a wealth of optional seminar and training experiences available in this institution, the Harvard Medical School, Harvard School of Public Health, Harvard University and MIT. The following are integral to the program for all fellows:

  • Course work
    The faculty of this training program has developed an introductory course directed by Drs. Xavier and Christian-Reinecker which covers basic concepts of molecular and cellular biology and basic laboratory approaches.
  • Research Journal Club
    All fellows participate in Research Journal club, exclusively dedicated to rigorous examination of basic scientific articles. Faculty and trainees are responsible in rotation for analysis of a basic science article and a review of the relevant background. Articles for discussion are selected from journals such as Cell, Nature, Mol. Cell Biol, EMBO, and Science. Articles are selected for their basic importance or illustration of a particular experimental approach.
  • Research Seminars
    Two active research oriented seminar series are maintained on a longitudinal basis in the MGH GI Division. Speakers include members of the training program, scientists from the greater Boston area and other invited speakers.
  • Work-in-Progress Seminars
    These seminars are intended to review, evaluate and critique the research projects of the fellows. This provides an opportunity to review the direction of the research, consider whether appropriate progress has been made and provide an opportunity for suggestions as to alternative methodological approaches, possible collaborations or consultation with other scientists, etc. Fellows make these formal presentations yearly.
  • Annual GI Unit Research Retreat
    GI fellows also have the opportunity to present their work at this annual showcase of the Unit’s broad research activities. The opportunity for both poster and oral presentations, along with the benefit of interaction with fellow trainees and faculty members, provides helpful critiques and fosters new collaborations.
  • MGH Office of Research Career Development Series
    This series complements the Unit’s career development activities by offering seminars and workshops on grant writing, manuscript preparation, promotion criteria, and work-life balance.

In addition to these series, numerous additional longitudinal seminars are sponsored by the various laboratory groups of the MGH and more broadly in the Boston biomedical community. Preceptors are expected to provide guidance in identifying those most worthwhile; in a recent typical week 42 announced laboratory seminars were conducted at the MGH alone!

CLINICAL RESEARCH TRAINING
In recognizing the very different foundation needed by fellows in clinical investigation, a distinctive program has been developed.

  • Course work: Typically, training begins with intensive summer course work at the Harvard School of Public Health (HSPH) through its internationally regarded Program in Clinical Effectiveness. In this program, fellows are immersed in a nine-week didactic, hands-on curriculum in epidemiology, biostatistics, study design, decision analysis, and research ethics. This program provides a certificate of completion. However, for the appropriate fellow, these courses can be used to partially meet the requirements to obtain a Masters in Public Health from HSPH. Other fellows interested in more translational science may elect to enter a separate Masters of Science degree program offered by the Harvard Medical School Catalyst program focused on training in clinical and translational science.
  • CATALYST program / MGH Clinical Research Program: In addition, clinical research fellows will have at their disposal didactic resources provided by the MGH Clinical Research Program and the Harvard CTSC (also referred to as the Harvard CATALYST Program). These programs offer a wide array of didactic offerings throughout the year, including an intensive one-week course for translational investigators on genomics, proteomics, cohort assembly, repository and tissue banking, and bioinformatics. Other offerings include seminars in clinical trial design, biostatistics, and bioethics.

GI Unit Clinical Research Interest Group. GI fellows are expected to attend a monthly dinner conference in which all faculty and fellows who engage in clinical research meet to discuss works in progress and present research findings.

MGH Office of Research Career Development Series. This series complements the Unit’s career development activities by offering seminars and workshops on grant writing, manuscript preparation, promotion criteria, and work-life balance.

We participate in the Gastroenterology Fellowship Match through the National Residency Matching Program. Applications should be submitted through the Electronic Residency Application Service. We are committed to the match resolution regarding gastroenterology fellowship applicants provided by the American Gastroenterological Association (AGA), American College of Gastroenterology (ACG), American Association for the Study of Liver Diseases (AASLD), and the American Society for Gastrointestinal Endoscopy (ASGE). We do NOT offer any positions outside of the match.

We will participate in the 2014 Match for positions beginning on July 1, 2015. Applicants are encouraged to submit their applications through ERAS by July 15, 2014. The deadline for applications is September 15, 2014. Applicants selected for an interview will be invited to visit us through out September and October 2014.

Fellowship interview dates:
 • September 8
 • September 24
 • September 26
 • October 3
 • October 8
 • October 9

Gastroenterology Fellowship at Massachusetts General Hospital

Phone: 617-726-7802


Andrew T. Chan, MD, MPH
Program Director
Gastroenterology Training Program

Ramnik J. Xavier, MD, PhD
Chief
Division of Gastroenterology

Daniel C. Chung, MD
Clinical Chief
Division of Gastroenterology

Raymond T. Chung, MD
Director of Hepatology
Division of Gastroenterology

Brenna W. Casey, MD
Endoscopy Training Director
Gastroenterology Fellowship

Mariane Leonard
Fellowship Coordinator
55 Fruit Street
GRJ 722
Boston, MA 02114
Phone: 617-726-7802
Fax: 617-726-3673
Email: mleonard1@partners.org

Additional information about Graduate Medical Education at MGH and Partners HealthCare is available through http://www.partners.org/research/gme/research_gme.asp. This includes information about trainee contracts, policies, benefits and responsibilities. 

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