GI motility and functional diseases constitute a significant portion of patients in GI and primary care clinical practice, but an increasingly specialized area of gastroenterology. The scope of training includes all areas pertaining to the diagnosis and treatment of patients with gastrointestinal motility and functional diseases, as well as clinical research pertaining to causation, epidemiology, diagnosis, prognosis and management of these diseases.
Applicants will be expected to have completed an ABIM-certified three-year training program in gastroenterology prior to beginning their advanced fellowship. For those applying from outside the United States, completion of equivalent post-graduate training in gastroenterology is acceptable. Passage of Boards part I and II is required and completion of part III is strongly encouraged. This training program is focused to develop an expertise beyond what is assumed as part of a standard GI fellowship.
Selection criteria will be based on the following: 1) Demonstrated interest in an academic career in GI motility and functional GI disease; 2) demonstrated interest in clinical/translational research in GI motility and functional disease; and 3) excellence in clinical care.
1) Demonstrated interest in an academic career in GI motility and functional GI disease
Applicants will preferably have demonstrated interest in clinical or translational research and begun to acquire some of the skills required to conduct research. This motility fellowship is intended to enable individuals to develop an academic career focused on issues in GI motility and functional GI disease. Trainees who have been involved in activities demonstrating interests consistent with this goal will be favored. Such activities would include research in GI motility during their GI fellowship; focused clinical activities involving motility/functional disease during their fellowship, participation in local and national programs focused on GI motility and functional disease, including those sponsored by the American Motility and Neuroenteric Society, International Foundation of Functional GI Disorders, and the American Gastroenterology Association.
2) Demonstrated interest in research in GI motility and functional GI disease
Prior experience in research is preferred but not required, with a demonstrated capacity to approach a particular area in motility and functional GI, dissect the issues and develop a research project to answer a specific question. As some applicants will be in their second year of GI fellowship, it is not expected that they will have completed a project or be far along in their research endeavors. Similarly, applicants will not be expected to have extensive expertise in clinical or translational research skills, as the program is intended for training in this area. However, applicants will be favored who have been involved in projects concerning GI motility and have begun to focus their efforts in this area.
3) Excellence in clinical care
Excellence in the clinical care of patients will be a high priority for the selection of trainees. Those who have demonstrated superb clinical judgment with a comprehensive knowledge base in general gastroenterology with compassionate care demonstrated during their residency and GI fellowship will be favored as well. These skills and characteristics will be assessed through their reference letters and fellowship evaluations.
The Motility Fellowship provides exposure to the breadth and depth of topics to increase expertise. Topics pertaining to etiology and pathogenesis will be taught in the context of clinical care, as well as in the context of the GI Motility Didactic Series and in weekly GI Rounds, which occasionally touch upon aspects of motility and functional pathogenesis.
Areas related to clinical care that pertain directly to the management of patient but are outside the field of gastroenterology, such as pathology and radiology, will be incorporated.
Particulars of diagnosis and management issues as well as pharmacotherapy and decisions relating to surgery will be conveyed in the routine course of managing both inpatients and outpatients primarily. There is a core reading curriculum, which consists of the seminal papers in GI motility and functional disease. Finally, motility fellows will also be involved in performing and interpreting GI motility testing and learn areas of diagnosis and management pertaining directly to motility and functional GI disease.
The curriculum has multiple goals:
- To learn appropriate methods and collection of data in support of a diagnosis of GI motility and functional GI disorders.
- To learn appropriate uses of medical therapies targeted for these diseases.
- To learn appropriate use of surgery when indicated for these diseases.
- To learn advanced formulation of complex problems within the sphere of GI motility and functional GI disease patient care.
- To learn the essentials of clinical investigation relevant to clinically-oriented questions in GI motility and functional GI disease and relevant to translation of basic pathophysiology to patient-oriented research.
- To learn to identify findings relevant to diagnosis and management of GI motility and functional GI disease in the course of diagnostic evaluations with motility testing.
Advanced fellows will be expected to have outpatient clinic sessions of continuity clinic. This will consist entirely of patients being evaluated in the Motility, Esophageal, and Colorectal Clinics for diagnosis and management of motility and functional GI disorders. In addition, the trainee will also have sessions in the GI Motility laboratory every week. These procedures, consisting of esophageal motility studies, gastroduodenal studies, and colorectal studies including anorectal manometry, will be done entirely under the supervision of one of the GI Unit and surgical faculty.
Fellows are expected in perform and analyze numerous GI motility studies to the level of independent proficiency including esophageal motility studies, gastric and small bowel studies (manometry, wireless motility capsules), indications and interpretation of scintigraphic transit studies, colonic motility studies, anorectal manometry, and pelvic floor rehabilitation/biofeedback.
Involvement in inpatient consultations and admissions will also occur as part of the exposure to clinical management of complex and challenging GI motility and functional disease.
At the discretion of individual fellows, two-week blocks may be spent in nutrition, pathology, speech pathology, or radiology, as appropriate to the interest and desire of the trainee. Fellows may rotate to other institutions such as Children’s Hospital of Boston to observe pediatric motility testing.
Fellows are expected to participate in an independent and supervised clinical or translational research project pertaining to gastrointestinal motility and functional disease. These may include retrospective studies as well as prospective studies of an observational nature or clinical trials. Dr. Kuo will directly supervise these activities. Fellows will be guided through the process of obtaining human studies approvals and in the structuring of the research and writing of the protocol. Fellows will be supervised at all times during direct patient interactions in the context of clinical research. Fellows will also receive instruction on methods of data collection and appropriate analysis.
Another component of this didactic area will be in learning to work with biostatisticians, available to the clinical research program of the GI Unit. Fellows will also receive training in clinical research through seminars available through the clinical research program at MGH. It is expected that each fellow will complete a manuscript describing their independent research in a manner suitable for publication.
Please contact Braden Kuo, MD to begin the application process.
Application involves a personal statement, two letters of recommendation, as well as an interview of the applicant. The application deadline is rolling, but ideally applications are received in January of the starting year and selection occurs by April. The ideal time to begin training is July.
Please contact Dr. Braden Kuo, Director of GI Motility Laboratory, for further information.