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From the Program Director

The overarching goal of the Gastroenterology and Hepatology Fellowship Program at the University of Kansas Medical Center is to provide superior training in all aspects of clinical and endoscopic gastroenterology and hepatology.

The program provides comprehensive education and experience in the diagnosis, treatment, and prevention of gastrointestinal, pancreato-biliary, and liver diseases through patient care, research, and education in a professional environment that is conducive to learning. With more than 10,000 diagnostic and therapeutic procedures performed within the program on an annual basis, there is ample opportunity for endoscopic training and research.

The fellowship program is designed to provide extensive clinical and research experience guided by expert faculty members that have active research programs in all aspects of gastroenterology and hepatology, allowing fellows to obtain training in clinical or basic research. The curriculum and evaluations incorporate the competency tenets of the American Council for Graduate Medical Education (ACGME) - medical knowledge, patient care, practice based learning and improvement, systems based practice, professionalism, interpersonal and communication skills.

Sincerely,

Prateek Sharma, MD
Professor of Medicine
Program Director GI Training
University of Kansas School of Medicine

More information about the program and our institutional policies is available by exploring the sections below:

The Fellowship Training Program at the University of Kansas School of Medicine has a long
tradition of excellence and a proven track record of producing competent and
compassionate gastroenterologists for both clinical practice and academic careers.
Gastroenterology has become an increasingly complex subspecialty over the years and
today’s gastroenterologists need to be up to date with the practice of general
gastroenterology, as well, as more subspecialized fields within gastroenterology, such as
hepatology, advanced interventional endoscopy, motility and the management of complex
chronic diseases, such as inflammatory bowel disease.

Our goal is to produce well rounded gastroenterologists who are able to competently
practice within these fields and also to prepare academically minded individuals to
competitively pursue further advanced training in these areas.

Each fellow's program can be tailored to the ultimate final goal of individualized training. All
fellows will have comprehensive training in general gastroenterology and endoscopy, six
months of dedicated research time, six months of hepatology practice, and exposure to
advanced endoscopic techniques.

General GI

Our general GI program includes 10 months of consultation, and upper and lower endoscopy
training in the first year.

The volume of EGD and colonoscopies at both facilities is sufficient to provide training to
each of our fellows. In the second and third years, 6-12 months of exposure to advanced
interventional endoscopy including therapeutic endoscopy with treatment of bleeding,
treatment of cancer, placement of stents, ERCP with sphincterotomy, and stone extraction
occurs.

A program of endoscopic ultrasound has been in place and is now expanding within our
division and can be in the future an area of training for our fellows.

Ambulatory Care Clinics

Outpatient clinic exposure is a critical feature of our training program and critical to the
understanding of the care of patients with GI disorders. Each of our fellows participates in
ambulatory GI and hepatology clinics, both at the University of Kansas Hospital and at the
Kansas City VA Medical Center.

A feature of our program is a dedicated continuity clinic for each of the fellows. These are
designed to enable the fellow to recruit patients that are of interest to the fellows or that the
fellows have seen on the wards or in the endoscopy lab and to provide longitudinal
ambulatory care. These clinics are staffed by faculty who supervise the assessment and
decision-making process of the fellows.

Hepatology

The Leaders in Gastroenterology have published (Gastroenterology) a guideline for the
development of three-year programs. Their recommendations are that at least five months
of the training have an intensive exposure to hepatology.

Our program has an independent liver transplant program and independent faculty whose
focus in training is in hepatology and liver transplantation. At least five months of our
program will include separate rotations with inpatient and outpatient hepatology
consultation, liver biopsy and paracentesis performance, liver biopsy interpretation, and preand post-transplant evaluation and management.

Research

Research in emphasized by the Leadership in Our GI training program. At least six months of
research is designed for each fellow. As mentioned above, for those fellows interested in a
career in clinical research or academics, a longer period of time can be obtained. This will be
clinical or a mixture of clinical and basic research, taking advantage of those faculty
members who have active research programs.

Our division currently has active research in the areas of Barrett’s esophagus and GERD,
liver diseases, GI cancer prevention, GI motility, and advanced endoscopy.
Fellows are encouraged to select areas of interest and then to interview with the faculty and
develop the programs that they would be involved with. An outline of goals, expectations,
and publications should be agreed upon at the start of the research experience.

Conferences

Several conferences each week are available and required for the fellows to attend. The
primary educational conference of the Division is GI Grand Rounds which takes place 5:00
pm to 7:00 pm each Tuesday evening. It has a long tradition at KU Medical Center and is
well attended by faculty both within our division and guest faculty from other departments.
The fellows and house staff on the GI service attend the conference and present cases and
reviews. It provides the integration of patient presentation with test results, pathologic
specimens, radiographic studies, surgical intervention, and consultation with other
appropriate services.

This conference involves journal clubs, during which important recent GI papers are
discussed, core GI lectures, GI physiology discussions and presentations of interesting
clinical cases. There are also dedicated pathology review conferences at both the University
of Kansas Hospital and VA Medical Center to review interesting and relevant pathologic
specimen that were obtained during endoscopy or liver biopsy.

The program of education as outlined above is designed to provide training and experience
for the fellow, allowing him/her the opportunity to develop competence of a specialist in
gastroenterology. This training includes clinical expertise with the development of history
and physical exam skills, consultation skills, interaction with other services in the evaluation
and management of patients, use of radiology, surgery, pathology, and related disciplines in
the assessment and management of patients with gastroenterologic disorders.

In addition, competence in endoscopy, including esophagogastroduodenoscopy, esophageal
dilation, flexible sigmoidoscopy and proctoscopy, colonoscopy with polypectomy,
percutaneous liver biopsy, percutaneous endoscopic gastrostomy, biopsies of the mucosa of
the esophagus, stomach and small bowel, and colon, treatment of bleeding, both variceal
and non-variceal are taught at KU Medical Center and at the VA Medical Center.

Competences will be determined, not only by the numbers, but also by their ability to
appropriately assess patients, understand the indications and risks, proceed with careful
evaluation during the procedure and recognize disease processes and plan appropriate
intervention. The American College of Gastroenterology has developed (with other societies)
guidelines for numbers of cases and the minimums that they require are easily met during
our training program.

During our conferences and consultation, we would expect to have formal instruction and
clinical experience and opportunities to all variety of these diseases of the gastrointestinal
tract:

  1. Diseases of the esophagus including reflux inflammatory diseases, ulcerative, and
    infectious disease.
  2. Acid peptic and Helicobacter related disorders of the gastrointestinal track.
  3. Motility disorders including gastroesophageal reflux disease, dysphagia (its analysis
    and management), gastroparesis of all types, pseudo obstruction, and chronic
    constipation.
  4. (Functional) bowel disorders including dyspepsia, Irritable bowel syndrome, chronic
    abdominal pain and non-cardiac chest pain.
  5. Inflammatory bowel diseases including ulcerative colitis, ulcerative proctitis, Crohn's
    disease, and other inflammatory diseases including pseudomembranous colitis,
    colitis associated with collagen vascular disorders.
  6. Malnutrition, malabsorption, and other disorders of nutrient assimilation.
  7. Vascular disorders including ischemic bowel, arteria-venous malformations etc.
  8. Gastrointestinal infections including Helicobacter, retroviral, "herpes, CMV, hepatitis,
    fungal and mycotic, and parasitic diseases.
  9. Gastrointestinal neoplasms including esophageal cancer, gastric cancer, small bowel
    cancer, colon cancer, pancreatic cancer, and hepatocellular carcinoma, and biliary
    tract tumors.
  10. Gastrointestinal diseases associated with acquired immunodeficiencies syndrome.
  11. Cholelithiasis and choledocholithiasis
  12. Chronic liver diseases:
    • Related to alcohol, related to chronic viral hepatitis, related to biliary tract
      disorders including primary biliary cirrhosis, primary sclerosing cholangitis.
    • Drug-induced hepatic injury
    • Management of chronic liver disease including assessment of portal
      hypertension including ascites and bleeding with utilization of paracentesis,
      TIPS, and endoscopic and surgical techniques.

In particular, during consultation and during conferences the trainee should be able to
evaluate patients who present with symptoms such as dysphagia, abdominal pain, acute
abdomen, acute and chronic nausea and vomiting, malabsorption, diarrhea, constipation,
gastrointestinal bleeding, jaundice, cirrhosis, with and without portal hypertension and
malnutrition, genetic or inherit disorders, depression, neurosis, and somatizations
syndromes The trainee should understand assessment, the use of consultative advisers to
assist and the ultimate treatment.

A gastroenterologist often works closely with gastrointestinal surgeons, and our program
emphasizes a good relationship with these colleagues. We stress the understanding of
surgical indications, management of patients pre and post operatively, and integrating care
and testing with our surgical colleagues in the management of patients.

At the conference level, and in daily clinical care, we emphasize that the trainees
understand the indications, contra indications, complications, limitations and interpretation
of a variety of diagnostic and therapeutic procedures. These include radiographic
procedures such as ultrasound of the abdomen, computed tomography, magnetic resident
imaging, vascular and nuclear medicine.

In the invasive radiographic program, we encourage the fellows to understand the
complications, limit his management of patient asses and interpret percutaneous
cholangiography, vascular intervention, TIPS, and drainage procedures as utilized by the
interventional radiologist.

Our program also maintains an active clinical and research motility program and a fully
complimentary diagnostic GI laboratory. Fellows are exposed to and understand the
indications and application of gastric, pancreatic and biliary secretory tests including gastrin
levels, gastric analysis, secretions, hydrogen breath testing, urea breath testing, pancreatic
polypeptide levels, and motility studies including esophageal manometry, gastroduodenal
manometry, anal rectal manometry, and 24-hour pH monitoring. Exposure to endoscopic
retrograde cholangiopancreatography is available.

It is our goal to expose all fellows to the appropriate indications and application of these
techniques and diagnosis and management of their patients. At certain level, a competence
is required, not only with diagnostic but also with therapeutic procedures in ERCP before the
individual can be fully certified. These include papillotomy and biliary and pancreatic stent
placement.

Competence will be measured by the expert faculty that is available supervising those
procedures.

Our clinical faculty is currently composed of 12 individuals at the University of Kansas
Medical Center and the Kansas City VA Medical Center; nationally and internationally
recognized faculty members are actively involved in fellowship education.

Four faculty members are located primarily at the VA and eight at the KUMC campus. Four
faculty members are hepatologists with a primary interest in management of liver diseases
and are involved with liver transplantation. Our faculty encompasses expertise in all areas of
GI including general gastroenterology, esophagology, inflammatory bowel diseases, motility,
hepatology, and interventional endoscopy with ERCP and endoscopic ultrasound.

Facilities for gastrointestinal surgery, gastrointestinal radiology, and gastrointestinal
pathology are readily available both the VA Hospital and Kansas University Medical Center.
Close interaction with critical care, ICU, pulmonary, oncology, and interventional radiology
provide for the full spectrum of patient management and fellow training opportunities.

Internal Medicine

University of Kansas Medical Center
Internal Medicine
Gastroenterology, Hepatology & Motility Division
Mailstop 1023
3901 Rainbow Boulevard
Kansas City, KS 66160
Phone: 913-588-6019
Fax: 913-588-3975