American University of Beirut

Goals

• To train fellows in the competent practice of clinical gastroenterology. This includes mastery of history taking, physical examination, and the ordering and proper interpretation of laboratory tests.
• To develop skills of consultation in Gastroenterology. This includes writing down a consultation, communicating findings to colleagues, as well as positive and professional enhancement of patient care.
• To train fellows in the competent and safe practice of diagnostic and therapeutic gastrointestinal procedures including EGD, colonoscopy, sigmoidoscopy, mucosal biopsy, polypectomy, variceal sclerotherapy/ligation, liver biopsy, diagnostic and therapeutic paracentesis, EUS, as well as familiarization with diagnostic and therapeutic ERCP. Full understanding of indications, contraindications, and proper interpretation of findings, are essential.
• To train fellows in the proper ordering, reading and interpretation of various diagnostic and therapeutic radiologic procedures including: USG, CT scan, barium studies, FNA and core biopsy of GI lesions, catheter drainage of collections...
• To train fellows in the ethical practice of Gastroenterology. Concepts such as: informed consent, honest and prompt reporting and management of procedure complications, management of terminally ill patients, and relating professionally to colleagues will be emphasized.
• To develop and enhance the fellows skills of teaching medical students and residents Gastroenterology.
• To involve the fellows in clinical and basic research taking place in the Division.

Duration of Fellowship Training

• Fellows need to spend a minimum of three years in the fellowship program. This standard has been adopted by most U.S. university hospitals. The three-year period is required for the fellows to have sufficient clinical and endoscopic experience. It will also secure some time for academic development (research and teaching).
• Fellows will be recruited from excellent Internal Medicine programs both from Lebanon and other countries.

​Program Overview

• Fellows will consult on ward and private patients. They will write their full notes including assessment and plan. They will communicate their findings to the attending of the week who will discuss the case before final recommendations are made. The findings and plans will be communicated to the Ward team. The fellows will follow up the patient, write progress notes and discuss developments/progress with the GI attending. The fellows are also encouraged to see private consults that raise interesting or challenging questions.
• The fellows will also evaluate patients referred to the GI Outpatient Department (OPD) in the three years of the program. The GI attending covering the OPD will supervise management.
• All diagnostic and therapeutic procedures done by the fellows must be assisted and/or supervised by a designated gastrointestinal endoscopist that will countersign the endoscopy report.
• Clearly defined and measurable end points of clinical and endoscopic competence need to be achieved before the fellow is given a certificate of completion of program. Fellows must complete a predetermined number of procedures, as determined by ACGME, before graduating from the program. This will be discussed with the fellows who will have to keep a log book of all procedures performed.. Being able to identify normal and abnormal findings is another requirement.
• Third year fellows will:
  • Evaluate all difficult/interesting cases on the ward or private floors.
  • Get training in therapeutic endoscopy
  • Spend six months of their time in research projects that will culminate in writing one or more original manuscripts.
• Fellows will read the equivalent of a modern textbook in Gastroenterology (such as Yamada, 2000 edition) over the three-year period. Individual chapters will be presented in prearranged meetings with a designated attending.
• Fellows prepare and present at the biweekly GI Journal Club under the supervision of a GI attending. Relevant articles will be selected and presented using the Power Point software. Emphasis will be placed on new concepts in clinical gastroenterology and/or endoscopy. A formal presentation of each paper’s merits, drawback, methodology, and statistical analysis will take place.
• Fellows prepare and present at the biweekly GI Grand Round. Interesting/difficult/teaching Cases will be selected from the Ward, OPD, and private floor and will be presented. A designated GI attending oversees the preparation and presentation. The attending ascertains that the appropriate literature review and teaching messages are effectively delivered. Coordination with the Departments of Radiology and Pathology will take place so that the appropriate X-rays, pathology slides will be presented at the conference for discussion and teaching. Endoscopic photographs and videotapes should also be presented.
• Arrangements will be made so that the fellows will get sufficient exposure to GI pathology and GI radiology material. This will be done through formal monthly seminars during which a pathologist and/or a radiologist present interesting/difficult/challenging cases to the Division.
• Arrangements will be made so that the fellows will attend at least one international meeting during their fellowship. Funds will be secured for that purpose.
• Arrangements will be made so that the fellows become proficient in the use of computers, various software, Internet surfing… for enhancing and disseminating knowledge. Formal seminars will be held in collaboration with the Medical Library, PC support…for that purpose.

Role of the Faculty in Teaching

• Members of the Faculty in the Division are ultimately responsible for the quality of medical care provided to patients seen by the fellows.
• Direct supervision of endoscopic and other procedures.
• Overseeing all academic activities such as conferences, journal clubs…
• Giving formal courses to the fellows including:
  • 6-12 hour course on “endoscopy and endoscopes” at the beginning of the year to first year fellows
  • A series of presentations (12-24) on the modern approach and management of “run of the mill” GI problems, such as upper GI bleeding, ascites, colon polyps, H-Pylori infection, etc…
    

Quality Control as Related to Teaching

• The Faculty will ensure that the fellows have attained an excellent level of gastroenterology knowledge. This can be done by examining their consult notes, their case presentations, by getting formal evaluations of their performance from students and residents, and by ensuring that they take formal regional or international exams (Arab Board, and eventually, American Board…).
• The Faculty will make sure that the fellows get to do an adequate number of diagnostic and therapeutic procedures for certification as set by the ASGE…
• Maintenance of the highest ethical standards will be monitored in periodic meetings to assure:
  • Prompt and honest reporting of complications
  • Thorough discussion of unexpected morbidity and/or mortality related to management of GI problems and implementation of preventive measures thereof
  • Satisfaction of patients, colleagues and nurses with the ethical conduct of the fellow…etc.
• Maintenance of a collegial relationship among fellows and between fellows and Faculty. In order to facilitate the training process, the following guidelines are adhered to:
  • A monthly schedule detailing the responsibility of each fellow is made.
  • One fellow is always available for coverage of inpatient and ER consults.
  • Sick patient are seen and worked up promptly by fellows and cases are quickly reported to the attending.
  • Fellows follow up their patients and report on their progress to the attending.

Clinical and Procedural Duties of the GI Fellows