1. Clinical Training
At least 12 of the 33 months will be spent primarily on clinical service. The Pediatric Gastroenterology, Hepatobiliary and Nutrition Division of New York Medical College cares for the entire spectrum of GI disorders in patients varying from 500-gram neonates to adolescents and beyond. The bulk of the clinical experience will be in the faculty practice of New York Medical College and the inpatient facilities of the Maria Fareri Children's Hospital at Westchester Medical Center.
The Gastroenterology inpatient service at the Maria Fareri Children's Hospital is one of the major strengths of the training program. WMC serves as the only tertiary care referral center located within an area of seven counties with a population of over 3 million. As the only Pediatric Gastroenterology Division in the area, essentially all children requiring subspecialty services are referred to the division. The hospital has a stated policy to never turn down patients who need tertiary care. Each trainee will spend at least 12 months "on-service" during the 3-year program. The daily inpatient census varies from 5 to 15 patients. In addition, we average 1 to 3 new consults daily, many of which require daily follow-up. This includes patients in both the Neonatal ICU and Pediatric ICU. Therefore, the GI service follows between 8 and 20 patients daily.
The liver transplant program at Westchester Medical Center is an active, thriving service. We average approximately 4 pediatric transplants per year. Our fellows are intimately involved in all aspects of pre and post transplant care and work closely with the transplant surgeons and hepatologists in providing care.
In addition to an active inpatient service at WMC, each fellow will have scheduled office hours in the faculty practice, where he or she will follow their "own" patients with chronic GI disorders throughout their fellowship. This continuity of care is an essential part of the training, and is affiliated with the pediatric faculty practice, http://www.cwpw.org.
The Pediatric Gastroenterology, Hepatology and Nutrition Division has a huge outpatient program, with approximately 10,000 outpatients per year. This translates into, on average, 120 patients per week in our outpatient facilities, of which approximately 20 - 30 are new. Essentially all patients are referred from their primary care physicians, and our faculty cares for all children regardless of their health insurance status or their ability to pay.
2. Educational Program
Our division has four hours of conferences per week. Each fellow is expected to attend and participate in the following division conferences:
Seminars are also designed by the faculty on statistics, research design, ethics of clinical research, and operational aspects of a pediatric gastroenterology facility.
Senior fellows are also expected to attend our transplant recommendation and review conference weekly.
There is a steady schedule of basic science and research conferences in the many departments of the medical school.
It is expected that each graduate of the training program will be skilled in teaching. Toward that aim, each fellow will be required to organize and deliver conferences to the division, the house staff and to the department with gradually increasing responsibility through the three years.
3. Research Training
The research component of the program is given equal weight to the clinical program. A minimum of 12 months will be devoted to research during the three- year program. It is expected that the fellow will develop projects in both basic and clinical research, and follow these projects through until completion and publication. Our fellows work closely with Dr. Marvin Medow, Ph.D. a member of our division who devotes much of his time to autonomic dysfunction and how it relates to the digestive system.
Clinical projects are ongoing in our division and it is expected that fellows are involved in initiating and implementing research studies and case reports. The fellow will meet with the program director frequently to help shape and focus the trainee’s research interests and design a program that is stimulating and productive. The goal is to have the research program tailored to the individual and organized so that the trainee can be productive as soon as the heavy clinical demands of the first year start to wane.
Each fellow is expected to develop at least one independent project, from inception all the way through to publication, with the fellow acting as first author (principal investigator.) In addition to intramural presentations of their work, fellows will be encouraged to present their data in abstract form in appropriate national and international scientific conferences in addition to submitting their data for publication in a peer-reviewed journal.
4. Pediatric Endoscopy
Fellows receive training in procedural skills, including esophagealduodenalgastroscopy and colonoscopy, liver biopsy and advanced endoscopic techniques. The division averages 1500 procedures per year, all which trainees participate in.
In addition fellows become experienced in lactose breath testing, esophageal and rectal mannometry as well as skilled in interpreting pH probes and capsule endoscopy.
Senior fellows spend one-month electives with the adult GI service to perfect advanced techniques as well as become familiar with ERCP and Endoscopic ultrasound.
During the third year, a second one-month elective is exclusively devoted to hepatology during which time the fellow is immersed in transplant care, including clinics and conferences.
Outside electives are a possibility and need to be discussed with the program director and ACGME staff at Westchester Medical Center.