Division of Gastroenterology & Hepatology

Thomas Jefferson University and the Division of Gastroenterology & Hepatology sponsor a one-year PGY-7 position for training in advanced endoscopic procedures. The program offers training in Endoscopic Retrograde Cholangiopancreatogram (ERCP), Endoscopic Ultrasonography (EUS), and other advanced procedures.

The Division of Gastroenterology & Hepatology at Thomas Jefferson University consists of 39 faculty members and 79 ancillary staff. The division supports 10 gastroenterology fellows, a hepatology fellow, and an advanced endoscopy fellow. The members of the division perform approximately 18,000 endoscopic procedures per annum, including 1,000 ERCP procedures and 1,300 EUS procedures. There are six physicians who perform advanced endoscopic procedures and are instrumental in the education and procedural training of the Advanced Endoscopy Fellow. The endoscopic ultrasound aspects of the training program benefit from a collaborative relationship with one of the strongest ultrasound divisions (within the Department of Radiology) in the world. The Advanced Endoscopy Fellowship at Thomas Jefferson University is currently in its tenth year. Previous fellows in this position have accepted academic positions across the United States and the world. Prior fellows would be happy to discuss the Advanced Endoscopy Fellowship at Thomas Jefferson University with any prospective candidate. Applicants considered for the Advanced Endoscopy Fellowship must be currently enrolled in or have completed an accredited three-year gastroenterology fellowship.

Endoscopic Facility

Thomas Jefferson University and Hospital boasts one of the most modern state-of-the-art endoscopy units in the nation. The University and Hospital operate 10 procedure rooms with 42 staff positions. The Interventional Endoscopy Unit (IEU) is designed as four mini-operating rooms to perform high-end procedures, including ERCP, EUS, deep enteroscopy, EMR, PDT, cryoablation, radiofrequency ablation, and enteral stenting. Two rooms are fully equipped for ERCP and two rooms are fully equipped for EUS. Each room has the capacity to provide general anesthesia. Endoscopic procedures are viewed on wall-mounted 50” flat-panel monitors to improve visualization of endoscopic detail. A fifth mini-operating room for the performance of advanced procedures was completed in 2013. The Gastrointestinal Endoscopy Unit (GEU) houses six state-of-the-art procedure rooms, with the focus on the efficient performance of standard outpatient endoscopic procedures.

All procedure rooms are linked to a state-of-the-art, 50-seat conference facility. The facility has four projection screens, each of which has the capability to simultaneously display four different images. The facility is designed so that persons in the conference room can view and have a two-way conversation with faculty members performing endoscopic procedures in any of the 10 procedure rooms. At the same time, persons in the conference room can view the endoscopic, fluoroscopic, or ultrasonic images in a HIPPA-compliant format.

Educational Objectives

The one-year Fellowship in Advanced Endoscopy is designed to develop the knowledge and skills to become an academic advanced endoscopist. This not only includes outstanding technical training, but emphasizes cognitive aspects of performing advanced procedures. These aspects include:

• Understanding the pathophysiology, natural history, and literature regarding disease entities associated with performing advanced endoscopic procedures.
• Understanding the literature that supports the endoscopic techniques performed.
• Education toward patient selection.
• Developing skills necessary to interpret the results of non-gastroenterological studies (i.e., MRI).
  
• Determining which advanced procedure is most appropriate for the patient's clinical situation.
  
• Stratifying patients with regard to procedural risk.
  
• Disclosing to the patient the risks of the proposed procedure.
  
• Obtaining informed consent.
  
• Understanding the potential procedural complications and their management.
  

Participation in the advanced endoscopy program includes:

• Admission of inpatients transferred specifically for advanced procedures.
  
• Patient preparation for advanced endoscopic procedures.
  
• The performance of advanced procedures.
  
• Report dictation, image and video archiving and management.
  
• Research data entry.
  
• Attendance at conferences.
  
• Inpatient consultation for patients considered for advanced endoscopic procedures.
  
• Inpatient care of patients having undergone advanced endoscopic procedures.
  
• Designing, writing, and conducting clinical research.
  

The fellowship emphasizes endoscopic research, and each fellow is expected to be actively involved in multiple research projects, and produce at least one publication by the end of the fellowship year. The division hosts an Endoscopic Research Group that meets monthly to discuss current and proposed research protocols.

The division hosts at least six educational conferences per week that include the following list of educational conferences offered by the Division of Gastroenterology & Hepatology for the training and education of Gastroenterology and Advanced Endoscopy Fellows:

• Endoscopy Conference – Held twice a month and is dedicated to various aspects of endoscopy, and includes an advanced endoscopy (ERCP and EUS) case conference.
  
• Weekly Medical Resident and Student Conferences – Fellows lecture medical students and residents on specific GI topics.
  
• Monthly Morbidity and Mortality Conference – Reviewal of untoward outcomes usually pertaining to endoscopic procedures.
  
• Weekly Journal Club – Fellows and attending physicians review and critique the current medical literature that pertains to the practice of gastroenterology and hepatology.
  
• Literature Review – Held twice a month, during which assigned articles relating to a focused topic in gastroenterology are reviewed in detail and discussed with an eye toward an in-depth understanding.
  
• Clinical Case Conference – Held weekly for three weeks of every month and is a classic case presentation and brief literature review.         
  
• Multidisciplinary Conference – Held once a month; frequently focuses on advanced endoscopic techniques and includes a dynamic educational interaction between surgeons, gastroenterologists, radiologists, interventional radiologists, oncologists, and pathologists.
• Pathophysiology Conference – A monthly conference that allows fellows to present an in-depth lecture on a specific topic.
• Colorectal Conference – Held once a month, during which multidisciplinary approaches to difficult colorectal problems are discussed.
  
• GI Grand Rounds/Research – A monthly conference where visiting lecturers are invited to give state-of-the-art lectures.         
  
• Fellows Meeting – Held monthly, during which all fellows meet with Program Directors to discuss issues regarding the fellowship program.
  
• GI Pathology Conference – A monthly meeting that allows fellows to study and appreciate the histologic correlates of the gastroenterologic disorders routinely encountered.
  
• Inflammatory Bowel Disease (IBD) Conference – A monthly conference for the purpose of discussing specific patient management issues in IBD.
  
• Motility Conference – Held monthly and reviews interesting motility cases from the prior week.
  
• Liver Pathology Conference – Meets weekly to review the week's liver biopsies and is attended by liver pathologists, the medical liver transplant service, and the surgical liver transplant service.
  
• Nutrition Conference – Held every other month.
  

In addition to the conferences sponsored by the Division of Gastroenterology, there are numerous conferences sponsored by other disciplines that are pertinent to Advanced Endoscopy Fellows. These conferences include the Multidisciplinary Pancreatic Periampullary Malignancy Case Conference, sponsored by the Department of Surgery.

Supervision & Evaluation

Fellows in the program are formally evaluated in writing and provided feedback at quarterly intervals. Research progress meetings are held weekly to maintain appropriate timelines. A procedure log is maintained through an endoscopic database to track procedural volumes.

The following faculty members perform advanced endoscopic procedures and are involved in the training and supervising the Advanced Endoscopy Fellow:

Anand Kumar, MD - Program Director
Thomas Kowalski, MD
Austin Chiang, MD
Alexander Schlachterman, MD