Division of Gastroenterology & Hepatology

Jefferson offers advanced training in hepatology and liver transplant medicine for individuals who have completed training in Internal Medicine, Gastroenterology, as well as through the American Board of Internal Medicine pilot three-year combined gastroenterology/transplant hepatology pathway. This is a clinical program with emphasis on clinical research and teaching.

Jefferson is one of the largest medical training facilities in the country, offering unique educational opportunities in patient and laboratory-based research. We have the Delaware Valley's oldest active liver transplantation program that has been in place since 1984, and manage more than 600 transplant candidates or recipients per year. This allows the fellowship candidate the opportunity to meet UNOS requirements for eligibility as a transplant hepatologist if so desired. The program is structured in such a way that the advanced liver fellow's activities will focus entirely on liver disease and transplantation, with special emphasis on clinical research.

Given the limited time period of training (one year), we provide the fellow a number of active research protocols from which he or she can choose to be a part. This program strongly encourages participants to contribute to an assigned protocol in a substantial way, so they have the opportunity to submit abstracts to national meetings and generate publications. The education of gastroenterology fellows, residents, interns, and medical students will be a daily exercise, providing lectures, morning rounds, and participating in trainee clinics. Clinical activities will include patient management in hepatology clinics, liver transplantation clinics, and the hepatology/liver transplant hospital service.

Our hepatology staff has depth in both clinical and laboratory realms. The primary mentor of the hepatology fellow, Danielle Tholey, MD, is the Program Director, Assistant Professor of Medicine and Director of our Fatty Liver Center. Dina Halegoua-De Marzio, MD is Associate Professor of Medicine, Associate Chief and Director of Research, Division of Gastroenterology and Hepatology and the Director, Jefferson Fatty Liver Center. Dr. Halegoua's areas of expertise are in metabolic associated steatotic liver disease and drug induced liver injury. Steven Herrine MD, is Professor of Medicine and Dean for Academic Affairs and Undergraduate Medical Education. Dr. Herrine’s areas of expertise are in viral hepatitis, liver transplantation, and medical education. David Sass, MD, is Professor of Medicine and Medical Director of Liver Transplantation. His clinical and research focus is directed at issues of advanced liver disease and transplantation. Jonanthan Fenkel, MD, is Associate Professor of Medicine and Director of the Hepatitis C Center. His areas of interest include: hepatitis C, HIV/HCV coinfection, portal hypertension, and liver transplantation. Jesse Civan, MD, Assistant Professor of Medicine and Medical Director of our Multidisciplinary Liver Tumor Center, has research interest in the pathophysiology, detection, and therapy of hepatocellular carcinoma. 

Clinical activities in hepatology at our program are designed to provide inpatient and outpatient experience in all facets of liver disease. The advanced hepatology fellow will be expected to develop an individual outpatient clientele (under supervision), so as to gain independence in decision-making and providing continuity of care. Education in managing patients before and after liver transplantation is concentrated in our liver transplant clinics, where medical and surgical staff work together. Each hepatology fellow is expected to spend at least six months on the inpatient hepatology service, primarily consisting of patients with advanced-stage liver disease and liver transplant recipients. Besides developing skills in managing patients with severe complications of hepatic failure, each fellow is expected to participate in making decisions concerning immunosuppression and recognition/management of post-operative problems (e.g., treatment of recurrent HCV). Weekly educational conferences include the liver transplant selection committee meeting, inpatient clinical conference, liver biopsy review, and radiology conference. Morbidity and mortality conference, journal club, multispecialty conference, and research conference also meet at regular intervals (every 2-4 weeks). Postgraduate courses in epidemiology, statistics, and molecular biology, to name a few, are available to fellows to enhance their educational experience, but are not required.

Education of medical students, residents, and gastroenterology fellows will be incorporated into the daily routine. This experience will include running a morning report for the hepatology service. The advanced hepatology fellow will be responsible for selecting teaching cases from the hepatology service on a weekly basis, from which short topics can be developed for instructional purposes. Relevant literature review will accompany the case, and discussion will be supervised by an experienced staff hepatologist. In addition, the hepatology fellow will be incorporated into weekly gastroenterology conferences for case discussions and critical literature reviews. Daily teaching rounds on the hospital service will provide a format for informal training of gastroenterology fellows, medicine residents, and interns.

Research will be one of the most strongly emphasized components of the advanced hepatology fellow's training experience. It is crucial for fellows to gain experience in the process of formulating research questions and developing pathways designed to answer these questions. Given the limitations of time, our program will abbreviate the process by providing experience in a selected protocol that is currently active. Most likely, this year's fellow will be incorporated into one of our active viral hepatitis protocols involved in the identification and treatment of patients with hepatitis C. In this way, the fellow can participate in the process of data accrual and analysis, with the intent to formulate abstracts for presentation of data at national meetings. Manuscript preparation will be the ultimate goal, and dedicated time will be allotted (~8 weeks) in order to accomplish this task. Book chapters and case reports are other potential sources of experience for the exceptional candidate able to complete the goals of a primary research project in a timely fashion.

The advanced hepatology fellow should come out of this one-year training program with a well-rounded experience in liver disease and transplantation. The trainee should feel comfortable managing patients with any of a variety of different types of liver disease as well as the complications of hepatic failure. Developing skills in the care of liver transplant patients will also be an integral part of their education. Productivity will be specifically linked to completion of achievable goals within a research project. Skills in teaching will be graded by students using questionnaires. Ultimately, we hope to help fellows develop careers in hepatology and liver transplantation while demonstrating how patient-directed research can be incorporated into day-to-day practice.

Transplant Hepatology

Rachel Redfield, MD
Undergraduate: The University of Maryland, College Park
Medical College: The University of Texas
Internship/Residency: Thomas Jefferson University Hospital
Gastroenterology Fellowship: Cooper University Hospital