Overview
Mission of the division is to train academic gastroenterologists and hepatologists. To achieve this goal, research is an integrated part of the program. Applicants are asked to designate in their application whether they wish to focus their research training in basic or clinical investigation at the time of application. The basic research pathway is for the fellow interested in laboratory-based research. Fellows whose interests center around patient-related research, including epidemiology, outcomes, or heath policy are encouraged to obtain formal training in clinical research leading to a master degree during the fellowship as the best preparation for an academic career. The first year is entirely dedicated to clinical training. The second and third year are devoted to research under direction of the mentor woven with additional clinical trainings to be successful in academic gastroenterology and hepatology.
First year
The first year of the program is devoted entirely to acquiring the clinical skills necessary to be an accomplished gastroenterologist and hepatologist. In addition to performing inpatient and outpatient consultations, the trainee gains considerable experience with those procedures necessary to fulfill this role. These procedures include upper gastrointestinal endoscopy, esophageal dilation, endoscopic band ligation, endoscopic hemostasis techniques, colonoscopy, polypectomy, and liver biopsy. Throughout the year, biopsy and x-ray interpretation are stressed. Trainees also get some exposure to endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography (EUS). Clinical training is divided equally among the three participating hospitals: Stanford University Medical Center , VA Palo Alto Health Care System, and Santa Clara Valley Medical Center . Each of the first-year fellows spends equal time at each hospital. The night call schedule and precise duties vary somewhat at each hospital. Description of the programs at each of the hospitals is given below. All fellows will identify one or more research mentors and projects during their first year.
Second and Third Year
Laboratory-based fellows spend a significant portion of their second and third years in bench-oriented research activities, while fellows interested in a more clinically-oriented research spend most of their second and third years gaining clinical and investigative skills as well as completing course work if part of a master degree program. Research fellows will spend the last two years, or more if needed, in one of the well-established research programs of a full-time Stanford faculty within or outside of the Division of Gastroenterology and Hepatology. Some fellows are supported, in their research year, by a National Institutes of Health (NIH) training grant. Fellows are encouraged to prepare independent applications for advanced research training, including National Research Service Awards, VA Career Development Awards, NIH Clinical Investigator and Physician Scientist Awards, or applications to pharmaceutical companies to carry out therapeutic trials. Our fellows have been very successful in procuring extradivisional funding such that support during the period of training has not been an issue.
During their second and third fellowship years, fellows will devote additional time to clinical activities to meet the requirements for board eligibility and certification including hepatology. Clinical activities include participating in one half-day continuity and other specialized outpatient clinic per week, performing procedures on clinic patients and sharing night-call responsibilities at Stanford and the VA. Laboratory-based fellows who remain in the program beyond the third year frequently choose to maintain their clinical skills by attending some outpatient clinics or performing endoscopic procedures, and are generally appointed as Clinical Instructors.
Fellows interested in clinically oriented research will devote considerably more time to patient care in their second and third years, including activities related to the specific clinical studies they are undertaking. For many, this means acquiring additional formal training by enrolling in a Master degree program in a related field. For other, it involves advanced training in general liver disease, transplant hepatology, and exposure to diagnostic and therapeutic ERCP, EUS, and advanced endoscopic techniques. Each fellow will work under the supervision of one or more faculty mentors, and each clinically oriented fellow is expected to complete one clinical study and submit one manuscript per year for each of their second and third years of training. Sufficient protected time is provided during the second and third years of training to facilitate completion of clinical studies. Planned research projects are presented at the GI Clinical Conference once a year during the second and third year of training, and a progress and more polished research talk is also presented at the end of the year by each of the second and third year fellows. A Research Committee monitors the progress of the research and provides oversight to each of the fellows.
