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PROGRAM ADVANCED ENDOSCOPY & PANCREATOLOGY ROTATION

GOALS AND OBJECTIVES

The Division of Gastroenterology at the University of Miami, Miller School of Medicine is offering a one year Advanced Endoscopy and Pancreatology Fellowship

Educational Goals:

The Advanced Endoscopy & Pancreatology fellowship offers hands-on experience in advanced endoscopic techniques applied to general GI, oncology and pancreatic disorders. This fellowship is designed for physicians who are planning a career in gastroenterology as an investigative and consultative therapeutic endoscopist with a focus in pancreatic diseases and disorders.  Fellows will receive advanced training in Diagnostic and therapeutic endoscopy, focusing on endoscopic ultrasound (EUS), Endoscopic Retrograde Cholangiopancreatography (ERCP), Balloon Enteroscopy, Endoscopic Mucosal Resection and Barrett’s Ablation.  The fellow will be immersed in gastrointestinal disorders in both non-cancer and cancer patients, and the endoscopic, diagnostic, and therapeutic modalities. The fellowship will emphasize the applications of modern diagnostic and therapeutic procedures in gastroenterology and pancreatology.

Primary goals:

Learn basic and advanced indications for endoscopic ultrasound with or without fine-needle aspiration biopsy (EUS FNA) in gastroenterology Learn indications and techniques for performing endoscopic retrograde cholangiopancreatography (ERCP) Learn the interplay between EUS and ERCP as complimentary technologies to approach pancreatobiliary diseases Understand and learn clinical and endoscopic management of pancreatic disorders including acute pancreatitis, chronic pancreatitis, pancreatic pseudocysts, pancreatic cysts, cystic neoplasms, and pancreatic neoplasms. Learn about gastrointestinal manifestations of patients undergoing treatment for different types of cancers not limited to the gastrointestinal tract Understand the management of dysplastic  Barrett’s and early esophageal cancer, using radiofrequency, EMR, and cryoablation

Clinical Experience:

This advanced endoscopy fellowship will consist of a one year fellowship at the University of Miami Hospital, University of Miami Hospital and Clinics/Sylvester Cancer Center, and Jackson Memorial Hospital. Fellows will have hands-on endoscopy experience, time for corresponding evaluation of inpatient consults, and dedicated research time for both clinical and translational research associated in advanced endoscopy and the associated corresponding medical conditions requiring these procedures. The Fellow will participate as the primary endoscopist during the procedures. The Fellow will also gain clinical exposure to pancreatic diseases and disorders in the outpatient and inpatient setting, and will attend interdisciplinary University of Miami Pancreas Center meetings to better understand pancreatology, advanced endoscopy, and the application of these novel diagnostic and therapeutic modalities into the clinical arena.

Competency Based Goals:

The following ACGME competencies are expected at the end of this rotation;

Patient care

• Fellows will learn to identify and understand the patient’s true needs, encompassing compassionate, respectful, and culturally competent care
• Deliver optimal care in a cost effective manner
• Learn to respect patient’s desire and wishes regarding their care particularly when dealing with terminally ill cancer patients
• Develop optimal patient/physician relationship  
• Learn to direct appropriate patient care between the Gastroenterology Service, Oncology and Surgery
• Discuss complications, benefits and limitations of different endoscopic procedures
• Detailed review of patient’s medical history including prior diagnostic tests, therapeutic procedures, chemotherapy and/or radiation treatments, and appropriate indication of different endoscopic procedures
• Develop the ability to be a leader and coordinate the care of oncological patients with the surgical team, oncologists and other healthcare workers

Medical Knowledge:

• Learn scientific method of problem solving and use evidence based decision
• Demonstrate an open and detailed approach to patient care, performing patient-specific literature search to improve his/her own knowledge applying to patient management
• Develop a wide knowledge base and apply to the diagnostic and treatment of gastroenterology patients
• Develop an attitude of caring from humanistic and professional values particularly in terminally ill patients
• Develop the endoscopic skills to manage and understand gastrointestinal problems in gastroenterology, pancreatology, and oncology patients
• Learn the utility of ancillary tests such as cytology, imaging tests and basic molecular pathology applied to the diagnosis of gastrointestinal cancer

Interpersonal and Communication Skills:

• Demonstrate competent oral and written communication skills, including chart

documentation

-     Medical record keeping to ensure optimal longitudinal care among different medical specialties

• Ability to work effectively as a consultant and leader to other healthcare providers treating chronic pancreatic disorders, mucosal lesions, and cancer patients.
• Ability to effectively interact with patients, families and other healthcare providers irrespective of their social, economic or cultural background.
• Ability to apply knowledge to communicate with colleagues, other fellows and nurses on service and in general with all range of socioeconomic and cultural backgrounds

Professionalism:

• Demonstrate commitment to self-improvement in all instances
• Demonstrate commitment to carry out professional responsibilities with adherence to ethical principles
• Able to identify patient’s needs that supersedes self-interest
• Respect for patient privacy and autonomy
• Respectful attitude when interacting with patients or families from other cultures, religions, sexual orientation, age groups, gender, terminally ill oncological patients and those with disability
• Develop the sense of accountability to patients, society and the profession
• Completion of assigned conferences (presenting cases during Gastroenterology, Pancreatic, Advanced Endoscopy, and Hepatobiliary conferences)

Practice-based Learning and Improvement:

• Enhance knowledge by appraisal and integration of medical literature into patient care
• Improve knowledge of basic anatomy of Endoscopic ultrasound, including use of teaching materials such as demonstrational DVDs and online resources
• Demonstration of the ability to investigate and evaluate standards of care of patients by constant review of scientific data
• Ability for the fellow to self-identify strengths and areas for improvement to continually improve care and practice
• Set learning and improvement goals in basic and advanced endoscopic procedures
• Improve knowledge by attending gastroenterology, pancreatic, and hepatobiliary multidisciplinary conferences. Apply the data learned to improve patient care

Systems-Based Practice:

• The fellow will understand how to work as part of a larger healthcare deliver system and will learn efficient standards of care
• Ability to call effectively and use other resources and community support such as social workers, home health agencies, etc.
• The fellow will  gain exposure to the importance of cost-conscious care and risk-benefit analysis in patient and population based healthcare
• Be a patient advocate
• Able to coordinate patient care within the health care delivery setting
• Identify system errors and develop solutions

Medical Knowledge:

The Fellows will be exposed to a great variety but not limited to malignant and premalignant conditions of the GI tract. The following conditions, diagnostic and therapeutic modalities will be incorporated into this fellowship:

Endoscopic ultrasound- staging of GI malignancies, evaluation of submucosal lesions, tissue acquisition of pancreatic masses and cysts. Latest application of interventional EUS. Pancreatic diseases- evaluation and management of acute pancreatitis, pancreatic cysts, acute recurrent pancreatitis, chronic pancreatitis, pancreatic pseudocysts, and pancreatic cancers. Biliary disorders- endoscopic retrograde cholangiopancreatography in patients with biliary disorders, pancreatic cancer and bile duct tumors. Barrett’s esophagus- Management of dysplastic, non-dysplastic, and cancer in patients with Barrett’s esophagus. The Fellow will be exposed to the latest endoscopic techniques of mucosal resection and ablation techniques including radiofrequency ablation. Palliation of GI cancers- Learn when to palliate GI symptoms in oncological patients: placement of endoluminal stents (biliary, esophageal, duodenal and colonic) and control of GI bleeding Colonoscopy - advanced and complex polypectomy techniques. GI manifestations in oncological and non-oncological patients- narcotic bowel, refractory vomiting, partial bowel obstruction, dysphagia, ileus, abdominal pain, and diarrhea.

Patient Population:

Fellows will perform consults on inpatients and outpatients seeking care at the University of Miami. This will include both cancer and non-cancer patients at the University of Miami Hospital and Jackson Memorial Hospital, and primarily cancer based patients at Sylvester Cancer Center. As a quaternary referral center, patients often have complex conditions requiring interdisciplinary diagnostic and management approaches. These include a wide range of gastrointestinal problems, oftentimes arising as a result of GI and non-GI malignancies and pre-malignant conditions, such as GI bleeding, upper and lower GI tract obstruction by tumors, dysphagia, chemotherapy induced GI symptoms, and biliary obstruction. The fellow will also be exposed to outpatient therapeutic endoscopy at the endoscopy units at the University of Miami Hospital, University of Miami Hospital and Clinics/Sylvester Cancer Center, and Jackson Memorial Hospital. Fellows will perform ERCP, endoscopic ultrasound (EUS), endoscopic mucosal resection, stent placement, and enteroscopy. The fellow will gain particular exposure to pancreatology, advanced endoscopy, and the application of these novel endoscopic diagnostic and therapeutic modalities in these clinical arenas.

Procedures:

Several diagnostic and therapeutic procedures are performed daily by the Fellow under direct supervision of our Faculty. Participation will depend on complexity and level of experience of Fellow. The following procedures are performed during the rotation:

• Endoscopic ultrasound with or without FNA
• ERCP with sphincterotomy and biliary stent, both plastic and metal
• ERCP with stone removal
• Endoscopic gastrostomy
• Rectal ultrasound
• Endoscopic mucosal resection
• Radiofrequency ablation
• Upper and lower endoscopy with luminal stenting, and control of bleeding
• Colonoscopy with or without polypectomy
• Enteroscopy (single balloon)

Radiology and Pathology

Results of imaging procedures and biopsies obtained are reviewed with the fellow supervised by a Faculty of our division. The Fellow will be able to examine cytology slides with the pathologist obtained during EUS guided biopsy. The Fellow will also participate in multidisciplinary conferences as part of the University of Miami Pancreas Center meetings and case conferences.

Fellow Supervision:

Fellows are supervised during all procedures, clinic visits and consults by a Board certified Gastroenterologist. All cases are reviewed by the Faculty with the Fellow prior to the procedure. Potential risks and limitations of the test are reviewed with the Fellow and the Faculty decides whether that procedure can be initiated and performed by the Fellow based on the fellows’ skill level.

Teaching:

The GI Advanced endoscopy and pancreatology fellowship is a procedure based fellowship. The Fellow will have intense hands-on experience in order to master their endoscopic skills. All patients referred for a procedure are first reviewed by the Fellow and then presented to the attending. The Faculty reviews the endoscopic approach to the problem. Fellows with the attending will incorporate imaging studies, details of the history and labs into procedural decision making. Fellows will also master their skills by use of standardized teaching materials including DVDs, online resources, and specialized GI meetings. Fellows attend all general conferences required by the general GI Fellowship Program. The Fellow will also attend the University of Miami Pancreas Center conferences, Hepatobiliary conference and the GI tumor boards at Sylvester Cancer Center. Other teaching methods include review of the literature pertinent to a specific patient or case and rounds with the attending.

Evaluation:

At the end of one year fellowship the Faculty will evaluate the Fellow addressing the six competencies. Evaluations, a hard copy, are reviewed with the Fellow and stored in the Fellow’s evaluation folder. Fellows will evaluate the supervising Faculty at the end of rotation. The evaluation will be reviewed with the fellowship Program Director. Fellows will also evaluate and review their fellowship experience at the annual end of the year program evaluation.

Current Employees:

If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position using the Career worklet, please review this tip sheet.

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