Pediatric Gastroenterology Fellowship Program

Mission

The mission of the Pediatric Gastroenterology Fellowship Program is to develop physicians who excel in their clinical care, are effective educators and life-long learners, and are able to develop new knowledge (research) to improve patient care.

Overview

The Michigan Medicine (University of Michigan) Pediatric Gastroenterology Fellowship provides excellent ACGME accredited clinical and research training. The Pediatric Gastroenterology Fellowship is a three-year program specifically directed toward individuals interested in pursuing academic careers or assuming leadership positions in clinical practice.

During the first year, fellows in the program spend approximately four to five months on the inpatient clinical service and 3 months on the consult service.The remainder of the first year is spent in the outpatient clinics and developing an academic or research interest. The second and third years concentrate on developing the skills and understanding necessary to become either a clinical scientist or a basic scientist, while also maintaining clinical skills through the regular fellows’ continuity clinic and one to two months on the inpatient and consult services.

The Pediatric Gastroenterology Division has an active inpatient and outpatient practice. Fellows follow their own continuity patients throughout their three years of training. The fellows' continuity clinic meets 1/2 day a week, typically on either Friday mornings or afternoons. When not on inpatient service, fellows rotate through the quaternary care clinics (i.e., liver transplant, intestinal rehabilitation) as well as the faculty clinics. They have the option to participate in those clinics throughout the remainder of their fellowship.

A growing number of Michigan Medicine off-site locations, as well as partnerships and joint ventures with other institutions, extend the range of training options both regionally and internationally.

The University of Michigan offers competitive salaries and benefits to our residents/fellows. An overview of salary, benefits and employment eligibility is available on the GME Office website, under “Prospective Residents/Fellows.”

Program Highlights:

  • Transplant Hepatology Program: The Pediatric Gastroenterology Division currently has 3 transplant hepatologists. Our transplant volumes place us among the top 15 programs in the nation; the transplant outcomes are among the best in the country.  In the State of Michigan, the U-M program is the largest, oldest, and most experienced liver transplant program. We have nationally recognized expertise in the study of adherence and transition for liver transplant recipients, and also are involved in multiple local and multi-center studies.
  • Inflammatory Bowel Disease Program (IBD): Both quality improvement and population management are essential components of our IBD program. The division cares for approximately 650 IBD patients and is very active in the ImproveCareNow network (ICN), a multi-institutional QI program. Our attendings and fellows meet weekly to discuss our sickest IBD patients and their care plans along with having regular meetings with our Pediatric Surgery colleagues. Fellows also are engaged in a quality improvement curriculum and also in projects which help them learn how to improve our excellent IBD care.
  • Intestinal Rehabilitation Program: The division follows patients with Short Bowel Syndrome and other types of intestinal failure, and has the largest and most active intestinal rehabilitation program within the state.
  • Fellows’ Continuity Clinic: Pediatric GI fellows have their own weekly clinic with a panel of patients for whom they are the primary caregivers.  They are closely supervised and have support in patient care to ensure the best possible outcomes.
  • Longitudinal Procedure Days: Fellows receive frequent procedure exposure during their first year and continue to have regular procedure days throughout the remainder of their fellowship. We believe it critical to maintain procedural skills throughout the fellowship.
  • Research: Fellows have abundant opportunities to pursue both clinical and bench research, and have protected research time in years 2 and 3. Their research is supported by the division and not dependent on external funding. 
  • C.S. Mott Children’s Hospital: The C.S. Mott Children’s Hospital in Ann Arbor forms the cornerstone for the majority of the Pediatric Gastroenterology division activities. First established in 1969, the current hospital is a 348 bed children’s hospital which opened in 2011. Mott is consistently ranked as one of the top children’s hospitals in the country by U.S. News & World Report and Parents magazine.
  • University of Michigan Health Center, Medical School, and University of Michigan: The fellowship has the privilege of being associated with an outstanding medical center, a nationally ranked medical school, and a university which consistently ranks as one of the best in the world. This environment allows for unique clinical and intellectual collaboration opportunities with multiple areas of the university system.
  • Ann Arbor: University of Michigan is located in Ann Arbor which has been highly ranked in multiple categories including “Best Places to Live,” “Best College Towns in America,” “Best College Towns for People Who Aren’t in College” and “Most Educated City in America” by USA Today, Forbes, Conde’ Nast Traveler, Fodor’s, and Business Insider.  
  • HOA membership: Fellows are automatically enrolled as members of the UM House Officer Association (HOA) which negotiates contracts for all house officers, including extremely competitive salaries and comprehensive employment benefits. For more details, click on this link: http://hoaumich.org/contract/2013/.

Clinical Training

Clinical training includes the development of broad clinical skills in pediatric gastroenterology with exposure to a diverse population of patients ranging in age from newborn to young adult with both complex and common gastrointestinal problems. The clinical emphasis is to diagnose, manage, and understand the physiology of gastrointestinal issues. To achieve this objective, trainees have a continuing and growing responsibility for the care of patients in the outpatient clinic throughout their training. Pediatric gastroenterology subspecialty trainees have their own clinic with a separate schedule. Patients, both new and return visits, are scheduled into the clinic the same way as an attending physician's patients are scheduled; the clinic is staffed by pediatric gastroenterology faculty members on a rotating basis.

The clinical experience includes patients with the following diagnoses:

Acute and chronic liver disease

Biliary disease

Chronic abdominal pain

Chronic diarrhea/malabsorption

Constipation

Gastroesophageal reflux

Inflammatory bowel disease

Pancreatic disease

Poor growth

Ulcerative colitis

Procedures

Broad clinical competence also includes the ability to perform gastroenterological tests and procedures safely and to interpret these results accurately. Procedures include the following:

Colonoscopy

Upper endoscopy

Stricture dilation

Sigmoidoscopy

Banding of esophageal varices

Endoscopic therapeutic injection

Hemostasis

Polypectomies

Liver biopsies

Paracentesis

pH probes (interpretation only)

 

Clinical Responsibilities and Expectations - Inpatient Service 

During inpatient rotations, fellows are responsible for all patients admitted to the Pediatric Gastroenterology Service The number of patients the fellows follow is variable, but generally are five to ten patients on the service. Fellows are supervised by the Pediatric GI attending on service. All patients are seen on the same day of admission. The Pediatric GI service rounds with residents, staff, and patients/families daily. Rounding with the primary inpatient GI team takes one-two hours per day depending on the census. During these patient-family centered rounds, each patient’s progress, physical examination, and treatment plans are discussed. If possible, the treatment plan is discussed in the context of a teaching experience with the house staff and medical students where pathophysiology and current medical advances are brought into the discussion of treatment decisions. Fellows are closely involved in medical decision making, all patients interactions, and teaching of residents and medical students.

Consult Service

Fellows evaluate consultations from other services and follow these patients’ progress as part of continuing management of the particular gastrointestinal problem. Consultations are seen within 24 hours of request. A curriculum on common consultation topics supplements this learning opportunity.

Clinical Responsibilities and Expectations - Outpatient Service

Fellows are responsible for the evaluation and follow-up care of the patients seen in the ambulatory setting. This includes the original evaluation, follow-up letters and calls to the family and physicians, inquiries regarding laboratory tests, involvement with gastrointestinal testing, and interpretation and viewing of radiological studies. Once the patient is evaluated, the history and physical examination are presented to the gastroenterology attending who then reviews or expands the history with the patient and examines important areas pertinent to the presenting complaint. A discussion of the differential diagnosis, clinical management, and final plan takes place either in the staff room or in the examination room with the family. In year 2 and later, the fellow discusses the clinical impression and management plan with the family with the attending present.

Longitudinal Continuity of Care - Inpatient Service

Continuity of patient care is assured by the assignment of new patients to the fellow currently on the inpatient gastroenterology service. The fellow is involved in all treatment decisions as long as the patients are hospitalized, and is encouraged to enroll the patient in their continuity clinic. This decision is made prior to the fellow rotating off service or as the patient is discharged while under their care. Appropriate clinic scheduling to their continuity clinic is part of discharge planning.

Longitudinal Continuity of Care - Outpatient Service

Fellows are scheduled for continuity clinic one-half day per week. New patients are scheduled in the fellows' continuity clinic each week and return to the fellow’s clinic as necessary.

Self-Instruction, Critical Thinking and Teaching Skills

Trainees are expected to demonstrate their interest in and ability to both critically reading manuscripts and teach individuals (medical students and house staff) in small group settings. Communication skills for scientific presentations and preparation of teaching materials for didactic presentations also are emphasized. Upon completion of their three year training, all trainees should be competent to be sub-board eligible and complete the pediatric gastroenterology specialty certification in a timely manner.

Research Opportunities (Scholarly Activity)

The University of Michigan has active clinical and basic science research programs which provide numerous opportunities for the Pediatric Gastroenterology Fellow Trainee. During the first year of fellowship, the trainee is expected to interview both basic and clinical scientists to determine the direction of their future research and identify a mentor for their research years.
Clinical Projects
Trainees choosing a clinical project are expected to review the pertinent literature to help design the research project; this includes preparation of the consent for the Institutional Review Board (IRB) approval. Trainees will be given the opportunity to participate in formal education in the protection of human subjects, and will be expected to understand the ethical and safety issues of research in the child or adolescent.
Basic Science Projects
Trainees choosing a basic science project are expected to review the literature pertinent to their research interest, help design the research project, collect data, learn and execute the appropriate statistical analyses, and prepare the data for presentation in both oral and written form. It is expected that the trainee will be first author on one or more peer reviewed manuscripts derived from their research project.

Supervisory Policy

The written guidelines are communicated and provided by the Department of Pediatrics and the University of Michigan Health System, at large, based on accreditation guidelines for hospitals (HCFA).  

The Division of Pediatric Gastroenterology complies with The University of Michigan Graduate Medical Education supervision policy.

  • The attending physician faculty evaluates, assesses and decides on a treatment plan for all patients admitted to the gastroenterology service on a daily basis.
  • He or she provides daily notes. The frequency of the written notes for patients under consultation varies depending on the complexity of the problem and the need for regular advice. This policy is followed whether a fellow is rotating on the in-patient service or not.
  • The fellow’s responsibility is to evaluate the patient first prior to the attending physician.
  • In addition, it is the fellow’s responsibility to immediately notify the attending physician of all new admissions, requests for consults, and significant worsening of a patient's status.
  • Similarly, in the outpatient service the attending physician evaluates all patients once the fellow has evaluated the patient and has delineated their own management plan.
  • All contacts with the attending faculty provide the opportunity for discussion of the clinical picture, social issues, or recent reports of the literature relevant to the current patient context.
  • Urgent consultation is offered to all areas of the hospital 24 hours a day, 7 days a week. 

Michigan Medicine Diversity, Equity, and Inclusion Initiatives

The Division of Pediatric Gastroenterology recognizes the value of a diverse and equitable community to education, scholarly activity, and patient care.  We prioritize diversity, equity, and inclusion as one of the central aspects of our overall mission. We seek to develop a diverse community by recruiting individuals of all cultural and ethnic backgrounds, sexual orientations and gender identities, and individuals with disabilities to participate within our group’s clinical and academic missions. 

We have therefore worked to incorporate DEI initiatives into our training curriculum and faculty development.  We participate with the Department of Pediatrics Diversity, Equity, and Inclusion Action Committee and have a faculty member in a leadership role of the that committee.  Our division receives bystander training and sessions on unconscious bias. Our faculty, trainees, and staff treat each other respectfully and value the contributions of each person. 

Michigan Medicine Global Health Initiatives

The medical school’s Global REACH program is a nationally recognized leader for developing individuals and programs to improve health and healthcare through collaborative partnerships in other countries. We have collaboration platforms in Brazil, China, Ethiopia, Ghana and India. Additional information on the Global REACH program is located at: http://globalreach.med.umich.edu/

Contact Information

Dr. Andrew Singer
Fellowship Program Director
Pediatric Gastroenterology
MPB 5200 SPC 5718
1500 East Medical Center Drive
Ann Arbor, MI 48109-5718
aams@med.umich.edu

Mary Kakritz
Fellowship Program Coordinator
Pediatric Gastroenterology
MPB 5200 SPC 5718
1500 East Medical Center Drive
Ann Arbor, MI 48109-5718
Office: 734-936-4717-
Fax: 734-763-7359
Mkakritz@med.umich.edu

 

Dr. Martin

Watch Dr. Martin, Chair of the Department of Pediatrics, speak about the benefits of training at Michigan Medicine.

 

Training at Michigan Medicine video

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