The Gastroenterology Fellowship Program

Rad M. Agrawal, M.D., Program Director

Length of program: 3 years
Number of position(s): 2

The Gastroenterology Fellowship Program offers comprehensive training in gastrointestinal diseases. Upon completing the program, fellows are sufficiently trained in gastroenterology to be eligible for certification. The program structure provides academic, clinical, endoscopic and clinical research components to fellows during a mandatory three-year period. In the third year, advanced therapeutic training to enhance skills in complex endoscopy is offered.

Clinical training provides fellows opportunities to handle diagnostic and therapeutic problems on inpatient and consultative services under the supervision of board-certified gastroenterologists.

<> Endoscopic training encompasses all upper and lower endoscopic procedures, including: esophagogastroduodenoscopy (EGD), various esophageal dilations, sclerotherapy, flexible sigmoidoscopy, colonoscopy, polypectomy, ERCP, sphincter of Oddi manometry, endoscopic sphincterotomy, biliary and pancreatic stent placements, stricturotomy, laser therapy, endosonography, enteroscopy, esophageal/gastric/small bowel/colonic motility studies and 24-hour pH monitoring studies.

The Center for Digestive Health offers a rich experience in outpatient GI with specific emphasis on inflammatory bowel disease, nutrition, functional bowel disease, hepatology and integrated medicine. Research trials and program development are a part of each of the center's disciplines. Fellows may elect to spend dedicated time in one of the specific disciplines or rotate throughout the center.

Clinical rotations include: radiology/nuclear medicine, general surgery (primarily gastrointestinal surgery cases) and hepatology. Clinical research is actively encouraged. Fellows may participate in division clinical research projects or design their own studies.

Clinical Rotations

Year 1
During Year 1 of the program, fellows are actively involved in teaching and managing patients on the inpatient service. In addition, they develop endoscopic skills in procedures such as EGD, endoscopic biopsy, cytology, biliary drainage, flexible sigmoidoscopy and endoscopic dilation. In the last six months of the Year 1, fellows learn and perform sclerotherapy and colonoscopies. They become proficient in performing and interpreting tests, such as various G.I. motility studies and 24-hour pH monitoring.

Supporting services include pathology, diagnostic and therapeutic invasive radiology, medical imaging, nuclear medicine, general surgery, hematology oncology and radiation oncology.

Year 2
Year 2 focuses on more advanced endoscopic procedures such as pneumatic dilations, diagnostic and therapeutic colonoscopies (with polypectomies), in addition to ERCPs, sphincter of Oddi manometry, sphincterotomies, stent placements, endosonography, enteroscopy and the therapeutic approach to complex G.I. bleeding. Year 2 and 3 fellows are responsible for advanced motility studies. Year 2 fellows serve as consultants on the inpatient services. They can participate in elective rotations with general surgery/radiology/pathology (internal rotations). Clinical research continues to be an important part of the Year 2 program.

Year 3
Advanced therapeutic training is offered during this year of training and includes: ERCPs, sphincter of Oddi manometry, esophageal pneumatic dilations, stricturotomy, endosonography and enteroscopy. Others may choose to devote Year 3 primarily to research or to the study of a particular disease process.

General Information

Writing case reports, participating in journal clubs, presenting papers at national meetings and publishing are significant parts of the program. Fellows are advised and encouraged to attend various national meetings. Multilevel, interdisciplinary conferences and seminars in gastrointestinal pathophysiology, clinical gastroenterology, hepatic histopathology, radiographic interpretation and procedural reviews engender a scholarly atmosphere and ensure high standards of excellence.

The distinction of this postgraduate training experience derives primarily from the blending of a large referral base, drawn from a broad tri-state geographic area, and the academic environment of Allegheny General Hospital. These factors help optimize the training experience.



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