The fellow will evaluate patients on the various services of the hospital services with faculty attendings.  Rounds are made daily with faculty attendings.  On rounds, teaching objectives include formulating a differential diagnosis and evaluating possible diagnostic possibilities and therapeutic options.  Attention is given to an understanding and evaluating possible diagnostic possibilities and therapeutic options.  Attention is given to an understanding of the underlying physiology and pathophysiology.  Procedures, when necessary and appropriate are performed by the fellow under the supervision of the faculty attending.  Fellows will learn all aspects of gastroenterology and liver disease care and will display all general competencies during this experience.

The fellow will participate in increasing levels of management/treatment involvement with patient needs depending on the fellow’s level of experience.  The fellow will be expected to formulate the differential diagnosis, institute diagnostic studies and recommend therapy.  Increased participation will result in increased gain of medical knowledge and skills and gastroenterology/hepatology.

Fellows will develop familiarity of problems with complex gastroenterological issues related to irritable bowel syndrome, inflammatory disease, motility disorders, malabsorption, and screening/surveillance for neoplasia or dysplasia.  In addition, structural abnormalities of the esophagus, stomach, duodenum, small bowel, pancreas, biliary tree, and liver may be encountered in the differential diagnosis.  Fellows will also gain knowledge and management of medications that may have serious systemic complications and/or the potential for drug interactions.  Fellows will also develop familiarity with standard treatments for common complications such as ascites, portal hypertension, or hepatic encephalopathy, and will build familiarity with standard treatments of chronic liver diseases, such as viral hepatitis, autoimmune liver diseases, metabolic diseases, drug-induced liver disease, fatty liver disease, and liver tumors.  Fellows will obtain exposure to the liver transplantation selection process and will receive experience in the timing of referring patients for liver transplantation            

The fellow will evaluate patients in the outpatient setting.  Referrals may be received from Medicine, Surgery, or other services lines in the Ochsner LSU Health System. Outpatient clinic encounters are made with a faculty attending specializing in hepatology.  An elective is also available to rotate to the Ochsner Medical Center (Jefferson, LA) for a two week exposure to transplant hepatology.  The purpose of supervised clinical encounters is to establish a differential diagnosis and therapeutic options for patients.  Discussions of basic anatomy and physiology with regard to liver diseases may arise.  Issues of costs for treatments, and effectiveness of various therapies, specifically for viral Hepatitis C may also arise.  With the rapidly evolving therapies in Hepatitis C, the fellow will be kept abreast of significant therapeutic changes.  The fellow will be involved in increasing levels of management of patients with more complex gastroenterological and liver disease process.  Fellows will also be provided instruction in end-stage liver disease management including pre-/peri-/post-transplant activities and hospice care of patient with acute and chronic liver disease.

The fellow will evaluate the small bowel video capsule endoscopy, gastrointestinal motility, and ambulatory pH studies completed in the endoscopy suite.  An attending physician is assigned to provide supervision in the evaluation of these studies.  The fellow will also participate in endoscopic procedures in the endoscopy lab.  Discussions of basic anatomy and physiology, including mental health and financial issues may arise in the rounds.  All clinical competencies will be employed in the care of motility studies/capsule endoscopy and endoscopy.

The fellow will evaluate patients on the infusion/Inflammatory Bowel Disease Clinic/Service. Patient receiving infusions for inflammatory bowel disease will be evaluated during their infusion visit.  An attending physician is assigned to provide supervision in the management of the patient during the infusion process.  Each patient has labs obtained prior to infusion that will be reviewed by the fellow and undergo a clinical encounter/physical examination.  This rotation creates a medical home environment for the patient to address concerns/problem between continuity gastroenterology clinic visits. The purpose of teaching rounds is to establish a differential diagnosis and therapeutic options for patients.  Discussions of basic anatomy and physiology, including mental health and financial issues may arise in the rounds. Fellows may also participate in endoscopic procedures in interim period between infusion clinical encounters.  All clinical competencies will be employed in the care of inflammatory bowel disease patients and endoscopy

Each fellow will also be assigned to a continuity gastroenterology/hepatology clinic in a 4 hour block in the 2nd floor GI Subspecialty Clinic in the Outpatient Care Building at 1541 Kings Highway, Shreveport, Louisiana.  The block is based on the fellow’s assigned rotation to maximize educational opportunities at the training sites.  Each fellow is expected to follow an average of four (PGY4) to eight (PGY6) patients in their continuity clinic on average over the three year fellowship experience with the average number of patients increasing as the fellowship experience proceeds.  No break in greater than 30 days is allowed throughout the entire 36 month training period.  The patients of the continuity clinic will represent a diverse patient population of all adult age groups, diseases, ethnicity, and gender.

The Scholarly Activities Rotation introduces the fellow to the field of gastroenterology and hepatology research.  Year 1 fellows begin development and planning for research, which Year 2 and Year 3 fellows develop formalized plans for research, work, and post-research outcomes.  The Section of Gastroenterology and Hepatology and the Department of Physiology have a moderate sized faculty with diverse clinical and academic interests.  Fellows will have the opportunity to complete scholarly activities of their choice with a faculty attending in varied areas of interest.  The fellow will participate in increasing levels of research activities, depending on the fellow’s level of interest and experience.  Knowledge gained is directly related to the time dedicated to this rotation.  The three dedicated months of research are spread out over the three years of the fellowship program; however, up to a total of six months of research dedicated rotations may be taken if elective months are utilized. Learn more about our Research Program.

Attendance: Mandatory  for Fellows/Faculty

LSUHS GI fellows present clinical cases in which all the ACGME competencies are taught to the other fellows, faculty, and other attendees.  The conference will also develop Practice Based Learning and Improvement and Systems Based Practice.  This conference will assist the fellow in realizing the limitations of their skills and knowledge.  A review of scientific studies and other expertise will be used to stimulate discussion.  The fellow will collate all health record materials (lab, radiology, pathology, etc) as necessary.  This conference is also the venue for presentation of morbidity and mortality (M & M) cases.  Participants are encouraged to present complications associated with patient care activities to address potential situations for system improvement and/or policy change in the care of patients.  This conference occurs weekly. Competencies Addressed:  SBP, MK, ICS, PBLI, P, PC

Attendance: Mandatory  for Fellows/Faculty

Review of gastroenterology/liver pathology by a member of the Department of Pathology.  This conference occurs once monthly in the pathology department at 2:00 P.M. on the first Thursday of the month.  Fellow/Faculty attendance commentary is provided. Competencies addressed:  PC, P, SBP, PBLI, MK

Attendance: Mandatory for Fellows/Faculty

This once quarterly conference is a brief review of research activities of the Section of Gastroenterology and Hepatology.  Speakers will be a mix of clinicians and basic scientists. Competencies addressed:  PC, P, ICS, PBLI, MK, SBP

(Attendance: Mandatory  for Fellows/Faculty)

This once a month conference entails a brief review of recent gastroenterology medical literature based on the New England Journal of Medicine Journal Watch Gastroenterology newsletter.  This forum will be led by one of the faculty members/senior fellows of the section.  Important new guidelines published by the following societies are also presented:  ACG, ASGE, AGA, and AASLD. Competencies addressed:  MK, PBLI, PC, SBP

(Mandatory - Faculty/Fellows, unless clinical activities prevent attendance)

This weekly conference at 8:00 A.M. on Wednesday reviews patient with hepatic, biliary, and pancreatic patients as compiled by the Departments of Radiology and Surgery, along with the Sections of Gastroenterology and Hepatology and Hematology/Oncology.  Competencies addressed:  SBP, PC, MK, PBLI

(Mandatory - Faculty/At least one faculty member must be present for conference). 

The weekly GI Questions/Video Conference is a forum to allow fellows to develop comprehension of important concepts in gastroenterology and hepatology.  The conference will be held every Thursday at the end of the weekly core curriculum conference.  The Digestive Diseases Self Evaluation Program/ACG Board Review Question of the Week provides the basis for this conference.  A topic is selected for each session based on the chapters of the program.  Fellows provide the leadership for this conference with faculty attendings providing discussion of concepts using a question and answer format.  Video sessions are derived from the ACG Education Universe The ACG Education Universe is an online, self-directed CME program that provides a way for all gastroenterologists to access outstanding tools in preparing for the GI boards, recertification, or obtaining necessary CME credits outside of the ACG meetings. Users can choose what they want to learn about, the format of the information, and how much time they want to devote to learning at any given point. A wide variety of education materials including lectures, journal articles, self-assessment test questions and more will allow the user to define the specific parameters for study to meet his or her needs and interest.  The Universe provides opportunities for GI trainees to enhance and measure their knowledge as the content and test questions relating to the core curriculum and materials relating to the ACGME competencies will continually developed and updated. Additionally, videos from the American Society of Gastrointestinal Endoscopy may be viewed for appropriate endoscopic topics.  Competencies addressed:  MK, PBLI, PC.

(Mandatory - Fellows/Faculty)

On a semi-annual basis, fellows will present an update of their quality improvement projects.  Level 1 fellows will provide an overview of their proposed project.  Level 2 fellows will provide an update on their project and success in data acquisition.  Level 3 fellows will provide a brief powerpoint style presentation of their outcomes data with future recommendations for the institutions.  Additionally practice guidelines of significant import related to the topic of interest may be provided at this conference by a faculty member.  Competencies addressed:  PBLI, MK, SBP, ICS, PC, P

(Mandatory - Fellows on rotation/VA faculty)

This bi-weekly Monday morning weekly conference at 7:00 a.m. is a conference for the presentation of an interesting case or journal article by a gastroenterology fellow.  Two fellows are provided 30 minutes each for the presentation.  Conference is mandatory for fellows assigned on the VA Service.  VA faculty gastroenterologists attend this conference. Competencies addressed:  MK, PBLI, PC, SBP, ICS

(Mandatory - Fellows/Faculty)

Current journal articles in gastroenterology/hepatology are presented and discussed on the second or third week of the month on a Wednesday evening.  Location alternates between a faculty member’s home and a restaurant (Dutch treatment).   One fellow will present an article for discussion and subsequent fellow/faculty commentary. Additional articles of interest are presented by faculty/fellows.  Competencies addressed:  MK, PC, PBLI, P, ICS, SBP

(Mandatory - Fellows/Faculty)

Recently released guidelines and guidelines of substantial import in gastroenterology/hepatology are presented and discussed on the fourth week of the month in the Thursday afternoon block conference time.  Two fellows will present an article for discussion and subsequent fellow/faculty commentary. Competencies addressed:  MK, PC, PBLI, P, ICS, SBP

(Mandatory - Fellows/Faculty)

Review of gastroenterology/liver radiology.  This conference occurs periodically.  Fellow/Faculty commentary is provided.  Competencies addressed:  PBLI, MK, SBP, ICS, PC, P

(Mandatory - Fellows/At least one faculty member must be present for conference). 

This intensive review of physiology conference is led by the fellows as a basic science review of the various physiology topics.  This conference is designed to be a 15-20 minute quick review of a physiology topic using the textbook:  Gastrointestinal Physiology, 7th Edition by Leonard R. Johnson.   A faculty representative is present for commentary.  Fellows are also encouraged to attend the 2nd year medical students physiology course for gastroenterology for more detailed physiology discussions.  The conference will be held after hours at a faculty member’s residence in a casual setting for three sessions lasting ~ 4 hours in the Spring of the academic year.   Competencies Addressed:  MK, ICS, PBLI

(Mandatory - Fellows/At least one faculty member must be present for conference)

This brief bio-statistics review is led by the fellows/faculty member as a basic review of the principles of statistical methods.  Topics covered will be basic principles to biostatistics.  This conference is designed to be a 15-20 minute quick review of several topics in the field of biostatistics.

(Mandatory – Fellows)

Held in the 3^rd Floor Lecture Hall of the medical school (Building B) at noon on Tuesdays.  Medicine Grand Rounds are usually suspended in the months of July.