Department of Medicine

Rotations

Master
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Baylor College of Medicine hepatologists and transplant surgeons provide training in both the outpatient clinics of the Baylor St. Luke's Liver Center and inpatient services of the Baylor St. Luke's Medical Center. Our transplant surgeons perform orthotopic liver transplantation (OLT) at the Baylor St. Luke's Medical Center, Texas Children's Hospital, and the Michael E. DeBakey VA Medical Center.

Baylor faculty hepatologists and transplant surgeons provide training in consultative care of patients with hepatobiliary diseases. The Baylor St. Luke's Liver Center is a state-of-the-art outpatient facility for outpatient clinical care. Hepatology and Liver Transplantation fellows participate in four half-day outpatient clinics devoted to new patient evaluations. One of the half-day clinics is devoted to UNOS-listed pre-OLT and care of post-OLT patients.

The full-time hepatology faculty provides supervision and teaching for Hepatology and Liver Transplantation fellows for each patient. Educational emphases include diagnosis and management of adult patients with acute and chronic liver diseases, inclusion and exclusion criteria for OLT, immunosuppression for autoimmune diseases and post-OLT patients, management of complications of post-OLT patients, and effective oral and written communication with patients, families, staff and referring healthcare providers.

We advocate cost-effective and evidence-based use of diagnostic testing, implementation of published guidelines, and evidence-based practices in all protocols.

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Inpatient Services

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Baylor full-time hepatologists and transplant surgeons provide consultative inpatient care. Consultative inpatient training of Hepatology and Liver Transplantation fellows, medical residents, medical students, and NP/PAs is directly supervised by full-time hepatology faculty on a daily basis. Each of our triple-certified hepatology faculty members rotates on the inpatient service for seven consecutive days. During this time, the faculty has no competing outpatient responsibilities and devotes their full attention to teaching and supervision.

Education is also provided to trainees by our team’s designated consultants in cardiology, pulmonology, nephrology, oncology, infectious diseases, endocrinology, therapeutic endoscopy and invasive radiology. All of our consultants are board-certified in their specialties. Fellows perform comprehensive initial consultations under direct daily supervision of an attending faculty hepatologist. They conduct daily follow-up assessments of all inpatients and discuss each patient daily with the hepatology attending, who independently sees and examines each patient, reviews all data and provides bedside teaching.

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Procedures

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Fellows are taught the indications, contraindications, limitations, complications, and interpretation of percutaneous and transjugular liver biopsies, diagnostic and large volume paracentesis with albumin replacement, assessment of esophageal varices using EGD, therapeutic endoscopy for upper gastrointestinal bleeding, transjugular intrahepatic portosystemic shunts, 2D echocardiography with agitated saline to detect pulmonary vascular shunts and right heart catheterization to assess pulmonary hypertension and portal systemic venous pressure gradients.

Fellows are also trained to perform diagnostic and therapeutic paracentesis, with and without US localization, in our outpatient procedure center. Fellows are also eligible for training in percutaneous liver biopsy. Faculty hepatologists supervise all procedures.

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On-Call Schedules

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Fellows are on-call every third weekend. The call schedule includes major holidays. Fellows on the inpatient service rotation do not remain in the hospital overnight and do not take first or second night call. Only full-time hepatology and transplant surgical faculty members take calls after hours and on weekends to ensure timely decision making.

This policy ensures that our fellows have adequate time for educational, scholarly activities and needed rest. We encourage our fellows to devote a minimum of one hour per day to self-education after hours.