The clinical track is a three-year program for fellows who intend to enter clinical academic practice upon completion of the training program. The emphasis is on clinical gastroenterology and hepatology with the opportunity for more formal clinical research training.
The fellowship program is based at several hospitals and clinics, including Michael E. DeBakey Veterans Affairs Medical Center, Ben Taub Hospital, and Baylor St. Luke’s Medical Center. These training sites provide diverse experiences in different clinical environments.
Each academic year is divided into 12 rotations, and each rotation is one month long. Throughout the rotations, first-year fellows perform, on average, 500 endoscopy procedures during their first year. Upon graduation, fellows will have performed on average 1,600 procedures split between esophagogastroduodenoscopy and colonoscopy.
First-Year Rotations
Ben Taub Consult Service: Three to four months. This service takes care of general gastroenterology, advanced endoscopy and non-transplant hepatology consults. This is a combined rotation of consults and endoscopy. Two to three first-year fellows are assigned each month. First-year fellows alternate days between taking new consults and doing endoscopy. The census of the service is 15-25 patients total, average of 8-10 new consults daily. There are usually one to two residents assigned to the rotation.
MEDVAMC Consult Service: Three to four months. This service takes care of general gastroenterology and advanced endoscopy consults. There is a separate team for hepatology consults at MEDVAMC. This is a combined rotation of consults and endoscopy. Two first-year fellows are assigned each month. First-year fellows alternate days between taking new consults and doing endoscopy. The census of the service is 10-20 patients total, average of 5-8 new consults daily. There is usually one resident assigned to the rotation.
BSLMC GI Consult Service: Two months. This service takes care of only general gastroenterology consults. There are separate teams for hepatology and biliary-pancreatic consults at BSLMC. This is a combined rotation of consults and endoscopy. One first-year fellow and one second-year fellow are assigned each month. The fellows alternate days between taking new consults and doing endoscopy. The census of the service is 20-30 patients total, an average of 8-10 new consults daily. There are usually one to two residents and a medical student assigned to the rotation.
MEDVAMC Hepatology Service: One month. This service takes care of hepatology consults at MEDVAMC, one of very few VA hospitals in the country with a liver transplant program where an average of 12-13 liver transplants are performed each year. Fellows attend HCC and liver transplant board meetings. The rotation includes 2-3 days of dedicated endoscopy time per week.
BSLMC Inpatient Transplant Hepatology Service: One month. This service takes care of hepatology consults and inpatient hepatology patients at BSLMC, which is one of the busiest transplant centers in Texas. Approximately 80 liver transplants are performed each year at BSLMC. This is a clinical rotation where fellows gain exposure to pre- and post-transplant hepatology and advanced liver disease management. Fellows attend hepatology/transplantation grand rounds, medical review board meetings, pathology case conference and case/journal club conferences. There are usually 2 residents and 2 advanced practice practitioners assigned to the rotation.
BSLMC Outpatient Hepatology Service: One month. This service takes care of hepatology consults at BSLMC, which is one of the busiest transplant centers in Texas. BSLMC is a tertiary referral center and fellows see referrals from all over the southwest United States. Every Friday is designated as an academic day with no required clinical responsibilities.
Second- and Third-Year Rotations
Ben Taub Senior: Two to three months. Two to three second- or third-year fellows are assigned each month. The senior fellows spend most of the time performing endoscopies. In addition to endoscopy, the senior fellows also support the first-year fellows with the consult service and participate in rounds with teaching responsibilities.
MEDVAMC Senior: Two-Three months. One second- or third-year fellow is assigned each month. The senior fellow spends most of the time performing endoscopies in the endoscopy suite at Michael E. DeBakey Veterans Affairs Medical Center. In addition to endoscopy, the senior fellow also supports the first-year fellows with the consult service and participates in rounds with teaching responsibilities.
BSLMC Inpatient Transplant Hepatology Service: Two to Three months. This service takes care of hepatology consults and transplant hepatology patients at BSLMC, which is one of the busiest transplant centers in Texas. Approximately 80 liver transplants are performed each year at BSLMC. This is a clinical rotation where fellows gain exposure to pre- and post-transplant hepatology and advanced liver management. Fellows attend hepatology/transplantation grand rounds, medical review board meetings, pathology case conference and case/journal club conferences. There is usually one resident and one to two advanced practice practitioners assigned to the rotation.
BSLMC GI Consult Service: One to two months. This service takes care of only general gastroenterology consults. There are separate teams for hepatology and biliary-pancreatic consults at BSLMC. This is a combined rotation of consults and endoscopy. One first-year fellow and one second-year fellow are assigned each month. The fellows alternate days between taking new consults and doing endoscopy. The census of the service is 20-30 patients total, an average of 8-10 new consults daily. There are usually one to two residents, and a medical student assigned to the rotation
BSLMC Pancreaticobiliary/Advanced Therapeutics Consult Service: One month. This service takes care of pancreaticobiliary and/or advanced therapeutics consults. There are separate teams for hepatology and general gastroenterology consults at BSLMC. This is a combined rotation of consults and endoscopy, including hands-on exposure to endoscopic ultrasound, endoscopic retrograde cholangiopancreatography, and other fluoroscopically-guided techniques for interested fellows. One senior fellow (second- or third-year) is assigned each month. The census of the service is 20-30 patients total, an average of 6-8 new consults daily. There is usually one resident assigned to the rotation.
Electives: The remaining estimated 12 monthly rotations for second- and third-year fellows are customizable elective months. Elective rotations take place at all three pavilions. The elective rotation includes a combination of
- Clinical responsibilities, including specialty clinics (e.g., Inflammatory Bowel Disease clinic, Pancreas clinic, Motility clinic, etc.)
- Elective endoscopy
- Protected academic time for research or other academic enrichment activities.
Longitudinal Clinic
Each fellow has one half-day per week of continuity clinic on Tuesday or Wednesday afternoons. The clinic is located in the modern Smith Clinic building, which is part of the Harris Health System. Fellows see approximately 4-6 patients per half-day. Fellows see a full spectrum of patients with general gastroenterology, pancreatic/biliary, motility, inflammatory bowel disease and non-transplant hepatology needs.
Call Schedule
Fellows are responsible for after-hours gastroenterology emergencies at the three affiliated hospitals. Fellows cover only one hospital at a time. There is no in-house call. Call responsibilities decrease progressively each year.
Ancillary Support: In all three hospitals, the endoscopy cart is always set up by an endoscopy tech for regular-hours, after-hours and travel cases. The endoscopy techs are also responsible for cleaning the endoscopy cart and reprocessing/ cleaning the scope after cases.
Weekend/Holiday Responsibilities:
Weekend coverage starts Friday, 5 p.m. until Monday, 7 a.m. Throughout the three years, fellows will not typically cover more than one weekend per month. Weekend calls are covered by fellows rotating in each consult service and by fellows from other rotations. Weekend responsibilities decrease progressively each year.