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, 550 endoscopy procedures during their first year. Upon graduation, fellows will have performed on average 1500 procedures split between EGDs 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 five-seven new consults daily. There is 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 10-15 patients total, average of two-five new consults daily. There are usually one to two residents 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 four-eight new consults daily. There are usually one resident assigned to the rotation.
MEDVAMC Hepatology Service: One month. This service takes care of hepatology consults and inpatient hepatology patients 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 to HCC and liver transplant boards. 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 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 Outpatient Hepatology Service: One month. This service takes care of outpatient hepatology patients at BSLMC. BSLMC is a tertiary referral center and fellows see referrals from all over the southwest United States. There are three half-days of dedicated endoscopy time per week. Every Friday is designated as an academic day with no required clinical responsibilities.
Second-Year Rotations
Ben Taub Senior: Two-Three months. Threeo 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 fellow 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: 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 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 Transplant Hepatology Service: Two months. This service manages hepatology consults at BSLMC. This is a clinical rotation where fellows gain exposure to pre- and post-transplant hepatology and advanced liver management. The liver transplant service participates in an average of 75-90 liver transplants per year.
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 four-eight new consults daily. There are usually one residents assigned to the rotation.
MEDVAMC Outpatient GI: One month. This is a combined clinical and endoscopy rotation. The senior fellow sees patients in IBD, motility and general GI clinics. Some half days are spent in the endoscopy suite at the Michael E. DeBakey VA Medical Center. Fellows gain exposure to esophageal motility procedures and capsule endoscopy.
Research: Three months of protected research time. Fellows identify a mentor and submit a research proposal at the end of their first year. Projects can be in quality improvement, clinical or basic science research. Research conferences are held during second year to follow the progress of research, and to receive feedback from faculty. Final presentations are held at the end of third year. Additional research months can be requested during the third year of fellowship based on the quality of the project.
Third-Year Rotations
MEDVAMC Hepatology Service: One month. This service takes care of hepatology consults and inpatient hepatology patients 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 to HCC and liver transplant boards. The rotation includes 2-3 days of dedicated endoscopy time per week.
BSLMC Therapeutics Service: Two-Three months. This service takes care of only advanced endoscopy consults. This is a combined rotation of consults and endoscopy. The fellow sees consults and gains exposure to advanced endoscopy procedures, including ERCP, EUS, ESD, POEM and bariatric endoscopy. This experience is not designed to train for proficiency in advanced endoscopy. The average census of the service is 5-15 patients. Fellows interested in advanced endoscopy fellowship may elect to do this rotation during the end of first year or second year.
MEDVAMC Outpatient GI: One month. This is a combined clinical and endoscopy rotation. The third-year fellow sees patients in IBD, motility and general GI clinics. Some half days are spent in the endoscopy suite at the Michael E. DeBakey VA Medical Center. Fellows gain exposure to esophageal motility procedures and capsule endoscopy.
BSLMC Luminal/IBD Outpatient: Two months. This is a combined clinical and endoscopy rotation. The third-year fellow sees patients in motility, advanced inflammatory bowel disease, and general GI clinics at McNair campus. Fellows gain exposure to high resolution esophageal manometry, Bravo wireless pH monitoring, impedance-pH monitoring, breath tests, capsule endoscopy and hemorrhoid banding. Fellows have the option to attend to colorectal surgery clinics and procedures.
Research/Elective: Two months of research/elective time. Fellows may elect to continue their research project or create an elective rotation that best suits their future career aspiration. Elective options may be clinically focused (i.e. motility, IBD, or advanced endoscopy) or related to quality improvement projects or medical education. Final presentations are held at the end of third year.
BSLMC Outpatient Hepatology Service: One month. This service takes care of outpatient hepatology patients at BSLMC. BSLMC is a tertiary referral center and fellows see referrals from all over the southwest United States. There are three half-days of dedicated endoscopy time per week. Every Friday is designated as an academic day with no required clinical responsibilities.
MEDVAMC Endoscopy: One month. This is a dedicated endoscopy month. The third-year fellow spends time performing endoscopies in the endoscopy suite at Michael E. DeBakey VA Medical Center. There are no inpatient or clinic responsibilities.
BSLMC Luminal Outpatient: Two months. This is a combined clinical and endoscopy rotation. The third-year fellow sees patients in motility and general GI clinics at McNair campus and Fannin Tower. Fellows gain exposure to high resolution esophageal manometry, Bravo wireless pH monitoring, impedance-pH monitoring, breath tests, capsule endoscopy and hemorrhoid banding.
BSLMC IBD Outpatient: Optional. One month. This is a combined clinical and endoscopy rotation to gain expertise in advance inflammatory bowel disease. Fellows have the option to attend to colorectal surgery clinics and procedures.
BSLMC Hepatology Outpatient: Optional. One month. This is a clinical rotation where the fellow attends transplant hepatology clinic and gains exposure to outpatient liver transplant management.
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 up to eight patients with general gastroenterology 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.
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.
July of the first-year fellowship is protected from both weekday night and weekend calls. First-year fellows also get an additional protected month of no weekday and weekend calls for a total of two months. Second-year fellows get three months free of call, and third-year fellows get four months free of call. In all three hospitals, the endoscopy cart is always set up by an on-call endoscopy tech for after-hours and travel cases.
Ben Taub Hospital
Weekday night calls are typically split three ways for a total of 5-6 nights per month.
Michael E. DeBakey Veterans Affairs Medical Center
Weekday night calls are typically split between two first-year fellows in the consult service, a total of 8-9 nights per month.
Baylor St. Luke’s Medical Center
Weekday night calls are typically split among three fellows for a total of 5-6 nights each per month.
