Fellows have one half-day clinic per week of continuity clinic alternating between MUSC and the Ralph H. Johnson VA Medical Center. This provides an opportunity to develop longitudinal relationships with patients and learn to care for patients with chronic GI and liver issues. Each clinic is staffed by rotating faculty to provide fellows with a breadth of experiences and practices.
Gastroenterology Luminal Consult Service
The GI “Luminal” Service provides inpatient gastroenterology consultation services for hospitalized patients at MUSC. While on this service, fellows see a breadth of general GI patients, including abdominal pain, diarrhea, dysphagia, inflammatory bowel disease, non-variceal gastrointestinal hemorrhage, and post-surgical GI complications. The goals of the Luminal Service are to teach fellows to skillfully perform inpatient consultation and endoscopic procedures, including diagnostic and therapeutic endoscopy along with feeding tube placement under the supervision of a GI faculty member. Residents and medical students rotate through the service, which offers fellows an opportunity to function in a supervisory role to develop and hone teaching skills.
Hepatology Consult and Inpatient Service
The Hepatology Consult Service provides inpatient hepatology consultation services for hospitalized patients at MUSC, while the Hepatology Inpatient Service cares for patients admitted with decompensated liver disease and post-transplant complications. While on this service, fellows see a breadth of liver disorders including but not limited to acute liver failure, decompensated liver disease, post-transplant complications, and variceal bleeding. In addition to clinical management exposure, during this rotation, fellows learn to skillfully perform inpatient consultation and supervise inpatient care on a resident-run service. They also learn to perform endoscopic procedures including variceal ligation, variceal gluing, and colonoscopies under the supervision of a Hepatologist. The active and growing liver transplantation program allows for significant interdisciplinary exposure and collaboration in a variety of formats. Fellows interact with various specialties such as surgery, radiology and pathology for clinical management of patients as well as during dedicated conferences. Fellows are also able to partake in transplant selection committee meetings each week.
The Pancreaticobiliary rotation provides inpatient consultation for patients requiring advanced endoscopic procedures at MUSC. During this rotation, fellows work closely with MUSC Advanced Endoscopy attendings through inpatient consultations, outpatient clinics, and endoscopic procedures. Some hands-on advanced endoscopy exposure is provided; however, formal training in endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) will generally be pursued during a fourth year of elective training.
VA Consult (Endoscopy) Service
The VA Consult Service provides inpatient Gastroenterology and Hepatology consultation services for all hospitalized patients at the Ralph H. Johnson VAMC. While on this service, the fellows will also receive focused training in general endoscopy by performing a panel of outpatient procedures each day. Training focuses on honing skills on screening, surveillance, and diagnostic upper and lower endoscopy, as well as therapeutic aspects of procedures such as biopsies, polypectomy, dilations, and gastrostomy tube placements under the supervision of a GI faculty member. Fellows gain a tremendous amount of training in endoscopy during these months, averaging 100 procedures per month. Residents and medical students rotate through the service, which will offer the fellows on opportunity to function in a supervisory role. This service is often chosen as the favorite rotation by fellows due to the extensive endoscopic experience.
MUSC Endoscopy Rotation
During the third year of training, fellows can elect to spend a month performing outpatient endoscopy at MUSC to further sharpen their general endoscopy skills under the supervision of a GI faculty member. Fellows will have the benefit of working with a variety of faculty allowing them to experience and strengthen their skills through a variety of techniques. The rotation is designed to solidify skills and improve efficiency with all general GI procedures as a step to prepare for practice as an independent endoscopist.
Outpatient Gastroenterology Clinic Rotation
During this rotation, fellows spend time in the MUSC ambulatory GI clinics under the supervision of GI faculty. This rotation allows for one-on-one education with various attending physicians while seeing a breadth of various general GI disorders, including esophageal diseases, functional bowel disease, small bowel diseases, and motility disorders.
Outpatient Hepatology Clinic Rotation
During this rotation, fellows are exposed to a breadth of hepatology pathology in an ambulatory setting. The fellows spend time in both transplant and general hepatology clinics. In Liver transplant clinic, fellows will see patient both pre- and post-transplant patients. In General Hepatology clinic, fellows will benefit from seeing both “bread and butter” cases and rare liver issues. Fellows also rotate through a dedicated multidisciplinary non-alcoholic fatty liver disease clinic, where they have the opportunity to perform transient elastography.
MUSC has long been known as a quaternary referral center for esophageal dysmotility. During this rotation, fellows spend time with Dr. Castell seeing outpatient clinic patients and learning to interpret esophageal manometry and pH-impedance studies. There is also the opportunity to become proficient in reading capsule endoscopy during this rotation.
Inflammatory Bowel Diseases (IBD) Rotation
Although significant IBD exposure will be gained through GI fellows clinic, the fellowship provides an IBD-specific rotation to solidify knowledge and see more complicated IBD cases. During this rotation, fellows work with an IBD specialist to care for outpatients with Crohn’s disease and Ulcerative Colitis. The rotation will also include exposure to the multidisciplinary pediatric IBD clinic, allowing for an understanding of caring for young adult patients with IBD Additionally, fellows perform endoscopy on IBD patients, which provides exposure to advanced diagnostic and therapeutic tools specific to this patient population.
Two months of research time is provided each year with extensive mentorship available. Fellows are encouraged to develop research projects, and funding is available to present at regional and national meetings. Opportunities are available for advanced training in research methods, including a Master of Science in Clinical Research Program (MSCR).
Considerable flexibility during the final year of fellowship allows fellows to rotate though multiple electives including Bariatric Surgery, Colorectal Surgery, Small Bowel training, Hepatology, additional Motility training, additional research time, and potential away months.