Rotations
UCSD Hillcrest GI (HC GI)
This is predominately a first-year rotation. There may be medical students, interns, and residents on this rotation. The fellow receives all consultations and determines the urgency of the consult. Depending on the consult, the fellow will decide which team member sees the patient and with what urgency. The fellow will either see or review the case with the other GI team members and make initial recommendations. All consults are presented by the fellow and team to the attending within 24 hours of consult receipt on attending rounds and sooner if it is an urgent (4-8 hours) or emergency (1-2 hours) consult. Fellows do not see any patients if they are on a "non-teaching" service. First-year fellows are expected to be very closely supervised by attending physicians in terms of consults, presentations, and endoscopic procedures. Fellows are learning how to efficiently conduct patient GI consultations, learning how to perform basic EGD and colonoscopies, and starting to learn therapeutic procedures (i.e., non-actively bleeding non-variceal hemostasis and non-complex polypectomy). They usually do not participate in advanced procedures such as ERCP. All endoscopic procedures are supervised by an attending physician who is present in the room.
Second- and third-year fellows who rotate on this rotation are expected to need less supervision by the attending physician than first-year fellows in terms of consults, presentations, and endoscopic procedures. Second- and third-year fellows are expected to provide more complete GI consultations, expected to be comfortable performing basic EGD and colonoscopies, and be comfortable performing therapeutic procedures (i.e., actively bleeding non-variceal hemostasis and complex polypectomy). They may participate in advanced procedures such as ERCP. All endoscopic procedures are supervised by an attending physician who is present in the room.
UCSD Hillcrest Hepatology Inpatient (Hep In)
This is predominantly a first-year rotation. There may be medical students, interns, and residents on this rotation. The fellow receives all consultations and determines the urgency of the consult. Depending on the consult, the fellow will decide which team member sees the patient and with what urgency. The fellow will either see or review the case with the other GI team members and make initial recommendations. All consults are presented by the fellow and team to the attending within 24 hours of consult receipt on attending rounds and sooner if it is an urgent (4-8 hours) or emergency (1-2 hours) consult. Fellows do not see any patients if they are on a "non-teaching" service. First-year fellows are expected to be very closely supervised by attending physicians in terms of inpatient consults, presentations, and endoscopic procedures. Fellows are learning how to efficiently conduct inpatient Hepatology consultations, learning how to perform basic EGD, colonoscopies, liver biopsies, and starting to learn therapeutic procedures (i.e., esophageal band ligation in non-bleeding settings). All endoscopic procedures are supervised by an attending physician who is present in the room.
Second- and third-year fellows on this rotation are expected to need less supervision by the attending physician than first-year fellows in terms of consults, presentations, and endoscopic procedures. Second- and third-year fellows are expected to provide more complete GI consultations, expected to be comfortable performing basic EGD, colonoscopies, liver biopsies, and be comfortable performing therapeutic procedures (i.e., actively bleeding variceal hemostasis). All procedures are supervised by an attending physician who is present in the room.
UCSD GI/Hepatology Outpatient (GI-Hep Out)
This is predominantly a first-year rotation. Fellows will see new and returning patients in a variety of Hepatology and GI clinics including general Hepatology, general GI, and liver transplant clinic. Fellows are expected to be very closely supervised by attending physicians in terms of outpatient consults, presentations, and endoscopic procedures. They will present every case to an attending physician. Fellows learn how to efficiently conduct outpatient Hepatology and GI consultations, learn how to perform basic EGD, colonoscopies, liver biopsies, and start to learn therapeutic procedures (i.e., esophageal band ligation in non-bleeding settings). All procedures are supervised by an attending physician who is present in the room.
Second- and third-year fellows on this rotation are expected to need less supervision by the attending physician than first-year fellows in terms of consults, presentations, and endoscopic procedures. Second- and third-year fellows are expected to provide more complete GI consultations, expected to be comfortable performing basic EGD, colonoscopies, liver biopsies, and be comfortable performing therapeutic procedures (i.e., actively bleeding variceal hemostasis). All endoscopic procedures are supervised by an attending physician who is present in the room.
San Diego Veteran Administration Medical Center Inpatient (VA In)
This is predominantly a first-year rotation. There may be medical students, interns, and residents on this rotation. The fellow receives all consultations and determines the urgency of the consult. Depending on the consult, the fellow will decide which team member sees the patient and with what urgency. The fellow will either see or review the case with the other GI team members and make initial recommendations. All consults are presented by the fellow and team to the attending within 24 hours of consult receipt on attending rounds and sooner if it is an urgent (4-8 hours) or emergency (1-2 hours) consult. Fellows do not see any patients if they are on a "non-teaching" service. First-year fellows are expected to be very closely supervised by attending physicians in terms of inpatient GI and Hepatology consults, presentations, and endoscopic procedures. Fellows are learning how to efficiently conduct inpatient GI consultations, learning how to perform basic EGD and colonoscopies, and starting to learn therapeutic procedures (i.e., not actively bleeding variceal and non-variceal hemostasis and non-complex polypectomy). They usually do not participate in advanced procedures such as ERCP. All endoscopic procedures are supervised by an attending physician who is present in the endoscopy unit.
Second- and third-year fellows who rotate on this rotation are expected to need less supervision by the attending physician than the first-year fellows in terms of consults, presentations, and endoscopic procedures. Second- and third-year fellows are expected to provide more complete GI consultations, expected to be comfortable performing basic EGD and colonoscopies, and be comfortable performing therapeutic procedures (i.e., actively bleeding variceal and non-variceal hemostasis and complex polypectomy). They may participate in advanced procedures such as ERCP. All endoscopic procedures are supervised by an attending physician who is present in the endoscopy unit.
San Diego Veteran Administration Medical Center Outpatient (VA Out)
The first-year fellows are expected to be very closely supervised by attending physicians in terms of outpatient GI and Hepatology consults, presentations, and endoscopic procedures. They present every case to the attending physician. Fellows are learning how to efficiently conduct outpatient GI consultations, learning how to perform basic EGD and colonoscopies, and starting to learn therapeutic procedures (i.e., not actively bleeding variceal and non-variceal hemostasis and non-complex polypectomy). They usually do not participate in advanced procedures such as ERCP. All endoscopic procedures are supervised by an attending physician who is present in the endoscopy unit.
Second- and third-year fellows who rotate on this rotation are expected to need less supervision by the attending physician than first-year fellows in terms of consults, presentations, and endoscopic procedures. Second- and third-year fellows are expected to provide more complete GI consultations, expected to be comfortable performing basic EGD and colonoscopies, and be comfortable performing therapeutic procedures (i.e., actively bleeding variceal and non-variceal hemostasis and complex polypectomy). They may participate in advanced procedures such as ERCP. All endoscopic procedures are supervised by an attending physician who is present in the endoscopy unit.
UCSD Thornton Inpatient (Thornton)
This is rarely a first-year rotation. There may be medical students, interns, and residents on this rotation. The fellow receives all consultations and determines the urgency of the consult. Depending on the consult, the fellow will decide which team member sees the patient and with what urgency. The fellow will either see or review the case with the other GI team members and make initial recommendations. All consults are presented by the fellow and team to the attending physician within 24 hours of consult receipt on attending rounds and sooner if it is an urgent (4-8 hours) or emergency (1-2 hours) consult. Fellows do not see any patients if they are on a "non-teaching" service. Occasionally, first-year fellows are assigned to this rotation. First-year fellows are expected to be very closely supervised by attending physicians in terms of inpatient GI and Hepatology consults, presentations, and endoscopic procedures. Fellows are learning how to efficiently conduct inpatient GI consultations, learning how to perform basic EGD and colonoscopies, and starting to learn therapeutic procedures (i.e., not actively bleeding variceal and non-variceal hemostasis and non-complex polypectomy). They usually do not participate in advanced procedures such as ERCP. All endoscopic procedures are supervised by an attending physician who is present in the endoscopy unit.
This is predominantly for second- and third-year fellows. The fellow receives all consultations and either personally or by supervising students/interns/residents assess the consults and presents the consult to the attending physician. Second- and third-year fellows are expected to provide more complete GI consultations, expected to run the service with supervision by the attending physician, expected to be comfortable performing basic EGD and colonoscopies, and be comfortable performing therapeutic procedures (i.e., actively bleeding variceal and non-variceal hemostasis and complex polypectomy). They get exposure to and may participate in advanced procedures such as ERCP, EUS, capsule endoscopy, and double balloon enteroscopy. All endoscopic procedures are supervised by an attending physician who is present in the room.
Kaiser Permanente (Kaiser)
This is rarely a first-year rotation. The fellow will receive all consultations and determines the urgency of the consult. The fellow will see the patient and make initial recommendations. All consults are presented by the fellow to the attending within 24 hours of consult receipt on attending rounds and sooner if it is an urgent (4-8 hours) or emergency (1-2 hours) consult. Fellows do not see any patients if they are on a "non-teaching" service. Occasionally, first-year fellows are assigned this rotation. First-year fellows are expected to be very closely supervised by attending physicians in terms of inpatient GI and Hepatology consults, presentations, and endoscopic procedures. Fellows are learning how to efficiently conduct inpatient GI consultations, learning how to perform basic EGD and colonoscopies, and starting to learn therapeutic procedures (i.e., not actively bleeding variceal and non-variceal hemostasis and non-complex polypectomy). They usually do not participate in advanced procedures such as ERCP. All endoscopic procedures are supervised by an attending physician who is present in the room.
This is predominantly for second- and third-year fellows. The fellow receives all consultations and either personally or by supervising students/interns/residents assesses the consults and presents the consult to the attending physician. Fellows are expected to need less supervision by the attending physician. Second- and third-year fellows are expected to provide more complete GI consultations, expected to run the service with supervision by the attending physician, expected to be comfortable performing basic EGD and colonoscopies, and be comfortable performing therapeutic procedures (i.e., actively bleeding variceal and non-variceal hemostasis and complex polypectomy). They may participate in advanced procedures such as ERCP. All endoscopic procedures are supervised by an attending physician who is present in the room.
Float/Multi-Specialty (Float)
This is rarely a first-year rotation. Fellows have the same lines of responsibility as described above for any rotation they are covering. While at Rady Children's Hospital on the Pediatric GI rotation, they work closely with the attending physician in a much more observational role. Occasionally, first-year fellows are assigned this rotation. First-year fellows are expected to be closely supervised by attending physicians in terms of inpatient GI and Hepatology consults, presentations, and endoscopic procedures. Fellows are learning how to efficiently conduct inpatient GI consultations and learning how to perform basic EGD and colonoscopies, and starting to learn therapeutic procedures (i.e., not actively bleeding variceal and non-variceal hemostasis and non-complex polypectomy). They usually do not participate in advanced procedures such as ERCP.
This is predominantly for second- and third-year fellows. Fellows are expected to need less supervision by the attending physician. Second- and third-year fellows are expected to provide more complete GI consultations, expected to run the service with supervision by the attending physician, expected to be comfortable performing basic EGD and colonoscopies, and be comfortable performing therapeutic procedures (i.e., actively bleeding variceal and non-variceal hemostasis and complex polypectomy). They may participate in advanced procedures such as ERCP.
On the weeks when fellows are not covering an inpatient rotation, they will rotate through subspecialty clinics such as capsule endoscopy, advanced endoscopy, motility disorders clinic, pediatric general GI clinic, pediatric GI endoscopy, and hereditary colon cancer syndrome.
Clinical Research/Motility
This is rarely for first-year fellows. They would be expected to start to identify research or scholarly projects and begin to plan for implementation.
Second-year fellows would be expected to have identified a project or projects and have started planning implementation and collecting data.
Third-year fellows would be expected to be completing data collection and starting to prepare the data for submission to a scientific meeting. Fellows doing scholarly activities such as case reports or book chapters would be expected to have submitted their data for publication.
Research (NIH T32)
Fellows on this rotation spend only a half day per week in their continuity clinic and rotate every second or third month doing a session of general endoscopy (i.e., screening colonoscopies) at the San Diego VAMC (VA Out-2 rotation).
Fellows are expected to be working on their research studies with their faculty sponsors. This includes basic, clinical, translational, and outcomes research. During their first research year, they are expected to learn appropriate research techniques and collect preliminary data. While in their second year, they are expected to collect data in preparation for publication and/or grant submission.
Night/Weekend Call
Fellows generally are on this rotation mostly in their first and second year, little if any in their third year. This rotation is for one week at a time from Friday to Thursday, including the weekend, nights, and holidays. There are no students, interns, or residents on this service. Fellows refer to the on-call GI attending for the week. There is an on-call Hepatology attending for complex liver patients.
The type of patient consults generally relate to acute gastrointestinal bleeding, bowel obstruction, abdominal pain, pancreatitis, choledocholithiasis, complications of cirrhosis, diarrhea, vomiting, constipation, and esophageal food impaction.
Fellows are responsible for receiving all new inpatient consults, follow-up on all existing consult patients on the UCSD Hillcrest GI inpatient, UCSD Hepatology inpatient, Thornton GI inpatient, and VAMC GI inpatient consult services. Fellows also answer after hour patient phone calls for the GI Division.
Fellows see consults either emergently (1-2 hours) or urgently (3-16 hours). Fellows must present every new consult to the attending physician to review case and management plans. Urgent or emergency endoscopies are done with the attending physician present for the entire case. Endoscopic cases usually involve treatment of esophageal food impactions, diagnosis and treatment of upper and lower gastrointestinal bleeding, and include both variceal and non-variceal bleeding.
First-year fellows are expected to require a large amount of attending input during their first six months (i.e., frequent phone calls/meetings with attendings to review patient data and recommendations). Then less input during their next six months than when they are second- or third-year fellows. Second- and third-year fellows are expected to be able to make decisions and appropriately manage and triage consults and phone calls.