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.