Veterans Administration San Diego Healthcare System (VASDHS)

VA San Diego HealthcareThe Veterans Administration San Diego Healthcare System (VASDHS) serves as a source of medical care for the United States military veterans. Fellows are exposed to a wide variety of general GI and liver diseases. This includes elderly patients and patients with chronic diseases related to smoking and alcohol as well as military-related disabilities. There is also an opportunity to do a high volume of endoscopies, especially screening colonoscopies, while doing outpatient rotations.

There is some exposure to advanced pancreatico-biliary procedures (EUS and ERCP). Common GI consult indications include upper GI bleeding (variceal and non-variceal), lower GI bleeding, iron-deficiency anemia, suspected GI malignancy, and pancreatico-biliary diseases (pancreatitis, choledocholithiasis, gallstone disease).

Common Hepatology consult indications include complications of end stage liver disease (ascites, encephalopathy, subacute bacterial peritonitis), and chronic liver diseases such as hepatitis B and C. There are also GI and Hepatology continuity clinics here. The most commonly performed procedures include EGD, colonoscopies, PEG placement, and liver biopsies. Fellows are also exposed to nutrition training during weekly nutrition rounds with a dedicated GI nutrition faculty member and to esophageal motility disorders and capsule endoscopy. The VAMC has full radiological (CT, MRI, US), pathologic, and surgical services for patient care.

Fellows in their first clinical year mainly do inpatient service, while those in their second and third years primarily do outpatient rotations. Outpatient rotations allow fellows to do high volumes of routine colonoscopies and upper endoscopies with less Attending assistance than a first-year fellow and also teaches them practice management techniques of triaging referrals and follow-up pathology.​

Rotation Clinical Yr 1
(months)
Clinical Yr 2
(months)
Clinical ​Yr 3
(months)
Total
(months)
VA In 3 1 0 4
VA Out 1 1 2 4
TOTAL 4 2 2 8