Inpatient at Veterans Affairs San Diego Healthcare System (VA In)

The inpatient rotation at the Veterans Affairs San Diego Healthcare System 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 gastroenterology and hepatology consults, presentations, and endoscopic procedures. Fellows are learning how to conduct inpatient GI consultations efficiently and how to perform basic EGD and colonoscopies. They are 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 gastroenterology consultations; to be comfortable performing basic EGD and colonoscopies; and to 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.

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