Rotations

University/Pavilion GI Consult Service (UNV/PAV GI)
This consult service covers the University and Pavilion campuses. It is comprised of one fellow and one general GI/advanced endoscopy attending. The fellow is responsible for managing all aspects of gastrointestinal care for the patients on the list, organizing rounds with the attending and other learners (students and residents are commonly on elective with us), and performing all necessary inpatient endoscopic procedures. There are approximately 850 beds between these two sites, which are located across the street from one another. University Campus is the primary teaching campus, housing the medical school, research facilities, and all major institutional clinical services. Due to the high volume, fellows can expect diverse pathology and a high-paced environment,  which will develop skills in organization, resourcefulness, and quick and accurate decision making.

University/Pavilion Liver Consult and Primary Service (UNV/PAV LIVER)
Fellows on this rotation provide consultative and procedural services for patients admitted to the University and Pavilion campuses with a broad range of liver-related pathologies. The service is comprised of one fellow and one transplant hepatology attending. Additionally, the fellow manages all patients admitted to the attending’s primary service – patients on the liver transplant list and liver transplant recipients who do not qualify to be on the surgical service. The primary service patients are always assigned to a house-staff team. The fellow, under the supervision of the attending, is responsible for running clinical and teaching rounds with the house staff and presenting all primary team patients during weekly multi-disciplinary transplant meetings. 

Memorial/Hospital at Home Consult Service (MEM/H@H)
Memorial Campus is located 2 ½ miles from the medical school campus and has approximately 320 inpatient beds. Patients admitted here have equally diverse pathology, but the lower volume slows down the pace considerably. One fellow provides all gastrointestinal and hepatobiliary disease-based consultative and inpatient endoscopic services for patients admitted at this campus and also for patients admitted to the UMass Hospital at Home program (patients healthy enough to be managed in their own homes by telemedicine and visiting nurses, but still requiring some degree of inpatient services). The attending for MEM/H@H changes day to day, and this provides the fellow (usually a senior) to take on a more independent decision-making role. Fellows usually find enough time to perform outpatient endoscopic procedures while also managing their primary inpatient responsibilities.

St. Vincent’s Hospital Consult Service (SVH)
Also located 2 ½ miles from the medical school campus, St. Vincent’s Hospital is a 320-bed private hospital where one fellow helps provide consultative and inpatient endoscopic services under the supervision of a St. Vincent-based gastroenterologist. This rotation gives fellows exposure to a different payer mix and allows them to experience the management of gastrointestinal diseases in a ‘community’ based setting. Similar to the MEM/H@H service, fellows usually have the opportunity to develop endoscopic skills by performing outpatient procedures with the staff gastroenterologist.

Inpatient Advanced Therapeutic Service (ERCP/Biliary)
One advanced endoscopy attending is assigned to the inpatient advanced therapeutic service (called ‘ERCP’), rotating weekly. The two UMass Chan advanced endoscopy fellows rotate on this service for the majority of the year. All second-year GI fellows are required to complete 2 weeks on this service, usually in the fall, prior to applications for the ASGE advanced endoscopy fellowship match (matched third-year GI fellows can choose to rotate on this service as well). The fellow on this rotation does not provide primary consult services; this is covered by the GI fellows on the other services described above. The fellow’s responsibilities include learning and performing various advanced endoscopic procedures, ranging from routine ERCP and diagnostic EUS to more nuanced procedures, including endoscopic gallbladder drainage, necrosectomy, luminal stent placement, endosuturing, etc. The fellow is expected to manage a list of all the patients that the ERCP/Biliary team is following, communicate with the consulting GI fellow and hospitalist/house-staff, and perform clinical rounds with the attending if necessary.

Nutrition (NTN)
During their second year of training, fellows are assigned two weeks of Nutrition, during which they are expected to watch and complete web-based videos and assignments. Progress is tracked by pre- and post-rotation assessments.

Motility (MOT)
All first-year fellows are assigned to a one-week outpatient clinical experience during which they learn how to perform Bravo pH/impedance catheter placement and interpretation, perform high-resolution esophageal manometry studies and interpretation, and based on the schedule, perform and interpret endoscopic EndoFLIP volumetric-based motility testing. Senior fellows are welcome to arrange for a similar experience based on interest.

Pathology (PATH)
All fellows complete one week of this rotation every year, during which they work with a GI Pathologist and learn how to read routine, common gastrointestinal, hepatic, and pancreaticobiliary pathology.

Radiology (RAD)
All fellows complete one week of this rotation every year, during which they work with a GI radiologist and learn how to read various radiologic studies used in the assessment of complaints and conditions pertaining to gastrointestinal, hepatic, and pancreaticobiliary pathology.

Endoscopy (ENDO)
Fellows are assigned to progressively more weeks of a dedicated endoscopy rotation during their three years.  They are expected to work with all GI faculty and focus on honing their skills with regard to general endoscopic procedures (EGD, colonoscopy, and video capsule endoscopy). Seniors may elect to spend some time specifically with an advanced endoscopy attending if interested, and this decision is usually based on their career goals. The training program requires the submission and reporting of procedure logs biannually, and fellows must reach set program-defined targets for general endoscopic procedures to meet requirements for graduation. 

Research/Endoscopy/Clinic (R/E/C)
Fellows get more and more R/E/C rotations as they progress in their training. Fellows are expected to use this block to work on scholarly activities and projects, join the GI faculty and perform endoscopic procedures, and see patients in their outpatient continuity clinics. Fellows are expected to meet criteria set by ACGME, UMass GME, and the UMass Chan training program with regard to scholarly activities. All fellows must be engaged in a quality improvement/patient safety project and clinical research. We ask our fellows to work towards one publication during their fellowship and submit for at least two poster/oral presentations to a major GI/liver conference.  Additionally, all fellows are asked to provide updates on their projects during the annual UMass Chan GI Research Day (in the form of posters or an oral presentation).

Clinics
With the exception of the inpatient service weeks, fellows can expect to have continuity clinics on all other blocks and rotations. Fellows will have continuity clinics in general GI and general hepatology. In addition, they are also assigned to an IBD clinic supervised by our IBD faculty, an urgent clinic, and a post-hospitalization/post-discharge clinic. Fellows develop and manage a panel of patients and function as the primary point of contact while providing all aspects of gastrointestinal and hepatology-based care. First and second year fellows also complete a set number of weeks seeing patients in the transplant hepatology clinic and advanced therapeutic/pancreaticobiliary diseases clinic with the transplant hepatologists and advanced endoscopists, respectively. This allows the fellows to develop an appreciation for managing these patients outside of the inpatient setting and make an informed decision in terms of further training. With enough notice and planning, fellows are also invited to arrange for specific clinics based on interest.

Electives 
We support the interest of fellows in doing an away elective with advanced notice and preparation. Fellows are asked to submit a proposal describing the goals of the experience and how it would supplement their training and career development. Electives away from UMass Chan require registration with and approval from the Graduate Medical Education office. Fellows are encouraged to apply to various grants and scholarships available through organizations like ACG and AGA, which support certain electives throughout the country.