Curriculum

Clinical Training
The curriculum for the Gastroenterology Fellowship varies, depending upon whether you chose the Clinical Scholars Track or NIH-sponsored Track. However, all clinical training includes patient care, procedures, elective rotations, didactic training and teaching opportunities as follows:

Patient Care
Several rotations in ambulatory and inpatient care are mandatory for all fellows. For example, on the gastroenterology hospital service you will serve as a first assistant to the staff and learn how to manage many types of cases - from the straightforward to the complex. Third-year fellows are expected to serve in a junior faculty-type role, directly supervising and guiding medical residents on the team together with the staff physician.

You also will participate in gastrointestinal consultations and perform procedures on these hospitalized patients. These experiences will help you learn pragmatic and scholarly approaches to a wide array of diagnostic and therapeutic gastrointestinal problems.

Your assignments will include several specialty areas that are largely hospital based, including nutrition and liver transplantation.

During the outpatient department rotation, you will rotate through most of the subspecialty clinics (e.g. pancreas, motility, IBD) where you will work directly with staff gastroenterologists.

Procedures
All procedures are performed under the direct supervision of Mayo Clinic staff gastroenterologists. Your procedural training will include upper endoscopy, esophageal dilatation, esophageal manometry, liver biopsy, small bowel biopsy, paracentesis, percutaneous endoscopic gastrostomy placement, colonoscopy and endoscopic retrograde cholangiopancreatography.

You will extend your endoscopic experience with therapeutic endoscopy, which includes sclerotherapy, electrocoagulation, hemoclip application, variceal banding and various stenting procedures. You also will have opportunities to learn about gastrointestinal motility, the dynamic assessment of pancreatic, hepatobiliary and gastrointestinal function and other procedures.

Elective Rotations
Several elective rotations are available including rotations to Mayo Clinic in Jacksonville , and Mayo Clinic in Arizona. You may also spend your elective time pursuing additional clinical or endoscopic experience at smaller private practices near Rochester, within the GI Division, or in other departments (e.g. Surgery, Radiology, Pathology).

Didactic Training
Clinical conferences, seminars, small discussion groups, journal clubs and one-on-one instruction are integral parts of the Gastroenterology Fellowship Program. You will work one-to-one with staff gastroenterologists during all aspects of your training. Bedside instruction and other informal teaching methods are also part of the training program.

Conferences
A variety of conferences are held each week in the Division of Gastroenterology. You also may find topics of special interest in other conferences sponsored by the departments of internal medicine, surgery, oncology, diagnostic radiology and laboratory medicine and pathology.

Monday
Gastroenterology Research Conference

Tuesday
Core Curriculum for Hospital Residents*
Core lecture for fellows
Journal Club

Wednesday
Various interest group conferences*
Internal Medical Grand Rounds

Thursday
GIH Grand Rounds

Friday
Various interest group conferences*

* Fellows make presentations at many of these conferences.

Teaching Opportunities
You will have the opportunity to teach Mayo Medical School students, visiting students from other medical schools and medical residents through bedside instruction and formal didactic lectures. There is an emphasis at the beginning of the fellowship program to teach fellows how to give effective presentations, and feedback is provided after most presentations.

Rotations - Clinical Scholars Track

Rotations - NIH-sponsored Track
If you are interested in a career with a strong emphasis on medical research, a three-and-a-half-year track is offered. Through an ongoing program with Mayo Clinic in Rochester, the NIH funds various two-year research projects.

Research Training
The Division of Gastroenterology and Hepatology is known internationally for the breadth and depth of its research activities with expertise in practically every area of Gastroenterology and Hepatology. As a result of our research efforts, in 2003, 260 original papers were published from the division. There are more than 40 clinical, translational and basic research programs with a principal investigator from the division.

Basic science support is provided in physiology, biochemistry and molecular biology, pharmacology, microbiology, genetics, immunology, cell biology, epidemiology, statistics and other areas.

At Mayo, research mentors closely supervise protocol development, the conduct of the study, data analysis and the final manuscript preparation. Critical peer and institutional reviews at each stage help to ensure high quality. Most Mayo fellows present their work at national meetings and publish several papers.

The integration of basic research and clinical research into practice has been one of the strengths of the division. Currently, there are 370 active patient-oriented protocols in the Division of Gastroenterology and Hepatology. Some of the major areas of research within the division include:

• Barrett's esophagus
• Celiac disease
• Chronic liver disease
• Colorectal cancer (prevention/early detection)
• Endoscopy (development of new procedures)
• The enteric neurosciences
• Inflammatory bowel disease
• Liver and biliary cancer
• Liver transplantation
• Pancreatic cancer
• Viral hepatitis

Current new initiatives within the division include a proteomics and genomics initiative, a clinical trials initiative and an obesity initiative.

The divisional research activities are coordinated through the Gastroenterology and Hepatology Research Committee that meets once a month. Research findings are presented at a weekly Research Conference.

Also see:

• Gastroenterology Research at Mayo Clinic.

Research - Clinical Scholars Track
Although fellows in the clinical track are not expected to formally participate in major research projects until the second year, they are encouraged to conduct small projects and participate in existing protocols throughout the program.

In addition to extensive input from a mentorship committee and the program director, a two-day research symposium is held in the fall of the first year to help fellows select their research projects. By the end of the first year, you will develop a research proposal and choose a preceptor to assist with your second-year research project.

Research - NIH-sponsored Track
The primary objective of this research track is to better prepare fellows to function as independent research investigators. Since the awarding of the initial training grant in enteric sciences to Mayo in 1966, the objective of this program has been to provide in-depth research training to qualified individuals to prepare them for independent academic careers.

Trainees are introduced to a large number of investigative techniques which they are expected to understand, master and apply to their particular project under the close supervision of an established investigator and in conjunction with experienced research technicians and other research fellows supported by other sources. Independence is encouraged, creativity fostered, and emphasis given to a total research experience.

Although there have been modifications in the faculty and in the facilities during the 38 years in which this training program has been in existence, the objective and general approach articulated above have remained unchanged. Indeed, the soundness of this approach is supported by the following general points:

• Nearly 65 percent of individuals who completed training in this program in the past 10 years hold full-time faculty positions at universities or medical schools.
• Many of these individuals have gone on to achieve prominence in academic gastroenterology, as evidenced by memberships on national or international committees, election to prestigious societies, and positions as directors of academic divisions or departments.

Protocols and Mentors
The training proposed is based on a close working relationship between trainees and faculty preceptors through a superior research project. The development of an acceptable research protocol is fundamental and, following review of the proposal at different levels, the investigation is initiated.

Through the successful construction of a protocol and prosecution of a project, you will:

• Clarify your objectives.
• Develop a plausible hypothesis.
• Understand experimental design.
• Become familiar with the theoretical and practical aspects of the methodology you employ.
• Accumulate and analyze data accurately effectively.
• Describe results, providing an abstract for presentation at a national or international meeting.
• Deliver a well-organized presentation, including the effective use of audiovisual techniques.

Later, it is expected that one or more manuscript(s) derived from this work will be accepted for publication by reputable peer-reviewed scientific journals.

The following faculty may serve as preceptors/mentors: