Curriculum

Clinical Training
Your training will include a broad exposure to common and unusual problems in the field of hepatology and liver transplantation, and guide you to develop the clinical skills necessary to evaluate and manage inpatients and outpatients with these problems. You will become skilled at liver biopsy, and interpretation of hepatobiliary imaging studies. Through your patient care experiences and educational conferences, the training program will help you to rapidly expand your knowledge base in the fields of hepatology and liver transplantation.

During your fellowship you will work on a one-to-one basis with faculty to provide patient care in ambulatory and inpatient settings. The favorable faculty ratio, large and diverse patient population, and state-of-the-art diagnostic, therapeutic, and research facilities combine to create an ideal educational setting. The “Mayo Clinic way” of graduate medical education ensures you will have the finest teaching and the broadest patient care experience possible during a busy, hands-on fellowship program.

In the outpatient clinic, you will follow a group of patients over the duration of your training program, to gain an understanding of the long-term course of diseases, and course of liver transplant patients. Your clinical activities are designed for their educational value to you.

The primary training site is Mayo Clinic's campus in Florida. Elective rotations at Mayo Clinic in Minnesota and at Nemours Children's Clinic in Jacksonville are also available.

Rotation Schedule
Schedules for fellows will vary, but will include the following exposures:

Rotation Descriptions

• Liver Transplantation
  The liver transplantation program at Mayo Clinic's Florida campus began in 1998, but represents an expansion and continuation of the internationally recognized Mayo Clinic liver transplantation program. The program is extremely busy and is expected to perform nearly 100 liver transplants a year. The liver transplant service and clinic are very active and provide exposure to patients with chronic liver disease who are being evaluated for liver transplantation, as well as patients at all stages following transplantation.
  
  You will become skilled in the management of patients with chronic hepatic insufficiency and fulminant hepatic failure. You will develop expertise in the management of all types of post-transplant complications including rejection, biliary complications, and complications of immunosuppression. This training will meet UNOS criteria for certification as a Liver Transplant Physician for fellows who complete a gastroenterology fellowship.
• Hepatobiliary Clinic
  During this rotation you will evaluate and manage patients with a wide variety of liver and biliary diseases, including cholestatic diseases, viral hepatitis, alcoholic liver disease, autoimmune hepatitis, and hepatobiliary neoplasms. You will develop skill in managing complications of chronic liver disease including portal hypertension, pruritis, and encephalopathy.

Research Training
Participation in clinical research is an important part of this training program. Fellows are expected to participate in clinical research projects with a faculty mentor. A Clinical Research Center provides facilities, equipment, and research nurse assistants to support your clinical research projects.

There are opportunities to collaborate with basic scientists in the Birdsall Research Center at Mayo Clinic Jacksonville, or with researchers at Mayo Clinic Rochester. The information generated in this year will form the basis for presentations at national meetings and in publications. A one month block of time is allocated for analyzing data, preparing presentations, and writing manuscripts.

Didactic Training
Clinical conferences, seminars, small-discussion groups, journal clubs and one-on-one instruction are all an integral part of the Fellowship in Hepatology and Liver Transplantation.

Teaching Conferences
We maintain an active schedule of teaching conferences relevant to hepatology and liver transplantation. The goal of these conferences is to help you develop the knowledge and skills necessary to function as an effective consultant in hepatology and liver transplantation in a clinical academic setting.

During a series of Hepatology Core Conferences, faculty members provide a didactic review of important topics in hepatology and liver transplantation. GI Basic Science Conferences cover important areas of hepatic physiology. Visiting professors give state-of-the-art talks and review cases with fellows. Other regular conferences provide teaching in the format of case discussions and literature reviews, and include: GI Medical-Surgical Conference, Hepatobiliary Case Conference, Journal Club, Liver Biopsy Conference, GI Research Conference, and Liver Transplant Selection Conference.

There are other conferences in the Division of Gastroenterology and Hepatology, as well as clinic-wide conferences such as Grand Rounds and Clinical-Pathologic Conferences. Other Mayo Clinic Jacksonville divisions and training programs also have active conference schedules that will include topics of interest.

Training in Scholarly Activities
We will help you develop your teaching skills, and your ability to give effective oral presentations. You will participate in the formal and informal teaching of colleagues, internal medicine and family medicine residents, medical students and nursing staff. You may have the opportunity to make presentations at national CME meetings sponsored by our division.

Teaching Opportunities
You will have the opportunity to teach internal medicine and surgery residents, Mayo Medical School students and visiting students from other medical schools through bedside instruction and formal didactic lectures.

Cardiac Life Support Certification
Certification in Basic Cardiac Life Support and Advanced Cardiac Life Support (ACLS) is required for all Mayo Clinic residents and fellows. ACLS courses are held during the last week of June, just before the start of the academic year. The ACLS course also is offered evenings every three months during the year to facilitate recertification.

Patient and Service Mix
As a regional medical center for the Southeast, Mayo Clinic Jacksonville registers more than 55,000 patients each year. Eighty-five percent of the clinic's patients are self-referred and come from within a day's drive. Although Mayo Clinic has a reputation for successfully handling the most obscure and difficult medical problems for people from around the world, common medical concerns are actually the norm. This allows you to see and treat an exceptional variety of illnesses during your clinical training.

Call Frequency
Your call schedule will vary by individual rotation. Mayo Clinic follows the recommendations of the Accreditation Council for Graduate Medical Education.

Moonlighting
Moonlighting is permitted for licensed residents and fellows beyond the PGY-1 level. Moonlighting activities may be scheduled during those times when you are assigned to consultative or outpatient rotations.

Evaluation
To ensure that you acquire adequate knowledge and develop your technical skills to expert levels, your performance will be monitored carefully during your Fellowship. You will be evaluated formally by supervising faculty members after each rotation. You will meet with the Program Director on a regular basis to review your evaluations, and will have the opportunity to provide critiques of your training experience and faculty performance. During meetings with the Program Director, you will be able to discuss ways that we may improve your training experience.

Career Development
You will meet periodically with the Program Director, your research mentor, and other faculty members to discuss your career goals. Mayo Clinic recruits the majority of its staff physicians from its own subspecialty training programs. Thus, when you successfully complete the Fellowship in Hepatology and Liver Transplantation, job opportunities may be available at Mayo Clinic's group practices in Jacksonville, Rochester, or Scottsdale.