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UCLA Pediatric Gastroenterology

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Training & Experience

 

The primary goal of UCLA's Pediatric Gastroenterology Training Program is to prepare individuals for a career in academic medicine. Individuals are chosen for the program that will pursue creative, scholarly endeavors to advance the science and practice of pediatric gastroenterology.

The training program integrates a strong background in basic and/or clinical research with excellent clinical training in pediatric gastroenterology medicine and is compliant with all regulations.

The overall goals of the training program are to:

  • provide an appropriate training environment where fellows increase their knowledge through direct interaction with a wide variety of patients requiring GI subspecialty care,
  • train fellows to diagnose and manage gastrointestinal, pancreatic and hepatobiliary disorders in infants, children and adolescents, and to proficiently perform gastroenterologic procedures,
  • foster professionalism, responsibility, respect, ethics and compassion for patients and their families,
  • teach the basis for scientific investigation, study design, and the analysis and reporting of study data resulting in a completed mentored research or scholarship project under the supervision of a scholarship oversight committee,
  • provide an environment that integrates basic science and translational teaching into clinical instruction,
  • equip fellows with the tools required for critical thinking and future success as independent and productive pediatric gastroenterologists,
  • develop expertise in all 6 core ACGME competencies, and
  • fulfill all the requirements to obtain certification in Pediatric Gastroenterology by the American Board of Pediatrics; develop the self-discipline required for life-long learning, maintenance of certification and compliance with regulations; and develop the expertise, administrative skills and insight required for career planning, adaptation, leadership and excellence in patient care.

Overview of Educational Program

The first year of training focuses on developing clinical judgment and procedural skills. During the first year, the fellow will be exposed to a wide variety of patients with gastrointestinal, hepatobiliary and nutritional diseases. Education will focus on the development of expertise for appropriate work-up, diagnosis and treatment of these conditions. Fellows will participate in well-organized and regularly scheduled practical and didactic training in the body of clinical, administrative, and research knowledge and skills including procedural skills that comprise the subspecialty of gastroenterology. Fellows should identify their area of interest and begin evaluating different research projects under the guidance of the program director. Fellows will be given a clinical duty-free period of four weeks to complete and submit a grant proposal to the various available training grants.

In the second and third years this knowledge is consolidated in the outpatient setting. Scholarly activities are emphasized during the second and third years. It is expected that abstracts are written and submitted to national scientific meetings for peer review during the second and third year of fellowship.

Clinical Training

Fellows acquire the clinical skills needed to independently practice pediatric gastroenterology through a wide range of clinical training, including: Pediatric Gastroenterology inpatient and consult service; continuity clinics; ambulatory subspecialty clinics (general GI clinic, IBD clinic, nutrition support clinic, liver transplantation clinic, intestinal rehabilitation and transplantation clinic); diagnostic procedures; and motility testing.

Fellows will care for patients with inflammatory bowel disease, hepatobiliary diseases, metabolic liver diseases, short bowel syndrome, feeding disorders, diarrheal diseases, gastrointestinal motility disorders, gastroesophageal reflux, celiac disease, pre and post liver transplant, pre and post intestinal transplant and other gastrointestinal disorders.

At the completion of training fellows will perform well over 150 upper endoscopies and well over 100 colonoscopies. They are also adequately trained in ileoscopy, enteroscopy, polypectomy, esophageal banding, gastrostomy tube placement, foreign body removal, liver biopsy, etc.

Unique aspects of our Inpatient Clinical Programs - We have a strong and longstanding tradition of a close working partnership between our program and the liver and intestinal transplant surgical service, both for pre and post-transplant care. Both teams co-manage the patients and joint multidisciplinary rounds, which occur twice per week with the pediatric GI fellows leading the rounds. Peds GI fellows have a unique opportunity to fully understand surgical procedures and transplant anatomy that is essential in the short and long term medical management and for the thoughtful planning of endoscopic procedures.

The Intestinal Rehabilitation Program frequently begins with the patient referral from NICU - the Pediatric GI fellow has the opportunity of following the outcome of these children, through all aspects of decision making, including both early and late surgical procedures, complex enteral feeding regimens, and inpatient and outpatient parenteral feeding programs. Pediatric GI fellows not only learn to manage a wide range of complications but partake in the complex medical and surgical management algorithms that bridge the spectrum from complete intestinal rehabilitation to intestinal failure and need for intestinal transplantation.

Unique Aspects of our Outpatient Programs - As several of our specialized outpatient programs (particularly the liver and intestinal transplant program, the IBD program and the home nutritional support programs) have been in existence for up to (and beyond) 25 years with the same senior faculty present since their inception, Pediatric GI fellows have the unique ability to understand the evolution of chronic disease processes over the course of an entire childhood, from birth to 20 years plus. This provides an invaluable understanding of the pathophysiology of childhood disease over decades. The essential aspects of planning transition of care for these young adults is an important, and often neglected aspect of their care and an opportunity for clinical research.

Research Training

Research is a major component of the UCLA Training Program in Pediatric Gastroenterology. Every Pediatric GI fellow is required to pursue investigative research under the guided mentorship of a faculty member. Fellows are expected to orally present their work to their colleagues and faculty at the end of their training.  Additionally, Pediatric GI fellows are expected to submit and present abstracts at national meetings, as well as publish their work in peer-reviewed journals. Research opportunities at UCLA are diverse in basic and clinical sciences. Research training is tailored to meet the particular needs and desires of the individual fellow.

Unique Aspects of Research Opportunities - Our fellowship program exists within the very large academic campus of UCLA, which affords the Pediatric GI fellows the potential to find mentors and establish research projects in a vast array of opportunities. This provides an invaluable resource particularly for basic science collaborations that several of our fellows have taken advantage of.  The adult GI program at UCLA also has a wealth of additional faculty engaged in cutting edge research which has applicability to pediatrics. Several of our fellows have been awardees of adult training grant opportunities and their research mentors have been within the adult GI program. This close collaboration between the adult and pediatrics programs gives our fellows wider access to opportunities not often available elsewhere. 

Research Tracks:

  • Basic Research: Fellows seeking careers in basic research require an advanced understanding of the physiology of the digestive tract and of the principles of cellular and molecular biology. They also must acquire basic laboratory skills and become competent in identifying the research question, in formulating a working hypothesis and study design, in using biostatistics, in the appropriate use of animals, and in state-of-the-art techniques in cellular and molecular biology. They must develop a clear understanding of the current body of knowledge in their areas of interest, of unanswered questions most relevant to gastrointestinal biology and disease, and of research ethics. They need to acquire practical experience in critical analysis of current scientific literature, in the use of computers (e.g., literature review, gene or protein sequence analysis), in scientific writing and presentation, and in the preparation of research proposals for funding and for evaluation by institutional review boards.
  • Clinical Research: Fellows seeking careers in clinical research, which includes patient-oriented research, epidemiology research, and outcomes research, need to acquire advanced and practical skills in state-of-the-art clinical research methods. Some of these skills include performing literature review, synthesis of appropriate research questions and hypothesis, selection of study design, application of cost-effectiveness and quality-of-life models, understanding approaches to sampling populations and making clinical measurements, understanding of fundamental principles of biostatistics and sample size estimations, understanding methods for optimizing quality control and data management, and understanding strategies to avoid bias. Trainees will develop a clear understanding of the current body of knowledge and important unanswered questions in their areas of interest, and of the ethics of research and human investigation. Trainees will acquire practical experience in the critical analysis of current literature, in the use of computers (e.g., literature review, database management and analysis, communication), in the presentation of their work in written and oral forms, and in preparations of proposals for funding and for evaluation by institutional review boards. Trainees who are part of the clinical research track are strongly encouraged to pursue a Master of Science in Clinical Research through the NIH-funded UCLA K30 program. The Master of Science in Clinical Research is offered by the Department of Biomathematics in the School of Medicine. Through didactic course work and a mentored research thesis, this program is designed to provide rigorous training to physicians in 1) the techniques and processes utilized in patient-oriented research, 2) creating a foundation in the computational and statistical sciences, and 3) developing a fundamental knowledge of the methods of clinical trials, biomedical ethics, and principles of clinical pharmacology.

Education

The program includes emphasis on the pathogenesis, manifestations and complications of gastrointestinal disorders. The fellows actively participate in organizing and planning conferences. Conferences include, but are not limited to: weekly pediatric GI Core Curriculum conference, weekly clinical case conference, weekly Departmental core curriculum lectures, weekly gastroenterology and liver pathology conference, monthly radiology conference, multidisciplinary rounds, and weekly journal club. Each trainee is called upon to give lectures, conduct conferences and report at seminars on material relating to gastroenterology. Individuals will develop the necessary skills to communicate knowledge of the field of Pediatric Gastroenterology to undergraduate and medical students, residents and other hospital personnel.