- Jacob Bilhartz, M.D.
- Ismaeel Hashemi, M.D.
- Haley Neef, M.D.
- Julia (Shuemein) Mar, M.D.
- Kelly Sandberg, M.D.
- Dana Steien, M.D.
Mission and Overview
The University of Michigan Pediatric Gastroenterology Fellowship provides excellent clinical and research training. The Pediatric Gastroenterology Fellowship is a three year program specifically directed toward individuals interested in pursuing academic careers or assuming leadership positions in clinical practice. The program is under the direction of Pamela Brown, M.D., Ph.D.
Fellows in the program will spend between four and five months during the first year on the inpatient clinical service. The remainder of the first year is spent in the outpatient clinics and on developing an academic or research interest. The second and third years will concentrate on developing the skills and understanding necessary to become either a clinical or a basic scientist, while maintaining clinical skills with the regular fellows' continuity clinic and one to two months on the inpatient service.
The Pediatric Gastroenterology Division has an active inpatient and outpatient practice. Fellows will follow their own continuity patients throughout their three years of training. The fellows' continuity clinic meets 1/2 day a week, typically on either Friday mornings or afternoons. Fellows will also rotate through the quaternary care clinics (i.e., liver transplant, intestinal failure) as well as the attendings' own clinics when not on inpatient service during their first three months of training, and they will continue to have the option to participate in those clinics throughout the remainder of the fellowship.
The clinical training will include the acquisition of broad clinical skills in pediatric gastroenterology with exposure to a diverse population of patients ranging in age from the newborn to the young adult, with both complex and common gastrointestinal problems. The clinical emphasis is to diagnose, manage and understand the physiology of gastrointestinal issues.
To achieve this objective, the trainees have a continuing responsibility for the care of patients in the outpatient clinic throughout their training. The pediatric gastroenterology subspecialty trainee has their own clinic with a separate schedule. Patients, both new and return visits, are scheduled into the trainee’s clinic the same way as an attending physician's patients are scheduled. The clinic is staffed by the pediatric gastroenterology faculty members on a rotating basis.
The clinical experience involves patients in (but not limited to) the following categories:
- Biliary disease
- Ulcerative colitis
- Gastroesophageal reflux
- Acute and chronic liver disease
- Chronic diarrhea/malabsorption
- Inflammatory bowel disease
- Chronic abdominal pain
- Pancreatic disease
- Poor growth
Broad clinical competence also includes the ability to perform gastroenterological tests and procedures safely and to interpret these results accurately.
- Upper endoscopy
- Stricture dilation
- Banding of esophageal varices
- Endoscopic theraputic injection
- Rectal suction biopsy
- Liver biopsies
- pH probes (interpretation only)
Clinical Responsibilities and Expectations Inpatient Service:
During inpatient rotations, the fellow is responsible for all patients admitted to the Pediatric Gastroenterology Service. The fellow evaluates consultations from other services and follows their progress, as part of continuing management of the particular gastrointestinal problem.
The number of patients that the fellow follows is variable. Generally, we follow five to eight patients on the service and an additional three-four consults.
The fellow is supervised by the Pediatric GI attending on service. The fellow’s responsibility is to immediately notify the attending physician about any admissions or new consultation requests, evaluate the patient first, and notify the attending about any significant worsening of the patients’ status. All patients are seen on the same day of admission and consultations are seen within 24 hours of request.
The Pediatric GI service rounds are done daily. This typically requires one hour per day in addition to rounding consults, although this is variable depending on the census. . During this time the patients’ progress, physical exam and the treatment plans are discussed. If possible, the treatment plan is discussed in the context of a teaching experience with the house staff and medical students where pathophysiology and current medical advances are brought into the discussion of treatment decisions.
The fellow is responsible for the evaluation and follow-up care of the patients seen in the ambulatory setting. This includes the original evaluation, follow-up letters and calls to family and physicians, inquiry about laboratory tests, involvement with gastrointestinal testing and interpretation and viewing of radiological studies.
Once the patient is evaluated, the history and physical examination are presented to the gastroenterology attending. The attending physician then reviews or expands the history with the patient and examines important areas pertinent to the presenting complaint. A discussion of the differential diagnosis, clinical management and final plan takes place either in the staff room or in the patient’s room with the family. In year 2 and later, the fellow discusses the clinical impression and management plan with the family with the attending present.
Longitudinal Continuity of Care Inpatient Service:
Continuity of patient care is assured by the assignment of new patients to the fellow on the inpatient gastroenterology service. The fellow will be involved in all the treatment decisions as long as the patients are hospitalized. The fellow is encouraged to enroll the patient in their continuity clinic and this decision is made prior to the fellow rotating off service or as the patient is discharged while under their care. Appropriate clinic scheduling to their continuity clinic is part of discharge planning.
Fellows are scheduled for continuity clinic on one-half day per week. New patients are scheduled in the fellows' clinic each week. These patients return to the fellow’s clinic as necessary.
Self-Instruction, Critical Thinking and Teaching Skills
The trainee is expected to demonstrate their interest in and ability to critically read manuscripts and teach individuals in small group settings (medical students and house staff). Communication skills for scientific presentations and preparation of teaching materials for didactic presentations are also emphasized. All trainees, upon completion of their three year training should be competent to be sub-board eligible, and complete the pediatric gastroenterology specialty certification in a timely manner.
The University of Michigan has active clinical and basic science research programs which provide numerous opportunities for the Pediatric Gastroenterology Fellow Trainee. During the first year of fellowship, the trainee is expected to interview both basic and clinical scientists to determine the direction of their future research.
Trainees choosing a clinical project are expected to review the pertinent literature to help design the research project. This includes preparation of the consent for Institutional Review Board (IRB) approval. Trainees will be given the opportunity to participate in formal education in the protection of human subjects and will be expected to understand the ethical and safety issues of research in the child or adolescent.
Basic Science Projects
Trainees choosing a basic science project are expected to review the literature pertinent to their research interest, help design the research project, collect data, learn and execute the appropriate statistical analyses, and prepare the data for presentation in both oral and written form.
It is expected that the trainee will be first author on one or more peer reviewed manuscripts derived from their research project.
Clinical: The trainee conducting clinical research will be expected to achieve competence in statistical methods and clinical research design. Specific training in drug development and pharmacokinetics is offered through a partnership with Pfizer Global Research where formal didactic sessions take place weekly for about 80 total hours of exposure. Health Research and Outcomes Analysis is taught through a Robert Wood Johnson course lasting one year.
Participation may be formalized by participation in the Master’s Program for Clinical Research Design either through the University sponsored K30 program or the Rackham School of Graduate Studies Master’s program, also know as the OJ/OC program. Trainees in clinical investigation are encouraged to apply for one of the Master’s programs in Clinical Research during their second year of training.
Basic Science: Trainees conducting basic science research are expected to participate in a Molecular Training Program Course during their second year of fellowship, a formal course taught in the Department of Internal Medicine that reviews basic laboratory skills with hands on participation. Trainees then enter a mentor laboratory to engage in formal research investigations including research design, statistical analysis, and appropriate laboratory techniques.
University of Michigan Graduate Medical Education (GME) Scholars Program
The GME Scholars Program consists of 2 tracks, a Medical Education Track and a Healthcare Administration Track. Interested house officers may choose to participate in one of the scholar program tracks during their training. This innovative program will provide participants with a longitudinal training (a 20-month mini-fellowship) experience in one of the above two areas of concentration. This training will be incorporated into their current GME training program, and is open to all University of Michigan house officers (residents and fellows). The primary goal of the GME Scholars Program is to better prepare graduates to assume and succeed in academic positions with a focus in either medical education or healthcare administration at leading academic medical centers. Additionally, the program will allow participants to establish strong mentoring relationships in their chosen area of study, a network for future collaboration, and might serve as a stepping stone to pursue further graduate study if desired. Program participants will begin to develop the knowledge base and skill set required for them to be successful as the next generation of physician leaders. For additional details, please visit the Web site:
Thank you for your interest in the University of Michigan’s Pediatric Gastroenterology Fellowship Program. All applications for 2014-2015 will be accepted through the ERAS Web site.
November 15, 2012– ERAS application submission opens
March 31, 2013– ERAS application submission closes
To be considered, applicants should have completed three years of training in an accredited pediatric residency program by the time the fellowship begins. Applicants are notified regarding interviews after their completed application has been received through ERAS.
December 1, 2012 – Pediatric GI Fellow Interviews begin
April 12, 2013 – Pediatric GI Fellow Interviews completed
Currently our faculty, fellows, and staff interview candidates during their visit to Ann Arbor and evaluate eligible candidates for their preparedness, communication skills, motivation, integrity, and aptitude and their previous performance in rigorous residency programs based on the individual interview, the evaluations, and other materials submitted by the applicant.
The division participates in the Pediatric Gastroenterology Fellowship match administered through the National Resident Match Program.
Eligibility Criteria:Applicants must submit the following required documents
- 2 letters of recommendation from members of your faculty
- 1 letter of recommendation from your program director
- Personal statement
- USMLE transcripts- Step I , Step II , and Step III scores
- ECFMG Transcripts if applicable
We do not offer observerships. We do not sponsor any visas and we do not accept H1 visas. To be considered for selection, eligible candidates must be either a US citizen or have permanent resident status (green card) because of our funding sources. We wish you every success in pursuing a career in Pediatric Gastroenterology. Please let us know if we can be of additional help.
Applicants must have completed an ACGME accredited three-year residency training program in general pediatrics in the United States or Canada or a foreign medical school that is listed the World Health Organization (WHO) by the time they begin their fellowship in Pediatric Gastroenterology.
Applicants must have a current valid, unrestricted license to practice medicine in the United States or Canada.
Because of our funding souce, we cannot accept any visas. We do, however, consider U.S. citizens and applicants with permanent resident status. Interviews will be offered to select applicants after review of their application and supporting documents in ERAS.
The Pediatric Gastroenterology faculty will select from among eligible applicants on the basis of their preparedness, ability, aptitude, academic credentials, communication skills and personal qualities, such as motivation and integrity. The program will not discriminate on the basis of sex, race, age, religion, color, national origin, disability, or veteran status.
The written guidelines are communicated and provided by the Department of Pediatrics and the University Health System at large based on accreditation guidelines for hospitals (HCFA).
- The attending physician faculty evaluate, assess and decide on a treatment plan for all patients admitted to the gastroenterology service on a daily basis.
- He or she provides daily notes. The frequency of the written notes for patients that are under consultation varies depending on the complexity of the problem and the need for regular advice. This policy is followed whether a fellow is rotating in the in-patient service or not.
- The fellow’s responsibility is to evaluate the patient first prior to the attending physician.
- In addition, it is the fellow’s responsibility to immediately notify the attending physician of all new admissions, requests for consults, and significant worsening of the patient's status.
- Similarly, in the outpatient service the attending physician evaluates all patients once the fellow has evaluated the patient and has delineated their own management plan.
- All contacts with the attending/faculty are a reason for the discussion of the clinical picture, social issues or recent reports of the literature.
- We offer urgent consultation to all areas of the hospital 24 hours a day, 7 days a week.