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Training Overview

This clinically-oriented fellowship allows fellows to tailor their clinical, research, and elective experience to prepare them for their future careers. Focusing elective and research time on particular areas provides advanced training for specific career goals.

Clinical training

During the two years of clinical training, fellows spend 12 months on clinical rotations at the Lebanon campus and 12 months of clinical time at the White River Junction (VT) V.A. campus. At the participating institutions, fellows are responsible for the performance of endoscopic procedures, patient consultations, and outpatient clinical visits with full staff supervision. Fellows have an outpatient clinic weekly at the V.A. and at the Dartmouth-Hitchcock Clinic which is longitudinal throughout the three years. Nighttime and weekend call is shared between all six fellows at the institutions on a rotational basis. All procedures are mentored during all three years.

Educational opportunities for the fellows are diverse, and include:

  • participation in the weekly Journal Club
  • weekly Case Presentations Conference
  • weekly GI/Surgical/Radiologic Case Review Conference
  • weekly Post-Clinic Conference at the V.A.
  • bi-weekly GI Pathology Conference at Mary Hitchcock Memorial Hospital (MHMH)
  • weekly GI Path Conference at the V.A.
  • bi-weekly Board Review/Fellows Conference
  • quarterly Endoscopy M+M, and
  • monthly GI Research Conference

In addition, there is a bi-monthly visiting professor series that discusses bench to bedside research advances. Fellows are also encouraged to attend the weekly medicine grand rounds and M+M conference.

Research training

The research experience is 12 months in duration and is designed individually. Fellows may take advantage of resources at the Geisel School of Medicine at Dartmouth, including Dartmouth Institute for Health Policy and Clinical Practice, the Norris Cotton Cancer Center, the Basic Science Departments, and other components of the academic medical center. Research fellows are mentored by a faculty member of the Section of Gastroenterology, but are free to pursue their research outside of the Section and even outside of the Department of Medicine.

Dartmouth-Hitchcock Gastroenterology has particular research interests in inflammatory bowel disease, pancreas disease, colon cancer screening and motility with multiple NIH, industry and privately funded, ongoing studies.

Management of disorders

Fellows will acquire expertise in the evaluation and management of the following disorders:

  • Diseases of the esophagus including EOE and achalasia
  • Acid peptic disorders of the gastrointestinal tract
  • Motor disorders of the gastrointestinal tract
  • Irritable bowel syndrome
  • Disorders of nutrient assimilation
  • Inflammatory bowel diseases
  • Vascular disorders of the gastrointestinal tract
  • Gastrointestinal infections, including retroviral, mycotic, and parasitic diseases
  • Gastrointestinal and pancreatic neoplasms
  • Gastrointestinal diseases with an immune basis
  • Gallstones and cholecystitis
  • Alcoholic liver diseases
  • Cholestatic syndromes
  • Drug-induced hepatic injury
  • Hepatobiliary neoplasms
  • Chronic liver disease
  • Gastrointestinal manifestations of HIV infections
  • Gastrointestinal neoplastic disease
  • Acute and chronic hepatitis
  • Biliary and pancreatic diseases

Clinical problems

Fellows will acquire expertise in the evaluation and management of patients with the following clinical problems:

  • Dysphagia
  • Abdominal pain
  • Acute abdomen
  • Nausea and vomiting
  • Diarrhea
  • Constipation
  • Gastrointestinal bleeding
  • Jaundice
  • Cirrhosis and portal hypertension
  • Malnutrition
  • Genetic/inherited disorders
  • Depression, neurosis, and somatization syndromes
  • Surgical care of gastrointestinal disorders

Diagnostic and therapeutic techniques and procedures

The program provides for instruction in the indications, contraindications, complications, limitations, and (where applicable) interpretation of the following diagnostic and therapeutic techniques and procedures:

  • Imaging of the digestive system, including:
    • Ultrasound
    • Computed tomography
    • Magnetic resonance imaging
    • Vascular radiography
    • Nuclear medicine
  • Percutaneous cholangiography
  • Percutaneous endoscopic gastrostomy
  • Gastric, pancreatic, and biliary secretory tests
  • Other diagnostic and therapeutic procedures utilizing enteral intubation and bougienage
  • Enteral and parenteral alimentation
  • Liver transplantation
  • Pancreatic needle biopsy
  • ERCP, including papillotomy and biliary stent placement
  • Endoscopic ultrasonography, including fine needle aspirations

Procedures

Opportunities are provided for the fellow to gain competence in the performance of the following procedures:

  • Esophagogastroduodenoscopy
  • Esophageal dilation
  • Proctoscopy
  • Flexible sigmoidoscopy
  • Colonoscopy with polypectomy
  • Percutaneous liver biopsy
  • Percutaneous endoscopic gastrostomy
  • Biopsy of the mucosa of esophagus, stomach, small bowel, and colon
  • Gastrointestinal motility studies
  • Nonvariceal hemostasis (upper and lower)
  • Variceal hemostasis
  • Enteral and parenteral alimentation
  • Liver biopsy
  • ERCP
  • Endoscopic ultrasonography, including fine needle aspirations and interventional EUS
  • Endoscopic treatment of gastroesophageal reflux disease
  • Endoscopic treatment of obesity
  • POEM
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