Curriculum

Gastroenterology is a specialty which embraces both the difficult intellectual challenges of internal medicine and the gratifying hands-on experiences of endoscopic practice. Our training program delves deeply into both ends of this spectrum. Regardless of the topic, the educational focus is on critical thinking and decision analysis rather than just current facts and techniques. On the procedural side, fellows receive abundant experience at all mentioned locations, while each has a different style of practice and different spectrum of disease. Fellows completing standard endoscopy training uniformly possess complete facility and comfort in routine procedures, including skills any busy practitioner will need such as hemostasis and gastrostomy. 

But gastroenterology extends well beyond the world of endoscopy, and our trainees receive exhaustive (and sometimes exhausting) instruction in the details of state-of-the-art medical practice. Hepatology, inflammatory bowel diseases, gastrointestinal motility, pancreatology – all are covered during the three-year curriculum, including both didactic instruction and patient care experience at the bedside.

Training Rotations Blocks

The curriculum consists of the following elements:

  • Maintenance of UK and VA continuity outpatient clinics, two half days per week throughout the period of training.
  • Not less than 18 months in clinical rotations, and not less than four blocks of protected research time. All inpatient rotations are consulting services, without primary patient care responsibilities.
  • Participation in one or more research project(s) spanning the entire 3-year training program.
  • Regular attendance at and participation in GI Division teaching conferences.

 

The typical distribution of clinical activity over three years is:

  • General inpatient care: 10 – 11 blocks, includes consultation at all three hospitals.
  • Hepatology: 6-7 blocks
  • Pancreato-Biliary: 4-5 blocks
  • Night float: a dedicated fellow is assigned to cover calls for two-week blocks, from 5 pm to 7 am, with no duties in the morning. This system helps to reduce fellows' fatigue and burnout while optimizing the quality of care provided to patients.
  • Endoscopy: 8-9 blocks at all four locations.
  • Ambulatory/Elective: 1-2 blocks
  • Research: 6 blocks

Teaching Conferences

Our conference schedule is continuously revamped to allow a return to the “good old days” when intellectually stimulating teaching presentations were a central part of any academic program.

The overall theme of organized didactic teaching conferences is to provide a mechanism for an organized and systematic coverage of gastroenterology topics during the three-year training program while at the same time allowing presenters the flexibility to focus the presentation on specific aspects of current interest or controversy. This structure ensures that each fellow receives exposure to the fundamentals of gastroenterology as outlined in the topic curriculum.

This is accomplished by a combination of two mandatory conferences: a weekly Fellows Clinical Conference and a weekly Core Curriculum Conference.

Fellows prepare some type of presentation for a conference or meeting an average of twice monthly. In some conferences, there is close interaction between the fellow and an assigned faculty member; other presentations are independently prepared by the fellow with more general guidance from the faculty.

Mandatory Conferences

GI Core Curriculum Conference: is a weekly conference presented by Gastroenterology attendings or invited presenters from Medicine or Surgery discussing specific topics in the area of expertise of the presenter.

Fellows Clinical Conference is a weekly conference at which one fellow prepares a presentation on a gastroenterology topic; topics are defined in the yearly schedule accordingly to the GI Core Curriculum. A faculty mentor with expertise in the topic is assigned to assist the fellow in preparing the presentation. Some topics are very specific, and fellows are expected to review the entire topic; other assigned topics are very broad, and fellows are expected to select a particular sub-topic of interest for review. In either case, fellows present a comprehensive review, including both areas of established knowledge and newer or less completely understood concepts. The presentation will emphasize clinical aspects of the topics, including presentation, diagnostic evaluation, and management strategies.

GI Motility Conference focuses on clinical and basic aspects of motility of the GI tract in health and disease. The conference consists of a short, focused presentation by an assigned faculty member or fellow, followed by review of the motility studies.  Fellows are provided with hands-on experience navigating the software for an accurate read.

Endoscopy Conference is presented by a team, consisting of one faculty member and one fellow, who together prepare a discussion of a topic. The topic involves a very specific or focused issue of controversy, uncertainty, or current development. A thorough review of the topic is presented in not more than 40 minutes followed by a discussion. The remainder of the conference consists of informative or interesting images from recent endoscopy cases.

GI Pathology Conference is a clinical conference led by the GI specialist from the Department of Pathology. The conference consists of a brief overview of a specific topic, followed by a review of recent gross and microscopic pathology, correlated with patient clinical history. In both parts of the conference, the emphasis is on pathologic findings and correlation with pathophysiologic and clinical features.

GI/Radiology Clinical Conference is a patient-based clinical conference attended by GI faculty and fellows, and Radiology faculty and residents. The conference is administered by the GI division; several GI cases are presented by fellows. Clinical histories and radiographic materials are presented from patients with medical/radiological/surgical aspects of their diseases, and a general discussion of clinical management proceeds. The discussion focuses on clinical disease features and management perspectives from the different disciplines.

Research Conference includes two or three research presentations by fellows or faculty on research projects in planning; preliminary data from projects underway; final data from completed projects; or presentations being prepared for regional or national meetings.

GI Journal Club is a monthly conference for review and discussion of articles recently published in peer-reviewed journals, attended by GI faculty and fellows. Two reviewers (consisting of both fellows and faculty) present a series of new articles. Every quarter we perform detailed analysis of the selected articles with the emphasis on methods of critical literature review. The presentation therefore focuses on critique of the significance of the research, experimental methods and study design, data collection and outcomes, statistical analysis, and conclusions.

Morbidity and Mortality Conference and GME Unit Level SWARM Conference: A case is presented by a fellow and a faculty member serves as a moderator for the discussion. Facilitator from the patient safety office is assigned to the GME ULS, which intends to discuss low-harm or no-harm/near miss events. The Vanderbilt MATRIX model is used for these presentations to help identify the general ACGME competencies involved in the case presentation. The GME ULS consists of making a timeline of the event, completing a fishbone diagram, identifying the 5 why’s in the root cause of the issue, and developing action items to try to prevent the issue in the future.

Practice Management Conferences are presentations oriented toward instructing fellows in how to manage the practice of gastroenterology after completion of training. Examples include medical malpractice, contract negotiation, and billing / coding methods.

Non-Mandatory Conferences

Internal Medicine Grand Rounds is run by the Department of Internal Medicine Fridays at noon and consists of presentations on a variety of topics related to Internal Medicine and its sub-specialties.

Gut Club is a periodic conference in which an internal or outside speaker with nationally or internationally recognized expertise is engaged to present an evening conference to local practitioners in an off-campus setting.

In addition, fellows have the opportunity to attend optional conferences during their ambulatory rotation or whenever they have a particular interest. These conferences provide a unique learning experience as they are multidisciplinary, allowing for input from other medical teams. The three conferences available to fellows are the Inflammatory Bowel Diseases Conference, the GI and Hepatology Tumor Boards, and the Transplant Selection Committee.

The GI department at the University of Kentucky offers an opportunity to network and collaborate with other nearby academic centers through annual conference presentations. Experts from the University of Kentucky, University of Louisville, and the University of Cincinnati come together periodically to present various topics, providing fellows with exposure to practices in other academic institutions. This collaboration enriches the learning experience for fellows, allowing them to gain insights into different approaches and perspectives in gastroenterology. By attending these conference presentations, fellows can expand their knowledge and skills, and build valuable connections with experts in the field from across the region. 

More Information

Training Environment

The primary site for the training program is the University of Kentucky Chandler Medical Center. This world-class facility, which opened in the summer of 2011, establishes a new standard of excellence in health care. From cutting-edge medical and information technology to eco-sensitive green roofs to an expansive art collection, UK’s astonishing Chandler Hospital takes a back seat to none. Planning is underway to create an equally advanced new endoscopy suite; but until then, UK’s existing endoscopy center is fully equipped to perform the complete array of standard and advanced procedures, affording comprehensive training opportunities. And ambulatory care is provided in the digestive health program clinic, again serving as an excellent venue for patient care and learning.

A variety of clinical experiences is provided at additional training sites. The Lexington Veterans Affairs Hospital is immediately adjacent to the Chandler Hospital and includes a complete endoscopy facility, as well as a modern outpatient clinic space. UK Good Samaritan Hospital, located a few blocks away but still on the University main campus, provides an acute care experience with a community hospital flavor. Additionally, fellows participate in endoscopic procedures at the ambulatory surgical center in Lexington, KY, further expanding their endoscopy training experience. This ambulatory setting allows fellows to gain valuable experience in performing procedures in a more streamlined and efficient environment, which is increasingly becoming the standard of care in modern endoscopy practice.

Training in multiple clinical settings provides many benefits for gastroenterology fellows. It allows them to have exposure to a wider range of patients and conditions, gaining a more diverse and well-rounded skill set. Additionally, training in different environments helps fellows learn to adapt to varying clinical situations, which is an essential skill for practicing gastroenterologists who must be able to provide high-quality care in a variety of settings.  It all adds up to a practice environment which is ideally suited to training gastroenterologists who will be ready to face the challenges of 21st century medicine.

Academic Formation

We are committed to training the academic physicians of the future, providing those who plan careers in ongoing instruction and scholarship with the tools they need to achieve sustainable and productive careers. It is a tribute to our ongoing success in this effort that half of our current faculty are graduates of our own training program, and former trainees have found success in other prominent programs around the country. Currently five of our 11 fellows are pursuing training which will lead to academic careers.  

Features of our fellowship program which enable this kind of formation include:

  • Customized training schedules in the second and third years, with protected time for academic pursuits and contiguous block time for research projects, as well as course work through the University's graduate school.
  • Graduate class training through the UK College of Public Health and other UK Graduate School programs free of charge, leading to a graduate certificate, master's degree, or PhD.
  • Collaboration with researchers across the University in a variety of disciplines leading to published scholarly works.
  • Abundant research opportunities in ongoing investigations now underway in collaboration with current faculty, as well as support for fellow-initiated research projects.
  • Intramural funding opportunities for protected time to pursue scholarly work.
  • Opportunities after fellowship completion for additional scholarship in faculty roles which provide a continuity transition from fellowship to full academic faculty status.

Among our current fellows, four are presently enrolled in graduate school classes (free of charge) which are expected to lead to master's degrees or PhDs.

Community Setting

The University of Kentucky is located in Lexington, KY, in the heart of the Bluegrass State.  With a population of about 300,000, Lexington boasts scenic neighborhoods, good public and private schools, a low crime rate, and great restaurants and shopping.  Sports excitement can be found at UK basketball and football games and the Keeneland thoroughbred race track. Great outdoor activities are abound in Kentucky, from the Daniel Boone National Forest in the mountains of eastern Kentucky to almost countless nearby lakes and rivers. Simply driving through the countryside surrounding Lexington is an amazing tour of beautiful vistas and historic horse farms. Fellows and their families find living in Lexington to be an enjoyable bonus to the excellent gastrointestinal training program.

In addition to the new fellow’s reception, the GI division at the University of Kentucky arranges periodic gatherings and social events for fellows, faculty, and their families. These events provide a valuable opportunity for fellows to build relationships with their colleagues and mentors in a relaxed and supportive environment. These gatherings provide an occasion for the fellows and their families to connect with each other, share experiences, and build lasting friendships.

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Result

Exit interviews with finishing gastroenterology fellows consistently find a high level of satisfaction with the quality of the educational experience.  And all gastroenterology trainees completing the program during the last 28 years have achieved board certification in gastroenterology by the American Board of Internal Medicine. GI in-training exam scores for the majority of fellows have been in the upper tercile. In addition, the program has maintained full accreditation with the Accreditation Council for Graduate Medical Education (ACGME). At the most recent site visit of the ACGME Residence Review Committee (RRC) in January 2016, the review committee commended the program for its demonstrated compliance with the ACGME’s requirements for graduate medical education.

To visit our web page with instructions and information about the application process as well as a timeline, click here.

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