OVERVIEW OF THE PROGRAM

During clinical training, fellows rotate among the four major teaching hospitals of UCSF: Moffitt-Long Hospital, the San Francisco General Hospital, the Department of Veterans' Affairs Medical Center, and the UCSF-Mt. Zion Hospital. Teaching, research, and clinical activities in gastroenterology are coordinated through the Division of Gastroenterology located on the Parnassus (main) campus. Rotation among these hospitals provides fellows with exposure not only to a large and diverse patient population, but also to an outstanding faculty representing clinical and scientific expertise in most areas of gastrointestinal and liver disease.

The adult Division of Gastroenterology consists of 35 full-time faculty, and a nearly equal number of GI-oriented faculty members in the Departments of Pathology, Pediatrics, Physiology, Psychiatry, Radiology, and Surgery. The Liver Transplantation program, established in 1988 and jointly administered by the Departments of Surgery and Medicine, enjoys national prominence and has further strengthened inter-departmental activities. In addition, the GI Division includes volunteer clinical faculty members selected from leading gastroenterologists in the Bay Area. They play an important role in formal and informal teaching activities and work closely with the fellows at all four hospitals. The extensive contact of fellows with both practicing clinicians and faculty investigators provides for a stimulating atmosphere of intellectual inquiry.

More general information about the UCSF Health Sciences Campus and Medical Center may be accessed at www.ucsf.edu.

HOSPITALS AND FACILITIES

Moffitt-Long Hospital and Clinic (UCSF-ML):

• 540-bed facility, located at the UCSF Medical Center Campus.
• Serves as a regional referral center for patients with a wide variety of medical and surgical problems in digestive diseases. The outpatient gastrointestinal and liver clinics are active in the diagnosis and management of patients with challenging and instructive problems from within and beyond the Bay Area.
• Major liver transplant program serving the western United States.
• GI endoscopy facility with ~10,000 procedures annually. It has 4 endoscopy rooms, a six-bed recovery room, conference room and state-of-the-art computer data and image processing with remote video monitoring system. Fluoroscopy rooms specially equipped for ERCP and interventional biliary radiology are housed in the Department of Radiology.
• Outpatient clinic is held 2 or 3 half days per week with 3-6 patients per fellow per clinic.

San Francisco General Hospital:

• 450-bed municipal hospital of the City of San Francisco.
• Serves a large multi-ethnic community as a primary care center. Housed in a modern physical plant, the San Francisco General Hospital is the central receiving unit for the entire city and admits a large number of acute medical and surgical gastrointestinal emergencies.
• A 22-Room GI Diagnostic Unit combines GI Clinic Rooms, faculty and staff offices and 5 GI procedure rooms, including an on-site flouroscopy unit. All major GI procedures are performed, including ERCP, endoscopic ultrasound, and manometry.
• Outpatient clinic is held 3 half days per week with 6-10 patient encounters per fellow per clinic.

San Francisco Department of Veterans' Affairs Medical Center (VAMC):

• Modern 250-bed facility located at Fort Miley overlooking the Golden Gate.
• The major referral center for veterans from the Oregon border to the North to the Santa Clara County line to the South.
• Recently built GI endoscopy facility with 4 endoscopy rooms, one fluoro room for ERCP, and a 6-bed recovery room.
• Outpatient clinic is held 2 half days per week with 3 new patient and 6-8 follow up visits per fellow per clinic

Mount Zion Cancer Center (MZ):

• A designated comprehensive cancer center funded by the National Cancer Institute (NIH).
• Site of specialized clinical programs including the UCSF Women’s Health Center and the UCSF Osher Center for Complementary and Alternative Medicine.
• Site of UCSF clinical programs in colorectal cancer and in inflammatory bowel disease, including central office of the UCSF Inflammatory Bowel Disease Center.
• Newly built endoscopy unit with four procedure rooms and an eight bed recovery room.
• Modern outpatient office space.
• Inpatient facility, including intensive care unit, for surgical specialities, including urological oncology and colorectal surgery.

DESCRIPTION OF THE TRAINING PROGRAM

The Program prepares fellows for a career in academic gastroenterology and hepatology. At the end of three years, fellows will be eligible for Board certification in Gastroenterology and will have undertaken investigation in a defined area of either laboratory-based or clinical research.

The program offers up to 6 positions distributed between two tracks: the Research track, and the Clinical track. All receive formal training in research. The differences are the amount of clinical training time after the first year and the total length of training (three to four years for the Research track; three years for the Clinical track). Applicants select a specific track and complete the application form for that track (see below).

Year 1: For both tracks, the first year consists of intensive basic training in gastroenterology with four months at the UCSF, SFGH and DVAMC sites, respectively. The activities include supervised evaluation of patients on the inpatient Consult Services and in the Gastrointestinal Outpatient Clinics. Trainees become fully competent in basic procedures (upper and lower endoscopy, liver biopsy). They participate in teaching conferences with pathologists, surgeons and radiologists at each site and present cases at Gastrointestinal Grand Rounds, a weekly Division-wide conference.

During this time, Research trainees join their mentor’s group meetings and formulate their project(s) for their remaining years. All other trainees attend the Division’s biweekly research meeting and select a mentor by the midpoint of the year. The full-time faculty members of the Division of Gastroenterology are engaged in clinical or basic research. Capsule descriptions of their respective programs are available here.

Years 2-3/4 (Research track):
Years 2-3 (Clinical track):

Research track: Trainees in this track pursue their research program for an additional two to three years (the standard fellowship and possibly one additional year). The research may be laboratory-based or patient-oriented. Applicants selected for interview are expected to identify potential research mentors and/or programs of interest prior to their visit to UCSF. The core mentor group consists of the faculty for the Division’s two NIH-funded training grants, one in luminal GI and the other in Liver. The research interests of this group can be reviewed at http://gidiv.ucsf.edu/gidiv/fellowship/TrainingFacInt.pdf. UCSF faculty outside this group may serve as mentors, with the review and approval of the fellowship steering committee. Extramural mentoring (for example, by faculty at UC Berkeley or Stanford) generally is not possible for administrative and logistical reasons.

Every effort will be made to schedule an interview with the faculty named by the applicant, but the discussion can – and in most cases should -- continue beyond the interview day, until the applicant has a firm commitment from a UCSF faculty mentor. The fellowship Program Director provides assistance with this process and should be included in all communications. Applicants for the Investigator track who lack the necessary commitment from a member of the training faculty will not be ranked for the fellowship match.

Laboratory-based research. Fellows join their chosen laboratory as early as possible in the second year and initiate their projects. Numerous practical and intellectual resources are available to fellows beyond the home laboratory. The UCSF Liver Center, which is based in the Division of Gastroenterology, is an NIH-funded consortium of approximately 70 independent investigators from several Departments of the School of Medicine and School of Pharmacy. It offers core facilities, access to experts and collaborative investigation. The UCSF sites are linked by free shuttle service as well as electronically. Each site has its complement of journal clubs and visiting lecturers that give further depth to the environment.

Patient-oriented research: Clinical training: The additional 6 months of clinical training required for Board eligibility, comprising 2 months on the Liver Transplant Service and 4 months as a senior fellow at SFGH, DVAMC or Mount Zion, will be scheduled during the second and third years. The only other clinical assignment is the ACGME-mandated continuity clinic (1/2 day per week).

Clinical track: Fellows in this track spend the second and third year obtaining a grounding in clinical research, teaching experience, and advanced clinical training. Clinical activities with teaching responsibilities occupy approximately 18 months, consisting of rotations on Liver Transplant (Moffitt-Long), the biliary service (Moffitt-Long), and GI motility as well as senior fellow duties at the VAMC, SFGH, and Mount Zion respectively. Fellows do a continuity clinic in years 1-3 and take a share of night and weekend call. Clinical electives are available in advanced endoscopy (ERCP and endoscopic ultrasound), inflammatory bowel disease at the Center for Colitis and Crohn’s Disease (MZ), clinical nutrition, GI motility, GI oncology, viral hepatitis, and others. Courses for developing teaching skills are available.

Research: This occupies approximately 25% of the combined 2nd and 3rd years in the Clinical Scholar track. It may be scheduled either as month-long blocks or dedicated days within clinical rotations, depending on the research objectives. Exceptionally productive fellows may have the option of extended research time. At the beginning of the second year, all fellows in this track take the introductory methods course in clinical research (see below).

Training in clinical research. All Clinical Investigators and those in the Basic Science Research track with a clinical research focus take an introductory methods course in September and October of the second year. The course (TICR, Training in Clinical Research) is designed specifically for trainees in clinical sciences and is taught by faculty from the Departments of Epidemiology and Medicine and from the UCSF Institute for Health Policy. Two workshops are part of the course: one in traditional clinical research, and one in outcomes research. Trainees carry out sample size calculations and learn to perform cost-effectiveness analysis and meta-analysis, and they practice analyzing outcomes in a secondary database. Consent forms and ethics also are covered. For those desiring in-depth instruction beyond that provided by the TICR course, the Department of Epidemiology and Biostatistics offers "Advanced Training in Clinical Research" (ATCR). This year-long course includes a Biostatistics Sequence and an Epidemiology Sequence, and students may enroll in one or both. Topics range from biostatistical methods to questionnaire design, intention-to-treat, instruction in writing proposals, informed consent and conflict of interest.

Senior Fellowship. Research track trainees may take a 4th year of fellowship, and some Clinical Investigators may want the same, for extending projects and/or becoming fully qualified in a specific clinical area. The Senior Fellowship is a transition year towards a regular faculty position. In most cases, fellows obtain support for the research component with an individual application to the NIH, the Foundation for Digestive Health and Nutrition, and others.

The core of the Senior Fellowship is special-focus advanced training, with the following options:

• Basic Laboratory Research: Protected time to extend a laboratory project.
• Advanced Training in Clinical Research: The year is used for extending an original research project and completing an MSc from UCSF or an MPH at the UC Berkeley School of Public Health.
• Transplant Hepatology: Fellows may apply for the ACGME-approved training that confers a Certificate of Advanced Qualification in Advanced Hepatology. The curriculum is 75% clinical training with a focus on liver transplantation, 25% clinical research. Details may be found at http://gidiv.ucsf.edu/gidiv/hepfellow.html.
• Viral Hepatitis This consists of one year of advanced training in viral hepatitis at Moffitt-Long or the VAMC. Fellows are expected to pursue an original research project while becoming expert in the fundamentals of clinical trial design.
• Advanced Endoscopy: Enrollees are expected to have a strong commitment to a career in academic gastroenterology. The fellow spends 6 months refining skills in advanced endoscopy (ERCP, endoscopic ultrasound) and 6 months on a related research project. Maximum two fellows per year.
• Inflammatory Bowel Disease: The fellow spends the year working at the UCSF Colitis and Crohn’s Disease Center, engaged in both the clinical care of IBD patients, and on related clinical or laboratory research projects.
• Health Services and Outcomes Research: Trainees will pursue advanced training and research focused on healthcare disparities, health policy, health economics and “T2” translational research (clinical trials to clinical practice).

TEACHING SCHEDULE

APPLICATION PROCEDURE

Please also see the UCSF residency and fellowship policies.

Instructions and timeline for applications (2011)

Track selection: Applicants must select one of these tracks. They will not be considered for both.

• Clinical
• Research

For any questions regarding our fellowship program or application procedure, the person to contact is Sadie McFarlane at (415) 476-3143 or via email at (sadie.mcfarlane@ucsf.edu). Please send applications to:

Brochure (Program Description)
Research Interests of Faculty Mentors