Gastroenterology, Hepatology and Nutrition|Description of the Program

The Harvard Medical School Fellowship in Pediatric Gastroenterology, Hepatology, and Nutrition is dedicated to training future academic leaders who will be active in advancing our field through either the pursuit of independent and original areas of scientific inquiry or the development of innovative programs in medical education, patient care, quality improvement, and advocacy.

The Mission of our Fellowship Training Program

The goal of our fellowship program is to provide trainees with an in-depth and comprehensive clinical experience followed by scholarly pursuit under the mentorship of an established investigator. We match each trainee with a mentor of academic prominence who both possesses the necessary resources, and displays the interest and ability to guide our trainees through their early years of career development. We seek to establish within our division an atmosphere that values intellectual achievement, curiosity, creativity, the courage to pursue new ideas, and academic excellence. We hope to foster in each of our trainees the tremendous personal satisfaction and inherent fun that accompanies such a career path, and in doing so provide them with an opportunity to make an impact in our field of medicine.

我们的培训项目旨在适应,encourage, and provide support for all fellows planning to develop careers in academic medicine. We recognize that there is a need to train promising young physicians to take leadership positions in the broadest range of academic pursuits. As such, we have developed our program to support trainees interested in pursuing careers as investigators in the disciplines of bench and clinical/translational research, as well as innovators in areas including medical education, patient advocacy, and public policy. Each year, five trainees match into our program.

We aim to position each of our fellows choosing to pursue training as physician-scientists the support and infrastructure to compete successfully for independent funding through theNational Institutes of Healthor for transitional foundation support in anticipation of competing for NIH funding. Similarly, we provide fellows choosing to pursue training as clinician-innovators with the skill set necessary for them to be productive and successful leaders in medical education, patient advocacy, public policy, and quality improvement.

In the past 30 years, we have developed a substantive infrastructure to provide the necessary support for all our trainees who are interested in moving forward with a career in academic medicine. Nearly 95 percent of the trainees who have graduated from our program over the last 10 years have remained in academics, and a substantial percentage of them have competed successfully for NIH funding. As such, we feel fortunate to be in a strong position to continue to foster the career development of our trainees over the long term.

More than 50 outstanding research faculty members have been recruited to support this effort (a ratio of approximately 5:1 faculty to trainee). Our faculty is composed of nationally and internationally recognized experts in the fields of cell biology, biochemistry, structural biology, genetics, immunology, physiology, biophysics, and microbiology. Equally extraordinary mentoring opportunities are available to trainees through our faculty of independent investigators in epidemiology, biostatistics, bioethics, outcomes and health policy, study design, and translational medicine. Our faculty members are making substantive contributions to their fields of research interest. All are publishing in journals of the highest quality and have successful records of training young investigators. Investigators from Harvard Medical School Departments of Cell and Developmental Biology, Microbiology, Immunology, Pathology, Medicine, and Pediatrics, and the Harvard School of Public Health Departments of Epidemiology, Biostatistics, and Nutrition are represented in our faculty. The overall annual research funding base for our division exceeds $10 million (including program grants) in direct support of our investigator-initiated research.

Curriculum: Fellowship Year 1

Our clinical programs provide care to children from Boston and from around the world. In addition to participating in a busy ambulatory program in general gastroenterology, first-year fellows also interact with faculty in established sub-specialty programs including Inflammatory Bowel Disease, Hepatology, Liver and Small Bowel Transplantation, Endoscopy, Nutrition, Short Bowel Syndrome and Intestinal Failure, Celiac Disease, Aero-Digestive Diseases, and Motility.

The first year of fellowship is devoted almost entirely to building a core proficiency in clinical medicine. The year is divided into approximately 13 blocks of 3.5 weeks each. Each fellow completes rotations on the Consult, Inpatient, and Hepatology Programs at Boston Children's Hospital. One rotation is dedicated entirely to the improvement of endoscopic proficiency. Two rotations are dedicated to fellow education in parenteral and enteral nutrition on the Clinical Nutrition Service at Boston Children's Hospital. Focused teaching time provides the opportunity for fellows to receive additional training with members of our hospital radiology staff to acquire proficiency in cross-sectional imaging, abdominal imaging, and fluoroscopy. Similarly, fellows have the opportunity to work individually with pathology staff to acquire core competency in recognizing standard pathophysiology, including GI atopic disease, inflammatory bowel disease, and hepatology.

All fellows participate for one half-day per week in an ambulatory teaching clinic, during which they are precepted by experienced clinical faculty in the diagnosis and management of pediatric patients referred for management of a variety of acute and chronic GI conditions. First-year fellows also spend one half-day per week in our procedure unit.

Curriculum: Fellowship Years 2 and 3

All fellows continue their weekly half-day ambulatory teaching clinic during years two and three of training. To broaden their training experience, fellows are also permitted to substitute subspecialty clinics in place of their general teaching clinics up to twice per month during their second and third years of training. This allows trainees to customize their training contingent upon their career interests. Most fellows choose to pursue further training in our hepatology program, and many choose to spend six-month blocks in our IBD, nutrition, and short gut programs.

All fellows complete one rotation on the Inpatient or Consult service at Boston Children's during each of their second and third years. As such, all fellows are afforded substantive protected time to pursue research and career development opportunities.

Didactics and Conferences

Teaching conferences include a weekly clinical conference conducted within our division and a biweekly combined adult and pediatric GI conference that is conducted in collaboration with adult GI trainees and faculty fromBrigham and Women's HospitalandBeth Israel Deaconess Medical Center(The Longwood Conference). We have weekly pathology conferences to discuss ambulatory and inpatient cases. Bimonthly conferences highlight ongoing basic or clinical research within our division and expose fellows to potential areas of investigation they may wish to consider during their second and third years of training. Finally, all fellows attend a weekly teaching conference series based on a core curriculum of pediatric gastroenterology, hepatology, and nutrition outlined by theNorth American Society of Pediatric Gastroenterology, Hepatology, and Nutrition(NASPGHAN). This is a fellows-only conference that features superb teaching from invited guest faculty.

作为一个学术Physi研究课程:培训cian

All fellows receive clinical training and graduate from our program with the skills that will qualify them for recruitment into any large academic tertiary clinical program.

Training Resources and Opportunities

Training is centered on mentoring each of our fellows in the development and execution of basic and patient-oriented (translational) research.

Basic research training currently underway in our division includes the full spectrum of related fields in intestinal biology that encompass most acute and chronic intestinal diseases including:

• epithelial cell and developmental biology
• innate and acquired mucosal immunology
• intestinal epithelial-microbial pathogenesis

Patient-oriented research in our division focuses on topics including:

• intestinal and nutritional epidemiology
• global health
• outcomes research
• clinical trials
• translational research in basic pharmacology

Research in Quantitative Sciences includes:

• quality improvement
• a systematic review of clinical practice
• development of evidence-based treatment algorithms
• medical education
• public policy and advocacy

Funding and research infrastructure are available through the Boston Children's Hospital Clinical and Translational Research Programs to support such research training. Support is similarly available to applicants with interests in other fields of GI-related basic or clinical research.

Clinician innovator training provides state-of-the-art training in the acquisition of educational skills or research in a defined clinical area. Academic programs in this fellowship training curriculum will focus on:

Formal Course Work and Seminars

All trainees have numerous opportunities to complete course work relevant to their fields of interest.

Trainees in the basic sciences may choose to audit courses offered through graduate programs atHarvard Medical SchoolandHarvard School of Public Health. Trainees in clinical science typically choose to complete academic course work relevant to their research in areas of basic epidemiology, study design, bioethics, and biostatistics. This can be obtained by enrolling in one of several degree programs at Harvard School of Public Health or Harvard Medical School to obtain a Master of Science or Master of Public Health. Alternately, many web-based asynchronous educational opportunities are available through the Harvard Catalyst.

Trainees in education typically choose to participate in one of the longitudinal educational programs available on the Longwood Medical campus, including the Rabkin Fellowship in Medical Education (offered through theShapiro Institute for Education and Research), theMacy Institute at Harvard Medical School, and the Harvard Medical School Academy Center for Teaching and Learning. Clinician-innovators may also attend the Summer Program in Clinical Effectiveness, offered through the Harvard School of Public Health. Several degree-granting programs are also available through competitive applications on the Harvard Medical School campus.

Scientific Mentoring and Career Development

The program is designed to mentor our trainees during and beyond the three formal years of fellowship training.

A formal scholarly oversight committee (SOC) is assembled for each trainee starting in their first research year. The SOC includes a member of the training program steering committee as chair, the trainee's primary mentor, the trainee's clinical advisor, and one or two invited faculty in the field most relevant to the trainee's academic program. This SOC acts as a "thesis committee" and guides each trainee on an individual basis through his/her significant decisions in career development. The SOC meets formally with the trainee at least twice each year and stays with the trainee as a primary mentoring resource throughout their tenure in the Harvard Program.