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 about 40 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-MC):

• 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 (DVAMC):

• 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 WomenÕs 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 six positions divided between two tracks: the Investigator track (analogous to the NRMP Basic Science Investigator), and the Clinical Scholar track (analogous to the NRMP Clinical Investigator). Applicants select a specific track. All receive formal training in research. The difference is the amount of clinical training time in the 2nd and 3rd years.

First year:

For both tracks, the first year consists of intensive basic training in gastroenterology apportioned equally among the UCSF, SFGH and DVAMC sites. 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 and gastrointestinal motility). 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, all trainees are expected to familiarize themselves with the research programs of the Division and, towards the midpoint of the year, select a mentor with whom they will begin to formulate a research program for the second and third years. All of 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.

Second and third years:

Investigator track: Trainees in this track spend two years pursuing their research program, which may be laboratory-based or patient-oriented. Applicants selected for interview are expected to identify potential research mentors and/or programs prior to their visit to UCSF. If the schedule permits, the visit will include meetings with those individuals. Incoming fellows select a mentor soon after acceptance into the program, and no later than the start of fellowship training. Those with a focus on clinical/outcomes research are expected to take both the introductory and advanced courses in clinical research methods (see below), and they may obtain a MasterÕs degree. UCSF offers an MS in Clinical Research; UC Berkeley offers an MPH. The sources of support for fellows in this track range from individual awards from the NIH or foundations to an NIH training grant or the mentorÕs funds. While support for the three years of training is guaranteed by the Division, fellows may be asked to apply for individual awards, in part to gain experience with the process of writing a grant application. Research occupies at least 75% of the second and third years. Clinical duties during the second and third years are limited to 6 months of additional training, which meets the requirements for Board eligibility in Gastroenterology. The clinical training component typically includes 2 months on the Liver Transplant Service, and 4 months as a senior fellow at SFGH, DVAMC or Mount Zion. These months are structured to allow research activity sufficient for maintaining the fellowÕs ongoing program. By ACGME requirement, all fellows spend 1/2 day per week in a continuity clinic throughout training.

Clinical Scholar track: For fellows in this track, the goals of the second and third years are a grounding in clinical research, honing teaching skills, and extending clinical training. Clinical activities with teaching responsibilities occupy approximately 18 months and research 6 months. At the beginning of the second year, all fellows in this track take the introductory methods course in clinical research (see below). They rotate on the Liver Transplant service (Moffitt-Long), and they serve as Senior Fellow at the VAMC, SFGH, and Mount Zion respectively. Courses on teaching skills are available. Clinical electives are available in areas such as advanced endoscopy (ERCP and endoscopic ultrasound), inflammatory bowel disease at the Center for Colitis and CrohnÕs Disease (MZ), clinical nutrition, GI motility, GI oncology, viral hepatitis, and others. It should be noted that electives in advanced endoscopy do not provide training to a level of sufficiency in these procedures. For this, a 4th year is required (see below).

The Fellowship Training Committee will consider alternative programs for the 2nd and 3rd years tailored to specific career goals.

Training in clinical research. In 1992, the Program was modified to include formal training in clinical research in collaboration with the Dept. of Epidemiology and Biostatistics at UCSF. This has been extremely successful, matching the results of the traditionally strong training in laboratory-based research. Trainees take an introductory methods course in September and October of the second year. Those who have already had comparable instruction (e.g., an MPH) may opt out. 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. It is required for all clinical research fellows and is taken early in the second year. Two workshops are part of the course: one in traditional clinical research and one in outcomes research. Trainees in the Clinical Research Workshop develop a protocol, carry out sample size calculations and have their proposal critiqued. Those in the Outcomes Research Workshop 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 Departments 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.

Laboratory-based research. The GI Division has leading laboratory-based investigators in various aspects of liver biology and disease, inflammatory bowel disease/mucosal immunology, and gastrointestinal motility/gut neurobiology. In addition, fellows have the option of selecting a research mentor outside the Division of Gastroenterology. Over the past 10 years, the training faculty have included scientists in Pathology, Microbiology and Immunology, Rheumatology, and Biochemistry and Biophysics. 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 40 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 electronically, and many seminars are televised. Each site has its complement of journal clubs and visiting lecturers that give further depth to the environment.

Senior Fellowship. At the end of the formal three-year training program, fellows showing an appropriate level of achievement may take an additional year 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 and can include performing as a clinical attending, with commensurate salary. 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 obtaining an MSc from UCSF or an MPH at the UC Berkeley School of Public Health.
• Transplant Hepatology: This consists of 2 to 3 months on the inpatient service of the Liver Transplant Unit (Moffitt-Long) and 9-10 months of research on a project related to liver transplantation. The fellow also has one half-day of outpatient clinic throughout the year. At the end of the year, the fellow will have met criteria for UNOS certification.
• Viral Hepatitis: This consists of one year of advanced training in viral hepatitis at Moffitt-Long 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 CrohnÕs Disease Center, engaged in both the clinical care of IBD patients, and on related clinical research projects.

TEACHING SCHEDULE

APPLICATION PROCEDURE

Instructions and timeline for applications (2009)

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

• Clinical Scholar
• Investigator

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