Pediatric Gastroenterology Fellowship

The primary goal of the program is to train academic pediatric gastroenterologists. We define academic gastroenterologists as those who are excellent clinicians encompassing skills in broad aspects of evaluation, diagnosis and management of primary and secondary diseases of the gastrointestinal tract and who are active in advancing the field by participating in research and/or education.

The first year of the program is devoted principally to clinical training, with both inpatient and outpatient activities and participation in an active consult service. The second and third years of the program are devoted primarily to laboratory and/or clinical research. In some cases, an additional year may be added for training in clinical nutrition.

  • Nutrition fellowship or training

    An independent three-year Nutrition fellowship is available. For those applicants interested in pursuing a traditional GI fellowship with additional Nutrition training, a combined four-year program is available. This program requires admission to each individual program and is comprised of the GI clinical year, a Nutrition clinical year and then the two-year research experience with a project that spans both fields.

    Fellowship training program director

    Elizabeth Rand, MD
    Gastroenterology Fellowship Training Program
    Division of Gastroenterology, Hepatology and Nutrition
    215-590-3247
    Email Dr. Rand.

    Division chief

    David Piccoli, MD
    Division of Gastroenterology, Hepatology and Nutrition
    215-590-2762
    Email Dr. Piccoli.

  • Information about the program
    • Training provided in an internationally renowned tertiary care pediatric hospital affiliated with the Perelman School of Medicine at the University of Pennsylvania
    • Clinical educators include an extensive GI and Nutrition faculty with diverse interests and expertise in the gamut of gastrointestinal diseases and procedures
    • Clinical and educational programs include:
         ° General gastrointestinal diagnostic service
         ° Inflammatory bowel disease
         ° Acute and chronic liver disease
         ° Liver transplantation
         ° Motility disorders diagnosis and management
         ° Home total parenteral and enteral nutrition
         ° Feeding and dysphasia disorders
         ° Hyperlipidemias and nutrition support service
         ° Related nutrition programs
    • Outpatient service with more than 16,500 patient visits per year
    • Inpatient service with more than 700 admissions per year and an average daily census of 15-20 patients
    • State-of-the-art endoscopy and diagnostic suite, with more than 3,500 procedures performed per year
    • State-of-the-art nutrition and growth lab for clinical research and procedures, including resting energy expenditure, dual X-ray absorptiometry and total body electroconductivity
    • Active inpatient and outpatient consult services
    • Formal association with other medical personnel including: medical subspecialists, surgeons, radiologists, nurse practitioners, nurses, nutritionists, psychologists and social workers
  • Specific information by years and/or rotation

    First year

    Inpatient service

    Goals: As described in the guidelines provided by the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN), the fellow should become competent in rendering age-appropriate inpatient care from evaluation to discharge of a broad range of gastrointestinal diseases, including intestinal mucosal diseases, motility disorders, hepatobiliary diseases, pancreatic disorders and functional problems from mouth to anus. Furthermore, the fellow should become competent in the performance of diagnostic and therapeutic invasive procedures. The fellow should learn to evaluate and ameliorate the psychosocial impact of disease, utilize available ancillary services and deliver cost efficient care.

    Objectives: The fellow will participate, with supervision from attending physicians, in all aspects of the care of patients of all ages hospitalized under the GI service at Children's Hospital. This care includes initial evaluation, formulation of differential diagnosis and evaluation, participation in diagnostic procedures, interpretation of laboratory, radiologic, pathologic and other testing, treatment and discharge planning. The fellow will perform daily duties as described in the Fellows Handbook. The fellow will also participate in teaching residents and students on rounds and at the bedside. The fellow will attend all teaching conferences.

    Outpatient service

    Goals: As described in the NASPGHAN guidelines, the fellow should become competent in rendering age-appropriate outpatient care from evaluation through long-term follow up or discharge from clinic as indicated for each disease process. The fellow should provide care to patients with a broad range of gastrointestinal diseases including intestinal mucosal diseases, motility disorders, hepatobiliary diseases, pancreatic disorders and functional problems from mouth to anus. Additionally, the fellow should learn to evaluate and ameliorate the psychosocial impact of disease, utilize available ancillary services and deliver cost efficient care.

    Objectives: The fellow will, with supervision from attending physicians, organize outpatient evaluation, diagnostic procedures and treatment, including hospital admissions as necessary. The fellow will perform history and examination, review of outside data and present cases to the attending physician as per the Fellows Handbook. The fellow will generate a clinic note and dictate a letter to the referring physician.

    Consult service

    Goals: The fellow should become proficient in the evaluation of primary and secondary gastrointestinal signs and symptoms in infants and children with non-GI disease. This includes primary GI diseases in those patients with extraintestinal presentations and secondary GI diseases in patients with known non-GI diseases. The fellow should be able to perform a complete history and examination and review any prior medical evaluation and testing. Formulations and recommendations must be reviewed with the supervising attending physician and then communicated to the referring team and placed in the patient record in a timely and respectful fashion.

    Objectives: The fellow will evaluate all patients as requested by any primary service at the Hospital. The fellow will present cases, write notes and communicate with the primary service as per the Fellows Handbook. The fellow will attend and make presentations in rotation at all teaching conferences.

    Procedure service

    Goals: The fellow should become increasingly proficient in the performance of various GI invasive procedures including patient assessment, sedation, procedural techniques and post-procedure monitoring and management. The fellow will ultimately develop skills to become independently proficient in diagnostic procedures such as upper and lower endoscopy, rectal suction biopsy, liver biopsy and manometry. The fellow will gain experience in therapeutic procedures including esophageal dilation, sclerotherapy, banding and polypectomy.

    Objectives: The fellow will review charts of scheduled outpatient procedures daily, will participate in the consent process, conscious sedation, the procedure, post-procedure management, communication with patients and families and generation of reports.

    Additional rotations

    Goals: The major goal of these rotations is to provide additional experience and insight into other specialties important to the evaluation and treatment of children with GI disorders, particularly Nutrition, Radiology and Pathology. The fellow will attend Continuity Clinic and participate in teaching conferences as allowed by the selective schedule.

    Objectives:

    • Nutrition — The fellow will spend a one-month rotation on the Nutrition service and will participate in various nutrition clinics (cystic fibrosis, renal disease, weight management (obesity), home total parenteral nutrition, etc.). The fellow will learn to perform nutritional evaluation, generate TPN formulations and interpret various nutritional tests, including bone densitometry, body composition testing and other specialized testing as determined by the nutrition service.
    • Radiology — The fellow will spend two weeks on rotation in the Department of Radiology observing fluoroscopic procedures, ultrasound and interventional radiology techniques. The main objective is for the fellow to gain an appreciation of the dynamic nature of the studies that is lost on review of the static images. The fellow will not perform these procedures.
    • Pathology — The fellow will spend two weeks on rotation in the Department of Pathology observing processing techniques and reviewing all GI case material submitted during that period. The main objective is for the fellow to view numerous biopsy specimens daily and to see multiple normal biopsies with the pathologists. A minor objective is for the fellow to gain a general understanding of the processing techniques and how specimen collection impacts the outcome of the processing.

    Night and weekend call

    Goals: The goal of night and weekend call is to provide the fellow with experience in the telephone triage of patients with acute changes in new or chronic illness and to provide training in cross-covering inpatients.

    Objectives: The fellow will obtain sign-out information from the inpatient and/or consult fellow as applicable prior to taking on-call responsibilities. Responsibilities are described in the Fellows Handbook.

    First-year clinical rotations

    • Approximately 12 weeks inpatient service
    • Approximately 12 weeks consult service
    • Approximately eight weeks outpatient service
    • Approximately eight weeks procedure service
    • Four weeks nutrition
    • Two weeks pathology
    • Two weeks radiology
    • Four weeks vacation
    • One-half day a week dedicated to the outpatient clinic

    Second and third years

    Research experience

    Goals: Each fellow will undertake a specific project or projects — under the guidance of a clinical mentor — with the goal of significant participation in research. This is one of the requirements of the American Board of Pediatrics for certification in Pediatric Gastroenterology, the NASPGHAN guidelines and our program goal to produce graduates who will become academic gastroenterologists. The division chief and program director will assist each fellow in the selection of an appropriate project and mentor.

    Objectives: The specific objectives of each project will vary greatly depending on the project selected and the mentor chosen. The long-term goal is for each fellow to submit at least one manuscript describing their research experience to a peer-reviewed journal for publication. The fellow will attend project specific conferences and the standard clinical GI conferences.

    Outpatient service

    Goals: See First year, Outpatient service

    Objectives: See First year, Outpatient service

    Night and weekend call

    Goals: See First year, Night and weekend call

    Objectives: See First year, Night and weekend call

  • Research expectations and opportunities
    • Rigorous laboratory and/or clinical research training under the guidance of faculty in the division, other divisions of the Hospital and other departments of the University of Pennsylvania and its School of Medicine
    • Research training supported by the division, including a NIH training grant in Gastrointestinal Sciences held jointly with the adult GI section
    • Research projects selected during the first year under the guidance of the research fellowship director and other mentors
    • Outstanding research environment, including these areas of investigation in the division:
      • Molecular biology of the enteric nervous system
      • Central nervous system control of gastrointestinal function
      • Immunology of the intestinal tract and abnormalities in inflammatory bowel disease
      • Hepatobiliary diseases including Alagille syndrome and biliary atresia
      • Intestinal and hepatic lipoprotein metabolism in hyperlipidemia
      • Nutritional status assessment in chronically ill children
      • Factors influencing the development of infant and childhood obesity
      • Energy requirements, growth and body composition in children with cerebral palsy, cystic fibrosis and sickle cell disease
      • Evaluation of calcium metabolism and bone mineralization in TPN-fed children
      • Evaluation of community-based dietary education programs for children with hypercholesterolemia
      • Clinical research in inflammatory bowel disease, liver disease, nutrition, liver transplantation and pancreatic disease
      • Genotype and phenotype studies in Alagille syndrome
      • Growth and nutrition in chronic liver disease
      • Pathobiology of cystic fibrosis liver disease
      • Cellular cholesterol metabolism and atherosclerosis
      • High density lipoproteins and cholesterol transport
      • Structure-function relationships of lipoproteins and apolipoproteins
      • Intestinal absorption of cholesterol and vitamins
      • Stress neurobiology and neurophysiological correlates of stress-induced pathology
    • Opportunities for research training in state-of-the-art laboratories at affiliated institutions, including the Departments of Medicine, Biochemistry, Genetics, Microbiology, Pathology and Laboratory Medicine and Physiology at the University of Pennsylvania School of Medicine and the Wistar Institute
    • High publication output and placement in academic positions for fellowship graduates
  • Conference Schedules

    Weekly

    Pathology conference

    Interesting biopsy results from the previous week are presented on an overhead screen by a pediatric pathology faculty member.

    Outpatient clinic conference

    Rotating schedule of Journal Club, research presentations and combined discussions with various services, including Radiology, General Surgery, Nutrition, Pulmonology and Allergy/Immunology.

    Clinical case conference

    Presentation of an interesting case by the fellow to the GI divisions of Children's Hospital and the Hospital of the University of Pennsylvania. Following the case presentation, there is a discussion of disease epidemiology, pathophysiology and treatment. Both adult and pediatric GI fellows participate in this conference.

    GI lecture series

    • Pediatric Grand Rounds
    • GI Grand Rounds
    • Nutrition lecture series
    • Nutrition journal club
    • Surgical Grand Rounds
    • Digestive and liver disease research seminar

    Special programs

    • Raffensperger Symposium
    • Philadelphia GI Training Group Symposia
    • Komarov Research Prize
  • How to apply

    The three-year fellowship seeks physicians who will have completed two to three years of training in an accredited residency program in order to sit for the American Board of Pediatrics certifying examination.

    The following information should be sent to Tiffany DiBruno

    1. Completed application. 
    2. Current photograph (released only after interview is offered)
    3. Personal statement
    4. Three letters of recommendation
    5. Dean's letter (MSPE)
    6. Medical school transcript
    7. Parts 1, 2 and 3 of the USMLE, taken within the 7-year time frame as required by the Commonwealth of Pennsylvania, or equivalent scores
    8. If a graduate of a medical school outside the United States, Canada or Puerto Rico, valid ECFMG certificate or one that does not expire prior to the start of the fellowship
    9. If not a citizen of the United States or permanent resident, a copy of current, appropriate visa will be required.

    The fellowship director reviews completed applications. Selected candidates will then be invited to interview.

    National Resident Matching Program (NRMP)

    Our fellowship program participates in the National Resident Matching Program (NRMP). To learn more, visit NRMP, or contact the program at 202-828-0676.

    Tobacco-free hiring policy

    To help preserve and improve the health of our patients, their families and our employees, The Children’s Hospital of Philadelphia has a tobacco-free hiring policy. This policy applies to all candidates for employment (other than those with regularly scheduled hours in New Jersey) for all positions, including those covered by the Collective Bargaining Agreement.

    Job applicants who apply after July 1, 2014 will be expected to sign an attestation stating they’ve been free of nicotine or tobacco products in any form for the prior thirty (30) days. They will also undergo a cotinine test as a part of the Occupational Health pre-placement drug screen administered after the offer of employment has been accepted but before the first day of hire.

    Exemptions: Attending physicians (excluding CHOP physicians in the Care Network), psychologists, principal investigators and/or Penn-based faculty are exempt from this process to better align with our colleagues at the University of Pennsylvania Perelman School of Medicine.

    Contact

    Tiffany DiBruno
    Secretary, GI & Nutrition Fellowship Program
    Ph: 215-590-3247
    Fax: 215-590-3606
    Contact by email.

Reviewed by Elizabeth B. Rand, MD on September 01, 2013