Overview
Five or six general gastroenterology fellowship positions are available each year. There are a total of 16 general GI fellows and one advanced endoscopy fellow currently at IU School of Medicine.
There are four hospitals at which GI fellows rotate: Indiana University Health University Hospital (UH), Eskenazi Hospital, Richard L. Roudebush Veterans Affairs Medical Center (VAMC), and IU Health North Hospital.
UH is a tertiary care center with complex cases transferred from across Indiana and neighboring states. Fellows rotate on three consult services during fellowship – GI, ERCP, and liver. There are always internal medicine residents rotating on the GI and ERCP consult services. There is a PA who can help with the liver consult service. Additionally, there is an inpatient liver service at UH that serves as a primary admitting and discharging team. This service has a team of internal medicine residents and a dedicated pharmacist and care manager. Almost all patients on this service are awaiting a liver transplant or post-transplant.
The VAMC serves veterans from across Indiana along with Illinois and Kentucky. Fellows rotate on an inpatient consult service usually with internal medicine residents and students. Fellows participate in both inpatient and outpatient endoscopy.
Eskenazi is the county and safety net hospital that serves a diverse patient population with a variety of routine and complex GI and liver diseases. A significant number of the patients speak Spanish or other languages and there are in-person and video interpreters available. Fellows participate in both inpatient and outpatient endoscopy.
IU Health North Hospital located in Carmel, a suburb of Indianapolis, provides an experience most like a community practice with a mixture of consults and endoscopy. First year fellows spend an average of four months at the various UH rotations, three months at the VAMC, three months at Eskenazi, and one month at IU Health North.
Fellows are assigned to continuity clinics either at the VAMC or at Eskenazi. All fellows have one half-day per week of continuity clinic throughout fellowship.
One month per year, fellows are assigned an outpatient block where they can rotate in subspecialty continuity clinics in inflammatory bowel disease, motility, pancreaticobiliary, and hepatology.
In the third year of training, fellows who are preparing for an academic career in a specific subspecialty can switch part of their weekly continuity clinic to the subspecialty clinic.
There is no in-house call for GI fellows. Call is one week at a time. One fellow takes “bleeder call” from home. This fellow will cover consults at Eskenazi and VAMC during the weekend. This fellow will cover procedures at VAMC, Eskenazi, and UH during the weekend. During the week, the fellow continues to take call from home and may have to come in for emergent endoscopies overnight. Fellows cover UH, Eskenazi, and VAMC while on call at night. First year fellows typically cover 4 weeks/year, while second and third years cover 3-4 weeks/year. For the first two weeks of call that a first-year fellow takes, the fellow is paired with a senior fellow who will help with logistics, etc.
A second fellow takes “patient call” from home at night and on weekends for one week at a time. These are calls from clinic patients about urgent issues, post-procedure complications, etc. Each fellow typically covers 3-4 weeks/year.
Benefits
Fellows receive four weeks of vacation per year and generally split these into one-week vacations at a time.
Fellows request their vacation time prior to the start of each academic year. In addition to the scheduled four weeks of vacation, each fellow will get an extra five or six days off around either Christmas or New Year's Day. Fellows also get an extra 3 days of time off throughout the year to extend 3 other weekends into long weekends.
IU School of Medicine and IU Health recognize several holidays including:
- Independence Day
- Labor Day
- Thanksgiving
- Christmas
- New Year’s
- Memorial Day
The VAMC recognizes all federal holidays. Endoscopy units and clinics are closed on holidays. The on-call fellow covers holidays at Eskenazi and VAMC along with any emergent endoscopies at UH. Additionally, three fellows will round on current patients on UH services in the morning on these days. In addition to the scheduled four weeks of vacation, each fellow will get an extra five or six days off around either Christmas or New Year’s Day. Fellows also get an extra 3 days of time off throughout the year to extend 3 other weekends into long weekends.
Endoscopy
All fellows gain ample experience with endoscopic maneuvers such as foreign body removal, variceal banding, esophageal dilation, PEG tube placement, chromoendoscopy, and large colon polyp resection. Interested fellows may also gain competence in other procedures during their fellowship such as, but not limited to, esophageal stent placement, balloon assisted enteroscopy, and radio frequency ablation of Barrett’s esophagus.
The bulk of endoscopy experience during fellowship occurs during dedicated endoscopy blocks without having to cover a consult service. Fellows also perform endoscopies while on call and consults. Generally, first year fellows will have three months of dedicated endoscopy blocks, while second and third years will have five to six months of dedicated endoscopy blocks each year.
Most endoscopy experience throughout fellowship is at VAMC and Eskenazi while also performing endoscopy at IU facilities. Additionally, senior fellows rotate at a busy IU outpatient endoscopy center. On average, by the end of their third year, fellows have performed more than 1,000 endoscopic procedures, which significantly exceeds the recommended benchmarks and the national average.
General GI fellows get an average of three months of exposure to managing pancreaticobiliary diseases with the ERCP group at IU. During their second and third years of fellowship, they also get some exposure to using the side-viewer scope and can participate in a few procedures each day. However, general GI fellows do not get full training in ERCP or EUS, which requires enrolling in a fourth year of fellowship as advanced endoscopy fellow.
Education and Research
There are multiple conferences held throughout the week. All fellows are expected to attend.
Tuesday
• 4-5 pm: Attending lecture
• 5-6 pm: Grand rounds or Journal Club
Wednesday
• 7-8 am: Core curriculum lecture
Friday
• 7-8 am: Clinical case conference
With the guidance and help of the APD for research and the fellowship research committee, first-year fellows will identify a research mentor and a main research project by the middle of their first year. One rotation block will be dedicated to research in the first year. In June, the first-year fellows will present their research proposals and receive feedback from the division. Second-year fellows have three rotation blocks of research to work on their projects. Third-year fellows have one block of research to finalize their projects and hopefully submit as a manuscript. Additional research time can also be allocated to fellows with an interest in research-track academic careers.
Fellows meet with the fellowship research committee chair at the beginning of their first year to identify their areas of interest and they are suggested several potential research mentors accordingly to choose from.
In addition, at the end of the first quarter of the first year, the program director assigns each fellow a personal mentor to help with personal and career advice throughout fellowship.
Fellows may pursue Masters/PhD degrees during their training and this can be incorporated into their schedule.
Fellows are encouraged to submit abstracts and attend national conferences, such as DDW, ACG, and AASLD. Each fellow receives an education fund to cover expenses related to educational endeavors, including travel and attendance at national meetings.
Other Work/Life FAQs
Most fellows live within 10-25 minutes from the hospitals. Several fellows live in the downtown area (near Massachusetts Avenue or by the canal) and the commute is typically less than 10 minutes. There are some fellows who have either bought or rented houses in the nearby suburbs, but even during rush hour the commute is unlikely to be greater than 30 minutes.
Moonlighting is not permitted for first year fellows. Second and third year fellows can moonlight with the approval of the program director. Per ACGME rules, moonlighting must count towards the 80-hour workweek.
IU School of Medicine has a strong reputation of training excellent gastroenterologists, which allows graduates to end up at their location of choice throughout the country, in various academic and non-academic positions. Some fellows will go on to pursue an additional year of training in a subspecialty within GI. The IU School of Medicine GI fellowship can tailor each fellow’s experience to allow them to pursue their career goals. About 50% of our graduates are thriving at academic institutions, and about 50% are excelling in private practices.