Training and Curriculum
Fellows gain comprehensive training in all facets of gastroenterology and hepatology as well as investigative research.
Cedars-Sinai is the largest nonprofit hospital in the western U.S., and U.S. News & World Report currently ranks the Cedars-Sinai Division of Digestive and Liver Diseases second in the nation. The inpatient and outpatient clinical rotations at Cedars-Sinai provide fellows with exposure to a diverse set of patients with a variety of gastrointestinal, pancreaticobiliary and liver diseases that meet competency requirements of the Accreditation Council for Graduate Medical Education.
The comprehensive program covers 36 months and offers both a clinical track and research track to tailor the experience toward each fellow's career goals. The core clinical training includes 18 months of dedicated clinical rotations in inpatient general gastroenterology, inflammatory bowel disease (IBD) and hepatology. The program also offers fellows outpatient rotations in general gastroenterology, endoscopy, motility, IBD, pancreaticobiliary disorders and nutrition, in addition to their half-day continuity clinic throughout their fellowship. Additionally, fellows have numerous elective and research months that provide them with additional opportunities to further explore their interests and hone their expertise. Below are the typical training schedules for each fellowship track.
Inpatient Consultation Service
- Gastroenterology Consultation Service
Fellows work closely with gastroenterology faculty members to evaluate and manage patients with acute gastrointestinal and pancreaticobiliary diseases who have been hospitalized for medical, surgical, obstetric and other primary services. As a result of having specialized faculty and serving as a major referral center in the area, fellows serve as consultants on common cases such as gastrointestinal bleeding, nausea and vomiting, and abdominal pain as well as for highly complex motility disorders and functional bowel disease. In addition, the fellow is responsible for general pancreaticobiliary consults. Fellows are expected to perform endoscopic procedures on all patients for whom they performed consultations, if indicated.
- Inflammatory Bowel Disease Service
Fellows work with dedicated faculty in IBD to help provide comprehensive diagnoses and treatments to our complex IBD patient population. The IBD inpatient service—part of our world-renowned IBD center and leading-edge research—provides the fellow a unique opportunity to learn the art of medicine when dealing with highly complex patients with IBD. Fellows will be involved in a multidisciplinary approach, often working alongside colorectal surgeons, pain management specialists, clinical social workers and dietitians. Fellows are also responsible for presenting complicated cases at a weekly, multidisciplinary IBD case conference and for participating in unique psychosocial seminars.
- Hepatology Service
Fellows work with the faculty's transplant hepatologists and a dedicated nurse practitioner to evaluate, work-up and manage inpatients with any of a variety of liver diseases. The fellow will be involved with general hepatology consults as well as cases that involve patients with compensated and decompensated liver disease, those awaiting liver transplantation and post-transplant management. Fellows will be exposed to the entire spectrum of viral hepatitis, alcoholic liver disease, nonalcoholic fatty liver disease, autoimmune hepatitis and drug-induced liver disease. Fellows have the unique opportunity to consult and manage post-transplant patients on the transplant service and become familiar in acute and chronic rejection and managing immunosuppressive therapy.
Fellows rotate at high-volume outpatient endoscopy centers at Cedars-Sinai and Kaiser Permanente Los Angeles, with the primary goal of working under direct supervision of faculty members to gain proficiency in diagnostic endoscopy and therapeutics. Diagnostic upper endoscopy and colonoscopy are emphasized first, followed by therapies such as polypectomy, esophageal dilation, hemostasis and banding. The fellow is expected to learn the principles of anesthesia, including conscious sedation and monitored anesthesia care. The fellow's time on this rotation is dedicated exclusively to performing endoscopic procedures.
Outpatient General Gastroenterology Clinic
Fellows rotate through Cedars-Sinai clinics to learn the principles of providing outpatient general gastroenterology care. The rotation focuses on community-based gastroenterology consultations and offers a unique opportunity for community-based education. Providing our fellows the opportunity to work in a high-volume gastroenterology clinic with busy clinicians as well as private practitioners on bread-and-butter clinical topics offers valuable real-world experience.
Outpatient Inflammatory Bowel Disease Clinic
Fellows evaluate new referrals and perform follow-up examinations with established patients in several half-day clinics each week at the IBD clinic. Fellows work alongside IBD specialists to learn the highly complex outpatient management of intestinal and extra-intestinal IBD. The experience includes decision-making in IBD therapies, medication management, lab monitoring and colonoscopy surveillance. Fellows learn the complexity and the wide variation of management between patients in our high-volume, high-complexity IBD clinic.
Outpatient Gastrointestinal Motility Clinic
Fellows work alongside faculty with specialization in motility disorders to evaluate patients in the gastrointestinal motility clinic. Fellows are exposed to a large number of patients with a variety of dysmotility disorders, including achalasia, gastroparesis, small bowel dysmotility, functional bowel disease, small intestinal bacterial overgrowth, colonic inertia and pelvic floor disorders. Fellows learn to perform and interpret high-resolution esophageal and anorectal manometry, lactulose breath testing and pH monitors, among other tests, during their time in the motility program.
Outpatient Pancreaticobiliary Clinic
Fellows will participate in evaluating patients alongside our interventional gastroenterologists and pancreatologists in the ambulatory setting. Fellows will gain exposure to patients with chronic pancreatitis, sphincter of Oddi dysfunction and pancreatic and biliary malignancies, among many other conditions. This rotation also allows fellows the opportunity to learn how to interpret small bowel endoscopy and determine the type of interventional endoscopy procedure indicated, if any, based on findings.
Outpatient Hepatology Clinic
Fellows work with the faculty's transplant hepatologists to evaluate patients in the ambulatory setting. They will be exposed to the outpatient management of the entire spectrum of liver diseases, including viral hepatitis, alcoholic liver disease, nonalcoholic fatty liver disease, autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis and drug-induced liver disease, among many others. Fellows also have the opportunity to learn about the management of those with compensated and decompensated cirrhosis who are either pre- or post-transplant.
Nutrition and Small Bowel Endoscopy
This multidisciplinary rotation is designed to provide fellows with an education in the diagnosis and management of nutritional clinical issues. Under the guidance of the gastroenterology faculty members and dietitians, education in the diagnosis and management of malabsorption and diarrheal diseases is provided in an inpatient and outpatient setting. Fellows who wish to specialize in nutrition at an advanced level will also receive training on total parenteral nutrition. Further opportunities to interpret capsule endoscopy videos as well as to perform double balloon endoscopy are available as part of this rotation.
Part of the mission of the fellowship program is to train fellows in clinical investigation and to contribute to each fellow's scholarly and academic development. As such, all fellows are expected to identify a research mentor early in their fellowship and pursue a defined research project. Fellows in the clinical track will have up to eight months of dedicated time to engage in scholarly activity while those in the research track will have 18 months. This time is intended for the fellow to become familiar with the investigative process by identifying a research question, developing a protocol, obtaining Institutional Review Board approval, collecting data and participating in statistical analysis—all of which is intended to generate academic productivity. Fellows are encouraged to submit and present their research findings at local and national conferences as well as to draft and submit manuscripts for peer review.
A unique aspect of Cedars-Sinai is its wide spectrum of basic, translational and clinical research endeavors. When adjusted for the number of faculty, the Division of Digestive and Liver Diseases is one of the top divisions nationwide in receiving federal research funding. Cedars-Sinai also has scores of laboratories on its campus dedicated to research. Pavilion, which is an 11-story, 820,000-square-foot, state-of-the-art facility, brings clinical practice and translational research together under one roof. These extensive resources offer our fellows the opportunity to engage in leading-edge research across a variety of disciplines, including gastroenterology, immunology, liver immunology, alcoholic liver disease, non-alcoholic steatohepatitis, liver cancer, colon cancer and pancreatic injury and cancer, among many others.
Master's Program in Health Delivery Science
Conferences and Didactics
Various conferences and didactic lectures complement the fellow's education in patient care while integrating core topics in the principles of gastroenterology and hepatology.
- Gastroenterology and Hepatology Grand Rounds: weekly
- Core Lecture Series: weekly
- Journal Club: twice monthly
- Clinical Guidelines and Board Review Series: weekly
- IBD Case Conference: weekly
- Morbidity and Mortality Conference: quarterly
- Esophageal Case Conference: monthly
- Pancreatitis Case Conference: weekly
- Capsule Endoscopy Review: twice monthly
- Hepatobiliary-Pancreatic Case Conference: quarterly
- Liver Pathology Conference: weekly
- Gastrointestinal Pathology Conference: monthly
- Psychosocial Seminar: monthly