Description of the Program

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Program Description, Curriculum, and Mentoring Program
The overall goal of the Harvard Medical School Fellowship in Pediatric Gastroenterology, Hepatology, and Nutrition is to train 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 or patient care and advocacy.

Mission of our Fellowship Training Program
The goal of our fellowship training program is to provide an in-depth and comprehensive experience for trainees by having them join a highly productive research group at the forefront of its field. We emphasize training in the scientific method and hypothesis-based research. We seek to match each trainee with a mentor of prominence who has the resources and displays the interest and ability to guide our trainees through their early years of career development and training. We seek to establish within our division an atmosphere that values intellectual achievement, curiosity, creativity, courage to pursue new ideas, and academic excellence. Our environment helps to show each trainee the tremendous personal satisfaction and inherent fun that accompanies such a career path, as well as demonstrating the impact each individual can have on medicine.

Our fellowship training program is designed to accommodate, encourage, and provide support for transitioning to independent investigator. We aim to position each of our qualified Physician-Scientist trainees at the end of their first or second year of T32 support for further NIH funding via career development awards, or for transitional Foundation funding in anticipation of such application to the NIH at a later date. Similarly, our goal is to provide Clinician-Innovators with the tools necessary to be innovative leaders in our field and to compete for Institutional, Foundation, or Federal support.

In the past 20 years, we have had sufficient infrastructure to provide such transitional support for all our trainees who displayed interest in moving forward with an academic career. Nearly 95% of our trainees over the last ten years have remained in academics, and 39% are NIH funded. Fortunately, we are in a strong position to foster the career development of our trainees over the long term.

Over forty outstanding research faculty support this effort (a ratio of 4:1, faculty to trainee). Within the scope of disease-oriented basic science research training, 26 nationally and internationally recognized experts in the fields of cell biology, biochemistry, structural biology, genetics, immunology, physiology, biophysics, and microbiology are represented. Equally impressive mentoring opportunities are available to trainees through a faculty of 14 independent investigators in epidemiology, biostatistics, bioethics, outcomes and heath policy, study design, and translational medicine. All research faculty are well funded by the NIH and are actively and substantively contributing to their fields of research interest. All are publishing in journals of the highest quality and have successful records of training young investigators. The 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. The overall research funding base exceeds $10 million per year (including program grants) in direct support for investigator-initiated research.

Curriculum: Fellowship Year 1
Our clinical programs provide care to children  from Boston and children from all corners of 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: Inflammatory Bowel Disease, Hepatology, Solid Organ 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 13 blocks of 3.5 weeks each. Fellows complete eleven rotations on the consult or inpatient services of the GI, Hepatology, and Nutrition Programs at Children's Hospital, Boston. In addition to rotating on the Consult, Inpatient, Hepatology and Liver Transplant services, 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.

All fellows participate in the one half-day per week in the ambulatory teaching clinic, during which they will be precepted by experienced clinical faculty in the diagnosis and management of pediatric patients referred for a variety of acute and chronic GI conditions.

Curriculum: Fellowship Years 2 and 3
In years 2 and 3, all fellows will continue their weekly half-day ambulatory clinic. Fellows pursuing the Physician-Scientist curriculum will complete one rotation on the ward or consult services at Children's Hospital during each of their second and third years. Fellows pursuing training as Clinician-Innovators will complete three ward or consult rotations during each of their second and third years of training.

Didactics and Conferences
Teaching conferences include a weekly clinical conference conducted within our division and a combined adult and pediatric GI conference that is conducted in collaboration with adult GI trainees and faculty from Brigham and Women's Hospital and Beth Israel Deaconess Medical Center (The Longwood Conference). We have weekly Pathology and Radiology conferences to discuss ambulatory or inpatient cases. Bi-monthly conferences are dedicated to highlighting basic or clinical research within our division and to 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 in the core curriculum of Pediatric Gastroenterology, Hepatology, and Nutrition. This is a fellows-only conference that features superb teaching from our clinical faculty.

Research Curriculum: Training as a Physician-Scientist or a Clinician-Innovator
We offer two academic fellowship training curricula. One is dedicated to training fellows as Physician-Scientists to conduct original basic or patient-oriented (clinical) research. The other is dedicated to training fellows in the skills necessary to become master Clinician-Innovator and innovators in the arenas of medical education, health policy, and patient care and advocacy. Each year, three trainees will be admitted to the Physician-Scientist curricula, and one trainee will be admitted to the Clinician-Innovator curricula.

The Physician-Scientist training program is centered on mentoring fellows in the development and execution of basic and patient-oriented (clinical) research. Disease-oriented basic research training conducted in the fellowship program focuses on three related fields in intestinal biology and disease research: 1) epithelial cell and developmental biology, 2) innate and acquired mucosal immunology, and 3) intestinal epithelial-microbial pathogenesis. These aspects of intestinal epithelial cell biology represent a central component of most acute and chronic intestinal diseases and the core competence of our established research programs.

Patient-oriented research focuses on the following: 1) intestinal and nutritional epidemiology (including global health), 2) outcomes research, and 3) clinical trials, including translational research in basic pharmacology of novel therapeutics. An outstanding and well-established General Clinical Research Center is available to support such research training. The Center is located at Children's Hospital with our own Dr. Richard Grand as Program Director. The Harvard Program can easily accommodate applicants with interests in other fields of GI-related basic or clinical research, and these applications are welcomed.

The Clinician Innovator academic program will provide state-of-the-art training in the acquisition of educational skills or in research in a defined clinical area. Academic programs in this fellowship training curriculum will focus on five areas: 1) curriculum development projects, 2) critical review or meta-analysis of the literature with respect to a particular clinical practice, 3) systematic review of clinical practice or the development of evidence based treatment algorithms, 4) quality improvement initiatives, and 5) public policy analysis and patient advocacy. 

Formal Course Work and Seminars
All trainees are expected to complete relevant course work in their field of interest. For trainees in the basic sciences, the entire catalog of courses offered by the graduate programs at Harvard Medical School is open to them. For each trainee, we will financially support one graduate level course per semester (with approval from the trainee's scientific mentor as to timing and course selection). For all trainees in clinical science, we encourage didactic course work in basic epidemiology, study design, bioethics, and biostatistics. This is obtained by matriculating through 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. Clinician-Innovator trainees will be required to participate in one of the didactic longitudinal programs available on the Longwood Medical campus, including the Rabkin Fellowship in Medical Education (offered through the Shapiro Institute for Education and Research), the Macy Institute at Harvard Medical School, and the Harvard Medical School Academy Center for Teaching and Learning.

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

Starting in the first research year, a formal Scholarly Oversight Committee (SOC) is assembled for each individual trainee and 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 committee acts as a "thesis committee" and guides each trainee on an individual basis through his/her major 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.

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The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”
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