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Description of the Program

Program Description, Curriculum, and Mentoring Program
The Harvard Medical School Fellowship in Pediatric Gastroenterology, Hepatology, and Nutrition is dedicated to training 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, patient care, quality improvement, and advocacy.

Mission of our Fellowship Training Program
The goal of our fellowship training program is to provide trainees with an in-depth and comprehensive clinical experience followed by scholarly pursuit under the mentorship of an established investigator. We match each trainee with a mentor of prominence who both possesses the requisite resources and displays the interest and ability to guide our trainees through their early years of career development. We seek to establish within our division an atmosphere that values intellectual achievement, curiosity, creativity, courage to pursue new ideas, and academic excellence. We hope to foster in each trainee the tremendous personal satisfaction and inherent fun that accompanies such a career path, and in doing so  provide them with an opportunity to make an impact in our field of medicine.

Our training program is designed to accommodate, encourage, and provide support for fellows transitioning to careers in academic medicine. We recognize that there is a distinct need to train young physicians to take leadership positions in the broadest range of academic pursuit.  As such, we have developed discreet, but often overlapping, programs to support trainees interested in pursuing careers as:

  • Physician-Scientists - Those interested in pursuing hypothesis driven, traditional, NIH-funded projects including:
    • Bench research
    • Patient-Oriented translational research
  • Clinician Innovators – Those interested in leading initiatives that while critical to the medical mission, do not generally meet criteria for funding support through the NIH or other federal agencies including:
    • Quality Improvement
    • Medical Education
    • Patient Advocacy
    • Public Policy

Each year, three trainees match into the Physician-Scientist curricula, and one trainee matches into the Clinician-Innovator curricula.

We aim to position each of our fellows choosing to pursue training as Physician-Scientists the support and infrastructure to compete successfully for independent funding through the NIH or for transitional Foundation support in anticipation of competing for NIH funding. Similarly, we provide fellows choosing to pursue training as Clinician-Innovators with the skillset necessary for them to be innovative leaders in medical education, patient advocacy, public policy, and quality improvement.

In the past 30 years, we have developed a substantive infrastructure to provide this type of transitional support for all our trainees who are interested in moving forward with an academic career. Nearly 95% of the trainees who have graduated from our program over the course of the last ten years have remained in academics, and 39% are NIH funded. As such, we feel fortunately, to be in a strong position to continue to foster the career development of our trainees over the long term.

Over fifty outstanding research faculty members have been recruited to support this effort (a ratio of approximately 5:1, faculty to trainee). Within the scope of disease-oriented basic science research training, we have on our faculty nationally and internationally recognized experts in the fields of cell biology, biochemistry, structural biology, genetics, immunology, physiology, biophysics and microbiology. Equally impressive mentoring opportunities are available to trainees through our faculty of independent investigators in epidemiology, biostatistics, bioethics, outcomes and health policy, study design and translational medicine. Our faculty members have competed successfully for NIH and foundation funding and are making substantive contributions 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 annual research funding base for our Division exceeds $10 million (including program grants) in direct support of our investigator-initiated research.

Curriculum: Fellowship Year 1
Our clinical programs provide care to children from Boston and from around 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 including Inflammatory Bowel Disease, Hepatology, Liver 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 approximately 13 blocks of 3.5 weeks each. Fellows complete rotations on the Consult, Inpatient, and Hepatology Programs at Children's Hospital. 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. Focused teaching time will enable each fellow to work individually with our radiology staff to acquire proficiency in cross-sectional imaging, abdominal imaging, and fluoroscopy.  Similarly, fellows are afforded time to work individually with pathology staff to acquire core competency in recognizing standard pathophysiology including GI atopic disease, inflammatory bowel disease, and hepatology.

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

Curriculum: Fellowship Years 2 and 3
All fellows continue their weekly half-day ambulatory teaching clinic during years 2 and 3 of training. To broaden their training experience, fellows are also permitted to alternative general with sub-specialty clinics during their second and third years of training.  This allows trainees to customize their training contingent upon their career interests.  Most fellows choose to pursue continue experirence in our Hepatology program.  Many choose to spend six month blocks in our IBD, Nutrition, and Short Gut Programs.  Fellows pursuing the Physician-Scientist curriculum will complete one rotation on the Inpatient or Consult service at Children's Hospital during each of their second and third years. Fellows pursuing training as Clinician-Innovators will complete three rotations on the Inpatient or Consult services during each of their second and third years of training.  As such, all fellows are afforded substantive protected time to pursue research and career development opportunities.

Didactics and Conferences
Teaching conferences include a weekly clinical conference conducted within our division and a bi-weekly 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 conferences to discuss ambulatory and 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 series based on a core curriculum of Pediatric Gastroenterology, Hepatology, and Nutrition outlined by the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN). This is a fellows-only conference that features superb teaching from invited guest faculty.

Research Curriculum: Training as a Physician-Scientist or a Clinician-Innovator
All fellows receive identical clinical training and graduate from our program with the skills that will qualify them for recruitment into any large academic tertiary clinical program.  The Physician-Scientist training program is centered on mentoring fellows in the development and execution of basic and patient-oriented (translational) research. Disease-oriented basic research training conducted in the fellowship program focuses on three related fields in intestinal biology and disease research including:

1)     Epithelial cell and developmental biology

2)     Innate and acquired mucosal immunology

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
  3. Clinical trials, including translational research in basic pharmacology of novel therapeutics.

Funding and research infrastructure are available through the Children's Hospital Clinical and Translational Research Programs to support such research training. Support is similarly available to applicants with interests in other fields of GI-related basic or clinical research.

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

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

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.

Physician-Scientists: Trainees in the basic sciences may choose to audit courses offered through graduate programs at Harvard Medical School and Harvard School of Public Health. For all trainees in clinical science, we encourage didactic course work relevant to their research in areas of 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-Innovators: Trainees can choose 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. Clinician-Innovators may also attend the Summer Program in Clinical Effectiveness, offered through the Harvard School of Public Health.  Several degree-granting programs are also available through competitive applications on the Harvard Medical School campus.

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 SOC 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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