AASLD Advanced/Transplant Hepatology Fellowship
Clinical Program Description
The objective of the Advanced/Transplant Hepatology Fellowship is to provide superior clinical and research training in the field of hepatology. Following completion of the one-year fellowship, the candidate will become competent in evaluating and managing liver transplant candidates with acute and chronic liver failure, as well as managing liver transplant recipients during the peri-operative and post-transplant period. The candidate will also become competent in the care of patients with a variety of acute and chronic liver diseases including management of acute liver failure, viral hepatitis, complications of portal hypertension, and hepatocellular carcinoma.
Upon completion of the program, candidates will have training to provide expert hepatology consultation, qualify for UNOS certification as a transplant hepatologist, and meet all requirements to sit for the ABIM Certificate of Added Qualification (CAQ) in transplant hepatology.
The Hepatology Fellowship will combine inpatient and outpatient clinical experience in general and transplant hepatology, as well as clinical and/or translational research opportunities.
The program will incorporate 12 months of inpatient and outpatient liver transplant and general hepatology service, with 4 weeks of vacation taken throughout the year.
The trainee will spend 6 months of the year on the combined hepatology consult and liver transplant service. During these rotations, the fellow will be responsible for the care of 5-15 inpatients, including floor and ICU patients. Inpatient rounds are performed everyday by a team of physicians including a transplant surgeon and/or a hepatologist, a liver transplant surgery fellow, 1-2 gastroenterology fellows, 2 liver transplant extended providers (PAs, NPs), clinical transplant nurse coordinators, a PharmD, a social worker, and a dietitian. At times, medical and surgical residents, as well as medical students may be a part of the team.
The hepatology fellow will have primary responsibility for interfacing between the attending physician/s and the care of the patients. The fellow, in junction with other care providers on the team, will be expected to acquire clinical data, develop a diagnosis/treatment plan, and execute the plan under the guidance of the service attending physician/s. The fellow will assist with the didactic and bedside teaching of gastroenterology fellows, residents, and medical students, guiding them in the care of advanced acute and chronic liver disease. The fellow will also have adequate exposure to the clinical and ethical decisions involved in at least 5 cases of living-related liver transplantation. While on inpatient rotations, the trainee will continue to attend two continuity care outpatient clinics (1 general hepatology, 1 liver transplant).
The trainee will spend 6 months dedicated to outpatient medicine, encompassed by general hepatology and liver transplant clinics. During this time, the fellow will have eight, 4-hour clinic sessions per week (4 general hepatology, 4 liver transplant).
In the general hepatology clinic, the fellow will see new consults and returning patients with various liver diseases, including viral hepatitis, autoimmune liver disease, and metabolic liver diseases. For one designated general hepatology clinic, the fellow maintains a continuity clinic, providing consultation and assuming responsibility for the longitudinal care of his or her patients. During general hepatology clinic, the fellow will be designated to see approximately 2 new patients and 4-6 return patients in a 4-hour block under the supervision of an attending hepatologist. The fellow is expected to evaluate patients and develop a diagnostic and treatment plan that is to be communicated directly to the patient. Their skills in this regard include prompt and accurate communication with referring physicians, appropriate resource utilization and diagnostic test ordering. The fellow will be given resources equal to that of the attendings to manage their clinic patients and provide care.
The fellow will spend time in a dedicated liver transplant surgical clinic once a week caring for patient’s immediate post-liver transplant (typically within 3 months after transplantation) under the supervision of an attending transplant surgeon. 3 sessions will be spent in the liver transplant medical clinics working in conjunction with an attending hepatologist. These clinics are devoted to evaluation of new transplant candidates, management of patients on the liver transplant waiting list, and care of patients at least three months out after transplantation.
The remaining two sessions per week will be used for miscellaneous activities including administrative duties and research time. These sessions may also include time allotted to perform procedures (endoscopy, liver biopsy, and paracentesis), read liver related films with staff radiologists, observe interventional radiology procedures (transjugular intrahepatic portosystemic shunt placement, hepatic venous measure gradient measurement), and spend time at the Emory Pediatric Liver Transplant Program.
The hepatology fellow will continue to perform:
- Liver biopsies
- Selected endoscopic procedures during the year.
The fellow is expected to complete 30 liver biopsies during the one-year fellowship. In addition to the core procedure requirements, the fellow will observe at least 3 liver transplant procedures and 3 organ procurement calls.
The fellow will be required to attend all liver related conferences including:
- Weekly liver transplant pathology conference
- Weekly general hepatology pathology conference
- Weekly liver transplant radiology conference
- Weekly liver transplant selection conference
- Weekly Transplant Center Grand Rounds
- Weekly Gastroenterology Grand Rounds
- Monthly hepatology journal club
- Quarterly morbidity and mortality conference
*In addition, the hepatology fellow will be required to present at least 4 lectures throughout the year for the purpose of medical education.