Gastroenterology & Hepatology Fellowships

On behalf of Cleveland Clinic’s Gastroenterology and Hepatology fellowship training program, we welcome your interest in our program. We offer a three-year fully ACGME accredited training program that includes a NIH-funded T32 training opportunity. Our mission is to train physicians to be outstanding clinicians, endoscopists and investigators in the fields of Gastroenterology and Hepatology. We offer two tracks of training:

• Categorical track- a traditional three year training program in Gastroenterology and Hepatology with an emphasis on clinical and endoscopy training and development of clinical research skills.
• T32 training grant track- a four to five year training program with a minimum of two years spent pursuing translational research and a minimum of two years of clinical and endoscopic training.

Given our reputation as a prime tertiary referral center as well as the numbers and variety of patients seen in our Department, fellows will see and care for a broad spectrum of gastroenterologic and liver diseases. In addition, our highly specialized faculty is well recognized nationally and internationally, allowing fellows exposure to a wide breadth and depth of expertise in the varying subspecialty fields of Gastroenterology and Hepatology.

We believe that our program offers unparalleled training that will allow you to reach your goals of developing into an outstanding Gastroenterologist/Hepatologist.

Jean-Paul Achkar, MD
Program Director, Gastreoenterology Fellowship
Chair, Digestive Disease Institute Education Committee

Ahmed Kandiel, MD, MPH
Associate Program Director, Gastroenterology Fellowship

Claudio Fiocchi, MD
Director, T32 Fellowship Program

John Vargo, II, MD, MPH
Chairman, Department of Gastroenterology and Hepatology
Vice Chairman, Digestive Disease Institute

»Curriculum

The goal of our fellowship program is to train the best academic and clinical gastroenterologists to meet the future needs of our profession in patient care, teaching, and research. We are dedicated to training physicians who can lead our profession in this changing era of health care and research.

The primary means of training is on-site care of patients with digestive disease disorders over the three-year fellowship program in a supervised setting, which enables independent thought and evaluation of patients. Our fellows are exposed to patients in the in-patient and out-patient settings. To be certain that the full spectrum of digestive diseases is encountered by each fellow in a setting with optimal supervisory expertise, rotations are established in inpatient and outpatient hepatology, inpatient gastroenterology, consultative gastroenterology, endoscopy, GI diagnostic laboratory, clinical nutrition and inflammatory bowel disease.

Our commitment is to train young physicians to a high level of clinical, academic, and systems competence, becoming professional leaders throughout their career in this rapidly changing field. Our goal is that our graduates excel in the six core competencies described by the ACGME:

• Patient Care
• Medical Knowledge
• Practice Based Learning and Improvement
• Interpersonal and Communication Skills
• Professionalism
• Systems Based Practice

As delineated below, our curriculum offers excellent training in all of these core areas. By mastering these competencies, our graduates will be leaders throughout their career.

Mentorship

Each fellow is paired with a Staff Physician as their Adviser. Their role is to provide career counseling, ensure that each resident is developing well clinically, operating at the requisite skill level and filling leadership positions. More subtly, their role is to demonstrate a model for professionalism.

Research and Professional Development

The research opportunities at the Cleveland Clinic are outstanding – and thus all fellows are expected to be productive in clinical research throughout their fellowship. You will have access to our our multiple institutional databases, electronic medical record which houses our massive clinical experience, and national databases.

Each fellow then selects Staff Physician as their Research Mentor. Their role is to assist with developing research projects and publications.

A major thrust of the fellowship program is to train fellows in the techniques of clinical investigation. All fellows spend at least nine months performing clinical research. This experience will involve exposure to the research process by selection of a scientific question, protocol design and critique, IRB and regulatory processes, data collection, statistical analysis, and presentation. Fellows present their initial protocol to the center that they have chosen to work in for open critique and then provide their final protocol to the entire Department for further discussion.

Fellows travel to present research at national conferences is supported and fully funded, allowing you to make national contacts among leaders in the field. Activity in research ensures our fellows are not only up to date in their medical knowledge, but advance the field of Gastroenterology and Hepatology.

Clinical Training

Rotations

Gastroenterology Inpatient Service

The overall educational goal of this rotation for fellows is to develop skills in the management of the hospitalized patient with GI disease in a cost-effective and expedient manner. The fellow serves as a junior consultant for residents, interns, and medial students and helps assure that quality care is rendered to all patients on the service. A significant component of the learning experience comes from working closely with all patients admitted to the GI hospital service and being aware of ongoing developments throughout the day including diagnostic, therapeutic, social, and administrative details of patient care.

Hepatology Inpatient Service

The overall educational goal of this rotation for fellows is to develop skills in the management of the hospitalized patient with liver disease in a cost-effective and expedient manner. The fellow serves as a junior consultant for residents, interns, and medical students and helps assure that quality care is rendered to patients on the service. A significant component of the learning experience comes from working closely with patients with liver disease requiring inpatient care including patients: 1) with complications of chronic liver disease, 2) undergoing liver transplant evaluation, 3) awaiting transplantation, 4) with fulminant hepatic failure, 5) admitted for complications related to transplantation, and 6) inpatient hepatology consultations.

Hepatology Consult

The overall educational goal of this rotation for fellows is to develop consultative skills in the management of the hospitalized patient who presents with or develops liver symptoms or disease, and evaluation for transplantation.

Gastroenterology Consult and Acute Bleeder Service

The overall educational goal of this rotation for fellows is to develop consultative skills in the management of the hospitalized patient who presents with or develops GI symptoms or disease. The consult service is also responsible for emergency endoscopy of all patients with GI bleeding in the ICUs during regular working hours. Therefore fellows on the consult service will learn how to perform emergency endoscopies in the ICUs under the supervision of the attending physician.

Endoscopy

The overall educational goal of this rotation for fellows assigned to the endoscopy rotation work directly under the supervision of different faculty doing endoscopy. No procedures are performed unsupervised. Fellows maintain a log of all cases they perform during their fellowship. Training will first emphasize diagnostic upper endoscopy, and conscious sedation. This will be followed by esophageal dilatation, therapy of upper GI bleeding, emergency upper endoscopy, percutaneous gastrostomy, diagnostic colonoscopy, and polypectomy.

Training in therapeutic ERCP along with other advanced procedures such as endoscopic ultrasonography, photodynamic therapy, placement of self-expandable metallic stents, endoscopic tumor ablation and mucosal resection with the ultimate goal of obtaining credentialing in these procedures is not the goal of the three year curriculum and is obtained only after successful completion of a fourth year advanced therapeutic endoscopy.

Clinical Nutrition Service

The overall educational goal of this rotation is to provide our fellows with the tools which they need to provide their patients with appropriate and adequate nutritional support. This will be done by having each fellow rotate on the Nutrition Support Team in the first, second, and third years of training. During the first year, fellows will develop the skills to be facile in the management of nutritional support in hospitalized patients. This includes identifying patients with protein calorie malnutrition; assessing the protein and calorie needs of these patients; learning the techniques of both enteral and parenteral feeding along with the complications of these therapies; and learning how to monitor the adequacy of these interventions. The fellow should be available during their rotation to participate completely with the Nutrition Support Team and all of it’s activates including inpatient rounds, and morning conference/journal club. During the second and third year, the fellows spend 2 weeks on the inpatient service and 2 weeks in outpatient clinics with exposure to the intestinal rehabilitation program, obesity clinic, and bariatric surgery clinic.

Research

All fellows are required to carry out a research project as part of the fellowship program. This will usually be a clinical project but may also involve basic science research. A second quality improvement project is also required. All projects will be conducted under the close supervision and mentoring of a staff member experienced in research. There is a broad spectrum in choice of topics. Research projects are discussed with the monthly research committee meeting and presented to the Center the fellow is working in during the first year. The project should involve a hypothesis driven experiment, extensive review of the literature, appropriate design and development, obtaining institutional review board approval, recruitment and completion of the project, data analysis, preparation of an abstract for submission to a national meeting, and completion of a scientific manuscript. A research presentation is conducted in front of the entire Department prior to the initiation of a project. Results of the study are subsequently presented at the completion of the fellowship to the Department at a research conference.

Surgery Simulation

Cleveland Clinic's Center for Multidisciplinary Simulation has, flexible endoscopy, upper endoscopy , colonsocopy, and ERCP simulators to enhance the clinical learning experience.

Case Volumes

Below is a cumulative average of procedures performed during your fellowship period.

	Upper Endoscopy	Colonoscopy
Average Number of Procedures	600-800	300-500

Board Passage Rates

For Cleveland Clinic's Gastroenterology Fellowship Program, cumulative first time board passage rates 2005-2011 is 100%.

»Clinical Conferences

Morbidity and Mortality Conference

Each month the fellows report cases for the M&M conference. The conference faculty moderator selects cases for presentation based on their teaching merit, and moderates the discussion. The fellow who managed the patient presents the case and pertinent literature while focusing on clinical decision making, reasons for any complications and alternative management options., The main focus of the conference is improving clinical decision making to improve patient care.

Case Management Conference

Each fellow presents 30-minute management conferences at regular intervals throughout the academic year. This is a brief presentation that addresses diagnostic or management dilemmas that are debated amongst faculty and fellows. This conference is considered by many to be the highlight of our conference schedule.

State of the Art Conference

Each fellow presents a comprehensive, one-hour presentation on a specific topic of his/her choice using an extensive review of the literature. The fellows work with a faculty mentor in the development and synthesis of their presentation.

Gastroenterology Didactic Series

The academic year begins with a didactic core curriculum that reviews important topics in gastroenterology, hepatology and nutrition. Throughout the course of the academic year, distinguished faculty from the Digestive Disease Institute and other departments are invited to speak to fellows and faculty in various areas of interest.

Fellows Conference Series

This weekly series consists of four multidisciplinary areas:

• Radiology Rounds, designed to improve fellows ability to interpret basic radiology studies and determine which tests are applicable in specific clinical situations.
• Research Methodology helps fellows review the basic principles of clinical epidemiology and statistical design in order to critically interpret literature and elements of statistical design criteria.
• Pathology allows fellows to improve their ability to review and interpret histological specimens in an organ-based fashion from a variety of pathological conditions.
• Nutrition conference reviews the fundamentals of nutrition in a variety of pathological states including understanding concepts pertaining to parenteral and enteral nutrition, and obesity.

Board Review Conference

Fellows have a weekly board review conference based on ACG/AGA curriculum.

Gastroenterology Journal Club

A journal club is held monthly at an external location. Articles are selected by faculty around a theme, and presented in a critical fashion by the fellows. These are discussed in a congenial atmosphere. Topics are rotated month to month.

Subspeciality Conferences

Each subspeciality holds its own conferences (IBD, Liver Transplant, HPB, Intestinal Transplant, Clinical Nutrition, etc.) These conferences are made available to all fellows that wish to attend.

Grand Rounds

These one-hour seminars by esteemed Cleveland Clinic and visiting faculty are diverse presentations aimed at faculty, fellows, and residents. Presentations are on a broad range of topics, including clinical topic updates, world health, surgical history, etc. These are held monthly for Internal Medicine, General Surgery, and Transplant Center.

»Current Fellows

PGY 4 - 1st Year Gastroenterology Fellows

Jordan Holmes, MD

Residency: Cleveland Clinic

Whitney Jackson, MD

Residency: Thomas Jefferson University Hospital

Brad Confer, DO

Residency: Cleveland Clinic

Mangesh Pagadala, MD

Residency: NSMC Salem Hospital

PGY 5 – 2nd Year Gastroenterology Fellows

Mazen Albeldawi, MD
Residency: Cleveland Clinic
Research Mentor: Dr. Nizar Zein
Research Topic: Predicting Cardiovascular Complications After Liver Transplantation: A Role for Pretransplant Cardiovascular Risk Scores

Arthi Kumaravel, MD
Residency: Cleveland Clinic
Research Mentor: Dr. Prashanti Thota and Dr. John Vargo
Research Topic: Effect of statin therapy on neoplastic progression in patients with Barrett’s Esophagus

Carol Macron, MD
Residency: Cleveland Clinic
Research Mentor: Dr. William Carey and Dr. Nizar Zein
Research Topic: Liver cirrhosis and HCC

Paresh Mehta, MD
Residency: Cleveland Clinic
Research Mentor: Dr. John Vargo
Research Topic: Outcomes in advanced therapeutic endoscopy. This includes procedural sedation, obstructive sleep apena, and quality factors affecting procedure outcomes.

PGY 6 – 3rd Year Gastroenterology Fellows

Emily Carey, DO
Residency: MetroHealth Medical Center
Research Mentor: Dr. Arthur McCullogh
Research Topic: Fatty liver disease / NASH and cardiovasular disease risk-specifically endothelia dysfunction as a marker of early cardiovascular disease in NASH

Ibrahim Hanouneh, MD
Residency: Cleveland Clinic
Research Mentor: Dr. Nizar Zein
Research Topic: Breath test analysis in liver disease

Saul Kane, MD
Residency: Temple University Hospital
Research Mentor: Dr. Nizar Zein
Research Topic: Immunogenetics of Spontaneous Bacterial Perotinitis

Udayakumar Navanetthan, MD
Residency: University of Cincinnati Hospital
Research Mentor: Dr. Bo Shen and Dr. Ravi P. Kiran
Research Topic: Natural history of PSC and impact on IBD

»Staff Physicians

Swallowing

• Edgar Achkar – Consultant Staff
• Monica Ray
• Prashanthi Thota

IBD

• JP Achkar
• Aaron Brzezinski
• Carole Burke
• Ahmed Kandiel
• Bret Lashner
• Bo Shen
• Le Chu Su
• Yinghong Wang

Liver

• Talal Adhami
• David Barnes
• William Carey
• Dian Chiang
• Srinivisan Dasarathy
• Krysten Fairbanks
• Michelle Inkster
• Binu John
• Arthur McCullough
• K.V. Narayanan Menon
• Robert O’Shea
• Carlos Romero-Marrero
• Anthony Tavill – Consultant Staff
• Jamile Wakim-Fleming
• Claudia Zein
• Nizar Zein

General GI

• Mujtaba Butt
• Christine Lee
• David Lever
• Joseph Moses
• Monica Ray
• Prashanthi Thota
• Chung-Jyi Tsai
• Luke Weber

Advanced Endoscopy

• Prabhleen Chahal
• Sunguk Jang
• Mansour Parsi
• Madhu Sanaka
• Tyler Stevens
• John Vargo
• Greg Zuccaro

Nutrition

• Donald Kirby

Chronic Abdominal Pain

• Maged Rizk

»Alumni Career Pathways

2011 Graduates

Ashish Atreja, MD
Cleveland Clinic, OH

Dian Chiang, MD
Cleveland Clinic, OH

Binu John, MD
Cleveland Clinic, OH

Yinghong (Mimi)Wang, MD
Cleveland Clinic, OH

Karen Kim, MD
Rochester, NY

2010 Graduates

Tasneem Ahmed, MD
Dallas, TX

Xiao SuoLiang, MD
Canton, OH

2009 Graduates

Benjamin Levitsky, MD
Boston, MA

Mohammed Qadeer, MD
Lexington, NC

Francisco Marrero, MD
Cleveland Clinic, OH (2010 -Lake Charles, LA)

John Edmison, North Carolina
Greenville, NC

2008 Graduates

Ilche Nonevski, MD
Rockford, IL

Anajana Pillai, MD
Northwestern, Chicago, IL

Jhony Doumit, MD
St. Joseph, MO

2007 Graduates

Laura Bianchi, MD
Sacramento, CA

Jason Guardino, MD
Chicago, IL

Ahmed Kandiel, MD
Cleveland Clinic, OH
(2011 - Asst. Program Director, GI Fellowship)

2006 Graduates

Brent Lemberg, MD
Itchaca, NY

Karen Cesario, MD
Colorado Springs, CO

Woosuk Park, MD
Chicago, IL

»Locations

Cleveland Clinic

Cleveland Clinic was founded in 1921 by George Crile Sr., a general and endocrine surgeon; Frank Bunts, a neurosurgeon; William Lower, an urologist; and John Phillips, an internist. It was a new kind of medical center: a physician-led, not-for-profit, integrated hospital and group practice, equally dedicated to patient care, research, and education. Cleveland Clinic quickly became a world renowned training hospital, medical school and research institute, known for offering the most advanced medical care.

Cleveland Clinic's main campus consists of 41 buildings and more than 85 operating rooms, with constant expansion and renovation. The Gastroenterology offices are on the third floor and fifth floor of the A building (desk A30 and A50) in the Digestive Disease Institute.

Q3: New, State-of-the-art Endoscopy Unit

The Digestive Disease Institute’s advanced endoscopy unit, located in Glickman tower on Cleveland Clinic’s main campus, emphasizes both safety and quality. The 15,000-square-foot facility was built to improve both access and patient experience. The expansion doubled the number of therapeutic endoscopy suites for performing endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS) and deep enteroscopy. Specialized fluoroscopic equipment will allow for the next generation of 3-D cholangiography, which is available at only a handful of units nationally. The unit was designed to improve patient satisfaction and features private recovery rooms with TVs and seating for family members. It will help maximize communication between patients and caregivers and enable close interaction with the staff from other specialties, including anesthesiology, hepatobiliary surgery, colorectal surgery, thoracic surgery, oncology and radiation oncology, during treatment.

” This expansion will increase our ability to handle additional volume to speed up diagnosis and treatment of patients.” – John Vargo, MD, MPH

Cleveland Clinic is a large facility, how do I find my way around?

While Cleveland Clinic has a large campus, it is easily walkable from the visitor parking garages and the three on campus hotels: the InterContinental Hotel, the InterContinental Suites, and the Cleveland Clinic Guest House. Cleveland Clinic is immediately adjacent to the University Circle Neighborhood, home of the Case Western Reserve University, the Cleveland Orchestra, and the Cleveland Museum of Art. Cleveland Clinic is centrally located and accessible from the downtown, east, and west side residential neighborhoods.

»Application Information

What are you looking for in an applicant?

We are looking for outstanding individuals to immerse in a high volume environment that offers high quality, scientifically advanced care in an economically savvy environment. We seek the most promising physicians as demonstrated leadership abilities, academic productiveness, knowledge base, and positive personal qualities among applicants from diverse backgrounds.

What is your application process?

Cleveland Clinic has minimum requirements for fellowship application and employment, all of which are all required in the standard ERAS application. We have no secondary application form. We review every submitted application completely and carefully, and a selected group is offered on-site interviews.

What are your NRMP program codes?

Gastroenterology AAMC ID: 1968144F0

What are your fellows' employment benefits?

Residents are Cleveland Clinic employees with standardized salaries and other benefits.

What VISAs are supported by Cleveland Clinic?

Clinical Programs

For graduate medical education purposes (residency, fellowship and clinical research fellowship), Cleveland Clinic will accept H-1B temporary worker or J-1 exchange visitor (alien physician category – sponsored by the ECFMG) visas. International students enrolled in U.S. medical schools may use the post-graduate year of Optional Practical Training (OPT) for the first year of residency training. Information on this process should be obtained from the Designated School Official (DSO) at the medical school. Cleveland Clinic does not sponsor immigrant (permanent resident) petitions for research or clinical trainees (residents, clinical fellows, clinical research fellows, research fellows or postdoctoral fellows).

Research Programs

The H-1B, the J-1 exchange Visitor (research scholar category – sponsored by CCF) or F-1 student (sponsored by a U.S. college or university) with employment authorization are accepted by Cleveland Clinic for research purposes. Cleveland Clinic does not sponsor immigrant (permanent resident) petitions for research or clinical trainees (residents, clinical fellows, clinical research fellows, research fellows or postdoctoral fellows).

»Contact Us

Gastroenterology Education Coordinator

Cheryl Borowski
Gastroentrology Education Coordinator
216.445.7204
Fax: 216.636.2508
borowsc@ccf.org

External Rotations

Evelyn Delong
GME Coordinator
216.444.9989
delonge@ccf.org

International Physician Services / Visa

Janice M. Bianco
Manager, International Physician Services
Responsible Officer, Exchange Visitor Program
216.445.7681
biancoi@ccf.org

Institute Education Manager

Beth Christoff, BSN. MBA
Institute Education Manager
Digestive Disease Institute
216.445.2809
christb@ccf.org

Observerships / CIME

Graduate Medical Education
Main Office
216.444.5690
800.323.9259
Fax: 216.444.6112
Cleveland Clinic Operator
216.444.2200

The Hepatology Section of Cleveland Clinic's Digestive Disease Institute has had a long-standing fellowship program, which is designed to afford fellows the opportunity to receive sophisticated training in the care of patients with all forms of liver disease. In particular, the training program aims to give a broad base of experience in transplant hepatology, beyond what would be typically acquired in a general gastroenterology fellowship. The program is designed to meet the requirements for the Certificate of Added Qualification in Transplant Hepatology. It is based within the hepatology section, which compromises 14 physicians with a diverse range of clinical and research interests. In addition, because of the multidisciplinary nature of many liver diseases, the staff and fellows work closely with physicians and surgeons in liver transplant, interventional radiology, oncology, nutrition, infectious diseases, and general gastroenterology.

Dedicated rotations on both the inpatient and consult services expose fellows to a wide array of clinical issues in patients with acute and end stage liver disease; outpatient rotations in hepatology, as well as in infectious disease, radiology, nutrition, and pediatrics take further advantage of the broad spectrum of patient issues in hepatology.

A centerpiece of the fellowship is training and mentoring in research methods; our goal is that fellows will be successful academically, having had an opportunity to design, execute, and present or publish their research over the course of their training. We are committed to educating our fellows to become clinically excellent as well as leaders in hepatology.

We believe our fellowship offers outstanding training, and look forward to your application.

Robert S. O’Shea MD, MSCE
Fellowship Program Director, Hepatology
Department of Gastroenterology and Hepatology
Digestive Disease Institute

Nizar Zein, MD
Medical Director, LiverTransplant
Section Head, Hepatology and Chief, Section of Hepato-biliary Diseases
Department of Gastroenterology and Hepatology
Digestive Disease Institute

John Vargo, II, MD, MPH
Chairman, Department of Gastroenterology and Hepatology
Vice Chairman, Digestive Disease Institute

»Karim Camel-Toueg International Fellowship in Hepatology

Orascom Construction Industries Announces the establishment of the Karim Camel-Toueg International Fellowship in Hepatology at Cleveland Clinic in memory of the late Karim Camel-Toueg

In collaboration with Cleveland Clinic and its Hepatology Center, part of the Digestive Disease Institute, ranked #2 by U.S.News and World Report, OCI has established an endowed fellowship program under the supervision of Dr. Nizar Zein where one physician each year will experience a focused training opportunity in the evaluation and treatment of all forms of common and uncommon hepatic disorders in both adults and children, elevating their ability to best care for patients with liver disease, while also learning to be academically productive. The aim of this experience is to increase the number of qualified hepatologists to care for the millions of Egyptians with liver disease.

Interested candidates must meet the requirements established by Cleveland Clinic Graduate Medical Education. Clinical Programs for graduate medical education purposes (residency, fellowship and clinical research fellowship) at the Cleveland Clinic will accept H-1B temporary worker or J-1 exchange visitor (alien physician category – sponsored by the ECFMG) visas. Cleveland Clinic does not sponsor immigrant (permanent resident) petitions for research or clinical trainees.

For more information, please send a cover letter expressing your interest in the Karim Camel-Toueg International Fellowship and how this training opportunity would advance the care of patients in Egypt with liver disease as well as a CV, ECFMG and USMLE scores, and three letters of reference.

Submit Cleveland Clinic GME application and support documentation to mikhaib@ccf.org.

Download the application form.

All applications must be received by September 30, 2012.

»Curriculum

Cleveland Clinic Hepatology Fellowship Program Goals

The goal of our fellowship program is to train the best academic and clinical hepatologists to meet the future needs of our profession in patient care, teaching, and research. We are dedicated to training physicians who can lead our profession in this changing era of health care and research.

Our commitment is to train young physicians to a high level of clinical, academic, and systems competence, becoming professional leaders throughout their career in this rapidly changing field. Our goal is that our graduates excel in the six core competencies described by the ACGME:

• Patient Care
• Medical Knowledge
• Practice Based Learning and Improvement
• Interpersonal and Communication Skills
• Professionalism
• Systems Based Practice

As delineated below, our curriculum offers excellent training in all of these core areas. By mastering these competencies, our graduates will be leaders throughout their career.

Mentorship

Each fellow is paired with a Staff Physician as their Advisor. Their role is to provide career counseling, ensure that each resident is developing well clinically, operating at the requisite skill level and filling leadership positions. More subtly, their role is to demonstrate a model for professionalism.

Research and Professional Development

The research opportunities at the Cleveland Clinic are outstanding – and thus all fellows are expected to be productive in clinical research throughout their fellowship. You will have access to our our multiple institutional databases, electronic medical record which houses our massive clinical experience, and national databases.

Each fellow then selects Staff Physician as their Research Mentor. Their role is to assist with developing research projects and publications.

Fellows travel to present research at national conferences is supported and fully funded, allowing you to make national contacts among leaders in the field. Activity in research ensures our fellows are not only up to date in their medical knowledge, but advance the field of Gastroenterology and Hepatology.

Clinical Training

The current Hepatology training program is based on training guidelines published by the American Gastroenterological Association and the American Association for the Study of Liver Diseases. These guidelines for training comprise the fund of knowledge required for level 1 and level 2 training, that is to train physicians who are competent to manage “the broad spectrum of hepatologial problems encountered in a typical gastroenterology practice (level 1), and training to prepare an individual to develop additional clinical and /or research expertise in Hepatology. In addition, however, both societies recognize the need to train physicians to manage patients with end-stage liver disease, as well as pre and post-transplant. Physicians who have not yet completed a gastroenterology fellowship have received two years of training in the program to achieve this; physicians who have completed gastroenterology fellowship receive an intense, broad based experience in liver transplantation with the goal of preparing them to manage these unique patients. The requirements for earning a certificate of added qualification in Transplant Hepatology, as well as the UNOS guidelines for training physicians to become a medical director of a liver transplant program have been met in this curriculum.

One year of specialized training in liver transplantation under supervision of a qualified transplant hepatologist and in conjunction with a transplant surgeon, including a minimum of 4 months on the clinical inpatient adult liver transplant service, with weekly continuity clinic for the 12 months. The remaining months should consist of other Hepatology or transplant related experience, including involvement in basic or clinical transplant research.

Rotations

Hepatology Clinic (Outpatient):

The outpatient experience, which comprises of a total of 22 weeks of the year, is designed to offer experience in the initial diagnosis and evaluation of patients with liver diseases, including the management of patients with a broad spectrum of common liver disorders. This includes the appropriate testing and treatment for patients with acute and chronic liver disorders, along with indications for treatment, and the side effects of therapy.

The fellow will rotate between clinics at main campus, to allow exposure to each of the staff hepatologists, as well as spend some time in the hepatitis C clinic, following patients on interferon therapy. In order to assure continuity of care, fellows will arrange follow-up of patients to coincide with their clinic rotation.

In order to gain as much exposure as possible to patients in the evaluation and management of liver transplant candidates, the fellow will continue in the Wednesday morning clinic throughout the year, staffing patients seen there with the Hepatology faculty. The fellow will also have an opportunity to perform endoscopic procedures on patients under the supervision of the adult Hepatology staff.

Hepatology Inpatient Service:

The inpatient hospital service makes up four months of the year, and is designed to expose the fellow to the most severely ill patients who have suffered complications of their liver disease. Patients are seen in consultation on the medical and surgical services, as well as managed primarily by the liver service, depending on the nature of their illness. An additional goal is for the fellow to gain experience in the management of patients throughout the period around liver transplantation, when decisions about immunosuppression are made. Lastly, the fellow does outpatient procedures during this rotation, including routine paracentesis (both diagnostic and therapeutic) and liver biopsies. This typically averages four paracentesis and one-two liver biopsies per day, enough to gain sufficient experience to meet the training criteria defined by the AASLD. Because of the busy nature of the inpatient consult and hospital primary services, these duties are divided equally between two fellows: the gastroenterology fellow rounding on the Hepatology service, and the Hepatology fellow.

The structure of the hospital service rotation includes daily rounds with the attending physician, as well as performance of outpatient procedures (liver biopsies and paracenteses) under the supervision of the attending physician, involvement in the teaching rounds with the transplantation.

Hepatology Consult:

The overall educational goal of this rotation for fellows is to develop consultative skills in the management of the hospitalized patient who presents with or develops liver symptoms or disease, and evaluation for transplantation.

Research:

The research component of the fellowship will be derived from the specific interests of the fellow. Interests of the adult Hepatology section are varied, with expertise in chronic viral hepatitis, fatty liver disease, portal hypertension, end-stage liver disease, public health and epidemiology, and transplant Hepatology. Under the guidance of a faculty mentor, the fellow will be supported through the process of developing an idea, designing and writing a protocol, IRB submission, and carrying out the project, along with data analysis, manuscript preparation and submission. The project will be presented to the entire Hepatology section in a formal conference for critique in the design phase and after data collection, cleaning, and preliminary analysis. The results will be submitted as an abstract to the annual meeting of the American Association for the Study of Liver Disease.

Surgery Simulation

Cleveland Clinic's Center for Multidisciplinary Simulation has, flexible endoscopy, upper endoscopy , colonsocopy, and ERCP simulators to enhance the clinical learning experience.

»Clinical Conferences

A significant portion of the fellowship education process comes from participating in an environment which allows for and fosters divergnt opinions and approaches to patient care. The Department conference and rotation format is designed to meet this expectation.

The diversity of clinical material at the Cleveland Clinic assures the likelihood of seeing both common digestive disease problems in great numbers as well as uncommon digestive disease problems. The didactic conference series is designed to supplement the fellows’ clinical exposure and reading with up-to-date and relevant reviews of topics of interest in basic and clinical science as outlined below.

State of the Art Lecture

The goal of this conference is to provide a comprehensive review by fellows and staff of the Department of selected topics in Gastroenterology and Hepatology in a three year cycle. These lectures complement core reading material presented at other conferences. Although not always pertinent to Hepatology or transplant, close to half of the conferences cover liver disease.

Management Conferences

The goal of this conference is to develop a logical approach to the differential diagnosis of common and uncommon digestive disease problems and to become familiar with management and treatment strategies for these problems.

During this one hour conference, one case is discussed. During the first half of the conference, relevant data are presented in an organized fashion and the presenting fellow gets opinions from the audience regarding an appropriate differential diagnosis and diagnostic approach. The second half of the conference is reserved for a presentation on the topic being reviewed. Fellows should review their presentations with the staff member that they saw the case with prior to presentation.

Liver Transplant Selection Committee Meeting

The goal of this conference is to present and discuss specific patients undergoing evaluation for liver transplantation. The fellow serves as the primary advocate for the patients he/she has evaluated, and presents the clinical overview to a committee of hepatologists, surgeons, social workers, ethicists, transplant coordinators, and other transplant professionals.

Pathology Conferences

The goal of this conference is to develop expertise in interpreting liver histopathology. Fellows will review slides on a multi-headed microscope in a multi-disciplinary conference, including pathologists, hepatologists, and liver transplant surgeons. At the end of the fellowship, the fellow should feel comfortable in reading normal and abnormal slides of the liver.

»Current Fellows

Mina Shaker

Karim Camel-Toueg International Fellowship in Hepatology

Sulieman Abdal Raheem

Residency: SUNY at Buffalo, School of Medicine

»Staff Physicians

• Talal Adhami
• David Barnes
• William Carey
• Dian Chiang
• Srinivisan Dasarathy
• Krysten Fairbanks
• Michelle Inkster
• Binu John
• Arthur McCullough
• K.V. Narayanan Menon
• Robert O’Shea
• Carlos Romero-Marrero
• Anthony Tavill – Consultant Staff
• Jamile Wakim-Fleming
• Claudia Zein
• Nizar Zein, MD

»Alumni Career Pathways

2011 Graduates

Naim Alkhouri
Pediatric and Adult Hepatology
Cleveland Clinic, OH

2010 Graduates

Emily Carey
Gastroenterology
Cleveland Clinic, OH

2008 Graduates

Achuthan Sourianarayanane
(2009 Clinical Associate Hepatology)
Gastroenterology
Cleveland Clinic, OH

»Locations

Cleveland Clinic

Cleveland Clinic was founded in 1921 by George Crile Sr., a general and endocrine surgeon; Frank Bunts, a neurosurgeon; William Lower, an urologist; and John Phillips, an internist. It was a new kind of medical center: a physician-led, not-for-profit, integrated hospital and group practice, equally dedicated to patient care, research, and education. Cleveland Clinic quickly became a world renowned training hospital, medical school and research institute, known for offering the most advanced medical care.

Cleveland Clinic's main campus consists of 41 buildings and more than 85 operating rooms, with constant expansion and renovation. The Gastroenterology offices are on the third floor and fifth floor of the A building (desk A30 and A50) in the Digestive Disease Institute.

Q3: New, State-of-the-art Endoscopy Unit

The Digestive Disease Institute’s advanced endoscopy unit, located in Glickman tower on Cleveland Clinic’s main campus, emphasizes both safety and quality. The 15,000-square-foot facility was built to improve both access and patient experience. The expansion doubled the number of therapeutic endoscopy suites for performing endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS) and deep enteroscopy. Specialized fluoroscopic equipment will allow for the next generation of 3-D cholangiography, which is available at only a handful of units nationally. The unit was designed to improve patient satisfaction and features private recovery rooms with TVs and seating for family members. It will help maximize communication between patients and caregivers and enable close interaction with the staff from other specialties, including anesthesiology, hepatobiliary surgery, colorectal surgery, thoracic surgery, oncology and radiation oncology, during treatment.

” This expansion will increase our ability to handle additional volume to speed up diagnosis and treatment of patients.” – John Vargo, MD, MPH

Cleveland Clinic is a large facility, how do I find my way around?

While Cleveland Clinic has a large campus, it is easily walkable from the visitor parking garages and the three on campus hotels: the InterContinental Hotel, the InterContinental Suites, and the Cleveland Clinic Guest House. Cleveland Clinic is immediately adjacent to the University Circle Neighborhood, home of the Case Western Reserve University, the Cleveland Orchestra, and the Cleveland Museum of Art. Cleveland Clinic is centrally located and accessible from the downtown, east, and west side residential neighborhoods.

»Application Information

What are you looking for in an applicant?

We are looking for outstanding individuals to immerse in a high volume environment that offers high quality, scientifically advanced care in an economically savvy environment. We seek the most promising physicians as demonstrated leadership abilities, academic productiveness, knowledge base, and positive personal qualities among applicants from diverse backgrounds.

What is your application process?

Cleveland Clinic has minimum requirements for fellowship application and employment, all of which are all required in the standard ERAS application. We have no secondary application form. We review every submitted application completely and carefully, and a selected group is offered on-site interviews.

What are your NRMP program codes?

Gastroenterology AAMC ID: 1968144F0

What are your fellows' employment benefits?

Residents are Cleveland Clinic employees with standardized salaries and other benefits.

What VISAs are supported by Cleveland Clinic?

Clinical Programs

For graduate medical education purposes (residency, fellowship and clinical research fellowship), Cleveland Clinic will accept H-1B temporary worker or J-1 exchange visitor (alien physician category – sponsored by the ECFMG) visas. International students enrolled in U.S. medical schools may use the post-graduate year of Optional Practical Training (OPT) for the first year of residency training. Information on this process should be obtained from the Designated School Official (DSO) at the medical school. Cleveland Clinic does not sponsor immigrant (permanent resident) petitions for research or clinical trainees (residents, clinical fellows, clinical research fellows, research fellows or postdoctoral fellows).

Research Programs

The H-1B, the J-1 exchange Visitor (research scholar category – sponsored by CCF) or F-1 student (sponsored by a U.S. college or university) with employment authorization are accepted by Cleveland Clinic for research purposes. Cleveland Clinic does not sponsor immigrant (permanent resident) petitions for research or clinical trainees (residents, clinical fellows, clinical research fellows, research fellows or postdoctoral fellows).

»Contact Us

Gastroenterology Education Coordinator

Cheryl Borowski
Gastroentrology Education Coordinator
216.445.7204
Fax: 216.636.2508
borowsc@ccf.org

External Rotations

Evelyn Delong
GME Coordinator
216.444.9989
delonge@ccf.org

International Physician Services / Visa

Janice M. Bianco
Manager, International Physician Services
Responsible Officer, Exchange Visitor Program
216.445.7681
biancoi@ccf.org

Institute Education Manager

Beth Christoff, BSN. MBA
Institute Education Manager
Digestive Disease Institute
216.445.2809
christb@ccf.org

Observerships / CIME

Graduate Medical Education
Main Office
216.444.5690
800.323.9259
Fax: 216.444.6112
Cleveland Clinic Operator
216.444.2200

Cleveland Clinic offers a comprehensive therapeutic endoscopy fellowship experience.

This one-year program includes training in endoscopic ultrasound, ERCP, balloon enteroscopy, Barrett's ablative techniques, endoluminal stenting, and other therapeutic techniques.

Both the technical and cognitive aspects of endoscopy are emphasized. Fellows are educated on all facets of endoscopic practice, including proper indications, equipment and technology, quality indicators, varying technical approaches, and the recognition and management of complications.

A clinical research project is an important component to the curriculum. Fellows may also spend time in our pancreas disease clinic, GI bleeding team, and esophageal diseases clinic based on their interest. A rich conference schedule includes management conferences and our multidiscipilinary hepatopancreaticobiliary conference, and augments the clinical experience.

The faculty in our program come from diverse backgrounds, with a variety of clinical and research interests. All our faculty are interested and invested in the education of our therapeutic trainees. We welcome your consideration of our program!

»Curriculum

Cleveland Clinic Advanced Endoscopy Fellowship Program Goals

The goal of our advanced endoscopy fellowship program is to train the best academic and clinical gastroenterologists to meet the future needs of our profession in patient care, teaching, and research. We are dedicated to training physicians who can lead our profession in this changing era of health care and research.

The primary means of training is on-site care of patients with digestive disease disorders over the one-year advanced endoscopy fellowship program in a supervised setting, which enables independent thought and evaluation of patients. Our fellows are exposed to patients in the in-patient and out-patient settings.

A major thrust of the advanced endoscopy fellowship program is to train fellows in the techniques of clinical investigation and endoscopic therapy. This experience will involve exposure to the research process by selection of a scientific question, protocol design and critique, IRB and regulatory processes, data collection, statistical analysis, and presentation. Fellows present their initial protocol to the endoscopy group for open discussion.

This document provides an overview of the advanced endoscopy fellowship training program including overall goals and objectives as well as specific goals and objectives for each rotation.

Overall Goals

• To provide skills necessary to understand, diagnose, and treat a wide range of complex gastrointestinal and biliary disorders
• To develop proficiency in all advanced endoscopic procedures
• To develop teaching ability for endoscopy
• To provide a meaningful and stimulating clinical research experience

Clinical Training

Our advanced endoscopy fellowship program provides education and training by three different modalities: a) faculty mentorship; b) didactic teaching by fellows and faculty; c) independent study by fellows. As delineated below, our curriculum offers excellent training in all of these core areas. By mastering these competencies, our graduates will be leaders throughout their career.

Overall Goals

• Assessment and management of acutely ill patients with gastrointestinal and liver disorders who are admitted to the hospital. Patient demographics consist of adult patients across all age ranges, ethnic backgrounds, and with acute and chronic disorders.
• Assessment and management of outpatients with various gastrointestinal and liver disorders. The patient mix includes adult patients across all age ranges, ethnic backgrounds, and with acute and chronic disorders.
• Effective interaction with primary care physicians and consultants both in the outpatient and inpatient settings.
• Develop proficiency in complex endoscopic procedures and associated interventions (endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, mucosectomy, dilation and stent placement for complex benign and malignant strictures)
• Learn the techniques of clinical investigation.
• Appropriate use of resources.
• Participation in quality assurance conferences.

The core curriculum of topics is covered over the one year cycle of the advanced endoscopy fellowship. Individual key subjects are reviewed by staff and fellows in formal didactic conferences. The finer points of management, pathophysiology, and diagnosis are formally reviewed during case management conferences, state-of-the-art lectures, and during case-based teaching in the hospital and clinics. These teaching methods address the ACGME six core competencies is listed below:

• Patient Care
• Medical Knowledge
• Practice Based Learning and Improvement
• Interpersonal and Communication Skills
• Professionalism
• Systems Based Practice

Our commitment is to train young physicians to a high level of clinical, academic, and systems competence, becoming professional leaders throughout their career in this rapidly changing field.

Mentorship

Each fellow is paired with a Staff Physician as their Advisor. Their role is to provide career counseling, ensure that each resident is developing well clinically, operating at the requisite skill level and filling leadership positions. More subtly, their role is to demonstrate a model for professionalism.

Research and Professional Development

The research opportunities at the Cleveland Clinic are outstanding – and thus all fellows are expected to be productive in clinical research throughout their fellowship. You will have access to our our multiple institutional databases, electronic medical record which houses our massive clinical experience, and national databases.

All fellows are required to carry out a prospective research project as part of the advanced endoscopy fellowship program. This will usually be a clinical project but may also involve basic science research. All projects will be conducted under the close supervision and mentoring of a staff member experienced in research. There is a broad spectrum in choice of topics.

Other opportunities for case reports, book chapters, other research projects and writing will be encouraged during the advanced endoscopy fellowship. A manuscript suitable for submission for publication must be submitted to the Program Director no later than June 1 of the year of the advanced endoscopy fellowship as a requirement for completing the advanced endoscopy fellowship.

These research months allow fellows the opportunity to pursue particular research in the Department. The bulk of the time on these rotations should be spent working on the research projects. One half day per week during this rotation is spent in the continuity care clinic and an additional half day may be spent in endoscopy. Presentation of research at regional or national meetings is strongly encouraged as the well as the preparation of a manuscript for submission to a peer-reviewed journal.

Research Goals and Objectives

• Develop an understanding of the processes required to perform clinical research.
• Formulate a specific hypothesis and design a protocol to test the hypothesis.
• Learn how to work with the IRB regarding regulatory affairs.
• Conduct a study.
• Use appropriate statistical analysis to analyze data.
• Present study results and submit a publication.

Each fellow then selects Staff Physician as their Research Mentor. Their role is to assist with developing research projects and publications.

Fellows travel to present research at national conferences is supported and fully funded, allowing you to make national contacts among leaders in the field. Activity in research ensures our fellows are not only up to date in their medical knowledge, but advance the field of Gastroenterology and Hepatology.

Rotations

Gastroenterology Inpatient Service:

The overall educational goal of this rotation for fellows is to develop skills in the management of the hospitalized patient with GI disease in a cost-effective and expedient manner. The fellow serves as a junior consultant for residents, interns, and medial students and helps assure that quality care is rendered to all patients on the service. A significant component of the learning experience comes from working closely with all patients admitted to the GI hospital service and being aware of ongoing developments throughout the day including diagnostic, therapeutic, social, and administrative details of patient care.

Hepatology Inpatient Service:

The overall educational goal of this rotation for fellows is to develop skills in the management of the hospitalized patient with liver disease in a cost-effective and expedient manner. The fellow serves as a junior consultant for residents, interns, and medical students and helps assure that quality care is rendered to patients on the service. A significant component of the learning experience comes from working closely with patients with liver disease requiring inpatient care including patients: 1) with complications of chronic liver disease, 2) undergoing liver transplant evaluation, 3) awaiting transplantation, 4) with fulminant hepatic failure, 5) admitted for complications related to transplantation, and 6) inpatient hepatology consultations.

Hepatology Consult:

The overall educational goal of this rotation for fellows is to develop consultative skills in the management of the hospitalized patient who presents with or develops liver symptoms or disease, and evaluation for transplantation.

Gastroenterology Consult and Acute Bleeder Service:

The overall educational goal of this rotation for fellows is to develop consultative skills in the management of the hospitalized patient who presents with or develops GI symptoms or disease. The consult service is also responsible for emergency endoscopy of all patients with GI bleeding in the ICUs during regular working hours. Therefore fellows on the consult service will learn how to perform emergency endoscopies in the ICUs under the supervision of the attending physician.

Endoscopy:

The overall educational goal of this rotation for fellows assigned to the endoscopy rotation work directly under the supervision of different faculty doing endoscopy. No procedures are performed unsupervised. Fellows maintain a log of all cases they perform during their fellowship. Training will first emphasize diagnostic upper endoscopy, and conscious sedation. This will be followed by esophageal dilatation, therapy of upper GI bleeding, emergency upper endoscopy, percutaneous gastrostomy, diagnostic colonoscopy, and polypectomy.

Training in therapeutic ERCP along with other advanced procedures such as endoscopic ultrasonography, photodynamic therapy, placement of self-expandable metallic stents, endoscopic tumor ablation and mucosal resection with the ultimate goal of obtaining credentialing in these procedures is not the goal of the three year curriculum and is obtained only after successful completion of a fourth year advanced therapeutic endoscopy.

Clinical Nutrition Service:

The overall educational goal of this rotation is to provide our fellows with the tools which they need to provide their patients with appropriate and adequate nutritional support. This will be done by having each fellow rotate on the Nutrition Support Team in the first, second, and third years of training. During the first year, fellows will develop the skills to be facile in the management of nutritional support in hospitalized patients. This includes identifying patients with protein calorie malnutrition; assessing the protein and calorie needs of these patients; learning the techniques of both enteral and parenteral feeding along with the complications of these therapies; and learning how to monitor the adequacy of these interventions. The fellow should be available during their rotation to participate completely with the Nutrition Support Team and all of it’s activates including inpatient rounds, and morning conference/journal club. During the second and third year, the fellows spend 2 weeks on the inpatient service and 2 weeks in outpatient clinics with exposure to the intestinal rehabilitation program, obesity clinic, and bariatric surgery clinic.

Research:

All fellows are required to carry out a research project as part of the fellowship program. This will usually be a clinical project but may also involve basic science research. A second quality improvement project is also required. All projects will be conducted under the close supervision and mentoring of a staff member experienced in research. There is a broad spectrum in choice of topics.

Research projects are discussed with the monthly research committee meeting and presented to the Center the fellow is working in during the first year. The project should involve a hypothesis driven experiment, extensive review of the literature, appropriate design and development, obtaining institutional review board approval, recruitment and completion of the project, data analysis, preparation of an abstract for submission to a national meeting, and completion of a scientific manuscript. A research presentation is conducted in front of the entire Department prior to the initiation of a project. Results of the study are subsequently presented at the completion of the fellowship to the Department at a research conference.

Surgery Simulation

Cleveland Clinic's Center for Multidisciplinary Simulation has, flexible endoscopy, upper endoscopy , colonsocopy, and ERCP simulators to enhance the clinical learning experience.

Case Volumes

Below is a cummaltive average of procedures performed during your fellowship period.

	Upper Endoscopy	Colonoscopy
Average Number of Procedures	600-800	300-500

Board Passage Rates

For Cleveland Clinic's Gastroenterology Fellowship Program, cumulative first time board passage rates 2005-2011 is 100%.

»Clinical Conferences

Clinical Conferences

It is expected that the most significant aspect of the learning experience will come from "hands-on" management of patients, supported by case-based independent reading of textbooks and selected journal articles. A significant portion of the advanced endoscopy fellowship education process comes from participating in an environment which allows for and fosters divergent opinions and approaches to patient care. The Department conference and rotation format is designed to meet this expectation.

Morbidity and Mortality Conference

Each month the fellows report cases for the M&M conference. The conference faculty moderator selects cases for presentation based on their teaching merit, and moderates the discussion. The fellow who managed the patient presents the case and pertinent literature while focusing on clinical decision making, reasons for any complications and alternative management options., The main focus of the conference is improving clinical decision making to improve patient care.

Case Management Conference

Each fellow presents 30-minute management conferences at regular intervals throughout the academic year. This is a brief presentation that addresses diagnostic or management dilemmas that are debated amongst faculty and fellows. This conference is considered by many to be the highlight of our conference schedule.

State of the Art Conference

Each fellow presents a comprehensive, one-hour presentation on a specific topic of his/her choice using an extensive review of the literature. The fellows work with a faculty mentor in the development and synthesis of their presentation.

Gastroenterology Didactic Series

The academic year begins with a didactic core curriculum that reviews important topics in gastroenterology, hepatology and nutrition. Throughout the course of the academic year, distinguished faculty from the Digestive Disease Institute and other departments are invited to speak to fellows and faculty in various areas of interest.

Fellows Conference Series

This weekly series consists of four multidisciplinary areas:

• Radiology Rounds, designed to improve fellows ability to interpret basic radiology studies and determine which tests are applicable in specific clinical situations.
• Research Methodology helps fellows review the basic principles of clinical epidemiology and statistical design in order to critically interpret literature and elements of statistical design criteria.
• Pathology allows fellows to improve their ability to review and interpret histological specimens in an organ-based fashion from a variety of pathological conditions.
• Nutrition conference reviews the fundamentals of nutrition in a variety of pathological states including understanding concepts pertaining to parenteral and enteral nutrition, and obesity.

Hepatobiliary Management Conference

This is a multi disciplinary conference attended by members of the therapeutic endoscopy section, general surgery, diagnostic imaging, gastrointestinal oncology, and radiation oncology. Typically, a series of case management issues are presented with group discussion. Fellows currently on the endoscopy rotation are urged to attend.

Gastroenterology Journal Club

A journal club is held monthly at an external location. Articles are selected by faculty around a theme, and presented in a critical fashion by the fellows. These are discussed in a congenial atmosphere. Topics are rotated month to month.

Subspeciality Conferences

Each subspeciality holds its own conferences (IBD, Liver Transplant, HPB, Intestinal Transplant, Clinical Nutrition, etc.) These conferences are made available to all fellows that wish to attend.

Grand Rounds

These one-hour seminars by esteemed Cleveland Clinic and visiting faculty are diverse presentations aimed at faculty, fellows, and residents. Presentations are on a broad range of topics, including clinical topic updates, world health, surgical history, etc. These are held monthly for Internal Medicine, General Surgery, and Transplant Center.

»Current Fellows

Mihir R. Bakhru, MD

Fellowship: University of Virginia Medical Center
Gastroenterology Residency: Cleveland Clinic
Research: A comparison of standard frequency to high frequency endosonography in patients with superficial esophageal cancers

Amit Bhatt, MD

Fellowship: Cleveland Clinic
Gastroenterology Residency: Cleveland Clinic
Research: Long -Term Follow Up of Cryospray Ablation for Barrett’s Esophagus with High Grade Dysplasia

Venkata Muddana, MD

Fellowship: University Health Center Pittsburgh
Gastroenterology Residency: Shady Side Hospital
Research: Advanced Endoscopy

»Staff Physicians

• Prabhleen Chahal
• Sunguk Jang
• Mansour Parsi
• Madhu Sanaka
• Tyler Stevens
• John Vargo
• Greg Zuccaro

»Alumni Career Pathways

2011 Graduates

Nirav Shah, MD
Philadelphia, PA

2010 Graduates

Mohammed Qadeer, MD
Lexington, NC

2009 Graduates

K.V. Narayanan Menon, MD
Cleveland Clinic, OH

2008 Graduates

Jason Guardino, MD
Sacramento, CA

2007 Graduates

Sanguk Jang, MD
Cleveland Clinic, OH

2006 Graduates

Tyler Stevens, MD
Cleveland Clinic, OH

»Locations

Cleveland Clinic

Cleveland Clinic was founded in 1921 by George Crile Sr., a general and endocrine surgeon; Frank Bunts, a neurosurgeon; William Lower, an urologist; and John Phillips, an internist. It was a new kind of medical center: a physician-led, not-for-profit, integrated hospital and group practice, equally dedicated to patient care, research, and education. Cleveland Clinic quickly became a world renowned training hospital, medical school and research institute, known for offering the most advanced medical care.

Cleveland Clinic's main campus consists of 41 buildings and more than 85 operating rooms, with constant expansion and renovation. The Gastroenterology offices are on the third floor and fifth floor of the A building (desk A30 and A50) in the Digestive Disease Institute.

Q3: New, State-of-the-art Endoscopy Unit

The Digestive Disease Institute’s advanced endoscopy unit, located in Glickman tower on Cleveland Clinic’s main campus, emphasizes both safety and quality. The 15,000-square-foot facility was built to improve both access and patient experience. The expansion doubled the number of therapeutic endoscopy suites for performing endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS) and deep enteroscopy. Specialized fluoroscopic equipment will allow for the next generation of 3-D cholangiography, which is available at only a handful of units nationally. The unit was designed to improve patient satisfaction and features private recovery rooms with TVs and seating for family members. It will help maximize communication between patients and caregivers and enable close interaction with the staff from other specialties, including anesthesiology, hepatobiliary surgery, colorectal surgery, thoracic surgery, oncology and radiation oncology, during treatment.

” This expansion will increase our ability to handle additional volume to speed up diagnosis and treatment of patients.” – John Vargo, MD, MPH

Cleveland Clinic is a large facility, how do I find my way around?

While Cleveland Clinic has a large campus, it is easily walkable from the visitor parking garages and the three on campus hotels: the InterContinental Hotel, the InterContinental Suites, and the Cleveland Clinic Guest House. Cleveland Clinic is immediately adjacent to the University Circle Neighborhood, home of the Case Western Reserve University, the Cleveland Orchestra, and the Cleveland Museum of Art. Cleveland Clinic is centrally located and accessible from the downtown, east, and west side residential neighborhoods.

»Application Information

What are you looking for in an applicant?

We are looking for outstanding individuals to immerse in a high volume environment that offers high quality, scientifically advanced care in an economically savvy environment. We seek the most promising physicians as demonstrated leadership abilities, academic productiveness, knowledge base, and positive personal qualities among applicants from diverse backgrounds.

What is your application process?

Cleveland Clinic has minimum requirements for fellowship application and employment, all of which are all required in the standard ERAS application. We have no secondary application form. We review every submitted application completely and carefully, and a selected group is offered on-site interviews.

What are your NRMP program codes?

Gastroenterology AAMC ID: 1968144F0

What are your fellows' employment benefits?

Residents are Cleveland Clinic employees with standardized salaries and other benefits.

What VISAs are supported by Cleveland Clinic?

Clinical Programs

For graduate medical education purposes (residency, fellowship and clinical research fellowship), Cleveland Clinic will accept H-1B temporary worker or J-1 exchange visitor (alien physician category – sponsored by the ECFMG) visas. International students enrolled in U.S. medical schools may use the post-graduate year of Optional Practical Training (OPT) for the first year of residency training. Information on this process should be obtained from the Designated School Official (DSO) at the medical school. Cleveland Clinic does not sponsor immigrant (permanent resident) petitions for research or clinical trainees (residents, clinical fellows, clinical research fellows, research fellows or postdoctoral fellows).

Research Programs

The H-1B, the J-1 exchange Visitor (research scholar category – sponsored by CCF) or F-1 student (sponsored by a U.S. college or university) with employment authorization are accepted by Cleveland Clinic for research purposes. Cleveland Clinic does not sponsor immigrant (permanent resident) petitions for research or clinical trainees (residents, clinical fellows, clinical research fellows, research fellows or postdoctoral fellows).

»Contact Us

Gastroenterology Education Coordinator

Cheryl Borowski
Gastroentrology Education Coordinator
216.445.7204
Fax: 216.636.2508
borowsc@ccf.org

External Rotations

Evelyn Delong
GME Coordinator
216.444.9989
delonge@ccf.org

International Physician Services / Visa

Janice M. Bianco
Manager, International Physician Services
Responsible Officer, Exchange Visitor Program
216.445.7681
biancoi@ccf.org

Institute Education Manager

Beth Christoff, BSN. MBA
Institute Education Manager
Digestive Disease Institute
216.445.2809
christb@ccf.org

Observerships / CIME

Graduate Medical Education
Main Office
216.444.5690
800.323.9259
Fax: 216.444.6112
Cleveland Clinic Operator
216.444.2200

Cleveland Clinic’s Nutrition Fellowship Program welcomes your interest in our program. This unique program is under the direction of the Center for Human Nutrition within the Digestive Disease Institute. Our program is open to physicians who have completed either a medical or surgical training program. The Fellowship takes 2 candidates each year, and the training consists of 6 months of active Fellowship training where the trainee is taught the essentials of Nutrition Support Consultation and care. The Cleveland Clinic’s Nutrition Support Team is a multidisciplinary service that is composed of physicians, nurses, dietitians, pharmacists, social workers, a physician's assistant and other support personnel. The NST is one of the largest teams in the world and has been in continuous service since its inception in the mid 1970s. It interacts regularly with the Home Parenteral Nutrition Service that cares for over 180 patients currently. The trainee will focus on the basics of nutrition consultation caring for severely malnourished and other patients who have difficulty meeting their nutritional needs on their own. The initial focus is on enteral and parenteral nutrition care. During this time, the trainee will also have the opportunity to participate in research.

During the second 6 months, the trainee will transition into a Clinical Associate where part of their responsibility will be to round as a Physician Team leader on the Nutrition Support Team, putting into practice what they have learned. They will also have the opportunity to learn many other aspects of Nutrition Care both on an inpatient and outpatient basis. These areas can be tailored to the future interests of the trainee and may include, but not be limited to the following: bariatric medicine, eating disorders, Intestinal Rehabilitation, Intestinal Transplantation, eating disorders, wellness, endocrinology and metabolism.

We believe that our Fellowship Program offers a unique experience that is available in few other medical centers in the world.

Donald F. Kirby, MD
Director, Center for Human Nutrition

»Curriculum

The one year Cleveland Clinic Nutrition Fellowship is designed for the physician who wishes to specialize in nutrition-centered medical care. It is one of a few select programs in the United States that are predominantly patient-based in adult medicine. This, along with the unique patient population of the Cleveland Clinic, makes this an exceptional curriculum for advanced training in clinical nutrition.

Nutrition Fellows acquire expertise in a variety of nutrition related areas including enteral and parenteral nutrition, intestinal failure, home parenteral nutrition, nutrition support access device management, as well as the opportunity to participate in a wide variety of nutrition programs from wellness to bariatric medicine. Fellows will gain sufficient training and experience to be eligible to sit for the examinations offered by the National Board of Nutrition Support Certification that conveys the CNSC (certified nutrition support clinician) designation.

Since the program’s inception in 1994, more than three-quarters of our graduates have gone on to complete a gastroenterology fellowship. Almost half currently maintain professions specifically dictating the use of clinical nutrition.

Program Description

Why Nutrition?

Each year, two fellows are recruited for this 12-month program. The fellowship is provided by the Center for Human Nutrition, as part of Cleveland Clinic’s Digestive Disease Institute. Fellows acquire proficiency in the recognition and management of patients with protein-energy malnutrition and nutritional abnormalities associated with intestinal malabsorption, inflammatory bowel disease, chronic liver and renal disease, pancreatic insufficiency, cancer cachexia, and critical illness. Individuals with training in other specialties and subspecialties, such as gastroenterology, endocrinology, critical care medicine, and general surgery, will gain further benefit from this program.

Fellows expand their nutrition expertise by participating in the following areas:

• Rounding daily on inpatients with the physician-directed, multidisciplinary Nutrition Support Team.
• Care of individuals, in the inpatient and outpatient settings, who are dependant on home parenteral nutrition (the Cleveland Clinic cares for one of the largest groups of home parenteral nutrition patients in the world).
• Observing techniques for the insertion and care of enteral access devices, as well as understanding the role of temporary and permanent central venous catheters for administration of parenteral nutrition.
• Contributing to the department’s educational conferences and research activities. The fellow should expect to devote one-half of his/her time to clinical research, after an initial training period.
• Rotating with the Intestinal Rehabilitation and Transplant Program to focus on nutrition care for the inpatient and outpatient populations experiencing intestinal failure.
• Opportunity for involvement in a variety of nutrition-related outpatient clinics and settings, including wellness, bariatric medicine, preventative cardiology, gastroenterology, and eating disorders.

Mentorship

Each fellow is paired with a Staff Physician as their Adviser. Their role is to provide career counseling, ensure that each resident is developing well clinically, operating at the requisite skill level and filling leadership positions. More subtly, their role is to demonstrate a model for professionalism.

Research and Professional Development

The research opportunities at the Cleveland Clinic are outstanding – and thus all fellows are expected to be productive in clinical research throughout their fellowship. You will have access to our our multiple institutional databases, electronic medical record which houses our massive clinical experience, and national databases.

»Clinical Conferences

Center for Human Nutrition Continuing Education Conference (Center for Human Nutrition)

This conference is held weekly, primarily on Thursday mornings at 8 AM. The conference consists of variety of educational activities including live lectures, webinars, journal club presentations, and case study presentations with a focus on nutrition support.

Medical Grand Rounds (Department of Medicine)

This conference will substitute for the Center for Human Nutrition Continuing Education Conference, on occasion, when a nutrition-related topic is presented.

GI Fellow Education Conferences (Department of Gastroenterology & Hepatology)

Morbidity and Mortality Conference

Each month the fellows report cases for the M&M conference. The conference faculty moderator selects cases for presentation based on their teaching merit, and moderates the discussion. The fellow who managed the patient presents the case and pertinent literature while focusing on clinical decision making, reasons for any complications and alternative management options., The main focus of the conference is improving clinical decision making to improve patient care.

Case Management Conference

Each fellow presents 30-minute management conferences at regular intervals throughout the academic year. This is a brief presentation that addresses diagnostic or management dilemmas that are debated amongst faculty and fellows. This conference is considered by many to be the highlight of our conference schedule.

State of the Art Conference

Each fellow presents a comprehensive, one-hour presentation on a specific topic of his/her choice using an extensive review of the literature. The fellows work with a faculty mentor in the development and synthesis of their presentation.

Gastroenterology Didactic Series

The academic year begins with a didactic core curriculum that reviews important topics in gastroenterology, hepatology and nutrition. Throughout the course of the academic year, distinguished faculty from the Digestive Disease Institute and other departments are invited to speak to fellows and faculty in various areas of interest.

GI Fellow Lecture Series (Department of Gastroenterology & Hepatology)

Fellows Conference Series

This weekly series consists of four multidisciplinary areas:

• Radiology Rounds, designed to improve fellows ability to interpret basic radiology studies and determine which tests are applicable in specific clinical situations.
• Research Methodology helps fellows review the basic principles of clinical epidemiology and statistical design in order to critically interpret literature and elements of statistical design criteria.
• Pathology allows fellows to improve their ability to review and interpret histological specimens in an organ-based fashion from a variety of pathological conditions.
• Nutrition conference reviews the fundamentals of nutrition in a variety of pathological states including understanding concepts pertaining to parenteral and enteral nutrition, and obesity.

»Staff Physicians

Swallowing

Edgar Achkar – Consultant

Staff

Monica Ray
Prashanthi Thota

IBD

JP Achkar
Aaron Brzezinski
Carole Burke
Ahmed Kandiel
Bret Lashner
Bo Shen
Le Chu Su
Yinghong Wang

Liver

Talal Adhami
David Barnes
William Carey
Dian Chiang
Srinivisan Dasarathy
Krysten Fairbanks
Michelle Inkster
Binu John
Arthur McCullough
K.V. Narayanan Menon
Robert O’Shea
Carlos Romero-Marrero
Anthony Tavill – Consultant

Staff

Jamile Wakim-Fleming
Claudia Zein
Nizar Zein

General GI

Mujtaba Butt
Christine Lee
David Lever
Joseph Moses
Monica Ray
Prashanthi Thota
Chung-Jyi Tsai
Luke Weber

Advanced Endoscopy

Prabhleen Chahal
Sunguk Jang Mansour
Parsi Madhu Sanaka
Tyler Stevens
John Vargo
Greg Zuccaro

Nutrition

Donald Kirby

Chronic Abdominal Pain

Maged Rizk

»Alumni Career Pathways

2011 Graduates

Jackie Celstien, Cleveland Clinic, OH
Sreenija Suryadevara Cleveland Clinic, OH

2010 Graduates

Abdullah Shatnawei, Cleveland Clinic, OH

»Locations

Cleveland Clinic

Cleveland Clinic was founded in 1921 by George Crile Sr., a general and endocrine surgeon; Frank Bunts, a neurosurgeon; William Lower, an urologist; and John Phillips, an internist. It was a new kind of medical center: a physician-led, not-for-profit, integrated hospital and group practice, equally dedicated to patient care, research, and education. Cleveland Clinic quickly became a world renowned training hospital, medical school and research institute, known for offering the most advanced medical care.

Cleveland Clinic's main campus consists of 41 buildings and more than 85 operating rooms, with constant expansion and renovation. The Gastroenterology offices are on the third floor and fifth floor of the A building (desk A30 and A50) in the Digestive Disease Institute.

Q3: New, State-of-the-art Endoscopy Unit

The Digestive Disease Institute’s advanced endoscopy unit, located in Glickman tower on Cleveland Clinic’s main campus, emphasizes both safety and quality. The 15,000-square-foot facility was built to improve both access and patient experience. The expansion doubled the number of therapeutic endoscopy suites for performing endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS) and deep enteroscopy. Specialized fluoroscopic equipment will allow for the next generation of 3-D cholangiography, which is available at only a handful of units nationally. The unit was designed to improve patient satisfaction and features private recovery rooms with TVs and seating for family members. It will help maximize communication between patients and caregivers and enable close interaction with the staff from other specialties, including anesthesiology, hepatobiliary surgery, colorectal surgery, thoracic surgery, oncology and radiation oncology, during treatment.

” This expansion will increase our ability to handle additional volume to speed up diagnosis and treatment of patients.” – John Vargo, MD, MPH

Cleveland Clinic is a large facility, how do I find my way around?

While Cleveland Clinic has a large campus, it is easily walkable from the visitor parking garages and the three on campus hotels: the InterContinental Hotel, the InterContinental Suites, and the Cleveland Clinic Guest House. Cleveland Clinic is immediately adjacent to the University Circle Neighborhood, home of the Case Western Reserve University, the Cleveland Orchestra, and the Cleveland Museum of Art. Cleveland Clinic is centrally located and accessible from the downtown, east, and west side residential neighborhoods.

»Application Information

What are you looking for in an applicant?

We are looking for outstanding individuals to immerse in a high volume environment that offers high quality, scientifically advanced care in an economically savvy environment. We seek the most promising physicians as demonstrated leadership abilities, academic productiveness, knowledge base, and positive personal qualities among applicants from diverse backgrounds.

What is your application process?

Cleveland Clinic has minimum requirements for fellowship application and employment Please contact Bob Dechicco (dechicb@ccf.org) for further application information. We review every submitted application completely and carefully, and a selected group is offered on-site interviews.

What are your fellows' employment benefits?

Residents are Cleveland Clinic employees with standardized salaries and other benefits.

What VISAs are supported by the Cleveland Clinic?

Clinical Programs

For graduate medical education purposes (residency, fellowship and clinical research fellowship), Cleveland Clinic will accept H-1B temporary worker or J-1 exchange visitor (alien physician category – sponsored by the ECFMG) visas. International students enrolled in U.S. medical schools may use the post-graduate year of Optional Practical Training (OPT) for the first year of residency training. Information on this process should be obtained from the Designated School Official (DSO) at the medical school. Cleveland Clinic does not sponsor immigrant (permanent resident) petitions for research or clinical trainees (residents, clinical fellows, clinical research fellows, research fellows or postdoctoral fellows).

Research Programs

The H-1B, the J-1 exchange Visitor (research scholar category – sponsored by CCF) or F-1 student (sponsored by a U.S. college or university) with employment authorization are accepted by Cleveland Clinic for research purposes. Cleveland Clinic does not sponsor immigrant (permanent resident) petitions for research or clinical trainees (residents, clinical fellows, clinical research fellows, research fellows or postdoctoral fellows).

»Contact Us

Clinical Nutrition Education Coordinator

Bob Dechicco
Gastroentrology Education Coordinator
216.445.2362
Fax: 216.444.8703
dechicb@ccf.org

Gastroenterology Education Coordinator

Cheryl Borowski
Gastroentrology Education Coordinator
216.445.7204
Fax: 216.636.2508
borowsc@ccf.org

Visiting Residents and Fellows Rotations

Evelyn Delong
GME Coordinator
216.444.9989
delonge@ccf.org

International Physician Services / Visa

Janice M. Bianco
Manager, International Physician Services
Responsible Officer, Exchange Visitor Program
216.445.7681
biancoi@ccf.org

Institute Education Manager

Beth Christoff, BSN. MBA
Institute Education Manager
Digestive Disease Institute
216.445.2809
christb@ccf.org

Observerships/ CIME

Graduate Medical Education

Main Office
216.444.5690
1.800.323.9259
Fax: 216.444.6112
Cleveland Clinic Operator
216.444.2200