Transplant Hepatology Fellowship

Welcome

Cleveland Clinic 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. The fellowship is based within the Hepatology Section within the Department of Gastroenterology, Hepatology and Nutrition, which compromises 13 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, critical care, interventional radiology, oncology, nutrition, infectious diseases, and general gastroenterology.

Cleveland Clinic remains one of the largest liver transplant programs in the United States, having performed 210 liver transplants in 2021, 33 of which were living donors. The living donor liver transplant program at Cleveland Clinic additionally offers innovative laparoscopic surgery for donors as well as a paired donation program.

Dedicated rotations on the primary Inpatient, Medical Intensive Liver Unit, 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 and transplant, as well as in endoscopy, infectious disease, radiology, and oncology 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.

Graduates of the program have been consistently successful in obtaining faculty positions as Transplant Hepatologists, with a majority continuing to practice in academic environments.

We look forward to reviewing your applications and to sharing our training program with you.

Robert S. O’Shea MD, MSCE
Fellowship Program Director, Hepatology
Department of Gastroenterology, Hepatology & Nutrition

Christina Lindenmeyer, MD
Fellowship Associate Program Director, Hepatology
Co-Director, Medical Intensive Liver Unit
Department of Gastroenterology, Hepatology & Nutrition

William D. Carey, MD
Section Head, Hepatology
Department of Gastroenterology, Hepatology & Nutrition

Overview

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 Section of Hepatology, part of the Digestive Disease and Surgery Institute, OCI has established an endowed fellowship program under the supervision of hepatology faculty 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. elevate 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 to Cheryl Borowski, Education Coordinator, at borowsc@ccf.org.

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 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 hepatological 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 a 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 the 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 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-ups 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 the 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, colonoscopy, 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 that allows for and fosters divergent 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 the 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 whom 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.

Fellows & Alumni

2017-2018 transplant hepatology fellows

• Christina Lindenmeyer, MD
• Sasan Sakiani, MD
• Nicole Welch, MD

Alumni career pathways

• 2011 Graduate - Naim Alkhouri, Pediatric and Adult Hepatology, Cleveland Clinic, OH
• 2010 Graduate - Emily Carey, Gastroenterology, Cleveland Clinic, OH
• 2008 Graduates - Achuthan Sourianarayanane (2009 Clinical Associate Hepatology), Gastroenterology, Cleveland Clinic, OH

Staff Physicians

• William D. Carey, MD, Hepatology Section Head
• Jamak Modaresi Esfeh, MD, Medical Director, Living Donor Liver Transplantation
• Robert O’Shea, MD, Program Director, Transplant Hepatology Fellowship
• Christina Lindenmeyer, MD, Associate Program Director, Transplant Hepatology Fellowship
• Talal Adhami, MD
• Olumuyiwa Awoniyi, MD
• Dian-Jung Chiang, MD
• Srinivasan Dasarathy, MD
• Sobia Laique, MD
• Shreya Sengupta, MD
• Jamile Wakim-Fleming, MD, Director, Fatty Liver Disease Program
• Nicole Welch, MD
• Maureen Whitsett, MD

Locations

Cleveland Clinic

Cleveland Clinic was founded in 1921 by George Crile Sr., a general and endocrine surgeon; Frank Bunts, a neurosurgeon; William Lower, a 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 (desks A30 and A50) in the Digestive Disease and Surgery Institute.

Q3: New, state-of-the-art endoscopy unit

The Digestive Disease and Surgery 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 two on-campus hotels: the InterContinental Hotel and the InterContinental Suites. 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 with 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 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
Gastroenterology 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

Observerships / CIME
Graduate Medical Education
Main Office
216.444.5690
800.323.9259
Fax: 216.444.6112

Cleveland Clinic Operator
216.444.2200