Cleveland Clinic Florida offers a three-year program providing in-depth training in gastroenterology, hepatology, and nutrition as well as training in clinical research to qualified applicants who have successfully completed their training in internal medicine. As of 2014, we are accepting 2 candidates per year of training for a total of 6 candidates.
The program’s goals are fourfold: to meet the training guidelines of the American Society of Gastrointestinal Endoscopy in all basic endoscopic procedures; to provide the inpatient and consultative gastroenterology skills necessary to understand, diagnose and treat a wide-range of gastrointestinal disorders; to develop teaching abilities; and to provide a meaningful and stimulating clinical research experience. There is sufficient flexibility to provide the necessary skills for trainees that wish to pursue an academic or clinical practice career.
The first year of the fellowship is mostly a clinical year with rotations in the inpatient/outpatient gastroenterology and hepatology service, endoscopic procedures and motility laboratory. The second and third year also includes rotations in the hepatology and liver transplant service in Cleveland Clinic, Ohio. Research is expected to be a continuous process during the full 3 years of training with dedicated rotations each year. Under the careful supervision of a mentor, fellows are expected to design, implement and publish a research study.
The facilities and equipment are state of the art providing for training in ERCP, endoscopic ultrasound, capsule endoscopy, enteroscopy and motility. We have an outstanding faculty of 10 gastroenterologists in our Weston facility with subspecialty interests in colon polyps and cancer, nutrition, hepatology, gastrointestinal motility, advanced endoscopy, pancreas and inflammatory bowel disease. In addition to our own faculty, we closely interact with the divisions of colorectal surgery, bariatrics, radiology and pathology to provide for a well-rounded educational experience.
|Hosp. Jr. Attending
The fellow assigned to this rotation will take care of consults requested and procedures during working hours and be responsible for the care of patients directly admitted to the Gastroenterology service. The on-call fellow will complete after hours consults, admissions, emergency endoscopy and weekend coverage. Attendings will rotate for one week at a time during this 4-week module. Our patient population comes with a wide variety of pathology and there is an average of 10 patients on the service at any given time.
This rotation is usually combined with the outpatient rotation or clinical research rotation so that endoscopic and clinical rotations do not become routine or monotonous. Fellows work directly under the supervision of a faculty member. No procedures are performed unsupervised.
Training will initially emphasize diagnostic upper endoscopy, diagnostic colonoscopy and conscious sedation. This will be followed by upper endoscopic therapeutic intervention, and therapeutic colonoscopy. An exposure to ERCP/EUS is introduced late in the second year or early in the third year of the fellow’s endoscopy rotation and continues throughout the third year.
The hepatology rotation will include outpatient consultation and inpatient care of patients with liver disease at Cleveland Clinic Ohio. This rotation is intended to complement the experience the fellow will achieve evaluating and managing inpatients and outpatients with liver disease at our Weston campus.
The fellow is expected to interview and examine the patient and present the case along with a differential and management plan to the respective attending. The staff will then verify the history and findings and provide feedback on the case. This rotation is usually combined with an endoscopy or research rotation so that the experience is similar to “real-world” gastroenterology in which a gastroenterologist is not typically seeing office patients for an entire month.
All GI fellows are required to carry out research projects, ideally prospective, as a condition of successful completion of the fellowship program. All projects will be conducted under the supervision and mentoring of a staff member.
There is wide latitude in choice of topics. A title and outline should be submitted in writing and approved by the research mentor and submitted to the program director during the first year of training. Recruitment and completion of the project, data analysis, preparation of an abstract for submission to a national meeting, and completion of a scientific manuscript is the responsibility of the fellow in close supervision by the staff member. Progress in its design, application and results will be presented at our research conference. Other opportunities for case reports, book chapters, other research projects and writing will be encouraged during the fellowship.
Fellows will learn the methods and interpretation of esophageal manometry, impedance and pH testing, capsule endoscopy, and breath testing. Rotation will be divided in half days complementing with another rotation for 2 modules. The rotation will be supervised predominantly by Dr. Schneider but for the area of capsule endoscopy where other attendings will participate.
A 4-week module will be conducted with rotations in the colorectal, bariatric and liver transplant surgery to expose the fellow to the indications, contraindications, and techniques of different surgical procedures. The fellow will also get the surgeons viewpoint on a variety of gastrointestinal problems.
This rotation will consist of mini-rotations in risk management, nutrition, pharmacy, TPN and pathology. The risk management rotation will consist of one hour per day throughout this 4-week rotation in which the fellow will review our safety event reporting system (SERS). This will permit exposure to incidents occurring in our hospital on a daily basis and subsequently discuss these with our risk management director. He will also take part in the Peer Review Committee monthly meeting.
The pharmacy rotation will involve several areas of pharmacy including TPN/Enteral nutrition, infectious diseases, pharmacokinetics and ICU. For nutrition, there will be a 3-4 day rotation with the pharmacist in the mornings who will teach TPN and enteral nutrition. The pathology rotation will consist of half days during a 2 week period in which the fellow will discuss GI pathology cases with the pathologist.
Hospital Jr. Attending
During the senior year of training the fellow will assume the role of an attending physician in the wards. The fellow is expected to do clinical and teaching rounds as if he were the attending physician. Although there is constant supervision by the attending physician during rounds, interventions will be kept at a minimum.
GI Didactic Conferences
A significant portion of the fellowship education process is based in an environment that allows for and promotes different opinions and views of patient care. The department conference and rotation format is designed to meet this expectation.
The didactic conference series is designed to supplement the fellow’s clinical exposure and reading with up-to date and relevant reviews of topics of interest in basic and clinical science as outlined below.
1. State of the Art Lecture (1 per month)
These conferences are given by the GI attendings providing a critical analysis of the scientific literature in an up to date analysis of evidence-based medicine.
2. Management Conference (1 per month)
This dynamic and interactive conference is designed to develop an evidence-based approach to common and uncommon digestive disease cases. Presented by the fellow and mentored by an attending with expertise in that topic.
3. Radiology Conference (1 per month)
This conference is based on brief case presentations followed by a didactic discussion of the radiologic findings together with a GI radiologist. An average of 4 cases are presented in each session as well as lectures about different diagnostic imaging modalities used in the gastroenterology field.
4. Pathology Conference (1 per month)
This conference is based on brief case presentations followed by a didactic discussion of the histopathologic findings together with a GI pathologist. An average of 4-5 cases are presented in each session as well as a review of the literature pertaining to the case.
5. Journal Club (1 per month)
During this conference, each fellow presents one current article and performs a critical review of the study methodology and results. This is followed by a brief discussion and question session.
6. Board Review Conferences (2 per month)
This consists of a Board Review talk and a question and answer session for the second talk. For one of these talks there is a review lecture towards preparation for the Gastroenterology Boards (William Steinberg’s Board Review and Mayo Clinic Gastroenterology & Hepatology Board Review). The question session is taken from a variety of materials.
7. IBD Conference (1 per month)
The goal of this conference is to present an inflammatory bowel disease case, followed by a review of the evidence and recommendations in their management. This conference is in association with the Colorectal Surgery Department and is presented by one fellow of each department.
8. Research Conference (1 per month)
During this conference, the fellows and attendings propose research ideas, discuss methodology and provide an update on their ongoing research projects.
9. Multidisciplinary Conferences
This includes Liver Tumor Board, GI Oncology Board and Hepatopancreatobiliary Board. These meeting are opportunities to discuss a multidisciplinary approach to different gastrointestinal diseases. It is attended by faculty and trainees from different specialties.
10. GI Basic Science Conference (1 per month)
The fellows will present and review chapters of the Sleissenger and Fordtram’s textbook of gastrointestinal and liver diseases in a summarized format and incorporating up to date reviews when appropriate.
Publications (past 3 years)
Thoma M, Jimenez Cantisano B, Hernandez A, Perez A, Castro F. Comparison of adenoma detection rate in Hispanics and whites undergoing first screening colonoscopy: a retrospective chart review. Gastrointest Endosc 14 January 2013 (Article in Press DOI: 10.1016/j.gie.2012.11.003)
Gonzalez G, Wilkinson LM, Carcano C, Kumar A, Mohammed T, Lurix E, Castro F, Kirsch J. Triple-Phase Abdominal CT for detecting Spontaneous Porto-Pulmonary Shunts Cirrhotic Patients. Journal of Gastroenterology and Hepatology 2012; 27: 1837-41
Erim T, Rivas J, Velis E, Castro FJ. Role of High Definition Colonoscopy in Colorectal Adenomatous Polyp Detection. World J Gastroenterol 2011; 17: 3173-78.
Lurix E, Schneider A, Jagpal A, Reddy S. Great Expectations: Questionnaire Evaluation of Irritable Bowel Syndrome Patients Outlook on Diagnosis and Treatment. Am J Gastroenterol 2011; 106(2): AB1309.
Thoma M, Schneider A. Medication-induced Esophageal Tattoo in a Patient with Eosinophilic Esophagitis. Gastrointest Endosc. 2011 Jan; 73(1):154
Thoma MN, Castro F, Golawala M, Chen R. Detection of Colorectal Neoplasia by Colonoscopy in Average-Risk Patients Age 40-49 Versus 50-59 Years. Dig Dis Sci 2011; 56: 1503-1508.
Zapatier JA, Kumar AR, Perez A, Guevara R, Schneider A. Preferences for ethnicity and sex of endoscopists in a Hispanic population in the United States. Gastrointest Endosc. 2011 Jan;73(1):89-97, 97.e1-4.
Lurix E, Zapatier J, Ukleja A. (2011) Radiation Enterocolitis. In: Guandalini S, Vaziri H (Ed.) Diarrhea Diagnostic and Therapeutic Advancements (pp 141-158) Springer
Zapatier JA, Schneider A, Parra JL. Overestimation of ulcerative colitis due to melanosis coli. Acta Gastroenterol Latinoam. 2010 Dec;40(4):351-3.
Gonzalez G, Castro F, Berho M, Petras R. Autoimmune Enteropathy Associated with Cessation of Interferon-Alpha Therapy in Chronic Hepatitis C. Digestive Diseases and Sciences 2010; 55:1490-1493.
Kumar A, Gonzalez G, Wilkinson L, Glockner J, Mohammed T, Castro-Pavia F, Kirsch J. CT Findings in Spontaneous Porto-Pulmonary Shunts in Patients with Portal Hypertension: A Case Series and Review. Journal of Thoracic Imaging 2010; 25(3) 70-74.
Varughese S, Kumar A, George A, Castro FJ. Morning-Only One-Gallon Polyethylene Glycol Improves Bowel Cleansing for Afternoon Colonoscopies: A Randomized Endoscopist-Blinded Prospective Study. Am J Gastroenterol 2010 Nov;105(11):2368-74.
Lurix E, Hernandez A, Thoma M, Castro F. Adenoma detection rate is not influenced by full-day Blocks, time, or modified queue position. Gastrointestinal Endoscopy 2012; 75: 827-834.
Thoma M, Golawala M, Castro F. Comparison of the Detection Rate of Colorectal Neoplasia by Colonoscopy in Average-Risk Patients Ages 40-49 vs. 50-59 Years. Am J Gastroenterol 2009; 104 (A430).
Massive hemobilia during endoscopic retrograde cholangiopancreatography in a patient with cholangiocarcinoma: a case report. Bagla P, Erim T, Berzin TM, Chuttani R.Endoscopy. 2012;44
Direct Visualization Of The Left Atrial Appendage Using Esophageal Radial Endoscopic Ultrasound: An Alternative To Tee. Baez-Escudero JL, Buitrago I, Erim T, Novaro GM.Heart Rhythm. 2013 Aug 13. doi:pii: S1547-5271(13)00856-4. [Epub ahead of print]
Cholangioscopy: the biliary tree never looked so good! Erim T, Shiroky J, Pleskow DK.Curr Opin Gastroenterol. 2013 Sep; 29(5):501-8
Double balloon overtube assisted endoscopic pancreas function test as a tool to rule out chronic pancreatitis in a patient with a previous Frey procedure. Lara LF, DeMarco DC. Gastrointest Endosc 2013;77:671-2
Issues related to colorectal cancer screening in women. Jimenez B, Palekar N, Schneider A. Gast Clin North Am. 2011 June;40(2):415-26
Standards for nutritional support: adult hospitalized patients. Task force on standards for nutritional support for adult hospitalized patients. Ukleja A, Freeman KL, Gilbert K et al. Nut Clin Pract 2010;25:403-414
Altered GI motility in critically ill patients: Current understanding of pathophysiology, clinical impact and diagnostic approach. Ukleja A. Nut Clin Pract 2010;25:16-25
Presentations (past 3 years)
Lara L, Ukleja A, Kurako K, Charles R. Incidence of Complications Associated with Overtube Assisted Enteroscopy ACG 2012 Abstract and Poster Presentation.
Jimenez Cantisano B, Palekar N, Berho M, et al. Pulmonary Carcinoid and Papillary Urothelial Neoplasm in a Patient with Crohn's Disease. ACG 2012 Abstract and Poster.
Zapatier J, Perez A, Rodriguez S, Kumar A, Charles R. Factors Associated with Poor Bowel Preparation Scores and Their Impact on Adenoma Detection Rate. ACG 2012 Abstract and Poster Presentation.
Moxey B, Schneider A, Rivas J, Hoffman J. A Rare Case of Primary Hodgkin Lymphoma of the Liver. ACG 2012 Abstract and Poster Presentation.
Moxey B, Schneider A, Allende A, Castro F. Eosinophilic Gastroenteritis- A Case of Mistaken Identity. ACG 2012 Abstract and Poster Presentation.
Lara L, Erim T, Palekar N, et al. What is the variability of the peak bicarbonate concentration according to age? A study on patients with and without chronic pancreatitis. ACG 2012 Abstract and Poster Presentation.
Moxey B, Palekar N, and Berho M. Autoimmune Enteropathy and Bullous Pemphigoid. ACG 2012 Abstract and Poster Presentation
Agarwal A, Jimenez B, Schneider A. Henoch-Schonlein Purpura
Presenting in an Adult as Gastrointestinal Hemorrhage. Poster presented in the 2011 Florida Chapter ACP Meeting.
Morris M, Zapatier JA, Gonzalez G, Schneider A. Preferences for Ethnicity and Gender of Endoscopists Within a Hispanic Population. DDW abstract # T1539, 2009.
Roger Charles, MD
Fernando Castro, MD
Director, Fellowship Program
Tolga Erim, DO
Luis F. Lara, MD
Medical Director, Pancreas Clinic
Nicole Palekar, MD
Ronnie Pimentel, MD
Associate Program Director
Alison Schneider, MD
Director, GI Motility Laboratory
Andrew Ukleja, MD
Brenda Jimenez Cantisano, MD
Bobby Zervos, MD
Cleveland Clinic Florida
2950 Cleveland Clinic Boulevard
Weston, Florida 33331