Advanced Practice Provider Inflammatory Bowel Disease Fellowship

Overview

The Department of Gastroenterology, Hepatology and Nutrition at The Cleveland Clinic has created a one-year Advanced Practice Provider (APP) Fellowship for the purpose of training an APP to be a competent, autonomous provider in the sub-sub specialty of Inflammatory Bowel Diseases (IBD).  

The management of IBD has become more complex with an emphasis on early recognition of disease flares and therapeutic drug monitoring with treatment to target strategies.  As pivotal members of the IBD multi-disciplinary care team and, oftentimes, the first point of care contacts for the patients, the APP needs to be well-versed in the diagnosis, management and monitoring of IBD.  However, there is a significant educational gap in providing them with the tools to assess and manage these increasingly complex patients in terms of IBD related knowledge and effective clinical practice guidance. Nursing clinical education has traditionally suffered from insufficient rotations with qualified and willing preceptors for structured learning.  Therefore, many APPs may not be exposed to high-quality education in specialized areas such as IBD. Advanced IBD Fellowships for physicians have been developed to address similar gaps in general gastroenterology training, but none exist for APP’s.

The goal of the program is to develop top applicants that completed advanced practice provider training into expert IBD clinicians, educators, and leaders in the field of IBD. This will be accomplished by a structured curriculum based on the advanced IBD entrustable professional activities (EPAs). Elements of the curriculum include:

• Outpatient care of patients with IBD.
• Inpatient care of patients with IBD.
• Exposure to IBD endoscopy and surgery.
• Interdisciplinary management of IBD patients with colorectal surgery, pathology, radiology, nutrition, psychosocial care, dermatology, rheumatology.
• Care of the IBD patient with ileal pouch anal anastomosis (IPAA).
• Transition of care.
• IBD medical home.
• IBD research.
• Clinical trials.
• Teaching medical students, residents and fellows in IBD.
• Mentoring, research and professional development.
• Core educational reading materials.
• Attendance at national IBD conferences.

Why choose Cleveland Clinic?

Cleveland Clinic is uniquely positioned to launch the first APP IBD fellowship.  Cleveland Clinic has a longstanding physician IBD fellowship producing leaders in the field as well as a rich tradition of educating nursing leaders in the Stanley Shalom Zielony Nursing Institute. The program faculty includes internationally recognized experts in IBD education and Cleveland Clinic led the multi-society ACG Crohn’s and Colitis Foundation task force that published the Entrustable Professional Activities for Advanced IBD Fellowship training.

The Advanced Practice Provider Inflammatory Bowel Disease Fellowship program is committed to providing exceptional advanced interdisciplinary training in inflammatory bowel diseases for advanced practice providers with the highest potential to be future leaders in the field.

Register today

Registration is open now for July 2022 program start. Register here.

Curriculum

The APP Fellowship will be based at Cleveland Clinic Main Campus in Cleveland, Ohio with the ability to travel to our satellite facilities as educational opportunities arise. The fellowship is 12 months long with planned start in July 2022. The application process is currently open. Benjamin Cohen, MD, MAS and Jessica Crimaldi, MSN, APRN, CNP will chair the recruitment and management of the program along with other members of the department. The chosen fellow will spend approximately seventy percent of their time on direct clinical care of patients.

The first quarter of the fellowship will be spent on General Gastroenterology (GI) foundational training followed by three quarters of IBD focused training. Teaching methods will include modeling by staff physicians and APP’s, participation in weekly conferences, direct 1:1 instruction by staff physicians, use of scientific literature and information technology, and recommended reading. Required rotations are outlined below. The IBD fellow is expected to work with the breadth of the IBD clinical faculty to gain a variety of experiences in IBD management. The curriculum will be developed to ensure competency is reached in the advanced IBD entrustable professional activities (EPAs). EPAs are defined as the comprehensive set of tasks or responsibilities that any practicing subspecialist should be capable of performing in their particular field. EPAs are critical to guiding curriculum development as they offer tangible goals for aligning teaching and training within clinical practice. Fellows will have the opportunity to use elective time to create more intensive experiences in areas of interest.

Required fellowship rotations

First quarter rotations

• General GI clinic.
• Esophageal and motility clinic.
• Pancreaticobiliary clinic.
• Hepatology clinic.
• IBD clinic.

Second, third and fourth quarter rotations

• IBD clinic.
• Inpatient GI consults and/or IBD service (if started).
• GI pathology.
• Abdominal radiology.
• Dermatology.
• Colorectal surgery.
• Pediatric IBD.
• Psychiatry and psychology.
• Nutrition support.
• Rheumatology.

The remaining thirty percent of the fellow’s time will be spent on research, quality improvement, and/or education projects. The fellow will be expected to contribute to ongoing research projects within the department and section and if the opportunity arises become a sub-investigator to a clinical trial. The fellow will attend a national IBD conference (i.e. Advances in Inflammatory Bowel Disease or Crohn’s and Colitis Congress). Funding for conference attendance will be provided in similar fashion to employed APPs.

The fellow will be required to complete a Capstone Project that will be due during the fourth quarter prior to the completion of their fellowship. The Capstone Project will be in an area that is of interest to the fellow and specific plans and requirements will be individualized. Examples of acceptable Capstone Projects include a State of the Art presentation, publication of a peer-reviewed article (original research or review article), or completion of a quality improvement project with presentation to the IBD Section.

Standing education offerings

Fellows will have access to an abundance of educational opportunities and experiences by virtue of training at Cleveland Clinic. Within the Digestive Disease and Surgery Institute the fellow will have access to standing GI and IBD educational offerings.

Standing GI and IBD educational offerings at Cleveland Clinic

Procedural shadowing opportunities

Fellows will be expected to complete several shadowing experiences including:

• Endoscopy (colonoscopy, sigmoidoscopy, pouchoscopy, ileoscopy and upper endoscopy).
• Anorectal manometry.
• Colorectal surgery (J pouches, ileo-colic resection, colectomy, exam under anesthesia).
• Physical therapy biofeedback.

Required training

Fellows will complete all required training listed below in order to be in compliance with CCF regulatory requirements and human investigator training.

Clinical expectations

All fellows must provide patient care that is compassionate, appropriate, and effective for the treatment of IBD. Expectations include:

1. Fellows will obtain and document appropriate history taking, physical exam, and laboratory interpretation skills for IBD patients in the outpatient ambulatory clinic and inpatient consult service.
2. Fellows should be able to develop and implement treatment plans by utilizing appropriate information systems and resources to help manage IBD patients. Fellows should also be able to discuss new cases and any clinical problems with an attending physician, consultant, and/or supervising attending within an appropriate time interval.
3. Fellows will be expected to review the medical charts and records before clinic and finish clinic notes within 24 hours of the office visit. Fellows will be expected to follow-up on laboratory testing and imaging studies ordered for the patients they saw with the IBD faculty and to communicate results along with plan of care to the IBD attending and patient with appropriate documentation including co-signature by the IBD attending.
4. Fellows should be able to perform independent research for evidence based literature to answer specific clinical questions arising from patient care, review and present current literature including medical trial data. 
5. Fellows should also be able to organize clinical data of complicated IBD patients, compare personal practice patterns to larger populations, and analyze personal practice patterns systematically and look to improve.
6. Demonstrate competence in the relevant general GI and Advanced IBD Entrustable Professional Activities.

Mentoring and professional development

Mentoring will be provided by the program directors as well as an additional clinical mentor either assigned or chosen by the fellow. The program directors will assist in case of challenges in finding appropriate support. The IBD faculty is expected to promote the APP IBD fellow within their means and the program directors will update the group on the current state of career planning of the fellow and how we can help build a pathway as a group. This structure is already in place for the physician IBD fellow.

The fellow is invited to participate in the Crohn’s and Colitis Congress, DDW, ACG and Advances in IBD conference for which members of the Cleveland Clinic IBD faculty are part of the organizing committees. A stipend for one (possibly two) national conferences will be provided.

The fellow may be included as a reviewer for the IBD 360 journal (Regueiro) and other journals based on recommendations of the IBD faculty.

The fellow will routinely present at internal conferences as well as at the international IBD Live weekly case conference.

The fellow is expected to consistently read during the fellowship year, which includes reading relevant chapters, review articles, and original publications obtained from structured literature searches when appropriate. 

IBD reading

Fellows will be responsible for self-directed learning using the Crohn’s and Colitis Foundation APP reading list. Faculty will provide additional reading based on advances in the field.

Oversight and management

The fellow will be mentored and managed by both IBD physicians and an APP leader as clinical mentors within the department. A primary capstone project mentor will be identified by the second quarter of the fellowship. Clinical mentors will meet at least biweekly with the fellow and capstone project mentors will meet at least monthly. A clinical competency committee will be formed to monitor the fellow’s progress through their fellowship. Evaluations will occur through the following methods:

1. Direct observation during clinics, conferences, and rounds.
2. Staff evaluation of fellows through MedHub quarterly.
3. Semi-annual evaluation by Program Directors.
4. Faculty evaluation by the fellows.
5. Written evaluation and feedback from trainees, students, residents, nurses, and patients.

Eligibility

In order to be considered, an APP must submit a complete application by the stated deadline and have:

• Completed, at minimum, a master’s program with degree conferred.
• National board certification.
• Licensing in Ohio obtained before start date without any restrictions.
• Ability to be credentialed by The Cleveland Clinic Medical Executive Committee and Board of Governors.
• References from at least three people who can speak to the applicants skills as an APP.

Faculty

IBD fellowship director: Benjamin Cohen MD, MAS, AGAF (Clinical, Clinical Trials)

Associate IBD fellowship director: Jessica Crimaldi, MSN, APRN.CNP (Clinical)

Core mentoring faculty:

• Florian Rieder MD, PhD (Clinical, Translational Science)
• Miguel Regueiro MD (Clinical, Medical home)
• J.P. Achkar MD (Clinical, Education)
• Bret Lashner MD (Clinical, Education)
• Taha Qazi MD (Clinical, J-Pouch)
• Anne Sullivan CNPP (Clinical, APP education)
• Rebecca Wainwright CNP (Clinical)
• Jake Kurowski MD (Clinical, Pediatric IBD)
• Stefan Holubar MD (Colorectal surgery)
• Mark Baker MD (Abdominal Radiology)
• Ilyssa Gordon MD (Clinical pathology)
• Antony Fernandez MD (Dermatology)
• Elaine Husni MD (Rheumatology)
• Stephen Lupe PsyD (Psychology)

Administrative support:

• Cheryl Borowski

Application Information

Application submission is currently open for a program start in July 2022.

• Register here.

For more information or questions in the interim, please contact the program directors:

Benjamin Cohen, MD
IBD fellowship Director (Clinical, Clinical Trials)
cohenb3@ccf.org

Jessica Crimaldi, MSN, APRN.CNP
Associate IBD fellowship director (Clinical)
crimalj@ccf.org