The Fellowship Training Program at AUBMC takes into account the needs and wishes of the fellows, institution, and the nation. It plans to train academics who will ultimately be involved in teaching and research in university hospitals, train general GI practitioners who will practice in community hospitals or in the countryside, and limit the ongoing drain of our residents and fellows who leave AUBMC to "continue" training outside.

Regardless of the "strategic goals", excellent teaching is one of the basic requirements for providing quality medical care to patients. It means that the gastroenterologist shall constantly stay abreast of developments in the field and shall incorporate advancements in her/his area in overall medical care in a timely fashion.

Goals
The goals of the fellowship program are to

1. train fellows in the competent practice of clinical gastroenterology. This includes mastery of history taking, physical examination, and the order and proper interpretation of laboratory tests.
2. develop skills of consultation in gastroenterology. This includes writing down a consultation, communicating findings to colleagues, as well as enhancing patient care positively and professionally.
3. train fellows in the competent and safe practice of diagnostic and therapeutic gastrointestinal procedures including EGD, colonoscopy, sigmoidoscopy, mucosal biopsy, polypectomy, variceal sclerotherapy/ligation, liver biopsy, diagnostic and therapeutic paracentesis, and EUS, as well as familiarization with diagnostic and therapeutic ERCP. Full understanding of indications, contraindications, and proper interpretation of findings are essential.
4. train fellows in the proper ordering, reading, and interpretation of various diagnostic and therapeutic radiologic procedures including: USG, CT scan, barium studies, FNA, core biopsy of GI lesions, and catheter drainage of collections.
5. train the fellows in the ethical practice of gastroenterology. Concepts such as informed consent, honest and prompt reporting and management of procedure complications, management of terminally ill patients, and relating professionally to colleagues will be emphasized.
6. develop and enhance the fellows' skills of teaching gastroenterology to medical students and residents.
7. involve the fellows in clinical and basic research taking place in the division.

1. Fellows need to spend a minimum of two years in the fellowship program. The two-year period is required for the fellows to have sufficient clinical and endoscopic experience. It will also secure some time for academic development namely in research and teaching.
2. A modern and fully equipped endoscopic facility is a must.
3. Funds need to be secured to support the training of three fellows at any one time (one or two fellows to be taken per year).
4. Three to four board certified gastroenterologists with a solid academic background should supervise the program.
5. Fellows will be recruited from excellent Internal Medicine programs in the country. The decisions on fellow’s acceptance will be discussed in formal meetings involving the whole division.

1. First and second year fellows will consult on ward patients. They will write their full notes including assessment and plan. They will communicate their findings to the attending of the week that will see the patient and countersign the fellow’s notes. The findings and plans will be communicated to the ward team. The fellows will follow up with the patient, write progress notes, and discuss developments and progress with the GI attending. The fellows are also encouraged to see private consults who raise interesting or challenging questions.
2. The fellows will also evaluate patients referred to the GI Outpatient Department (OPD) throughout the duration of the program. The GI attending covering the OPD will supervise management.
3. All diagnostic and therapeutic procedures done by the fellows must be assisted and/or supervised by a designated gastrointestinal endoscopist who will countersign the endoscopy report.
4. Clearly defined and measurable end points of clinical and endoscopic competence need to be achieved before the fellow is given a certificate of completion of the program. For example, being able to reach the cecum 95 percent of the times in a reasonable time and without undue discomfort or risk to the patient is one of the requirements for competence in diagnostic colonoscopy. Being able to identify normal and abnormal findings is another requirement.
5. Fellows will read the equivalent of a modern textbook on gastroenterology (such as Sleisenger & Fordtran’s, 2006 edition) over the two-year period. Individual chapters will be presented in prearranged meetings with a designated attending.
6. Fellows prepare and present at the Biweekly GI Journal Club under the supervision of a GI attending. Relevant articles will be selected and presented using Power Point. Emphasis will be placed on new concepts in clinical gastroenterology and/or endoscopy. A formal presentation of each paper’s merits, drawbacks, methodology, and statistical analysis will take place.
7. Fellows prepare and present at the biweekly GI Grand Round. Interesting, difficult, and teaching cases will be selected from the ward, OPD, and private floor and will be presented. A designated GI attending oversees the preparation and presentation. The attending ascertains that the appropriate literature review and teaching messages are effectively delivered. Coordination with the Departments of Radiology and Pathology will take place so that the appropriate X-rays, and pathology slides are presented at the conference for discussion and teaching. Endoscopic photographs and videotapes should also be presented.
8. Arrangements will be made so that the fellows will get sufficient exposure to GI pathology and GI radiology material. This can be done through formal monthly seminars during which a pathologist and/or a radiologist present interesting/difficult/challenging cases to the Division. Illustrations of the “normal” will take place during those seminars. Educating the fellows about “what exactly to order” from the departments of pathology and radiology will take place.
9. Arrangements will be made so that the fellows will attend at least one international meeting during their fellowship (preferably the AGA). Funds will be secured for that purpose.
10. Arrangements will be made so that the fellows become proficient in the use of computers, various software, internet surfing, and the like for enhancing and disseminating knowledge. Formal seminars will be held in collaboration with the Saab Memorial Medical Library, PC support, and much more for that purpose.

1. ensuring the quality of medical care provided to patients seen by the fellows.
2. directly supervising endoscopic and other procedures.
3. overseeing all academic activities such as conferences, journal clubs, and the like.
4. giving formal courses to the fellows including
   1. 6-12 hour course on "endoscopy and endoscopes" at the beginning of the year to first year fellows.
   2. a series of 12 to 24 presentations on the modern approach and management of "run of the mill" GI problems, such as upper GI bleeding, ascites, colon polyps, H-Pylori infection, and the like.

1. The faculty will ensure that the fellows have attained excellent knowledge of gastroenterology. This can be done by examining their consult notes, their case presentations, by getting formal evaluations of their performance from students and residents, and by ensuring that they take formal regional or international exams, namely, the Arab Board and the American Board.
2. The faculty will make sure that the fellows get to do an adequate number of diagnostic and therapeutic procedures for certification as set by the ASGE.
3. Quality control in the Endoscopy Suite, including complications, negative endoscopies, success rate in various therapeutic procedures, is the subject of another write up by Dr. Ala’ Sharara.
4. Maintenance of the highest ethical standards will be monitored in periodic meetings to assure
   1. prompt and honest reporting of complications,
   2. thorough discussion of unexpected morbidity and/or mortality related to management of GI problems and implementation of preventive measures thereof,
   3. satisfaction of patients, colleagues and nurses with the ethical conduct of fellows.
5. Maintenance of a collegial relationship among fellows and between fellows and faculty. In order to facilitate the training process, the following guidelines are adhered to
   1. a monthly schedule detailing the responsibility of each fellow is made.
   2. one fellow is always available for coverage of inpatient and the Emergency Department consults.
   3. the schedule for endoscopies does not compromise availability for patient care.
   4. fellows oversee patient workups done by students and residents on elective rotations. This is done before cases are presented to the attending.
   5. sick patients are seen and worked up promptly by fellows and cases are quickly reported to the attending.
   6. fellows follow up with their patients and report on their progress to the attending.