The pediatric transplant hepatology fellow will train for 12 months, starting in July, devoting approximately 25% time to research and 75% time to a combination of inpatient, outpatient, radiology, liver pathology and adult hepatology services. Also included in the program are 15 vacation days, 10 sick days and five personal days (which can be utilized for local, regional or national conferences). With the exception of the adult hepatology rotation at Barnes-Jewish Hospital, the Pediatric Transplant Hepatology Fellowship Program is exclusively based at St. Louis Children’s Hospital. Rotations are as follows:
Inpatient
This rotation will instruct the fellow in the care of hospitalized patients with liver disease. This will include, but is not necessarily limited to, patients with acute and chronic liver disease with primary liver problems and liver transplant patients, as well as patients admitted with other issues who require consultations. The fellow will function under the supervision of the hepatology faculty, with the goal of developing an understanding of the common issues arising in the care of these patients.
Outpatient
This rotation will instruct the fellow in the diagnosis and management of acute and chronic liver diseases, and post liver transplant patients seen at an outpatient tertiary referral center. By the end of the rotation, the fellow is expected to be able to form a differential diagnosis and outline an appropriate management plan, then follow that patient’s course with appropriate follow up, interaction with other consulting services and recommend changes in care, as indicated.
Radiology
The fellow will be expected to select the appropriate imaging modality for a diversity of clinical situations, and to interpret and communicate the results to the patient, family and other providers. The fellow will review liver imaging with the radiology attending and observe interventional radiology procedures. Radiology cases will be reviewed and discussed throughout the fellowship year. Objectives are to:
- Understand the indications for and interpretation of the following modalities: plain radiographs, hepatobiliary ultrasonography with Doppler, abdominal CT and MRI, hepatobiliary scintigraphy (HIDA), PET/PET-CT
- Observe and discuss with the attending interventional radiologist the following studies: ultrasound guided paracentesis and liver biopsy, transhepatic cholangiogram with and without catheter (stent) placement, hepatic venogram, portal venogram, Transjugular intrahepatic portosystemic shunt (TIPS) and cancer embolization treatments
- Attend the weekly multidisciplinary adult hepatobiliary imaging conference during the rotation and whenever a pediatric hepatology or liver transplant patient is reviewed at this conference
Liver pathology
During the liver pathology rotation, the fellow will review and learn the histopathologic features of pediatric hepatobiliary disorders best diagnosed by tissue examination. Objectives are to:
- Review liver biopsy slides with a board certified pathologist, with special expertise in pediatrics or hepatology. All biopsies from inpatients will be reviewed by the fellow with the inpatient team and the attending pathologist during the rotation.
- Present new cases, especially those that are complex or have variable diagnostic and management strategies, at our weekly GI pathology conference.
- Demonstrate knowledge in the different techniques of processing and staining, interpreting the histological picture and formulating differential diagnoses.
- Review histopathology slides of typical pediatric cases of hepatobiliary diseases from the collection in our Department of Pathology.
- Discuss the histopathologic findings of patients undergoing liver biopsy or upper or lower GI endoscopy with other providers, team members, the patient and their family.
- Attend the weekly pediatric and/or adult liver pathology conferences if their patients are being reviewed but also encouraged to attend as many conferences if available.
Adult hepatology
The adult hepatology service includes inpatient and outpatient evaluation of adults with liver disease, evaluation for transplantation, peri-operative care and long term follow up. The fellow will understand the spectrum of conditions, procedures, outcomes and complications in liver disease and liver transplantation across different age groups. The fellow will develop a working knowledge about conditions typical for adult patients with liver disease. In addition, he/she will gain experience with the specific challenges within an adult liver transplant program including psychosocial problems, financial/insurance difficulties and higher patient volumes.
Objectives are to:
- Evaluate, present and follow patients in the adult hepatology clinic
- Attend adult hepatology inpatient rounds including multidisciplinary adult liver transplant rounds
- Attend the weekly hepatobiliary conferences
- Develop a familiarity of care practices, so as to better transition care of young adults with liver diseases
Research
This rotation will provide an opportunity for trainees to participate in research or other scholarly activities including a research project (with faculty mentorship), initiate (by collaborations) clinical trials within the department and/or take part in quality assurance/quality improvement or process improvement projects. Most often, the trainee’s primary mentor is a faculty member in the Division of Gastroenterology, Hepatology Program, but trainees may consider doing research projects in other departments of the school of medicine, thus taking advantage of the full range of training experiences offered at Washington University School of Medicine. Objectives are to:
- Understand fundamentals of research including basics of research design, data analysis (biostatistics), public policy, economics, health education, designing trials, recruiting subjects
- Learn responsible use of informed consent, standards of ethical conduct of research, clinical
- Perform epidemiology and outcomes analysis
- Gain hands-on experience with conducting a clinical research project including research design (where feasible), data analysis, subject recruitment, data collection, data analysis and manuscript preparation
- Provide sufficient exposure to research to allow trainees to make an informed decision about pursuing a career involving research
- Provide sufficient exposure to research to allow trainees to critically assess basic and clinical research literature and to be competent in using available medical informatics systems
- Co-author a manuscript