History

The Inflammatory Bowel Disease (IBD) Center at Thomas Jefferson University was created more than 20 years ago and is led by Patricia Kozuch, MD, Director of the IBD Center, and Raina Shivashankar, MD, Associate Director of the IBD Center. As a division, we see more than 1,500 IBD patients per year and offer the most up-to-date techniques in diagnosis and management of IBD.

Duration

One-year fellowship

Prerequisite Training/Selection Criteria

Completion of a three-year ACGME-accredited internal residency, three-year ACGME-accredited gastroenterology fellowship, and passing score on STEP 1, 2, 3 exams.

Goals & Objectives for Training

The Division of Gastroenterology & Hepatology at the Thomas Jefferson University Hospital offers an Advanced IBD Fellowship training (non-ACGME-accredited) for individuals who want to gain expertise in the management of patients with IBD, including all aspects of ambulatory care and long-term follow-up.

This one-year fellowship is offered to individuals who have completed a three-year residency in internal medicine and a three-year fellowship in gastroenterology. After completion of this advanced fellowship, fellows will have gained expertise in the subspecialty of IBD.

The goal of the IBD fellowship is to train physicians for an academic career. The program is structured in such a way that the advanced IBD fellow's activities will focus entirely on IBD with special emphasis on clinical research. Because the treatment of IBD is quite complex, given complicated clinical situations, multiple treatment modalities, and need for shared decision-making, we believe that focused time spent on learning IBD care is very important. Due to our volume of IBD patients, we believe that the IBD Center at Jefferson will be able to provide both the breadth and depth of knowledge required to manage patients with IBD.

Our goal is to expose advanced IBD fellows to the following:

• Ambulatory care of patients with IBD (e.g., when to initiate biologics, management of patients on biologics/immunomodulators, post-operative medical management, IBD second opinions).
• Endoscopic management of IBD (e.g., techniques in chromoendoscopy, stricture dilation, cancer surveillance, pouchoscopies).
• Participate in didactic IBD-focused conferences.
• Completion of a research project focused on IBD.

Additionally, we aim to establish long-term mentoring relationships with our fellows to aid in their career development. Thus, the one-year IBD fellowship will provide a complete curriculum encompassing clinical work, research, and didactics.

Facilities

All training will occur at Thomas Jefferson University Hospital main campus.

Educational Program (Basic Curriculum)

Clinical activities in IBD at our program are designed to provide outpatient experience in all facets of IBD. The advanced IBD fellow will be expected to participate in ambulatory IBD care (under supervision), so as to gain independence in decision-making and providing continuity of care. Education in managing patients before and after IBD surgery is concentrated in our IBD clinics; the IBD fellow will be able to work closely with our colorectal surgeons. The ambulatory curriculum consists of the following goals:

1. Identify IBD subtype and grade disease activity.
2. Recommend evidence-based IBD medications and learn how to manage therapies.
3. Manage complications of IBD.
4. Understand specifics of endoscopic procedures as they relate to patients with IBD.
5. Understand how to perform IBD consultative care and communicate with the referring provider.
6. Use preventive health strategies for patients with IBD.

Educational conferences include journal club, clinical case conference, morbidity and mortality conference, multispecialty conference, and research conference that meet at regular intervals (every 2-4 weeks). Electives in IBD pathology, radiology, colorectal surgery, and nutrition will also be available such that the fellow can enhance his or her learning.

Research will be emphasized as part of the advanced IBD fellow's training experience. It is crucial for fellows to gain experience in the process of formulating research questions and developing pathways designed to answer these questions. The fellow can participate in the process of data accrual and analysis, with the intent to formulate abstracts for presentation of data at national meetings. Manuscript preparation and publication will be the ultimate goal.

The advanced IBD fellow should graduate from this one-year training program with a well-rounded experience in IBD management. Ultimately, we hope that a dedicated year focused on the care of patients with IBD will help the advanced fellow not only develop a strong clinical foundation in IBD, but also demonstrate how patient-directed research can be incorporated into day-to-day practice.

Supervision & Evaluation

Trainees will be supervised on a one-to-one basis across the different rotations. Trainees will meet with the program director on a monthly basis to review progress and evaluations. Faculty are asked to complete evaluations of trainee monthly. The Clinical Competency Committee, made of the supervising faculty, will meet every six months to assess the trainee competency.

Raina Shivashankar, MD
Program Director

Patricia Kozuch, MD
Cuckoo Choudhary, MD