The Division of Gastroenterology & Hepatology at the University of North Carolina at Chapel Hill offers a fellowship (subspecialty residency) program in Gastroenterology and Hepatology that accepts one - three new fellows each year beginning in July. The goal of this program is to prepare individuals broadly trained in gastroenterology and hepatology for careers in either clinical care or research. Applicants to both clinical and research fellowship positions must have completed an internal medicine residency program from an accredited US institution. For the clinical track, effective January 1, 2004, UNC Hospitals accepts residents who have been issued a J-1 visa and who hold a current ECFMG certificate. At the time of application, foreign nationals must hold a J-1 visa. We do not accept conditional guarantees that the individual may or may not have a J-1 visa prior to or at the time of fellowship. H1-B visas are not sponsored at UNC Hospitals after December 31, 2003. In addition, UNC Hospitals does not sponsor E-B or O-1 visas, including EAD (Employment Authorization Document). M.D. fellows elect either a clinical or research academic track. Electing a research track can involve special funding considerations. Our program is nationally recognized and highly competitive; each year we receive an average of 375 applications.
Our faculty members serve at the highest levels of many national organizations, including the American Gastroenterological Association, the National Commission for Digestive Diseases, and the Crohn's and Colitis Foundation of America. We published more than 200 papers in peer-reviewed journals last year, received more than $20 million in grant funding, and completed more than 14,000 procedures. Our patient satisfaction surveys are consistently high.
The clinical track is a three-year program for fellows who intend to enter clinical academic practice upon completion of the training program. The emphasis is on clinical gastroenterology with the opportunity for more formal clinical research training.
Currently a first-year clinical fellow spends time on each of the following rotations: 1) adult GI consultations, 2) endoscopy, 3) adult liver consultations, and 4) outpatient clinic, with minimal time allotted for research activities. In the second year, in addition to the aforementioned rotations and research time, fellows do rotations in nutrition, motility, and biliary work. In the third year the clinical fellow has extensive biliary exposure and continues consultative and outpatient clinic work and endoscopy. The minimal exposure to biliary work during the second year (average 25 ERCPs) helps to prepare for the extensive work encountered during the third year (average 200+ ERCPs and 200+ EUS).
Funding for the clinical fellowship program is from the Division of Gastroenterology & Hepatology. Clinical fellows are paid by the Department of Medicine but in accordance with the GME pay scale because, as subspecialty residents, they are appointed through our Office of Graduate Medical Education, http://gme.unchealthcare.org. Current salaries appear under ‘Benefits for Residents’.
Applicants who are interested in research training should apply directly to the basic or epidemiology programs. We offer research training in Digestive Disease Epidemiology and Basic Science. For more information about the Epidemiology Training Program CLICK HERE. For more information about the Basic Science Training Program CLICK HERE.
The research track is typically a comprehensive four-year program for those who plan to pursue a research career. The research track includes 24 months of clinical rotations as described below in “Summary of Rotations” (years 1 & 2). All fellows must complete a minimum of 18 months of clinical gastroenterology training to be permitted to sit for the GI board exam. For the epidemiology track, we anticipate two years of graduate school work and two years of core clinical work. For the basic science track, we expect a commitment of two years of bench work and two years of core clinical work. Fellows who wish to condense a research track from four years to three years must request permission to do so.
Funding for the research fellowships is primarily from Institutional Public Health Service. Salaries from federal sources carry a year-for-year payback that requires the fellow to work in an academic setting after completion of training. Because of these funding considerations, applicants to our research programs must be either US citizens (by birth or naturalization) or hold a permanent immigrant visa status (green card). Additionally, because of the provisional status of the Employment Authorization Document, applicants to our research programs cannot present with an EAD.
Salary is commensurate with cumulative experience. Research fellows on training grants are paid according to the current NIH pay scale. Please refer to the NIH notice in regard to stipends for FY2012 funds, available at http://grants.nih.gov/grants/guide/notice-files/NOT-OD-12-033.html. Stipend amount is determined by the number of previous years of related work experience, including lab time, private sector time, hospitalist time, and time as Chief Resident.
Advanced Endoscopy Fellowship
Our optional fourth-year endoscopy fellowship offers advanced training in diagnostic and therapeutic ERCP and EUS procedures. There are three main instructors for this training, which offers monthly combined training in ERCP and EUS procedures. Our GI Procedures Unit averages 500 ERCPs + 150 sphincterotomies and 500 EUS procedures a year. There is only one slot per year. There is a prerequisite of three years of GI training from an accredited US program. Because the fellow in this position will bill independently to a certain extent, the physician in this position cannot hold a J-1 visa. We do, however, accept H1-B, E-B and O-1 visas for this position. Because of issues relating to the transfer and sponsorship of visas from outside institutions to ours, it is advisable that the individual present with an Employment Authorization Document (EAD), which is easier to arrange because transfer is not an issue. Visa issues can be addressed to Ronit Weingarten of our Office of International Student and Scholar Services (OISSS), phone 919-962-5661, fax 919-962-4282, firstname.lastname@example.org, http://global.unc.edu/isss, hours M-F 9 AM to 4 PM.
Funding for this track derives in large part from the Department of Medicine. Slot availability is not guaranteed on a yearly basis but is offered based on need and availability of funds.
Interested individuals should apply through the ASGE web site at www.asge.org. Once there, click on 'trainee resources' and, under the 'education' header, detailed information is provided about the advanced endoscopy fellows (AEF) Match and how to apply, including a scheduled timeline.
Facilities and Patients
All of our clinical services are based at UNC Hospitals. UNC Hospitals (UNCH) consists of North Carolina Memorial Hospital, UNC Women's and Children's Hospital, UNC Neuropsychiatric Hospital, and UNC Cancer Hospital. These hospitals are contiguous and are located on a health affairs campus that includes schools of Medicine, Dentistry, Public Health, Pharmacy and Nursing. The health affairs campus is adjacent to the University of North Carolina main campus. UNCH is an acute care and referral hospital with 800 licensed beds. There are approximately 150 adult medicine beds, including intensive care units.
The UNC Health Care System is a not-for-profit integrated health care system owned by the state of North Carolina and based in Chapel Hill. It exists to further the teaching mission of the University of North Carolina and to provide state-of-the-art patient care.
The GI Division performs more than 14,000 endoscopic procedures each year and over 1,000 GI-Liver consultations per year.
Fellows spend one half-day per week in a faculty-supervised GI Clinic where they have the opportunity to perform outpatient consultations and to participate in long-term follow up of patients with gastrointestinal disease. Fellows are expected to spend two years in general GI work, but upon their third year may have a specialty clinic. The fellows and faculty of our Division take part in over 13,000 outpatient visits per year in various GI Clinics. There are approximately 3,400 new patients coming to the adult GI Clinics each year.
The Diagnostic and Treatment Center consists of a 9,000 square foot area located in the basement of UNC Hospitals. In any given year, we perform an average of 6,500 colonoscopies, 4,900 upper GI endoscopies, 750 flexible sigmoidoscopies, 500 ERCPs, 500 EUSs, 250 esophageal dilatations, 280 esophageal manometric studies, 150 sphincterotomies, 100 PEGs, 75 esophageal banding procedures, 200 video capsule endoscopies, and 100 small bowel enteroscopies.
Our GI Motility Unit offers esophageal and anorectal manometry and biofeedback. We have also added a low compliance balloon system to assess visceral sensation thresholds for research and clinical evaluation of patients with functional GI disorders. We now have a free-standing state-of-the-art biofeedback lab.
Our physicians utilize a Web-based electronic permanent archive for medical records called WebCIS (Clinical Information System). This system is quite user friendly and is upgraded periodically. Incoming patient records can be attached to a patient’s profile, and physicians can use WebCIS to generate consult notes, interim notes, and Rx requests. Outpatient clinic notes are interfaced with WebCIS so that when a physician dictates a note, it appears automatically in the permanent record. The company we use for transcription services is E-scription. For procedure reports, we use a specialized program called ProVation.
Conferences and Seminars
There are a number of formal and informal clinical and research teaching activities within the Division:
- Weekly core curriculum series (one hour);
- Weekly GI Grand Rounds (one hour), with Morbidity and Mortality (M & M) conference held the first Tuesday of each month;
- Weekly GI Medical/Surgical clinical conference (one half hour);
- Weekly research seminar (one hour);
- Monthly GI Journal Club (two hours);
- Monthly Functional GI Disorders (FGID) discussion group (two hours).
Weekly GI Grand Rounds and monthly Journal Club meetings involve participation of both faculty and fellows. All fellows regardless of track are required to attend a composite of 85% of these six conferences.
Each clinical fellow has one half-day per week of continuity clinic. In this clinic, fellows see three new patients and 2 - 6 return patients. This clinic is precepted by a GI attending.
In addition, fellows participate in the following subspecialty clinics during their ambulatory rotation: esophageal clinic, general and transplant liver clinic, hepatitis clinic, IBD clinic, IBS clinic, and motility clinic/lab.
For clinical fellows it is expected that at the end of the first year a project mentor will be chosen and the outline of a research project will be developed. The mentor will help identify the resources required to carry out the research project. During the second year the fellow is expected to carry out the research project and during the third year continue further work on the project or a new project and write the project up for publication. It is hoped that preliminary work from the research project will be submitted in abstract form either to the AGA or ACG.
Summary of Rotations
Endoscopy – two-three months
Hepatology – two-three months
Inpatient GI Consultation – two-three months
Outpatient GI Clinic (Ambulatory) – two-three months
Research - one month
Biliary – one month
Endoscopy – two-three months
Hepatology – two-three months
Inpatient GI Consultation – one-two months
Motility - 1/2 month; Nutrition 1/2 month
Outpatient GI Clinic (Ambulatory) – two-four months
Research - two months
Biliary - six months
Endoscopy - one month
Hepatology - one month
Inpatient GI Consultation - one month
Outpatient GI Clinic (Ambulatory) - one month
Research - two months
For a listing of our current fellows, please click here.