AdventHealth Orlando Inpatient Consult Service
Traditional consult experience at a large tertiary care academic medical center. This experience provides exposure to an unparalleled variety of disease processes and pathology. Fellows spend significant time on the inpatient consult services, where they learn how to identify and manage a wide array of GI and liver diseases including gastrointestinal bleeds, inflammatory bowel disease, diarrhea, refractory nausea and vomiting and abnormal liver enzymes. Teaching and management rounds are combined and patient-based, in which current cases are presented for discussion with interpretation of clinical data, differential diagnosis, pathophysiology, indication for endoscopy and imaging with emphasis on evidence driven management of the patient. All inpatient endoscopic procedures are performed by the GI faculty and GI fellows on the consult service, allowing for fellows to see a patient from presentation to procedure and ultimately to resolution of the patient’s complaint. Fellows serve as team leaders - mentoring and teaching other trainees including residents, interns, and medical students on the team.
Ambulatory Rotation
During the Ambulatory Rotation, fellows spend half-days rotating through our numerous sub-specialty focused clinics working alongside faculty in inflammatory bowel disease, general gastroenterology, hepatology, complex functional GI and motility disorders, pelvic floor disorders, and pancreaticobiliary disease. Second and third year fellows during their ambulatory rotation will have significant exposure to all forms of motility evaluation. They will have the opportunity to see patients in the office with our motility specialists, perform motility testing, and gain experience interpreting various motility tests. Fellows will have dedicated time for interpretation and analysis of the various motility tests such high-resolution esophageal manometry, capsule endoscopy, high resolution anorectal manometry, pH- Bravo and pH-Impedance testing, EndoFLIP testing, SmartPill interpretation, and breath test interpretation. Fellows will also rotate through pelvic floor clinic with colon and rectal surgery.
Hepatology Consult Rotation
During this rotation, fellows develop expertise in the diagnosis and management of hospitalized patients with liver diseases such as the complications of acute and chronic liver disease, variceal bleeding, hepatic encephalopathy, spontaneous bacterial peritonitis, post-liver transplant complications, abnormal liver enzymes/function tests, and various other conditions.
Fellows will accumulate significant experience in understanding the role of liver biopsy and radiographic investigations (including invasive radiology, i.e., trans-jugular intrahepatic portosystemic shunt [TIPS]. Fellows on this rotation also participate in liver conferences including liver tumor board and transplant selection conference.
Endoscopy Rotation
Starting in the first year, fellows under direct faculty supervision learn the skills needed to perform diagnostic, screening, and surveillance upper endoscopy and colonoscopy, as well as therapeutic aspects of the endoscopy, such as mucosal biopsy, polypectomy, hemostasis, stricture dilation, and gastrostomy tube placement.
Pancreato-biliary rotation
Second year fellows will rotate through Center for Interventional Endoscopy (CIE) for at least two months of the year. On this rotation, fellows work closely with advanced endoscopy faculty in both the outpatient and inpatient setting. This rotation provides a wide range of exposure to interventional endoscopy techniques including complex EMR, ERCP, EUS, third space endoscopy (i.e., POEM) and endoluminal stenting. The focus of this rotation is on cognitive training for management of advanced pancreaticobiliary diseases and lays the foundation for fellows interested in careers as advanced endoscopists.
Apopka Rotation
This rotation is a hybrid rotation with exposure to outpatient endoscopy cases, outpatient clinic and inpatient consults at AdventHealth Apopka campus. Typically, fellows perform endoscopies in the morning followed by faculty-precepted clinic in the afternoon. The inpatient consult team is supported by an advanced practice registered nurse (APRN) who sees majority of the inpatient consults, though the fellow maybe asked to see inpatient consults at the discretion of the attending faculty. During this rotation, fellows hone consultative and endoscopy skills needed for community gastroenterology practice. There is also the opportunity to do inpatient endoscopy cases when needed in the hospital.
Continuity Clinic
Each GI fellow participates in a half-day session of continuity clinic each week. Fellows see between five and eight patients during each clinic session. Clinic is staffed by GI core faculty.
