Transplant Hepatology Fellowship

Curriculum

Program Goals & Objectives

The Transplant Hepatology fellowship is a 1-year training program designed to satisfy the ABIM requirements for the Transplant Hepatology subspecialty board examination. 

The 1-year curriculum is designed to provide the fellow to acquire core knowledge above and beyond what they received during their Gastroenterology fellowship.  This is done through both ambulatory and in-patient consult rotations combined with specific experiences in transplant immunology, molecular diagnostics, transfusion medicine.  Our ambulatory rotations include dedicated pre- and post- liver transplant, hepatocellular carcinoma, cirrhosis, viral hepatitis, non-alcoholic fatty liver disease, and HIV-liver disease clinics in addition to general Hepatology clinics.

Below You Will Find the Following Curriculum Information:

Tracks

We offer 2 pathways.  The traditional 4th year program for those who have completed a 3 year Gastroenterology Fellowship and the 3rd year Transplant Hepatology Pilot Program for select individuals already in our GI Fellowship.  The clinical experiences are similar with the exception of the research requirement and expectation for those in the 4th year track.

Typical Schedule

Ambulatory Clinics

(these will be attended on a rotational basis to provide a broad experience)
  Monday Tuesday Wednesday Thursday Friday
Morning • Team Meeting
• Liver Transplant
• HBV clinic
• Liver Transplant
• HIV-Liver
• Cirrhosis
General Hepatology
• Liver Transplant
• NAFLD
• General Hepatology
• HCV Treatment
• Endoscopy
Afternoon • General Hepatology • HCC • General Hepatology • General Hepatology
• NAFLD
• HCV Treatment
• Endoscopy

In Patient Clinics

  Monday Tuesday Wednesday Thursday Friday
Morning • Team Meeting
• Liver
Biopsy
• Rounds
Liver Biopsy Rounds Liver Biopsy Rounds Liver Biopsy Rounds Rounds
Afternoon Rounds Rounds Rounds Rounds Rounds

The MCV Hospital Inpatient Hepatology service provides an opportunity for fellows to participate in the care and management of adult patients admitted to the hospital with acute and chronic liver diseases.

The fellow operates within the context of a multi‐disciplinary team, managing conditions that include, but are not limited to, acute liver failure, decompensated cirrhosis, evaluation of abnormal liver tests or imaging, and post-transplant care.

Additionally, the rotation affords the opportunity for the fellow to engage directly in the subspecialty-specific oversight and education of GI Fellows, internal medicine housestaff and medical student learners rotating on the service. All of this occurs under the supervision of the responsible ward attending faculty members from the Division of Gastroenterology, Hepatology and Nutrition.

Rotations

    Team Meetings

    Every Monday morning the Hepatology and Liver transplant teams at the VCU Medical Center meet to discuss all patients currently hospitalized at this institution.  The transplant hepatology fellow will attend this meeting every week while on the VCU Medical Center rotation.  This meeting keeps the entire Hepatology and Liver Transplant teams, including the Medical Director, informed regarding the current health of all patients being followed by the transplant program and potential new patients to the program.  The management of all hospitalized patients is discussed, especially those with cirrhosis and their potential candidacy for liver transplantation.  Liver transplant coordinators, who also attend the meeting, are informed regarding status changes of patients already on the liver transplant waiting list.  A treatment plan is developed for all hospitalized patients. 

    Liver Biopsy

    Liver biopsy procedures are performed at either the VCU Medical Center 4 mornings per week.  All patients who require a liver biopsy for evaluation of acute or chronic liver disease, all post-liver transplant recipients who require liver biopsy and all potential living liver donors who require liver biopsy as part of their donor evaluation are performed during this time. All biopsies will be reviewed by the fellow with an attending once weekly.

    Endoscopy

    The transplant hepatology fellow will participate in Endoscopy 1 half day each week to maintain competency.  The fellow will be responsible for performing elective upper and lower endoscopy and variceal band ligation as indicated in patients with cirrhosis who are being evaluated for or awaiting liver transplantation, as well as other patients with cirrhosis.  The transplant hepatology fellow will perform these endoscopic procedures under the direction of an attending Gastroenterologist/Transplant Hepatologist.  The fellow will not participate in any advanced endoscopic procedures such as ERCP or endoscopic ultrasound.

    Liver Transplant Outpatient Care

    Liver transplant clinic is held 5 mornings each week at the VCU Medical Center.  The transplant hepatology fellow will participate in the care of patients seen in this clinic.  Patients with cirrhosis being evaluated for liver transplantation, patients already on the liver transplant waiting list and post-transplant recipients are all seen during this clinic.  This will provide the transplant hepatology fellow with a broad experience in caring for both pre-and post-transplant recipients.  Patients with ascites may require paracentesis during their clinic appointment.  The hepatology/liver transplant clinic has a procedure area where large volume or diagnostic paracentesis can be performed if required during the out-patient clinic visit without requiring that the patient be hospitalized for this procedure. 

    In-patient care

    The transplant hepatology fellow at VCU will participate in In-Patient rounds every day.  Rounds begin at 8 am on the dedicated Digestive Disease Service.  This service is staffed by interns, residents, and 1 GI Fellow.  Consults and patients not on the DHS are seen in the afternoon.  All patients cared for by the Hepatology and Liver Transplant team will be seen each day during In-Patient rounds.  This will include patients with acute or chronic liver failure being evaluated for liver transplantation, patients who are currently on the liver transplant waiting list and who developed complications which required them to be hospitalized, patients who have recently had a liver transplant and patients who underwent liver transplantation some time ago and are hospitalized for post-transplant complications or another medical reason.  The Transplant Fellow will help supervise and help teach the GI fellow and medical house staff during this rotation.

    Liver Clinics

    There are dedicated clinics for those with HCC, viral hepatitis, NAFLD, HIV-liver diseases, and those on HCV treatment. 

Conferences

    Liver Histology Conference

    A scheduled liver histology conference is held once each week at VCU.  During this conference all slides from the liver biopsies performed during the previous week will be reviewed.  This will include liver biopsy specimens from patients with chronic liver disease and post-liver transplant patients who underwent liver biopsy to assess for possible acute or chronic allograft rejection or recurrent disease.  During this conference the liver histology findings will be utilized to formulate a treatment plans for these patients.  Various management issues will also be discussed based upon the liver histology findings.  The transplant hepatology fellow will attend this conference every week. There is also a pathology conference held with pathology residents every other month.

    Journal club

    This meets every Monday in conjunction with the liver histology conference.  The Transplant Hepatology fellow will present 1 article in depth for discussion among the faculty and GI fellows. 

    Liver Transplant Patient Selection Committee

    The liver transplant patient selection committee meets once each week at VCU.  The members of the committee represent a diverse group involved in the long term care of the patient.  This includes transplant hepatologists, liver transplant surgeons, liver transplant coordinators and the liver transplant financial coordinator, social workers and psychologists.  The transplant hepatology fellow will attend and actively participate in this weekly conference.  During each meeting all patients currently undergoing liver transplant evaluation testing are discussed and decisions regarding the ability of these patients to be accepted for liver transplantation and placed on the active liver transplant waiting list are made.  The current health and MELD scores of all patients on the liver transplant waiting list are reviewed.  Patients who are no longer candidates for liver transplantation are either inactivated or removed from the liver transplant waiting list.

    Case management conference

    Case management conferences are held weekly.  The case management conference is a teaching conference during which patients with difficult and or unusual management issues are discussed in a multidisciplinary environment.  The conference is attended by gastroenterologists, transplant hepatologists, general and transplant surgeons and radiologists.  Each patient’s case is presented by a fellow or resident and various attendings lead the multidisciplinary discussion.  The Transplant Hepatology fellow will attend this conference each week and present the cases of difficult pre- and/or post-liver transplant patients.

    Gastroenterology Grand Rounds

    Formal didactic lectures by the gastroenterology fellows, attendings and visiting professors are presented to the members of the division of gastroenterology.  The transplant hepatologists and the transplant hepatology fellows will attend this conference each week.  During the academic year each fellow will provide one formal lecture on a topic related to liver transplantation.  A list of topics presented at this conference is attached (appendix # 2) Once each month a journal club will substitute for the didactic lecture.  The transplant hepatology fellow will participate in journal club and be asked to review recent articles from the medical literature related to liver transplantation.

    Transplant Conference

    Conducted every Thursday from 12:30-1:30 PM.  In this conference topics related to transplant are discussed.

Unique Learning Opportunities

    The Transplant Hepatology Fellow will have access to the AASLD Learning site, ACG Universe, and Up-To-Date.