Clinical Hepatology Training
Rotation Educational Goals and Objectives
Patient Care
- First Year: The fellow will evaluate the patient with liver disease by obtaining important data through the medical history and physical examination and combining this with laboratory data to formulate a relevant, complete differential diagnosis; learning the indications, risks and benefits of procedures on patients with liver disease. The fellow will have an introduction to pathology of the liver and to liver biopsy technique with ultrasound guidance. The fellow will also participate in diagnostic and therapeutic paracentesis.
- Second and Third Years: The fellow will evaluate the patient with liver and biliary disease at the specialist level, developing competence in liver biopsy technique and interpretation of liver biopsies, esophageal variceal band ligation, argon plasma coagulation of vascular ectasias (gastric antral vascular ectasia, etc).
The fellow will also perform:
- management of patients with acute hepatitis and acute liver failure.
- management of patients with chronic liver diseases, including chronic hepatitis B and C virus infection.
- diagnosis and management of cirrhosis of liver including complications of cirrhosis.
- screening, diagnosis and management of hepatocellular carcinoma.
- indications for liver transplantation.
Medical Knowledge
The fellow will:
- understand the pathophysiology and pathology of variety of liver diseases and the biliary tree.
- understand the molecular and genetic basis of liver diseases.
- understand metabolic liver disease.
- understand the importance of evidence based methods and the analysis of outcomes of therapy of liver disease with reference to socioeconomic and political issues in an urban hospital.
Practice-Based Learning
The fellow will:
- gain experience in the management of patients with chronic illnesses and with frequent recurrences, such as chronic hepatitis C, hepatitis B, and autoimmune hepatitis, by following patients in the continuity clinic after discharge and developing discharge plans, monitoring therapy, complications and outcomes.
- focus on clinical hepatology by assuming responsibility for the hepatology clinic and protocols in liver disease. The fellow will see all patients referred to the service for liver disease and present patients to the rounding attending on a daily basis. The fellow will participate in rounds on clinical nutrition and attend monthly seminars in nutrition with an emphasis on nutrition in liver disease. The fellow will follow transplant patients both at the transplant center and at the NYPBMH site, to understand appropriate monitoring and treatment after transplantation.
- assist in the performance of NYPBMH sonographically guided liver biopsies one morning a week and review the pathologic material. The fellow will assist in endoscopic procedures on patients with liver disease including esophagogastroduodenoscopy (EGD) for surveillance and treatment of esophageal varices and colonoscopy on patients with liver disease.
- assist in ERCP and endoscopic ultrasound (EUS) on patients with liver disease in the second and third year.
- learn the advantages and limits of technology in liver diseases through a review of current endoscopic therapies at the frontier of endoscopic therapy.
- learn the best methods for developing efficiencies in the office, hospital and endoscopy unit.
- understand the needs of patients and the need to provide patient satisfaction with evaluation and therapy, especially hepatitis C and cirrhosis of the liver, and hepatocellular carcinoma.
Teaching Models
The fellowship utilizes:
- lectures and on general clinical hepatology and liver pathophysiology.
- performance of histories and physical examinations of patients on the general service and the service of the fulltime faculty with discussion on daily attending rounds and review of radiological studies on these patients.
- participation in the evaluation and testing of patients referred to hepatology and liver transplant evaluation clinics.
- one-to-one training in liver biopsy, variceal ligation, and paracentesis with the clinical faculty during endoscopic sessions at the NYPBMH endoscopy unit, supplemented by American Society for Gastroenterology and other videotapes from the NYPBMH collection.
- the resources of the divisional library, NYPBMH library and the Weill Cornell online library and seminars under the auspices of the NYSGE.
Diseases
The fellow will understand:
- acute and chronic viral hepatitis B and C, including patients dual infected with HIV and hepatitis C.
- drug-induced hepatitis.
- autoimmune liver diseases.
- hepatic and biliary tumors.
- systemic complications of advanced liver disease: ascites, esophageal variceal hemorrhage, hepatomas.
- cirrhosis (including pre- and post-transplant monitoring).