Rotations

The first year of fellowship is designed to provide a broad exposure to inpatient and outpatient gastroenterology. First-year gastroenterology fellows often have no or very little hands-on experience with endoscopic procedures upon entering the program. As such, first-year fellows will learn the essential cognitive and practical principles of endoscopic diagnosis and management, on both inpatient and outpatient rotations.

There will be ten (10) months of full-time clinical rotations. 

• Four months devoted to inpatient gastroenterology
• Four months devoted to outpatient gastroenterology
• One month devoted to a mixed inpatient/outpatient hepatology rotation
• One month of elective clinical rotation

The non-clinical months are structured with one month of research and one month of vacation. On all months, excluding vacation, fellows will participate in one, half-day, weekly continuity clinic and GI conferences. Rotations are summarized below:

Gastroenterology Consult Service at MaineHealth Maine Medical Center (MHMMC) Portland

Four of the 12 months are devoted to an intensive inpatient rotation at MHMMC Portland, a level-one trauma tertiary care hospital on the MaineHealth Portland Campus. The first year fellow is taught the essentials of the GI inpatient consultation, building upon the knowledge acquired in internal medicine residency training. 

Fellows are expected to manage the inpatient consultative service and perform inpatient endoscopic procedures directly supervised by a GI service attending. GI fellows will often work with internal medicine residents and medical students while on this service. 

As this is typically a busy inpatient service, an existing structure is present with two advanced practice providers (APPs). APPs will have an independent panel of patients, but will be able to cross-cover the GI fellow’s patient panel in certain circumstances, for example, when the fellow attends continuity clinic, is away for didactics, or in the setting of learner fatigue or medical leave, sickness, or absence. The APP's independent panel is not expected to interfere with the GI fellow’s learning experience.

Gastroenterology at MaineHealth Maine Medical Center (MHMMC) Biddeford

Four of the 12 months are devoted to an outpatient rotation at MHMMC Biddeford on the MaineHealth Biddeford Campus. A large outpatient clinic within a medical office building one block away from the hospital staffed by five, full-time, MaineHealth gastroenterologists and 2 APPs. 

These five gastroenterologists also perform outpatient procedures in the hospital-based endoscopy suite. Fellows will be assigned to work with an attending and spend half their given day in the clinic and the other half will be devoted to performing outpatient endoscopic procedures. 

Though this site will primarily serve as an outpatient experience, each of the five GI attendings rotates on a small-census, APP-run, inpatient GI service. The fellow will participate in this inpatient service by performing inpatient GI procedures directly supervised by the service attending. The goal is to allow fellows to focus their energy and activity on the outpatient GI environment.

Hepatology at MHMMC Portland

Fellows will gain valuable knowledge and skills in the care of patients with advanced liver disease. This is a mixed inpatient and outpatient experience. Approximately a third of the time will be devoted to inpatient hepatology consults at MHMMC Portland, half of the time devoted to outpatient consults at the MaineHealth Adult Specialty Care Gilman St Portland on the MaineHealth Portland campus, and the remainder of the time devoted to a mix of one half-day of outpatient endoscopy on hepatology patients and educational activities. 

The fellow will present patients during bedside rounds with the hepatology attending. Fellows will be supervised by a hepatology attending in the outpatient clinic. The half day of endoscopy will be with the hepatologist and expose the fellow to hepatology patients requiring endoscopy (e.g. variceal treatment).

Fellows’ Continuity Clinic at MHMMC Biddeford

Each week, fellows will participate in their continuity clinic on the MaineHealth Biddeford campus. This will be in the same clinic where fellows participate in their MHMMC Biddeford outpatient clinic. This will consist of a half-day, and the average patient panel for the first year fellow will be four to six patients. The goal of this experience is to equally represent both male and female patients with disease presentation to encompass the full breadth and depth of gastroenterology. The clinic will be staffed by a GI attending.

Elective

The first-year fellow in the elective month will spend two to four weeks on elective. Options include:

• Two weeks of elective during two separate months, with vacation during the other two weeks of the respective month 
• Four weeks of elective all within one month with vacation shared with the research month

The elective rotation will allow the fellow a concentrated experience within a subspecialty of gastroenterology (e.g. motility, inflammatory bowel disease) or within a field that shares its discipline within the gastroenterology space (e.g. body radiology, colorectal surgery, pediatric gastroenterology/nutrition). All of these electives by default take place either at MHMMC Portland or MHMMC Biddeford; however, an outside elective can be arranged on a case-by-case basis. Fellows will meet with the program director in the beginning of the year to discuss and arrange their elective time.

Research

During the research month, the first-year fellow will spend two to four weeks on research. Options include:

• Two weeks of research during two separate months, with vacation during the other two weeks of the respective month
• Four weeks of research all within one month with vacation shared with the elective month 

To graduate, each fellow is expected to take part in a research project. MaineHealth is a medical community focused primarily on clinical activities, and as such, research activities are expected to surround patient care related activities. Such research projects include, but are not limited to, case studies, chart reviews, systematic reviews, and quality improvement projects. Fellows will be expected to present their respective works at least internally within MaineHealth but are also encouraged to publish and/or present in regional and national gastroenterology and hepatology conferences.

Vacation

Each fellow will be receive four weeks of vacation per academic year. Vacation will be taken in two week increments during elective or research months. 

The second year of fellowship is designed to build on the skills learned during the first year. At this point in the fellowship training, it is expected that the starting second-year fellow has become comfortable with many aspects of inpatient and outpatient gastroenterology and has a foundation in endoscopy. 

The second-year fellow will continue to strengthen their general GI skills, cognitively and procedurally, while also getting the majority of their exposure to hepatology. They will also be introduced to advanced endoscopy by participating in the pancreaticobiliary service. They will begin to learn to be junior leaders by coaching first-year fellows, internal medicine residents and students that rotate on these respective services.

There will be ten (10) months of full-time clinical rotations.

• Four months devoted to mixed inpatient/outpatient hepatology
• Two months devoted to inpatient gastroenterology
• Two months devoted to outpatient gastroenterology
• One month devoted to pancreaticobiliary service
• One month of elective clinical rotation

The non-clinical months are structured with one month of research and one month of vacation. On all months, excluding vacation, fellows will participate in one, half-day, weekly continuity clinic and GI conferences. Rotations are summarized below:

Hepatology at MaineHealth Maine Medical Center (MHMMC) Portland

Fellows will gain valuable knowledge and skills in the care of patients with advanced liver disease. This is a mixed inpatient and outpatient experience. Approximately a third of the time will be devoted to inpatient hepatology consults at MHMMC Portland, half of the time devoted to outpatient consults at the MaineHealth Adult Specialty Care Gilman St Portland on the MaineHealth Portland campus, and the remainder of the time devoted to a mix of one half-day of outpatient endoscopy on hepatology patients and educational activities.

The fellow will present patients during bedside rounds with the hepatology attending. Fellows will be supervised by a hepatology attending in the outpatient clinic. The half day of endoscopy will be with the hepatologist and expose the fellow to hepatology patients requiring endoscopy (e.g. variceal treatment).

Gastroenterology Consult Service at MaineHealth Maine Medical Center (MHMMC) Portland

Fellows will spend two months are devoted to an intensive inpatient rotation MHMMC Portland, a level-one trauma tertiary care hospital on the MaineHealth Portland Campus. The second-year continues what was taught from the first year, building on the essentials of the GI inpatient consultation. 

Fellows are expected to manage the inpatient consultative service and perform inpatient endoscopic procedures directly supervised by a GI service attending. GI fellows will often work with internal medicine residents and medical students while on this service. 

As this is typically a busy inpatient service, an existing structure is present with two advanced practice providers (APPs). APPs will have an independent panel of patients, but will be able to cross-cover the GI fellow’s patient panel in certain circumstances, for example when the fellow attends continuity clinic, is away for didactics, or in the setting of learner fatigue or medical leave, sickness, or absence. The APPs independent panel is not expected to interfere with the GI fellow’s learning experience.

Gastroenterology at MaineHealth Maine Medical Center (MHMMC) Biddeford

Two of the 12 months are devoted to an outpatient rotation at MHMMC Biddeford on the MaineHealth Biddeford Campus. A large outpatient clinic within a medical office building one block away from the hospital staffed by five, full-time, MaineHealth gastroenterologists and 2 APPs.

These five gastroenterologists also perform outpatient procedures in the hospital-based endoscopy suite. Fellows will be assigned to work with an attending and spend half their given day in the clinic and the other half will be devoted to performing outpatient endoscopic procedures.

Though this site will primarily serve as an outpatient experience, each of the five GI attendings rotates on a small census, APP-run, inpatient GI service. The fellow will participate in this inpatient service by performing inpatient GI procedures directly supervised by the service attending. The goal is to allow fellows to focus their energy and activity on the outpatient GI environment.

Pancreaticobiliary Service at MHMMC Portland

One month is devoted to an intensive, hospital-based, pancreaticobiliary service rotation serving both inpatient and outpatients. Though the rotation is called "pancreaticobiliary," the reality is that a number of non-pancreaticobiliary advanced therapeutic cases (e.g. endoscopic mucosal resection, large polypectomies) are performed by the same providers who do pancreaticobiliary work. The second-year fellow, therefore, will be exposed to all aspects of advanced therapeutic endoscopy including, but not limited to:

• Endoscopic retrograde cholangiopancreatography (ERCP)
• Endoscopic ultrasound (EUS)
• Endoscopic mucosal resection (EMR)

Fellows are expected to manage inpatient pancreaticobiliary consults separate from the general inpatient gastroenterology service at MHMMC Portland. Fellows on this rotation will also aid the MHMMC Portland GI fellow (and cross-cover if needed). They will also participate in outpatient procedures. Given the busy nature of this service, this will be shared with one APP. The APP will have an independent panel of patients, but will be able to cross-cover the GI fellow’s patient panel in certain circumstances, for example when the fellow attends continuity clinic, is away for didactics, or in the setting of learner fatigue or medical leave, sickness, or absence. The APPs independent panel is not expected to interfere with the GI fellow’s learning experience.

Fellows’ Continuity Clinic at MHMMC Biddeford

Each week the fellow will participate in their continuity clinic in Biddeford, ME. This clinic will be in the same clinic where the fellows participate in their MHMMC Biddeford outpatient clinic. This will consist of a half-day, and the average patient panel number for the second-year fellow will be 6 to 8 patients. The goal of this experience is to equally represent both male and female patients with disease presentation to encompass the full breadth and depth of gastroenterology. The clinic will be staffed by a GI attending.

Elective

The second-year fellow will spend two to four weeks on an elective rotation. Options include:

• Two weeks of elective during two separate months, with vacation during the other two weeks of the respective month
• Four weeks of elective all within one month with vacation shared with the research month

The elective rotation will allow the fellow a concentrated experience within a subspecialty of gastroenterology (e.g. motility, inflammatory bowel disease) or within a field that shares its discipline within the gastroenterology space (e.g. body radiology, colorectal surgery, pediatric gastroenterology/nutrition). By default, all of these electives take place at either MHMMC Portland or MHMMC Biddeford; however, an outside elective can be arranged on a case-by-case basis. Fellows will meet with the program director in the beginning of the year to discuss and arrange their elective time.

Research

During the research month, the second-year fellow will spend two to four weeks on research. Options include:

• Two weeks of research during two separate months, with vacation during the other two weeks of the respective month
• Four weeks of research all within one month with vacation shared with the elective month

To graduate, each fellow is expected to take part in a research project. MaineHealth is a medical community focused primarily on clinical activities, and as such, research activities are expected to surround patient care related activities. Such research projects include, but are not limited to, case studies, chart reviews, systematic reviews, and quality improvement projects. Fellows will be expected to present their respective works at least internally within MaineHealth but are also encouraged to publish and/or present in regional and national gastroenterology and hepatology conferences.

Vacation

Each fellow will be given 4 weeks of vacation per academic year. Vacation will be taken in two week increments during elective or research months. 

The third year of fellowship is designed to solidify the skills necessary to be an independent, competent, gastroenterologist. This also is an opportunity for the fellow to acquire further advanced therapeutic endoscopic skills. Fellows will also participate in a mandatory rotation at MaineHealth Pen Bay Hospital to expose them to rural gastroenterology. This final year also allows fellows to explore more subspecialties within gastroenterology by affording them additional elective months.

There will be ten (10) months of full-time clinical rotations.

• Five months on a pancreaticobiliary rotation
• Three months of elective
• One month mixed inpatient/outpatient hepatology rotation
• One month outpatient rotation at MaineHealth Pen Bay Hospital. 

The non-clinical months are structured with one month of research and one month of vacation. On all months, excluding vacation, fellows will participate in one, half-day, weekly continuity clinic and GI conferences. Rotations are summarized below:

Pancreaticobiliary Service at MaineHealth Maine Medical Center (MHMMC) Portland

Five months are devoted to an intensive, hospital-based pancreaticobiliary service rotation serving both inpatient and outpatients. Though the rotation is called "pancreaticobiliary," a number of non-pancreaticobiliary advanced therapeutic cases (e.g. endoscopic mucosal resection, large polypectomies) are performed by the same providers who do pancreaticobiliary work. The third-year fellow, therefore, will be exposed to all aspects of advanced therapeutic endoscopy including, but not limited to:

• Endoscopic retrograde cholangiopancreatography (ERCP)
• Endoscopic ultrasound (EUS)
• Endoscopic mucosal resection (EMR)

Fellows are expected to manage inpatient pancreaticobiliary consults separate from the general inpatient gastroenterology service at MHMMC Portland. Fellows on this rotation will also aid the junior fellow on the MHMMC Portland GI service (and cross-cover if needed). They will participate in outpatient procedures performed as well. 

Given the busy nature of this service, this will be shared with one advanced practice provider (APP). The APP will have an independent panel of patients, but will be able to cross-cover the GI fellow’s patient panel in certain circumstances, for example when the fellow attends continuity clinic, is away for didactics, or in the setting of learner fatigue or medical leave, sickness, or absence. The APPs independent panel is not expected to interfere with the GI fellow’s learning experience.

Hepatology at MHMMC Portland

Fellows will gain valuable knowledge and skills in the care of patients with advanced liver disease. This is a mixed inpatient and outpatient experience. Approximately a third of the time will be devoted to inpatient hepatology consults at MHMMC Portland, half of the time devoted to outpatient consults at the MaineHealth Adult Specialty Care Gilman St Portland on the MaineHealth Portland campus, and the remainder of the time devoted to a mix of one half-day of outpatient endoscopy on hepatology patients and educational activities.

The fellow will present patients during bedside rounds with the hepatology attending. Fellows will be supervised by a hepatology attending in the outpatient clinic. The half day of endoscopy will be with the hepatologist and expose the fellow to hepatology patients requiring endoscopy (e.g. variceal treatment).

Outpatient Rotation at MaineHealth Pen Bay Hospital

Recognizing that most of the Maine population lives in a rural setting, an important objective for the GI fellowship is to expose the fellow to rural gastroenterology. This mandatory rotation at MaineHealth Pen Bay Hospital gives the fellow this important rural experience. 

MaineHealth Pen Bay Hospital is located in Rockport, ME, approximately 90 miles (1 hour and 45 minutes by car) from Portland. Fellows will work in both the inpatient and outpatient environment. The site director is a therapeutic endoscopist and it is expected that the third-year fellow will participate in advanced therapeutic procedures as well. The goal of this experience is to give the fellow an opportunity to move towards autonomy, yet still in a supervised setting. 

Importantly, fellows will have meals and lodging provided by the Sponsoring Institution. Expenses related to travel to and from MaineHealth Pen Bay Hospital will also be covered. During their one month rotation, fellows will continue their continuity clinic at MHMMC Biddeford; however, all patients will be seen virtually (via telehealth) eliminating the need for travel. Fellows will also be expected to continue participation in weekly didactics, virtually, during this rotation.

Fellows’ Continuity Clinic at MHMMC Biddeford

Each week, the fellow will participate in their continuity clinic in Biddeford, ME. For reference, this clinic will be located in the same clinic where the fellows participate in their MHMMCB outpatient clinic. This will consist of a half-day, and the average patient panel number for the third year fellow will be 8 patients. This experience is felt to represent equally both male and female patients and disease presentation to encompass the full breadth and depth of gastroenterology. The clinic will be staffed by a GI attending.

Elective

The third-year fellow is afforded 3 months total of elective time to allow for more exposure and opportunities within subspecialty GI. The elective rotation will allow the fellow a concentrated experience within a subspecialty of gastroenterology (e.g. motility, inflammatory bowel disease) or within a field that shares its discipline within the gastroenterology space (e.g. body radiology, colorectal surgery, pediatric gastroenterology/nutrition). 

By default, all of these electives take place either at MHMMC Portland or MHMMC Biddeford; however, an outside elective can be arranged for on a case-by-case basis. Fellows will meet with the program director in the beginning of the year to discuss and arrange their elective time.

Research

During the research month, the third-year fellow will spend two to four weeks on research. Options include:

• Two weeks of research during two separate months, with vacation during the other two weeks of the respective month
• Four weeks of research all within one month with vacation shared with the elective month

In the third year, it is expected the fellow will present and/or publish their work within research - at the minimum, internally within MaineHealth, but fellows are encouraged to publish and/or present in regional and national gastroenterology and hepatology conferences. Research is a graduation requirement from the fellowship. 

MaineHealth is a medical community focused primarily on clinical activities, and as such, research activities are expected to surround patient care related activities. Such research projects include, but are not limited to, case studies, chart reviews, systematic reviews, and quality improvement projects. 

Vacation

Each fellow will receive 4 weeks of vacation per academic year. Vacation will be taken in two week increments during elective or research months.