Anthony DiMarino, Jr., MD
Digestive Disease Institute
Chief, Division of
Gastroenterology & Hepatology
Advanced Hepatology Fellowship
Thomas Jefferson University offers advanced training in hepatology and liver transplant medicine for individuals who have completed training in Gastroenterology, as well as through the ABIM pilot 3-year combined gastroenterology/transplant hepatology pathway. This is a clinical program with emphasis on clinical research and teaching. Thomas Jefferson University is one of the largest medical training facilities in the country offering unique educational opportunities in patient and laboratory based research. We have the Delaware Valley's oldest active liver transplantation program that has been in place since 1984, and manage over 300 transplant candidates or recipients per year. This allows the fellowship candidate the opportunity to meet UNOS requirements for eligibility as a transplant hepatologist if so desired. The program is structured in such a way that the advanced liver fellow's activities will be focused entirely on liver disease and transplantation with special emphasis on clinical research. Given the limited time period of training (1 year), we will make available to the fellow, a number of active research protocols from which he can choose to be a part. This program will strongly encourage participants to contribute to an assigned protocol in a substantial way so that they will have the opportunity to submit abstracts to national meetings and generate publications. The education of gastroenterology fellows, residents, interns, and medical students will be a daily exercise providing lectures, morning rounds, and participating in trainee clinics. Clinical activities will include patient management in Hepatology clinics, Liver Transplantation clinics, and the Hepatology/Liver Transplant hospital service.
Our hepatology staff has depth in both clinical and laboratory realms. Steven Herrine, MD, Professor of Medicine, Transplant Hepatology Fellowship Director, and Vice Dean of Academic Affairs for the Sidney Kimmel Medical College, has focused his career on therapies for chronic hepatitis C, transplantation, and medical education. David Sass, MD is the Medical director of Liver Transplantation and maintains active interest in autoimmune liver diseases, portal hypertension and decompensated cirrhosis. Jonathan Fenkel, MD is particularly interested in chronic hepatitis C, as well as HIV/Hepatitis C coinfection. He started the Jefferson Hepatitis C Center which aims to coordinate care for patients with Hepatitis C, in the era of direct-acting antiviral medications. Jesse Civan, MD leads our Liver Tumor Program, in which we actively manage >300 patients with liver tumors yearly. Hie-Won Hann, MD, Professor of Medicine and internationally known for her investigative work on hepatitis B, particularly in Asian populations.
Clinical activities in hepatology at our program are designed to provide inpatient and outpatient experience in all facets of liver disease. The advanced hepatology fellow will be expected to develop an individual outpatient clientele (under supervision) so as to gain independence in decision making and providing continuity of care. Education in the management of patients before and after liver transplantation will be concentrated in our liver transplant clinics where medical and surgical staff work together. Each hepatology fellow is expected to spend at least 6 months on the inpatient hepatology service primarily consisting of patients with advanced-stage liver disease and liver transplant recipients. Besides developing skills in managing patients with severe complications of hepatic failure, each fellow is expected to participate in making decisions concerning immunosuppression and recognition/management of post-operative problems (e.g. treatment of recurrent HCV). Weekly educational conferences include the liver transplant selection committee meeting, inpatient clinical conference, liver biopsy review, and radiology conference. Morbidity and mortality conference, journal club, multispecialty conference, and research conference also meet at regular intervals (every 2-4 weeks). Postgraduate courses in epidemiology, statistics, and molecular biology, to name a few, are available to fellows to enhance their educational experience but are not required.
Education of medical students, residents, and gastroenterology fellows will be incorporated into the daily routine. This experience will include running a morning report for the hepatology service. The advanced hepatology fellow will be responsible for selecting teaching cases from the hepatology service on a weekly basis from which short topics can be developed for instructional purposes. Relevant literature review will accompany the case and discussion will be supervised by an experienced staff hepatologist. In addition, the hepatology fellow will be incorporated into weekly gastroenterology conferences for case discussions and critical literature reviews. Daily teaching rounds on the hospital service will provide a format for informal training of gastroenterology fellows, medicine residents, and interns.
Research will be one of the most strongly emphasized components of the advanced hepatology fellow's training experience. It is crucial for fellows to gain experience in the process of formulating research questions and developing pathways designed to answer these questions. Given the limitations of time, our program will abbreviate the process by providing experience in a selected protocol that is currently active. Most likely, this year's fellow will be incorporated into one of our active viral hepatitis protocols involved in the identification and treatment of patients with hepatitis C. In this way the fellow can participate in the process of data accrual and analysis with the intent to formulate abstracts for presentation of data at national meetings. Manuscript preparation will be the ultimate goal and dedicated time will be allotted (~8 weeks) in order to accomplish this task. Book chapters and case reports are other potential sources of experience for the exceptional candidate able to complete the goals of a primary research project in a timely fashion.
The advanced hepatology fellow should come out of this 1-year training program with a well-rounded experience in liver disease and transplantation. The trainee should feel comfortable managing patients with any of a variety of different types of liver disease as well as the complications of hepatic failure. Developing skills in the care of liver transplant patients will also be an integral part of their education. Productivity will be specifically linked to completion of achievable goals within a research project. Skills in teaching will be graded by students using questionnaires. Ultimately, we hope to help fellows develop careers in hepatology and liver transplantation while demonstrating how patient-directed research can be incorporated into day-to-day practice.
Anthony DiMarino, Jr., MD
Robert Coben, MD
Division of Gastroenterology & Hepatology
132 South 10th Street
Philadelphia, PA 19107