Thomas Jefferson University
Sidney Kimmel Medical College
Department of Medicine

Fellowships

Gastroenterology & Hepatology Fellowship

Jefferson offers a highly competitive three-year comprehensive training in gastroenterology and hepatology. Last year, more than 200 applications were received to fill three trainee positions. This year, we are recruiting for four trainee positions. The program is designed to produce superior subspecialists equipped to pursue academic careers emphasizing either clinical or bench research. The Jefferson Gastroenterology and Hepatology Fellowship affords ample inpatient and ambulatory experiences necessary to develop exceptional clinical and endoscopic skills. A clinical or basic science project supervised by a full time faculty member is an integral component of the fellowship training.

Objectives

Your medical training and the years that you have dedicated to becoming a doctor have provided you with a substantial amount of scientific knowledge and skill. To gain expertise in your chosen field of gastroenterology, further dedication to training in clinical medicine and research is necessary. At Sidney Kimmel Medical College, we offer fellowships in gastroenterology and hepatology emphasizing a distinctive blend of laboratory and clinical training. The major objectives of the program are:

  • To provide an optimal clinical setting in all areas within the field of gastroenterology

  • To pursue research which links clinical findings with published scientific data and laboratory investigations

  • To maintain an active academic curriculum which includes bedside teaching, endoscopic instruction and a comprehensive gastrointestinal conference schedule

We believe this hands-on combination, together with our respect for the individual's capacity and desire for knowledge, provides an exceptional postgraduate training program in gastroenterology and hepatology. We are proud of our low teacher to student ratio, which allows for personalized attention for those who want to learn in a progressive and intensive environment. Our staff of gastroenterologists and hepatologists holds the impressive credentials and experience required by a major medical center. They share the genuine desire to impart their knowledge and skills to others.

Facilities

Clinical training for the fellowship is primarily located at Thomas Jefferson University Hospital, in Center City Philadelphia. Jefferson is a 717 bed acute care facility which serves as a primary and tertiary care hospital for residents of Philadelphia and the surrounding Delaware Valley. The educational experience at Jefferson is enhanced by an active cadaveric and live-donor liver transplantation program.

Upper year fellows also spend two months per year at Underwood-Memorial Hospital (UMH), in nearby Woodbury, New Jersey, located approximately twenty minutes from Jefferson. UMH is a 350 bed community hospital at which fellows gain additional experience in primary consultative GI and further experience in interventional endoscopy.

The ambulatory care facilities at Jefferson are those of the Jefferson Digestive Disease Institute (JDDI), a newly renovated suite that comprises the outpatient, administrative and secretarial offices for the Academic Division of Gastroenterology and Hepatology. JDDI is located adjacent to the division's endoscopy and motility laboratories. The JDDI contains 15 fully-equipped examination rooms and a 60-seat conference room equipped with state-of-the-art audiovisual equipment. An office for clinical fellows, equipped with current reference textbooks and desktop computers, is also located in the JDDI.

Structure

The fellowship training program in gastroenterology is managed by Director Anthony J. DiMarino, Jr., MD, Academic Coordinator Robert Coben, MD and Associate Academic Coordinator Stephanie Moleski, MD. During the first year, clinical training is divided between inpatient gastroenterology consultation services, ambulatory endoscopic and clinical experiences and two months of dedicated research. The second year is comprised of rotations through the inpatient gastroenterology consultative services, inpatient hepatology consultation/liver transplantation service at Jefferson, ambulatory endoscopic and clinical experiences (including a clinic for liver transplantation patients) and three months devoted to research. Research and scholarly activities will comprise the majority of the third year. Third year fellows can gain additional training in advanced interventional endoscopy, hepatology, motility, inflammatory bowel disease and basic science research. During the three years of the fellowship, trainees maintain longitudinal outpatient gastroenterology and hepatology clinics that are always supervised by full time faculty. Each trainee is allotted four weeks paid vacation per year. Trainees have ample opportunity to acquire all the necessary diagnostic and therapeutic skills.

During the first year of fellowship, trainees are encouraged to meet with each of the basic science and clinical faculty in order to discuss participation in research. First year fellows are expected to have their research projects approved by Dr. DiMarino by October 1 of their first year. It is expected that fellows will engage in scholarly writing and plan and execute basic or clinical research. This is the primary focus of research rotations but, by necessity, these efforts continue during other rotations. Fellows are expected to submit the results of their research efforts for presentation at local and national meetings and, if suitable, for publication. The division sponsors fellows to attend at least one national meeting per year.

Trainees at Jefferson are intimately involved in educating Jefferson medical students, residents and visitors from other institutions. Fellows organize and participate actively in numerous divisional educational experiences including:

  • Journal Club

  • Literature Review

  • Pathophysiology Conference

  • Clinical Case Conference

  • GI Grand Rounds

  • GI Research Conference

  • Quality Assurance Conference

  • Inflammatory Bowel Disease Conference

  • GI Pathology Conference

  • GI Radiology Conference

  • Gastrointestinal Endoscopy Conference

  • Interdisciplinary Conference Which Includes GI/Surgery/Radiology/Pathology

In addition to GI grand rounds and GI research conference, each year a nationally recognized gastroenterologist or hepatologist is invited to be the James L.A. Roth Visiting Professor at Sidney Kimmel Medical College. This three-day program includes grand rounds, lectures, case presentations and informal seminars.

Fellows are formally evaluated by faculty on their:

  • Clinical judgment

  • Medical knowledge

  • History taking

  • Physical examination

  • Procedure skills

  • Humanistic qualities

  • Professional attitudes and behavior

  • Medical care

  • Self-motivated learning

  • Overall clinical competency

These written evaluations are discussed with the trainees on a regular basis. Fellows also evaluate faculty members on their availability, organization, teaching skills, fund of knowledge and interpersonal relationships. They also have the opportunity to evaluate the training program's overall quality, diversity of patient population, quality of teaching programs, structure and/or organization of the program, opportunity for and the quality of research experience and preparation for their future career.

Current Fellows

PGY - 4

Natalie Cosgrove, MD
Undergraduate: Bucknell University
Medical College: Temple University College of Medicine
Internship/Residency: University of Virginia

Kunjal (Komal) Gandhi, MD
Undergraduate: University of Florida
Medical College: University of Florida
Internship/Residency: Johns Hopkins Hospital

Sheela Reddy, MD
Undergraduate: Barnard College
Medical College: Albert Einstein College of Medicine
Internship/Residency: Beth Israel Deaconess Medical Center

Christina Tofani, MD
Undergraduate: La Salle University
Medical College: Penn State University College of Medicine
Internship/Residency: Hospital of the University of Pennsylvania

PGY - 5

Christopher Henry, MD
Undergraduate: Princeton University
Medical College: Jefferson Medical College
Internship/Residency: Thomas Jefferson University Hospital
Chief Residency: Thomas Jefferson University Hospital

Steven Krawitz, MD
Undergraduate: Johns Hopkins University
Medical College: Jefferson Medical College
Internship/Residency: Thomas Jefferson University Hospital

Haroon Shahid, MD, MS
Undergraduate: Rutgers University
Medical College: University of Medicine and Dentistry of New Jersey - Newark
Masters in Pharmacology/Human Investigation: Thomas Jefferson University
Internship/Residency: Thomas Jefferson University Hospital

Colin Smith, MD
Undergraduate: Kenyon College
Medical College: Jefferson Medical College
Internship/Residency: Thomas Jefferson University Hospital

PGY - 6

Cecilia Kelly, MD
Undergraduate: Fordham University
Medical College: Jefferson Medical College
Internship/Residency: Thomas Jefferson University Hospital

Richard Wu, MD, MPH
Undergraduate: University of California, Berkeley
Medical College: Drexel University College of Medicine
Masters in Public Health: Drexel University, College of Public Health
Internship/Residency: Duke University Medical Center

Advanced Fellows

Transplant Hepatology (3-year combined ABIM pathway)

She-Yan Wong, MD
Undergraduate: Washington University
Medical College: Jefferson Medical College
Internship/Residency: Northwestern Memorial Hospital
Fellowship: Thomas Jefferson University Hospital

Advanced Endoscopy

Pushpak Taunk, MD
Undergraduate: University of Miami
Medical College: University of Miami
Internship/Residency: Boston University Medical Center
Fellowship: Boston University Medical Center

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 American Board of Internal Medicine pilot three-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 more than 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 focus entirely on liver disease and transplantation with special emphasis on clinical research. Given the limited time period of training (one year), we provide the fellow a number of active research protocols from which he or she can choose to be a part. This program strongly encourages participants to contribute to an assigned protocol in a substantial way so they 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 more than 300 patients with liver tumors yearly. Hie-Won Hann, MD, Professor of Medicine, is 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 managing patients before and after liver transplantation is concentrated in our liver transplant clinics where medical and surgical staff work together. Each hepatology fellow is expected to spend at least six 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 one-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.

Advanced Endoscopy Fellowship

Thomas Jefferson University and the Division of Gastroenterology and Hepatology sponsor a one-year PGY-7 position for training in advanced endoscopic procedures. The program offers training in Endoscopic Retrograde Cholangiopancreatogram (ERCP), Endoscopic Ultrasonography (EUS) and other advanced procedures.

The Division of Gastroenterology and Hepatology at Thomas Jefferson University consists of 39 faculty members and 79 ancillary staff. The division supports ten gastroenterology fellows, a hepatology fellow, and an advanced endoscopy fellow. The members of the division perform approximately 18,000 endoscopic procedures per annum including 1000 ERCP procedures and 1300 EUS procedures. There are six physicians who perform advanced endoscopic procedures and are instrumental in the education and procedural training of the Advanced Endoscopy Fellow.  The endoscopic ultrasound aspects of the training program benefit from a collaborative relationship with one of the strongest ultrasound divisions (within the Department of Radiology) in the world. The advanced endoscopy fellowship at Thomas Jefferson University is currently in its tenth year. Previous fellows in this position have accepted academic positions across the United States and the world. Prior fellows would be happy to discuss the Advanced Endoscopy Fellowship at Thomas Jefferson University with any prospective candidate. Applicants considered for the advanced endoscopy fellowship must be currently enrolled in or have completed an accredited three-year gastroenterology fellowship.

Endoscopic Facility

Thomas Jefferson University and Hospital boasts one of the most modern state-of-the-art endoscopy units in the nation.  The University and Hospital operate ten procedure rooms with 42 staff positions. The Interventional Endoscopy Unit (IEU) is designed as four mini operating rooms to perform high-end procedures including ERCP, EUS, deep enteroscopy, EMR, PDT, cryoablation, radiofrequency ablation and enteral stenting. Two rooms are fully equipped for ERCP and two rooms are fully equipped for EUS. Each room has the capacity to provide general anesthesia. Endoscopic procedures are viewed on wall-mounted 50” flat panel monitors to improve visualization of endoscopic detail. A fifth mini operating room for the performance of advanced procedures was completed in 2013. The Gastrointestinal Endoscopy Unit (GEU) houses six state-of-the-art procedure rooms with the focus on the efficient performance of standard outpatient endoscopic procedures.

All procedure rooms are linked to a state-of-the-art 50-seat conference facility. The facility has four projection screens, each of which has the capability to simultaneously display four different images. The facility is designed so that persons in the conference room can view and have a two-way conversation with faculty members performing endoscopic procedures in any of the ten procedure rooms. At the same time, persons in the conference room can view the endoscopic, fluoroscopic or ultrasonic images in a HIPPA compliant format.

Educational Objectives

The one-year fellowship in advanced endoscopy is designed to develop the knowledge and skills to become an academic advanced endoscopist. This not only includes outstanding technical training but emphasizes cognitive aspects of performing advanced procedures. These aspects include:

  • Understanding the pathophysiology, natural history and literature regarding disease entities associated with performing advanced endoscopic procedures

  • Understanding the literature that supports the endoscopic techniques performed

  • Education toward patient selection

  • Developing skills necessary to interpret the results of non-gastroenterological studies (i.e., MRI)

  • Determining which advanced procedure is most appropriate for patients clinical situation

  • Stratifying patient’s with regard to procedural risk

  • Disclosing to the patient the risks of the proposed procedure

  • Obtaining informed consent

  • Understanding the potential procedural complications and their management

Participation in the advanced endoscopy program includes:

  • Admission of inpatients transferred specifically for advanced procedures

  • Patient preparation for advanced endoscopic procedures

  • The performance of advanced procedures

  • Report dictation, image and video archiving and management

  • Research data entry

  • Attendance at conferences

  • Inpatient consultation for patient’s considered for advanced endoscopic procedures

  • Inpatient care of patients having undergone advanced endoscopic procedures

  • Designing, writing and conducting clinical research

The fellowship emphasizes endoscopic research, and each fellow is expected to be actively involved in multiple research projects and produce at least one publication by the end of the fellowship year. The division hosts an Endoscopic Research Group that meets monthly to discuss current and proposed research protocols.

The division hosts at least six educational conferences per week that include the following list of educational conferences offered by the Division of Gastroenterology and Hepatology for the training and education of Gastroenterology and Advanced Endoscopy Fellows:

  • Endoscopy Conference – held twice a month and is dedicated to various aspects of endoscopy and includes an advanced endoscopy (ERCP and EUS) case conference

  • Weekly Medical Resident and Student Conferences – fellows lecture medical students and residents on specific GI topics

  • Monthly Morbidity and Mortality Conference – reviewal of untoward outcomes usually pertaining to endoscopic procedures

  • Weekly Journal Club – fellows and attending physicians review and critique the current medical literature that pertains to the practice of gastroenterology and hepatology

  • Literature Review – held twice a month, during which assigned articles relating to a focused topic in gastroenterology are reviewed in detail and discussed with an eye toward an in-depth understanding

  • Clinical Case Conference – held weekly for three weeks of every month and is a classic case presentation and brief literature review.         

  • Multidisciplinary Conference – held once a month, frequently focuses on advanced endoscopic techniques and includes a dynamic educational interaction between surgeons, gastroenterologists, radiologists, interventional radiologists, oncologists and pathologists.

  • Pathophysiology Conference – a monthly conference that allows fellows to present an in-depth lecture on a specific topic

  • Colorectal Conference – held once a month, during which multidisciplinary approaches to difficult colorectal problems are discussed

  • GI Grand Rounds – a monthly conference where visiting lecturers are invited to give state-of-the-art lectures         

  • Fellows Meeting – held monthly, during which all fellows meet with Program Directors to discuss issues regarding the fellowship program

  • GI Pathology Conference – a monthly meeting that allows fellows to study and appreciate the histologic correlates of the gastroenterologic disorders routinely encountered.

  • Inflammatory Bowel Disease (IBD) Conference – a monthly conference for the purpose of discussing specific patient management issues in IBD

  • Research Conference – a monthly conference geared towards guest lecturers who present their areas of expertise and research interests

  • Motility Conference – held monthly and reviews interesting motility cases from the prior week

  • Liver Pathology Conference – meets weekly to review the week's liver biopsies and is attended by liver pathologists, medical liver transplant service and the surgical liver transplant service

  • Nutrition Conference – held every other month

In addition to the conferences sponsored by the Division of Gastroenterology, there are numerous conferences sponsored by other disciplines that are pertinent to Advanced Endoscopy Fellows.  These conferences include the Multidisciplinary Pancreatic Periampullary Malignancy Case Conference sponsored by the Department of Surgery.

Supervision & Evaluation

Fellows in the program are formally evaluated in writing and provided feedback at quarterly intervals. Research progress meetings are held weekly to maintain appropriate time lines. A procedure log is maintained through an endoscopic database to track procedural volumes.

The following six faculty members perform advanced endoscopic procedures and are involved in the training and supervisizing the Advanced Endoscopy Fellow:

Thomas Kowalski, MD
David Loren, MD – Program Director
Ali Siddiqui, MD
Robert Coben, MD
Mitchell Conn, MD
Anthony Infantolino, MD