Transplant Hepatology Fellowship Curriculum

Baylor full-time hepatologists and transplant surgeons provide consultative inpatient care. Consultative inpatient training of Transplant Hepatology fellows, medical residents, medical students, and NP/PAs is directly supervised by full-time hepatology faculty on a daily basis. Each of our triple-certified hepatology faculty members rotates on the inpatient service for seven consecutive days. During this time, the faculty has no competing outpatient responsibilities and devotes their full attention to teaching and supervision.

Education is also provided to trainees by our team’s designated consultants in cardiology, pulmonology, nephrology, oncology, infectious diseases, endocrinology, therapeutic endoscopy and invasive radiology. All of our consultants are board-certified in their specialties. Fellows perform comprehensive initial consultations under direct daily supervision of an attending faculty hepatologist. They conduct daily follow-up assessments of all inpatients and discuss each patient daily with the hepatology attending, who independently sees and examines each patient, reviews all data and provides bedside teaching.

Fellows are taught the indications, contraindications, limitations, complications, and interpretation of percutaneous and transjugular liver biopsies, diagnostic and large volume paracentesis with albumin replacement, assessment of esophageal varices using EGD, therapeutic endoscopy for upper gastrointestinal bleeding, transjugular intrahepatic portosystemic shunts, 2D echocardiography with agitated saline to detect pulmonary vascular shunts and right heart catheterization to assess pulmonary hypertension and portal systemic venous pressure gradients.

Fellows are also trained to perform diagnostic and therapeutic paracentesis, with and without US localization, in our outpatient procedure center. Fellows are also eligible for training in percutaneous liver biopsy. Faculty hepatologists supervise all procedures.

Fellows are on-call every third weekend. The call schedule includes major holidays. Fellows on the inpatient service rotation do not remain in the hospital overnight and do not take first or second night call. Only full-time hepatology and transplant surgical faculty members take calls after hours and on weekends to ensure timely decision making.

This policy ensures that our fellows have adequate time for educational, scholarly activities and needed rest. We encourage our fellows to devote a minimum of one hour per day to self-education after hours.

Liver Forum

This seminar on an invited topic is conducted during a dinner, which is open to members of both the academic and practice communities.

Gastroenterology Journal Club

Two articles selected by the faculty are presented by trainees for group discussion at a dinner conference. Transplant Hepatology Fellows are included in rotation with Gastroenterology Fellows. Fellows present articles and prepare detailed handouts.

Hepatology Journal Club

This weekly journal club is held 7-8 a.m. Mondays and is devoted to a critical presentation by a fellow of one article in hepatology or liver transplantation. Each presentation is mentored by a hepatology faculty member. To prepare fellows for the challenges of practice in the era of translational medicine, we give special emphasis to genetics, proteonomics, metabolomics and immunology and inflammation. Clinical articles informing and extending information published in Practice Guidelines are also a priority.

Hepatology Seminar

This lecture-based seminar, held at noon on Mondays, is a forum for presentation of a variety of topics spanning basic, clinical and translational research applications to clinical issues in hepatology and liver transplantation.

Research Meeting

This 1.5 hour meeting is held on Tuesdays 7:30-9 a.m. The first 30 minutes is a forum for faculty and fellows to discuss progress in research projects and facilitate collaborations and mentoring. The next hour is devoted to clinical research in Advanced Liver Therapies, including vetting of new research protocols, systematic review of all patients in current clinical trials, site initiation training sessions for newly funded research protocols, and didactic teaching about compliance, regulatory issues and the conduct of clinical research.

Hepatology Case Conference

In this conference, held at noon on Wednesdays, a fellow discusses a difficult and/or informative clinical case with mentorship from a hepatology faculty member. Cases are selected to illustrate important principles and provide new updates from the literature.

Imaging Conference

This conference, held from 7-8 a.m. Thursdays, is devoted to the review of imaging studies performed on our patients with a special emphasis hepatobiliary neoplasia. It is conducted by senior interventional radiologists and attended by faculty in hepatology and liver transplant surgery, rotating medical residents and fellows in hepatology and liver transplantation and gastroenterology. Formal reviews are conducted and recommendations are made regarding OLT, resective and biliary reconstructive surgery, ablative procedures and chemotherapy for malignant tumors. Attendees acquire in depth knowledge of imaging techniques, interpretation, ancillary testing options and use of imaging in clinical decisions.

Gastroenterology Grand Rounds

This CME conference is held 8-9 a.m. Thursdays. Two 30-minute presentations are made; those devoted to the liver are scheduled to be presented second to accommodate walking time from the Imaging Conference.

Gastroenterology Grand Rounds

This CME conference is held 8-9 a.m. Thursdays. Two 30-minute presentations are made; those devoted to the liver are scheduled to be presented second to accommodate walking time from the Imaging Conference.

Medicine Grand Rounds

The Department of Medicine conducts Grand Rounds on Thursdays from 12:15-1 p.m. Fellows and faculty are encouraged to attend those related to hepatobiliary topics.

Gastroenterology Research Forum

This basic and clinical research seminar is held on Thursdays from 4-5 p.m. Invited speakers present results of research in gastroenterology and hepatology. Fellows and faculty are encouraged to attend lectures related to hepatology and liver transplantation.

Medical Review Board

This meeting, held on Fridays from 7-8:30 a.m., is a formal patient selection conference for our OLT program. It is attended by transplant surgeons, all transplant hepatologists, transplant consultants in psychiatry, cardiology, nephrology, transplant nurse coordinators, social workers, dietician and fellows in hepatology and liver transplantation and gastroenterology. Each candidate for OLT listing is presented and discussed in detail and consensus decisions are made. Patients whose circumstances have changed are also represented.

Hepatopathology Conference

This conference is conducted from 1-2 p.m. Fridays by a faculty hepatopathologist who projects, reviews and discusses liver biopsy slides generated by us or sent from outside institutions. In addition, we review OLT explants, hepatobiliary resections. This conference emphasizes critical appraisal and appreciation of the role of liver biopsy in formulating a diagnostic and therapeutic plan.

Advanced Liver Therapies, our program’s clinical research center, is directed by John M. Vierling, M.D., who serves as principal investigator for sponsored studies with all hepatology faculty members serving as sub-investigators. The staff includes an administrator, regulatory specialist, several full-time research coordinators and a laboratory and drug dispensing coordinator.

Facilities include examination rooms, sample preparation rooms, -80 degree Celsius freezers, conference rooms and consultation rooms. Investigator-initiated and industry-sponsored phase I-III trials are conducted on-site or at any of the hospitals staffed by BCM faculty. John A. Goss, M.D., program director for Liver Transplantation is the Principal Investigator for trials involving post-OLT immunosuppression or other therapies.

Fellows participate in clinical research by reviewing new and ongoing studies weekly during the research conference, assessing inclusion and exclusion criteria for studies in patients seen in the inpatient and outpatient settings, learning the basics of regulatory requirements and preparation of IRB submissions and performing clinical examinations of selected research patients.

We encourage each fellow to identify at least one specific topic of personal interest and to work closely with faculty mentors to formulate scholarly projects that can be finalized and submitted for publication within the 12-month training period. In addition, fellows are often invited by faculty members to co-author invited reviews and book chapters.