Goals and Objectives

The purpose of the training program is to provide advanced knowledge of the anatomy, physiology, pathophysiology, and therapeutics of the digestive system, and training in the cognitive and technical skills necessary to provide superlative care to patients with digestive diseases.

Permanente Medicine

A unique aspect of the training program at Kaiser Permanente Los Angeles Medical Center is the opportunity to train within an integrated care setting. Our mission is to provide affordable, high quality healthcare services and to improve the health of our members and the communities we serve. Our vision is to be the model for quality health care in the nation by being the best place to work and the best place to receive care. This philosophy is embedded in the unique curriculum developed here at Kaiser Permanente Los Angeles that is designed to enable our graduates to thrive in a changing healthcare environment.

Clinical Experiences and Rotations

A structured program of gradual advancement is provided for each fellow, with increasing responsibility and autonomy throughout the program. The core training consists of a minimum of 18 months of clinical rotations and weekly continuity clinic as required by the American College of Graduate Medical Education and American Board of Internal Medicine. The first year of training is clinical, highlighting outpatient clinics, consultation services, inpatient rotations and endoscopic procedures.

Individualized training program: in the second and third years of training, the curriculum is tailored to each fellow’s expressed area of interest e.g. therapeutic endoscopy, hepatology, inflammatory bowel disease, pancreatology, motility, and clinical research. Fellows are encouraged to pursue both on- and off-site elective rotations as well as cultivate an area of sub-specialty expertise.  The culmination of this individualized training experience is completion of a focused clinical research or quality improvement project in the fellow’s area of interest.

Required and elective rotations are scheduled throughout the three-year training period. These include rotations on the gastroenterology service, liver service, radiology, electives, and research rotations. Our program has affiliations with UCLA, Cedars-Sinai and other Kaiser Permanente locations throughout the Southern California region for elective rotations.

Fourth Postgraduate Year Fifth Postgraduate Year Sixth Postgraduate Year

Gastroenterology inpatient consult

5 months

Gastroenterology

5 months

Gastroenterology

2 months

Hepatology inpatient

3 months

Hepatology

2 months

Hepatology

1 month

Elective

2 months

Elective

4 months

Elective

7 months

Radiology

1 month

Research

1 month

Research

2 months

Research

1 month

Continuity Clinic

Once a week

Continuity Clinic

Once a week

Continuity Clinic

Once a week

Didactics

Our program has developed a rich didactic schedule which is dedicated to a specific thematic area per month. Didactics are given by faculty, fellows as peer-to-peer teaching, and special invited lecturers. Fellows participate in a monthly board review Q& A and attend weekly core curriculum didactics at UCLA.

An academic skills lecture series, including instruction on issues such as how to write a manuscript, review a talk, give a presentation, prepare a research protocol, and write a grant proposal. Further guidance is provided for practical instruction in and application of procedural techniques, teaching and research.
Workshops are provided on issues pertaining to healthcare economics, healthcare policy, healthcare quality, transitioning from fellowship to practice and retirement planning.

Day Time Rotating Conference & Rounds
Monday 12:00 PM – 1:00 PM Case Conference
Tuesday 12:00 PM – 1:00 PM
  • Board Review
  • On-Hands Training Sessions
Wednesday 12:00 PM – 1:00 PM
  • Research Conference
  • Fellows Conference
  • IBD Conference
  • Biliary Case Conference
Thursday 12:00 PM – 1:00 PM
  • Grand Rounds
  • Journal Club
  • Guideline Review
  • M & M
Friday UCLA Core Curriculum Lecture

Daily attending rounds

Training in endoscopy and additional gastrointestinal procedures

In addition to a longitudinal ambulatory endoscopic training experience in both upper and lower endoscopy throughout the 3 year curriculum, our program offers training in a wide array of additional gastrointestinal procedures including the following:

  • High resolution esophageal manometry
  • pH and impedence testing
  • Wireless capsule endoscopy
  • Anorectalmanometry
  • Hydrogen breath test
  • Deep enteroscopy including double-balloon enteroscopy
  • Endoscopic retrograde cholangiopancreatography (ERCP)

In addition to the aforementioned procedures, fellows have the opportunity to gain exposure to endoscopic ultrasound, radiofrequency ablation of Barrett’s esophagus, as well as chromoendoscopy during their elective rotations.

Fellowship FAQ (PDF)

Research

The Center for Digestive Health Research is a collaboration between the Kaiser Permanente Southern California Department of Research and Evaluation in Pasadena and the Division of Gastroenterology at the Los Angeles Medical Center.  Fellows have the opportunity to work with a full-time staff of biostatisticians, programmers and research associates to develop a variety of clinical research projects ranging from traditional epidemiologic studies, health services research to clinical effectiveness.  In addition to an expansive electronic medical record system serving over 3.6 million members, Kaiser Permanente Southern California also maintains several prospective disease registries that can be utilized for clinical research.  A separate clinical trials unit supports numerous ongoing clinical trials in digestive diseases across the region.

Support for fellow research

All fellows are expected to engage in either traditional clinical research projects or quality improvement initiatives.  Up to 10 months of protected research time is available through the course of the 3 year-training program as well as dedicated internal funding to support fellow research projects.  Funding is also available to support fellows in presenting and publishing their work at national meetings.

Recent presentations (faculty and fellows)

Dr. Wu – Recent publications (faculty & fellows

Enhanced Recovery in Mild Acute Pancreatitis: A Randomized Controlled Trial
Dong E, Chang JI, Verma D, Butler RK, Villarin CK, Kwok KK, Chen W, Wu BU.Pancreas. 2019 Feb;48(2):176-181. doi: 10.1097/MPA.0000000000001225.PMID: 30629020 Clinical Trial.

Influence of Ambulatory Triglyceride Levels on Risk of Recurrence in Patients with Hypertriglyceridemic Pancreatitis
Wu BU, Batech M, Dong EY, Duan L, Yadav D, Chen W.Dig Dis Sci. 2019 Mar;64(3):890-897. doi: 10.1007/s10620-018-5226-x. Epub 2018 Aug 9.PMID: 30094622

Cachexia, and not obesity, prior to pancreatic cancer diagnosis worsens survival and is negated by chemotherapy
Hendifar AE, Chang JI, Huang BZ, Tuli R, Wu BU.J Gastrointest Oncol. 2018 Feb;9(1):17-23. doi: 10.21037/jgo.2017.11.10.PMID: 29564167

Impact of Integrated Health Care Delivery on Racial and Ethnic Disparities in Pancreatic Cancer
Chang JI, Huang BZ, Wu BU.Pancreas. 2018 Feb;47(2):221-226. doi: 10.1097/MPA.0000000000000981.PMID: 29329156

Board Review Vignette: PPP Syndrome: Pancreatitis, Panniculitis, Polyarthritis
Dong E, Attam R, Wu BU.Am J Gastroenterol. 2017 Aug;112(8):1215-1216. doi: 10.1038/ajg.2017.203. Epub 2017 Jul 25.PMID: 28741613

Competing Risks for Mortality in Patients With Asymptomatic Pancreatic Cystic Neoplasms: Implications for Clinical Management
Kwok K, Chang J, Duan L, Huang BZ, Wu BU.Am J Gastroenterol. 2017 Aug;112(8):1330-1336. doi: 10.1038/ajg.2017.141. Epub 2017 May 23.PMID: 28534524

Patient Preferences for Management of Cystic Neoplasms of the Pancreas: A Cross-Sectional Survey Study
Verma D, Kwok KK, Wu BU.Pancreas. 2017 Mar;46(3):352-357. doi: 10.1097/MPA.0000000000000756.PMID: 28099258

Influence of Statins and Cholesterol on Mortality Among Patients With Pancreatic Cancer
Huang BZ, Chang JI, Li E, Xiang AH, Wu BU.J Natl Cancer Inst. 2016 Dec 31;109(5). doi: 10.1093/jnci/djw275. Print 2017 May.PMID: 28040693

Dr. Kwok – Recent publication (faculty & fellows)

The effect of prophylactic hemoclips on the risk of delayed post-endoscopic mucosal resection bleed for upper and lower gastrointestinal lesions: a retrospective cohort study
Chang K, Lee BS, Tekeste T, Nguyen A, Adeyemo M, Girgis A, Kwok KK, Crowson HM, Burris AO, Attam R, Chaya CT, Durbin TE, Giap AQ, Hunt GC, Iskander J, Kao KT, Lim BS.BMC Gastroenterol. 2020 Mar 6;20(1):60. doi: 10.1186/s12876-020-01199-x.PMID: 32143633

Impact of direct-acting oral anticoagulants and warfarin on postendoscopic GI bleeding and thromboembolic events in patients undergoing elective endoscopy
Tien A, Kwok K, Dong E, Wu B, Chung J, Chang J, Reynolds K.Gastrointest Endosc. 2020 Aug;92(2):284-292.e2. doi: 10.1016/j.gie.2020.02.038. Epub 2020 Feb 29.PMID: 32126220

Endoscopic ultrasound-guided transmural gallbladder drainage in malignant obstruction using a novel lumen-apposing stent: a case series (with video)
Chang JI, Dong E, Kwok KK.Endosc Int Open. 2019 May;7(5):E655-E661. doi: 10.1055/a-0826-4309. Epub 2019 May 2.PMID: 31058208

Enhanced Recovery in Mild Acute Pancreatitis: A Randomized Controlled Trial
Dong E, Chang JI, Verma D, Butler RK, Villarin CK, Kwok KK, Chen W, Wu BU.Pancreas. 2019 Feb;48(2):176-181. doi: 10.1097/MPA.0000000000001225.PMID: 30629020 Clinical Trial.

Patient Preferences for Management of Cystic Neoplasms of the Pancreas: A Cross-Sectional Survey Study
Verma D, Kwok KK, Wu BU.Pancreas. 2017 Mar;46(3):352-357. doi: 10.1097/MPA.0000000000000756.PMID: 28099258

A novel adjunctive cleansing method to reduce colony-forming units on duodenoscopes
Kwok K, Chang J, Lo S, Giap A, Lim B, Wu B.Endosc Int Open. 2016 Nov;4(11):E1178-E1182. doi: 10.1055/s-0042-116490. Epub 2016 Oct 20.PMID: 27853743

EUS-FNA of a Compressive Left Ventricular Intrapericardial Mass
Chang JI, Kwok KK.Am J Gastroenterol. 2016 Sep;111(9):1229. doi: 10.1038/ajg.2016.129.PMID: 27580774