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 YearFifth Postgraduate YearSixth Postgraduate Year
Gastroenterology inpatient consult5 monthsGastroenterology5 monthsGastroenterology2 months
Hepatology inpatient3 monthsHepatology2 monthsHepatology1 month
Elective2 monthsElective4 monthsElective7 months
Radiology1 monthResearch1 monthResearch2 months
Research1 monthContinuity ClinicOnce a weekContinuity ClinicOnce a week
Continuity ClinicOnce 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.

DayTimeConference & Rounds
Tuesday12:00pm-1:00pmBoard Review (Last Tuesday of the month)
Tuesday1:00pm-3:00pmCase Conference, research, quality improvement (conferences rotate)
Wednesday12:00pm-1:00pmPathology at Cedars-Sinai
Thursday12:00pm-1:00pmJournal Club, Biliary conference, M&M, Grand Rounds  (conferences rotate)
Friday8:00am-9:00amUCLA Core Curriculum Lecture
DailyVariesDaily 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.

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)

  • Kwok KK, Ngor Eunis W and Wu BU.  “Comorbidities should be considered in the management of cystic neoplasms of the pancreas”.  Oral presentation, Digestive Disease Week 2014., Chicago IL.
  • Reddy K, Yu W, Bebchuk J and Wu BU. “Gastric intestinal metaplasia and risk of gastric cancer”.  Poster presentation, Digestive Disease Week 2014, Chicago IL.
  • Yeh, JL, Ma S and Wu, BU.. “Regional variation in costs for acute pancreatitis”, oral presentation, Annual meeting of the American Pancreas Association, November 2013, Miami FL.
  • Nwe Z, Anand N and Wu, BU. “Disparities in treatment and survival in pancreatic cancer can be reduced: findings from a regional integrated healthcare system”. Poster presentation, Annual meeting of the American Pancreas Association, November 2013, Miami FL.
  • Tran A, Ngor EW and Wu BU.  “Risks and benefits of surveillance colonoscopy in the elderly”. Presidential plenary, Annual scientific meeting of the American College of Gastroenterology, October 2013, San Diego, CA.

Recent publications (faculty and fellows)

  • Wu BU, Longstreth GF, Ngor EW.  Colonoscopy versus sigmoidoscopy for average-risk screening: implications of a negative exam for prevention of colorectal cancer and racial disparities.  Gastrointestinal Endoscopy [in press]
  • Wu BU, Pandol SJ, Liu IL.  Simvastatin is associated with reduced risk of acute pancreatitis: findings from a regional integrated healthcare system.  Gut. 2014 Apr 17. doi: 10.1136/gutjnl-2013-306564. [Epub ahead of print]
  • Wu BU, Sampath K, Berberian CE, Kwok KK, Lim BS, Kao KT, Giap AQ, Kosco AE, Akmal YM, Difronzo AL, Yu W, Ngor EW.  Prediction of malignancy in cystic neoplasms of the pancreas: a population-based cohort study.Am J Gastroenterol. 2014 Jan;109(1):121-9; quiz 130. doi: 10.1038/ajg.2013.334. Epub 2013 Oct 1
  • Wu BU, Banks PA. Clinical management of patients with acute pancreatitis. Gastroenterology. 2013 Jun;144(6):1272-81. doi: 10.1053/j.gastro.2013.01.075. Review.
  • Anand N, Sampath K, Wu BU. Cyst features and risk of malignancy in intraductal papillary mucinous neoplasms of the pancreas: a meta-analysis.  Clin Gastroenterol Hepatol. 2013 Aug;11(8):913-21; quiz e59-60. doi: 10.1016/j.cgh.2013.02.010. Epub 2013 Feb 13. Review.
  • Cheng DW, Lu YW, Teller T, Sekhon HK, Wu BU.  A modified Glasgow Blatchford Score improves risk stratification in upper gastrointestinal bleed: a prospective comparison of scoring systems. Aliment Pharmacol Ther. 2012 Oct;36(8):782-9. doi: 10.1111/apt.12029. Epub 2012 Aug 28