Gastroenterology Los Angeles Medical Center - Curriculum

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.

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.

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)

Divergent Recommen-dations for Management of Gastric Intestinal Metaplasia vs Barrett’s Esophagus: A Matter of Social Justice. 
Dong E, Wu BU. Am J Gastroenterol. 2021 Apr;116(4):842-843. doi: 10.14309/ajg.0000000000000977. PMID: 33982968

Syphilitic Proctitis Presenting as a Rectal Mass: a Case Report and Review of the Literature. 
Costales-Cantrell JK, Dong EY, Wu BU, Nomura JH. J Gen Intern Med. 2021 Apr;36(4):1098-1101. doi: 10.1007/s11606-020-06414-9. Epub 2021 Jan 19. PMID: 33469766

Long-term follow-up of branch-duct intraductal papillary mucinous neoplasms with No change in first 5 Years of diagnosis.
Lee BS, Nguyen AK, Tekeste TF, Chang K, Girgis A, Adeyemo M, Hanna MS, Yao JF, Kwok KK, Giap AQ, Hunt GC, Chaya CT, Kao KT, Attam R, Ko A, Pio JR, Tovar S, Lim BS. Pancreatology. 2021 Jan;21(1):144-154. doi: 10.1016/j.pan.2020.10.040. Epub 2020 Oct 21. PMID: 33309223

Prevalence and Characteristics of Chronic Hepatitis C Among Asian Americans Are Distinct From Other Ethnic Groups.
Tien A, Sahota A, Yang SJ, Balbuena R, Chang M, Lim C, Fong TL. J Clin Gastroenterol. 2020 Oct 16. doi: 10.1097/MCG.0000000000001447. Online ahead of print. PMID: 33074947

Response. 
Tien A, Kwok K. Gastrointest Endosc. 2020 Sep;92(3):797-798. doi: 10.1016/j.gie.2020.05.024.PMID: 32838922

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

Identification of Individuals at Increased Risk for Pancreatic Cancer in a Community-Based Cohort of Patients With Suspected Chronic Pancreatitis. 
Jeon CY, Chen Q, Yu W, Dong EY, Chung J, Pandol SJ, Yadav D, Conwell DL, Wu BU. Clin Transl Gastroenterol. 2020 Apr;11(4):e00147. doi: 10.14309/ctg.0000000000000147.PMID: 32352677

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