Mission

The Mission of the NCC Fellowship in Pediatric Gastroenterology is to develop skilled, empathetic, well-rounded clinician-educators, and high-caliber military officers who are well-prepared for the unique aspects of clinical practice within the Military Health System (MHS). Emphasis is placed on clinical proficiency in the full spectrum of general pediatric gastroenterology, nutrition, military systems-based practice, relevant scholarly activity, quality improvement, and leadership.

Vision

The Tri-Service 3-year National Capital Consortium Fellowship in Pediatric Gastroenterology trains clinically, academically, and operationally versatile gastroenterologists who excel in military medicine.

Aims

• Aim 1: Develop skilled, well-rounded, and empathic clinicians who are prepared for the unique aspects of evidence-based practice in the MHS and pass their boards on the first attempt.
• Aim 2: Develop outstanding educators who serve as core teaching faculty in military graduate and undergraduate medical education programs.
• Aim 3: Develop academically proficient pediatric gastroenterologists well prepared to conduct scholarly activity and mentor others through relevant research and quality improvement projects within the military system.
• Aim 4: Develop high caliber, resilient military officers, well prepared to serve as subject matter experts and innovative leaders in military medicine.

The didactic curriculum includes several regularly scheduled conferences which occur weekly on Thursday afternoons. Pediatric Gastroenterology fellows will present several didactic lectures in this forum annually. Fellow participation in conferences is mandatory and staff participation is expected. The conferences which comprise this curriculum include the following:

1. Pediatric GI Journal Club meets monthly. Current, relevant journal articles are presented, analyzed and discussed in-depth by a fellow with a faculty mentor.
2. Pediatric GI Pathology Conference, in which histology from all cases from the preceding week are reviewed, occurs on Thursdays at 2 p.m.
3. Pediatric Radiology Conference occurs on Thursdays at 2:45 p.m. (or immediately following completion of Pediatric GI Pathology conference).
4. Clinical Management Conference is held weekly on Thursday afternoons at 3:30 p.m. Inpatients and complex outpatients are discussed at this conference.
5. Pediatric Surgery Conference is held quarterly, times/days may vary.
6. Pediatric Gastroenterology Textbook Rounds occur on Thursdays at 1 p.m., weekly.
7. A Clinical Controversies discussion occurs monthly in conjunction with Textbook rounds.
8. Pediatric Nutrition Conference is held monthly on Thursdays from 12 - 1:30 p.m.
9. Pediatric Inflammatory Bowel Disease case discussions are held weekly at 12:30 p.m.

In addition to the Pediatric Gastroenterology and Nutrition Fellowship educational curriculum, Pediatric Subspecialty Combined Fellowship Core Curriculum conferences are held every other month on Wednesday afternoons. This curriculum is designed to meet educational goals and objectives that are common to all the Pediatric Subspecialty Fellows in the NCC.

Elective rotations required for all fellows include two months of Transplant and General Hepatology at Georgetown University Hospital Medstar, three months of Inpatient GI at Inova Fairfax Hospital, and two weeks of Neurogastroenterology and Motility at CNMC.

The designated on-service fellow will be on call beginning at 7:45 a.m. hours on Monday morning until Friday afternoon at 4:40 p.m., at which time the fellow on call for the weekend begins his or her shift, which continues until 7:45 a.m. on the following Monday. All WRNMMC Pediatric Gastroenterology fellow night call is at-home call and thus is subject to ACGME duty hours regulations for at-home call as outlined previously. Clinical on-service time averages 19 weeks during the first year of fellowship, and weekend call is approximately one weekend in four. On-service rotations are usually for one week, the fellow’s call weekend for a particular month may or may not be a weekend adjacent to an on-service week as the weekday and weekend call schedules are made independently. The fellow will always have at least one day in seven free of responsibilities, averaged over a four-week period. Call switching and/or substituting call days as arranged among fellows is permissible. Continuity of patient care must be maintained, and appropriate patient hand-offs ensured.

Our Ped GI military unique curriculum involves a one-month rotation in Global Health and Humanitarian Medicine. As part of this curriculum, the fellows are required to take the Military Medical Humanitarian assistance course sponsored by the Uniformed Services University of Health Sciences (USUHS), and then participate in teaching the GI specific sessions including Diarrhea, Oral rehydration solution, and Nutrition.  Fellows are also required to participate in the Fundamentals of Global Health Engagement Course at USUHS as well. The highlight of this curriculum centers around a one-week humanitarian medicine trip to Honduras working with JTF-B performing nutritional assessments in children living in undernourished communities.

See rotation schedule above.

New fellows will work with an endoscopic simulation trainer as part of their endoscopy curriculum during their orientation to fellowship. The simulator will provide the fellow with some introductory hands-on training with the endoscope and its basic features through maneuvering a simulated colonoscopy.

Fellows are provided a plethora of opportunities to present complex patients in a public forum at the local, regional, national, and sometimes international level. Fellows are encouraged to participate in hospital committees and as fellow representatives within National Societies. Local leadership programs such as the “Leadership 2.0” curriculum and fellow/faculty development is highly encouraged as well.

The research experience will begin the first year with attendance at introduction to research didactic and training sessions as well as with clinical involvement. Clinical exposure will provide an introduction to clinical deficiencies of scientific evidence. Individual research projects are determined during the second half of the first year and protected research time for individual research projects begins during the second year. During years 2-3 the fellow has approximately ~ 70% protected time for research. Each fellow is assigned a specific scientific oversight committee (SOC) for the research experience. The SOC along with their research mentor and program director will provide guidance for the fellow in their progress through a research project. The timeline for progress will vary depending on types of projects and areas of research chosen but the fellow will prepare a written individualized research plan and present this to their SOC twice per year outlining their progress and plans. It is the responsibility of the SOC and Program Director to remind each fellow that the expected progress of project development, from initial study approval to manuscript development.

Patient safety is a major emphasis in the training of fellows. Each fellow is expected to participate in a Quality Improvement (QI)/Process Improvement (PI) project throughout their fellowship. This process will include didactics as well as direct work in the area of QI/PI. Formal education and training in this field may be accomplished in multiple ways:

• Participation in the WRNMMC Department of Pediatric QI/PI sessions. These are held monthly and provide basic structure for QI/PI and a venue for sharing of departmental-wide efforts in this area.
• Quality Rocks: This hospital-based didactic series is offered multiple times per year and serves as the institutional-wide effort to educate trainees and faculty in QI and Patient Safety.
• Training courses: Completion of the Institute for Healthcare Improvement (IHI) Open School basic course, A3 Yellow Belt course or DHA Lean Leader course, Clinical Quality Management course, Patient-Centered Caring Communication Initiative, and TeamSteps all contribute to a better understanding of quality and process improvement. 

• Fellows participate in fellow/faculty development courses designed to improve their educator skills as part of the Pediatric Subspecialty Core curriculum.  Examples include: “Precepting,” “Presentation Optimization,” “Teaching Patient Safety Every Day,” and “Bedside Teaching.”
• Additional faculty/fellow development lectures are offered through USUHS and are counted toward three separate 30-hour certificates in the areas of “teaching,” “academic leadership,” and “scholarship and research.”
• All of the fellowship military unique curriculum and required courses listed in the sections above serve to enhance fellow knowledge and promote professional development.

Rotations that occur outside Walter Reed include:

• Georgetown University Hospital Medstar
• Childrens National Medical Center
• Inova Fairfax Hospital
• NIH

MS4 elective rotations are offered at various times throughout the academic year, deconflicted with resident rotations, and may be requested through the General Pediatric Residency Program starting on the first Monday in December each year. Resident elective rotations are prioritized and offered throughout the academic year through the Chief Resident at schedule selection. Electives by non-National Capital Consortium military residents are offered upon request.

The Pediatric GI Fellowship hopes to recruit a diverse group of highly motivated individuals with interest and varying levels of military medicine experience across the Army, Navy, and Air Force. Please reach out to our Program Coordinator via email dha.ncr.walter-reed-med-ctr.list.ncc-pedsgastro@health.mil to set up an interview or rotational experience.

Program graduates take the American Board of Pediatrics’ Pediatric Gastroenterology Certification exam. This exam is offered biennially. To become fully board certified, applicants are eligible to take board certification exam in the month of November during odd years (i.e., 2025, 2027, etc.). To be eligible to take Pediatric Gastroenterology specialty board exams, graduates must complete all pre-requisites required by the American Board of Pediatrics and have a verification of training completed by October 30th of the exam year.

Fellows develop their individual teaching skills through a variety of activities. Each year, all fellows will give 3-4 didactic lectures on various GI “textbook topics” to the GI division, as well as one more formal lecture to the whole pediatric department during morning report. While fellows are on inpatient service, they will give informal presentations and lead discussions for the pediatric residents on the ward. Finally, during their junior attending rotation, they are expected to lead clinical based teaching sessions during rounds for other junior fellows and residents.

Fellows have the opportunity to give medical student small group classes as part of the undergraduate medical education at the University of Uniformed Services, teach part of the Military Humanitarian Assistance Course and supervise the objective structured practical examination for the NCC Pediatric Residency Program. During their final year of fellowship, they also provide a Grand Rounds presentation of their fellowship scholarly activity.

Our extensive team of faculty have a wide breath of academic, research, and professional experience. All are board certified Pediatric Gastroenterologists and have areas of focus for research to include GI disease in Autism, Eosinophilic Esophagitis, COVID-19, Alpha-gal, Constipation action plan development, Celiac disease, foreign body ingestions, as well as other military-relevant topics. Most faculty have earned the academic rank of Associate Professor or Professor.

In addition to oversight and feedback from the Clinical Competency and the Scholarly Oversight Committees, fellows work with individual faculty advisors on their quality improvement projects and research. Fellows are highly encouraged to participate in military service-specific or academic mentorship programs available through WRNMMC and USUHS.

The Pediatric Gastroenterology Fellowship hosts two off-site events to support program improvement and celebrate recent graduates each year. As part of the Pediatric Subspecialty Core curriculum, the five fellowship programs in Pediatric Infectious Diseases, Endocrinology, Gastroenterology, Hematology-Oncology, and Neonatology participated in a retreat which included an “Art in Medicine” activity and highlighted adaptive perspectives as useful for countering burn-out and improving resilience.