Advanced Inflammatory Bowel Disease Fellowship

Program Overview

Background

The IBD Center at Boston Medical Center offers specialized multidisciplinary care to patients suffering from Crohn’s disease or ulcerative colitis. Our staff work together to provide advanced ongoing care to help patients manage their conditions. The IBD center includes gastroenterologists, colorectal surgeons, nurse practitioners, radiologists, pathologists, rheumatologits, psychiatrists, obstetricians and gynecologists, and nutritionists. We have 3 gastroenterologists, one NP with expertise in IBD, 3 colorectal surgeons, 1 psychologist, GI nutritionist, GI pharmacist, 4 GI radiologists, 3 GI pathologists, 2 dermatologists, 2 RNs, as well as staff from OB/GYN, nutrition, behavioral health and rheumatology. Our colorectal surgeons see patients in the same physical space as the IBD staff allowing immediate access to consultations between the two services.

 

The IBD Center at BMC has seen over 1600 unique IBD patients over the past few years. The IBD Center has successfully participated in CCF Research Alliance studies, multiple investigator initiated studies and large pharmaceutical trials.

 

The Section of Gastroenterology at Boston Medical Center and the BU School of Medicine has 10 GI fellows (three per year) including one advanced IBD fellow. We perform 13000 endoscopic procedures per year and see over 14000 patients in the outpatient offices. There are 14 MDs, 2 NPs, 2 PA, 1 RD and 1 psychologist in the section. NIH funding for the GI section is approximately $2 million per year?. We have trained 22 fellows over the past 5 years.

 

Rationale for Advanced IBD Fellowship

The management of IBD is increasingly complex and marked by delays in diagnosis and wide treatment variation, attributable in part to gaps in knowledge of the range of available diagnostic and treatment options, including efficacy, safety, and side effects.1 Furthermore, the disease state often requires individualized management comprised of a combination of surgical and medical therapies, with emerging therapies currently under investigation. In order to remain current and gain necessary experiential training in research and patient care, an additional year of training is essential to help prepare a GI Fellow with the necessary skills for a career as a practicing clinician or as an academician/clinical investigator.

 

Key IBD Personnel in Gastroenterology and Surgery

Lilani Perera, MD, AGAF, FCCF (GI)                                                                                                             

Dr. Perera is the medical director of the IBD Crohns and Colitis Center in the Section of Gastroenterology at Boston Medical Center.

 

Other Key IBD Personnel in Gastroenterology and Surgery

Sharmeel K. Wasan, MD (GI)

Ansu Norohna, MD (GI)                                                                                                         

Juanita Pelton, PA (GI)

Santia Berberena, PsyD

Olga Beresneva, MD (Colorectal Surgery)

Jennifer Davids, MD, (Colorectal Surgery)

Samatha Rivard, MD,  (Colorectal Surgery)

 

Selection Criteria

Candidates for the Advanced IBD Fellowship will have successfully completed a clinical project in Inflammatory Bowel Disease during their fellowship. The selection committee will reach out personally to the applicant’s mentor and fellowship director to discuss their performance as a GI fellow and potential for a career as an independent IBD clinician and investigator. Applicants with participation in a CCF-endorsed IBD rotation as a fellow are encouraged, but not mandatory.

 

Program Goal for IBD Fellow

To become an independent clinician and clinical investigator in the area of inflammatory bowel disease.

 

Clinical Goals (3 Days of Direct Patient Care – Comprises 70% of Fellowship)

  • Diagnose and treat patients with Crohn’s Disease and ulcerative colitis.
  • Manage the unique needs of the hospitalized IBD patient.
  • Diagnosis and management of hepatobiliary, cutaneous, joint and ophthalmologic manifestations of IBD.
  • Diagnosis and management of disease and treatment related adverse effects in IBD patients.
  • Management of patients with an ileostomy and after IPAA.
  • Treatment of the post-operative IBD patient.
  • Proper use of endoscopic and radiologic procedures to assess and monitor IBD patients.
  • Competence in endoscopy for the IBD patient including dysplasia screening, balloon dilation and chromo endoscopy.
  • Understand the importance of nutritional therapies for the IBD patient.
  • Comprehensive understanding of treatment regimens for patients with IBD, including anti-inflammatory agents, immune modulators and biologic agents.
  • Understanding anticipated future treatments for patients with IBD and where they will fit in the algorithm of IBD treatment.
  • Be cognizant of the costs in the diagnosis and management of the IBD patient.
  • Learn to use intestinal US as a point of care service in IBD

 

Research Goals (1.5 Days Allocated as Research Time – Comprises 35% of Fellowship)

  • Initiate and complete a clinical research project in IBD.
  • Participate in ongoing clinical trials.

 

In addition to the IBD staff, several other faculty members would be available to help in study design, analyses and more, including: Dr. Paul Schroy (decision making); CITISI services and access to TriNetX database. Statisticians are collaborators at the Boston University School of Public Health. Finally, Gastroenterology faculty have appointments at the VA and there are opportunities to perform IBD outcome studies at the VA.

 

Educational / Teaching Expectations

  • Present IBD cases at GI Grand Rounds at least monthly
  • Be present and participate in weekly GI grand rounds, weekly fellow rounds including monthly journal club, weekly IBD Live with the Cleavland Clinic (via video link), biweekly radiology conference and pathology conferences.

 

At the end of the Advanced IBD Fellowship Program, the fellow should have a substantial understanding of our current knowledge of the pathophysiology and epidemiology of IBD. Fellows should have a detailed knowledge of current treatments, including nutritional and biologic therapies for inflammatory bowel disease and to critically evaluate the potential role of newer treatments in the management of these conditions. They will be prepared to independently manage the entire gamut of patients with IBD.

 

 Curriculum and Expectations

  • See a minimum of 20 IBD patients a week in 3 half day (4 hour) clinical sessions (One with Dr. Perera, One with Dr. Wasan, one with Dr Noronha and one independent session with general GI and IBD patients with supervision by Drs. Perera, Wasan or Norohna).
  • Perform 8-10 endoscopic procedures during 3 endoscopy sessions a week with special emphasis on endoscopy in patients with IBD (chromoendoscopy, balloon dilation, etc.)
  • Be involved with care of at least 40 hospitalized IBD patients and with transition of care from the inpatient service to outpatient office practice. Offer guidance to the GI consult team in the management of hospitalized IBD patients
  • Do one independent session of general endoscopy weekly
  • Attend one month on the general GI consult service

 

Outcome Metrics

The Advanced IBD Fellow will meet monthly with members of the leadership to discuss progress and set goals for the remainder of the training. Quarterly, an ACGME Milestones Report will be generated and reviewed with the applicant, which encompasses the six core ACGME domains of Patient Care, Medical Knowledge, Practice Based Learning and Improvement, Systems-Based Practice, Professionalism, and Interpersonal Skills and Communication. The Milestone Report is based on the Internal Medicine Subspecialty Milestones Project. Deliverables of the Advanced IBD Fellow may include, but are not limited to: Presentations at national meetings including ACG, DDW and Crohn’& Colitis congress meetings, publications and academic IBD appointment.

 

Ongoing IBD Research Studies at BMC

  • IBD Qorus
  • Evaluating treatment outcomes and predictors of mucosal healing in perianal and anal Crohn’s disease: Impact of medications, treatment duration, and psychiatric comorbidities
  • Health Literacy in IBD patients by IBD patients
  • REACTO-ASUC: REal-world Analysis of Clinical Treatment and Outcomes in ASUC (A Retrospective Multisite Study
  • Women’s Health in Inflammatory Bowel Disease
  • Use of social media by IBD patients

 

Interested applicants should submit CVs to Dr. Lilani Perera at Lilani.Perera@bmc.org