The gastroenterology rotation at Kaiser Permanente® is rarely a first-year rotation. The fellow will receive all consultations and determines the urgency of the consult. The fellow will see the patient and make initial recommendations. All consults are presented by the fellow to the attending within 24 hours of consult receipt on attending rounds and sooner if it is an urgent (4-8 hours) or emergency (1-2 hours) consult.
Fellows do not see any patients if they are on a "non-teaching" service.
Occasionally, first-year fellows are assigned this rotation. First-year fellows are expected to be very closely supervised by attending physicians in terms of inpatient GI and Hepatology consults, presentations, and endoscopic procedures. Fellows are learning how to efficiently conduct inpatient GI consultations, learning how to perform basic EGD and colonoscopies, and starting to learn therapeutic procedures (i.e., not actively bleeding variceal and non-variceal hemostasis and non-complex polypectomy). They usually do not participate in advanced procedures such as ERCP. All endoscopic procedures are supervised by an attending physician who is present in the room.
This rotation is predominantly for second- and third-year fellows. The fellow receives all consultations and either personally or by supervising students/interns/residents assesses the consults and presents the consult to the attending physician. Fellows are expected to need less supervision by the attending physician. Second- and third-year fellows are expected to provide more complete GI consultations, expected to run the service with supervision by the attending physician, expected to be comfortable performing basic EGD and colonoscopies, and be comfortable performing therapeutic procedures (i.e., actively bleeding variceal and non-variceal hemostasis and complex polypectomy). They may participate in advanced procedures such as ERCP. All endoscopic procedures are supervised by an attending physician who is present in the room.