Fellows generally are on the Night/Weekend Call rotation mostly in their first and second year, little if any in their third year. This rotation is for one week at a time from Friday to Thursday, including the weekend, nights, and holidays. There are no students, interns, or residents on this service. Fellows refer to the on-call Gastroenterology attending for the week. There is an on-call Hepatology attending for complex liver patients.
The types of patient consults generally relate to acute gastrointestinal bleeding, bowel obstruction, abdominal pain, pancreatitis, choledocholithiasis, complications of cirrhosis, diarrhea, vomiting, constipation, and esophageal food impaction.
Fellows are responsible for receiving all new inpatient consults, follow-up on all existing consult patients on the UC San Diego Medical Center - Hillcrest GI and Hepatology inpatients, Thornton Inpatient, and VAMC GI inpatient consult services. Fellows also answer after-hours patient phone calls for the GI Division.
Fellows see consults either emergently (1-2 hours) or urgently (3-16 hours). Fellows must present every new consult to the attending physician to review case and management plans. Urgent or emergency endoscopies are done with the attending physician present for the entire case. Endoscopic cases usually involve treatment of esophageal food impactions, diagnosis and treatment of upper and lower gastrointestinal bleeding, and include both variceal and non-variceal bleeding.
First-year fellows are expected to require a large amount of attending input during their first six months (i.e., frequent phone calls/meetings with attendings to review patient data and recommendations); then less input during their next six months than when they are second- or third-year fellows. Second- and third-year fellows are expected to be able to make decisions and appropriately manage and triage consults and phone calls.