Department of Medicine

Transplant Hepatology Fellowship Program

Rotations Description

Inpatient/Transplant: All transplant patients admitted to the Liver Service or medical services, including those in the intensive care units, will be followed by the fellow and the service hepatologist. They will function as the primary consultants for the assigned medical housestaff. An average of 75 patients are admitted to the service each month, along with about 10 new liver transplants per month. The fellow is involved with all aspects of inpatient transplant management. Daily rounds occur with the Transplant Surgeons and staff. In addition, each fellow is expected to participate in three cadaveric liver procurements and three liver transplantations. This is an unique opportunity to learn anatomy and gain an understanding of the “surgical” issues that arise in the peritransplant period. All associated procedures are performed by the fellow, including liver biopsies and paracentesis. The trainee will be also exposed to the evaluation of at least five adult-to-adult living donor liver transplantations.

Outpatient: This rotation involves extensive training in the evaluation of liver disease patients and procedures in the outpatient setting. The fellow will participate in one half-day general liver clinic (Shands and/or VAMC), one half-day liver failure clinic, and two half-day liver transplant clinics per week. In addition the fellow will participate in two half-day endoscopy clinics and will concentrate on liver biopsies. We currently perform about 1,000 liver biopsies per year and train fellows to use ultrasound guidance techniques. The trainee follows at least 20 new liver transplant recipients for a minimum of 3 months from the time of transplantation. The trainee is involved in the follow up of 30 or more liver transplant recipients who survived more than 1 year after liver transplantation to gain familiarity and expertise with the management of common long term problems (e.g., cardiovascular disease, nephrotoxicity, etc.). The trainee will participate in transplant recipient medical care, including acute cellular rejection, recurrent disease, infectious diseases, and biliary tract complications. During the outpatient rotation the trainee will have the opportunity to interact with the liver transplant coordinators and serve as a primary member of the transplantation team and participate in making decisions about immunosuppression.

Research: This rotation is protected for the pursuit of either clinical or basic research efforts. Fellows are paired with a mentor, who guides them through their research projects. All post-doctoral trainees will be encouraged to apply for other sources of funding at the end of the fellowship year in order to facilitate the transition to junior Faculty. A growing number of funding sources are available including: K08 mentored Clinical Scientist Development Award for laboratory-based trainees; K23 Mentored Patient-Oriented Research Career Development Award for patient-based research trainees; K30 Advanced Postgraduate Program in Clinical Investigation (APPCI) funding supported by the NIH award to UF; Individual National Research Service Awards; the Howard Hughes Medical Institute Postdoctoral Fellowship for M.D.s; American Liver Foundation Research Scholar Awards; American Digestive Health Foundation Research Awards; and/or the AASLD Physician Research Development Awards funded by various pharmaceuticals through non-directed educational grants.

In addition, relevant workshops, mini-symposia and seminars produced by the Education and Training Core Laboratory (ETCL) of the University’s Interdisciplinary Center for Biotechnology Research (ICBR). This facility is dedicated to the promotion of the use of current Molecular Biology Tools across disciplines. The workshops target graduate students and faculty who are interested in applying Molecular Biology methodology to their research, but do not have the necessary experience or background to appreciate the potential and limitations of the techniques. Instruction is provided in a highly interactive setting by both ICBR staff and invited experts. Each event is designed to foster interdisciplinary activity as participants come from diverse fields in keeping with our theme of collaborative research.

For fellows interested in a career in clinical research they will have the opportuinity to participate in the Science of Clinical Research which is an intensive 30-hour graduate credit course that was initiated in 1995 by the General Clinical Research Center (GCRC) and the College of Medicine. It is open to junior faculty and subspecialty trainees interested in furthering their understanding of clinical research. The course topics address basic elements of grantsmanship, funding opportunities, regulatory issues, clinical trial design, and biostatistical considerations. Although this curriculum targets clinical investigators, it will also prove valuable to basic investigators and trainees moving into translational projects.

Each postdoctoral fellow will be encouraged to attend appropriate modules offered by the IDP program as necessary to fill any gaps in their academic knowledge base. In addition, fellows will be required to participate in the Issues in the Responsible Conduct of Research Module. This is graduate-level course addressing laws, policies, guidelines and principles concerning the conduct of research in an ethical manner. The curriculum entails presentation and discussion of fundamental ethical issues, guiding principles and potential pitfalls, responsible conduct of research, and grantmanship. This research training is designed to ensure that upon completion of our program, the trainees possess the necessary technical skills and current scientific knowledge that are required to launch them into a career as an independent investigator.

Weekly Schedule for Inpatient Rotation, See Appendix A

Weekly Schedule for Outpatient Rotation, See appendix B