Hepatology Responsibilities for GI Fellows: Update
Inpatient service
1. The GI fellow should function as a “consultant” and should take personal responsibility for the overall
care of each patient on the liver service. The attending should be the fellow’s “consultant”. Residents
and medical students, if present, are there for education and do not obviate patient care responsibilities.
At the end of the day, it is the fellow who will ultimately be expected to know the patient’s clinical course.
2. The fellow should assist in arranging admissions and hospital transfers along with the hepatology nurses
– particularly after hours. These need to be coordinated with the hospitalist team. The fellow should
obtain clinical information (reason for admission, plan, etc.) from the admitting hepatologist and relay this
to the hospitalist team.
3. Fellows will be informed of scheduled admissions by the appropriate hepatology nurse. The fellow should
communicate information about these admissions to the hospitalist team prior to the scheduled
admission.
4. The fellow should coordinate all GI procedures on liver inpatients.
5. The fellow should coordinate and write orders for any pre-transplant evaluation testing, except for PFTs
and cardiac stress tests, which will be coordinated by the hospitalist team.
6. The fellow should coordinate discharge care and orders with the hospitalist service. Patients who are
under the outpatient care of a hepatologist should have their home-going prescriptions written by the
attending hepatologist. Discharge plans that involve outpatient laboratory tests, radiologic imaging or
other tests prior to their next clinic visits should be communicated to the appropriate primary liver
nurse/attending to optimize continuity of care.
7. The fellow and inpatient liver attending should meet every day (M-F) at 1:30 pm in the 4NW conf room
with the hospitalist teams to discuss patient management. If the attending cannot be present, the fellow
should attend by himself/herself.
8. The fellow should dictate a brief discharge note addressed to the referring MD (found on Oacis letters) on
any patient who will subsequently follow-up with hepatology after discharge, or who was transferred to
UCH for a primary liver problem. This note may be dictated using the service attending’s
name/passcode, but may also be sent as an email attachment to the service attending. This note should
contain the following key essential elements:
a. Date and reason for admission and date of discharge.
b. Brief summary of the hospital course including results of major interventions.
c. A complete list of the discharge medications and instructions.
9. The fellow should communicate with the Transplant Surgery fellow as frequently as needed, particularly
on issues involving inpatients who are active on the liver transplant list.
Outpatient Fellow (Research month)
1. The ambulatory fellow should be present at 8 am T-F for liver biopsies in the GIPR. Adjustments may
have to be made for continuity clinic. The fellow is responsible for checking to determine that recent
coags have been performed and are acceptable for a safe biopsy. The fellow will make certain that the
biopsy samples arrive safely in Pathology, and should meet at 3 pm in Pathology to review the
preliminary biopsy results.
2. The ambulatory fellow should attend at least 2 half day liver clinics with a liver attending each week.
3. Only the clinic attending can excuse a fellow from the outpatient responsibility.
Teaching
1. The fellow should help coordinate a time for attending teaching each day.
2. The fellow is responsible for daily teaching of medical students and residents, whether or not the
attending is available. These topics should focus on common GI/liver problems. In addition, the fellow
should conduct bedside teaching with the residents/students to point out physical examination findings.
Updated 7/25/07
Conferences
1. The fellow is responsible for attending the weekly Multidisciplinary Liver Transplant Meeting. Patients
who are being considered for liver transplantation, are awaiting liver transplantation, or have received
liver transplants, are discussed during this meeting.
2. The fellow is responsible for submitting the list of patients whose liver biopsies should be reviewed at the
Liver Path conference. This list should consist of, but is not limited to, interesting cases (non-hepatitis C
and non-fatty liver disease), challenging cases, and all post-liver transplant biopsies.
3. The fellow is responsible for submitting the list of inpatients whose radiological imaging need to be
reviewed at the Liver Radiology Conference.
Evaluations
Fellow evaluations will be based in part on satisfactory fulfillment of these responsibilities.
Donald Jensen, MD
Helen Te, MD
Smruti Mohanty, MD
Gautham Reddy, MD
Nancy Reau, MD
Rohit Satoskar, MD
Updated 7/25/07