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Osteopathic Gastroenterology Fellowship

Applications for the Parkview Medical Center Osteopathic Gastroenterology Fellowship Program are done through ERAS. If you are interested in more information, please contact Megan Sefcovic, Program Coordinator, 719-584-4980.

General Objectives of the Osteopathic Gastroenterology Fellowship Program

The Fellowship programs seeks to provide candidates with the opportunity to become consultant level subspecialists, qualified to function as independent resources for the communities in which they practice. The Fellowship program provides an intensive clinical exposure, an extensive didactic program, in which the Fellow is expected to actively participate, both as a student and a trainer, and an introduction to clinical research. While opportunities to participate in active research projects are available, this is not a research based fellowship program and candidates anticipating careers as physician-researchers are encouraged to seek training in programs more closely suited to their chosen career paths.

CLINICAL EXPERIENCE Fellows have formal instruction, clinical experience, and demonstrate competence in the evaluation and management of the following disorders:

  • Disease of the esophagus
  • Acid peptic disorders of the gastrointestinal tract
  • Motor disorders of the gastrointestinal tract
  • Irritable bowel syndrome
  • Disorders of nutrient assimilation
  • Inflammatory bowel diseases
  • Vascular disorders of the gastrointestinal tract
  • Gastrointestinal infections, including retroviral, mycotic, and parasitic infections
  • Gastrointestinal diseases with an immune basis
  • Gallstones and cholecystitis
  • Alcoholic liver diseases
  • Cholestatic syndromes
  • Drug-induced hepatic injury
  • Hepatobiliary neoplasms
  • Chronic liver disease
  • Gastrointestinal manifestations of HIV infections
  • Gastrointestinal neoplastic disease
  • Acute and chronic hepatitis
  • Biliary and pancreatic diseases
  • Women’s health issues in digestive diseases
  • Geriatric gastroenterology
  • Gastrointestinal bleeding
  • Cirrhosis and portal hypertension
  • Genetic/inherited disorders
  • Medical management of patients under surgical care for gastrointestinal disorders
  • Management of GI emergencies in the acutely ill patient

Internal Medicine sub specialties have, as their base, excellence in Internal Medicine. The Fellowship Program seeks to build on previously established knowledge and skills. The successful candidate will demonstrate competence in the broad field of Internal Medicine. Excessive exposure to Gastroenterology during an Internal Medicine Residency, thus limiting training in the other aspects of Internal Medicine does not optimally prepare a physician to specialize in these fields. The well-rounded candidate, demonstrating mastery of the primary specialty, will ultimately become a better consultant and physician. During the course of the Fellowship program, the trainee will spend a considerable amount of time on services other than Gastroenterology. These rotations are expected to broaden the knowledge and experience of the Fellow in such areas (i.e. Radiology, pathology, Surgery, Infectious Disease) which impact directly on patients with Gastroesophageal Illness.

This Fellowship program reflects the unique Osteopathic philosophy. As such, structure-function relationships, the integration of all body systems and Osteopathic Manipulative Therapy are integrated throughout the training program.

The program emphasizes graduated responsibility with the Fellow gradually assuming responsibility under the supervision of both the rotation supervisor and the Program Director. It is expected that the trainee will interact closely with attending physicians and other consultants. The Fellow serves as an educator, mentor and supervisor for junior house-staff. The Fellow is also expected to serve as a resource and aid to the Nursing Staff of the Hospital. The Fellow will be assigned to medical staff committees in a nonvoting status with responsibilities commensurate with level of training and skill. Administrative responsibilities are assigned under the supervision of the Program Director. In order to function effectively in the medical environment, the Fellow must become aware of costs, cost containment efforts, and the medical-legal implications of clinical decisions.

Outpatient experience occurs in the private offices of faculty members. Fellows in Gastroenterology are assigned four hours of clinic on average of one clinic a week.

The Fellow is encouraged to prepare an annual scientific paper upon a subject acceptable to the Program Director. The paper is to be suitable for publication, and, following approval by the Program Director should be considered for submission for publication to an appropriate per-review journal. The paper may take the form of an independent research project, a case report and review of the literature or such other form as the Program Director may approve. If the paper is accepted for presentation at a national conference, the program will pay the air fare, room and board, and presentation expenses for the fellow to attend the conference. There may a possibility of coordination with the basic science or translational research departments at CSU-Pueblo for research projects as well.

It is anticipated that the Fellow will maintain membership in the American College of Osteopathic Internists, American Osteopathic Association, and the American College of Gastroenterology. During the course of the Fellowship program the Fellow is encouraged to attend at least one of the annual meetings of these organizations. The choice of meetings is subject to the approval of the Program Director. The goal is for the Fellow to gain exposure to the professional societies they will interact with for the remainder of their career.

The program will pay for each fellow to sit for the Gastroenterology Board Review Course at the end of their third year. Payment will include the cost of the course, airfare, room and board.

The Fellow is expected to gain competence in the clinical and ancillary evaluation of patients presenting with symptoms potentially arising from gastroesophageal illness. Listed below are procedural skills which should be acquired by the trainee during the course of the program. The Program Director, advised by the faculty members, serves as the final arbiter of competence and satisfactory completion of the goals and objectives of the training program.

Technical and other skills

1. Fellows have formal instruction, clinical experience, and must demonstrate competence in the performance of the following procedures. A skilled preceptor must be available to teach and supervise the fellow during these procedures, which must be documented in each fellow’s record, giving indications, outcomes, diagnoses, and supervisor. Assessment is based on a formal evaluation process.

  • Esophagogastroduodenoscopy (EGD) (fellows must perform a minimum of 130 supervised studies).
  • Esophageal dilation (fellows must perform a minimum of 20 supervised studies).
  • Flexible sigmoidoscopy (fellows must perform a minimum of 30 supervised studies).
  • Colonoscopy with polypectomy (fellows must perform a minimum of 140 supervised colonoscopies and 30 supervised polypectomies).
  • Percutaneous liver biopsy (fellows must perform a minimum of 20 supervised procedures).
  • Percutaneous endoscopic gastrostomy (fellows must perform a minimum of 15 supervised procedures).
  • Biopsy for the mucosa of the esophagus, stomach, small bowel, and colon.
  • Gastrointestinal motility studies and 24-hour pH monitoring.
  • Nonvariceal hemostasis, both upper and lower (fellows must perform 25 supervised cases, including 10 active bleeders).
  • Variceal hemostasis (fellows must perform a minimum of 20 supervised procedures).
  • Other diagnostic and therapeutic procedures utilizing enteral intubation.
  • Moderate and conscious sedation.

2. Fellows must have formal instruction and clinical experience in the interpretation of the following diagnostic and therapeutic techniques and procedures:

  • Gastric, pancreatic, and biliary secretory tests
  • Enteral and parenteral alimentation
  • Pancreatic needle biopsy
  • ERCP in all its diagnostic and therapeutic applications
  • Imaging of the digestive system, including:

- Ultrasound, including endoscopic ultrasound

- Computed tomography

- Magnetic resonance imaging

- Vascular radiography

- Contrast radiography

- Nuclear medicine

- Percutaneous cholangiography

Fellowship Curriculum

Clinical

  • 3 years clinical
  • Some research during each of the three years
  • Integrate clinical research and clinical work
  • All fellows do a ½ day continuity clinic per week.

The fellowship training program is a full-time training program that must be of a minimum of 36 months in duration.

  • A minimum of 33 months must include supervised management of patients (clinical rotations).
  • A minimum of 12 months of training must be spent in any combination of the following: inflammatory bowel disease, endoscopic ultrasound transplant medicine, motility, nutrition, hepatology, oncology, biliary tract disease, advanced endoscopy including ERCP.
  • A minimum of 1 month rotation must focus on gastrointestinal motility disorders.

GI Conferences

All GI conferences are scheduled and the schedule put out on New Innovations.

Morbidity and Mortality will be on the forth Monday of the month at 7am.
GI/Surgical Conference will be on the second Wed of the month at noon.
GI/Pathology Conference will be on the third Wed of the month at noon.
GI/Radiology Conference will be on the forth Wed of the month at noon.

Clinical Case Conference will be held on the first, second and third Monday of the month at noon, during which GI fellows present current or recent interesting clinical cases for discussion by the entire GI division about proper diagnostic evaluation and management.

Grand Rounds will be held monthly on the first Wednesday of the month at 7am, for faculty, fellows, and community gastroenterologists that cover broad areas of clinical gastroenterology.

Fellows Journal Club & Research Update To review pertinent GI articles recently published in the literature; to critically review all aspects of a published article. It is also a time for fellows to update the faculty on the progress of their research projects. Journal Club will be held Thursdays before continuity clinic.

Research Seminar is presentations by fellows, faculty, or invited speakers regarding GI basic or clinical research and will be done every four months.

GI Summer Clinical Lecture Faculty review clinical aspects of acute management of common GI diseases. This is an introductory clinical series that goes from July to September each year on Tuesdays at 7am.

Core Curriculum Lecture Series is where fellows learn in depth about basic GI pathophysiology and attain new non-textbook knowledge on focused GI topics in a seminar format through study of literature and input from an assigned expert in the field. Fellows learn how to critically appraise and present recent scientific literature of a focused topic. This follows the GI/Hepatology Summer Clinical Lecture Series and goes from October to June each year.

Ambulatory Clinic

Parkview Gastroenterology operates an ambulatory clinic that will be utilized for Fellowship training with continuity of care.

Parkview Gastroenterology 1600 N. Grand Avenue, Pueblo, CO 81003 Phone: 719-595-7680

The payer mix is 59.2% Medicare, 10% Medicaid, 29.4% HMO/PPO/3rd Party, and 1.5% Self Pay. The approximate annual volume for 2012 was 3,175 patients and the annual number of visits in 2012 was 21,289. The facility has sufficient space and patient volume to accommodate 2 fellows in a continuity clinic for one half day each week. There are opportunities to expand the clinical services and as Parkview provides care to a medically underserved population, it will not be difficult to expand the patient base as needed.

Faculty

Dr. Ruzkowski

Chief of Medicine and Gastroenterology

Dr. Ruzkowski is board certified in Internal Medicine and Gastroenterology and came to Parkview Medical Center from Colorado Springs, CO. He earned his Degree from Chicago Medical School, Chicago, IL. His residency was done at Loyola University College/Edward Hines, Jr. VA Hospital, Hines, IL followed by Fellowship at Loyola University Medical Center, Maywood, IL. Dr Ruzkowski joined the Medical Staff in April, 2004 and works with Parkview Gastroenterology.

Dr. Fernandez

Program Director

Dr. Fernandez has practiced gastroenterology at Parkview Medical Center since he came from the University of Miami where he completed his fellowship in Gastroenterology. Prior to this, he was the Chief Medical Resident at the University of Connecticut.
Dr. Fernandez and a group of excellent physicians founded and started the Parkview Gastroenterology Fellowship where he has been serving as its Program Director.
Dr. Fernandez has written several per review articles and he has published multiple book chapters about Pancreatic-Biliary disease. He is very active in giving presentations in Inflammatory Bowel Disease, and other Gastrointestinal disorders.
Dr. Fernandez, specializes in Colon Cancer Screening, inflammatory Bowel Disease, Biliary-Pancreatic diseases and all Gastrointestinal Disorders, including reflux disease, irritable/inflammatory bowel disease, small bowel pathology, and celiac sprue.
Dr. Fernandez performs all endoscopic procedures: EGD, Colonoscopy, Small Bowel Balloon Enteroscopy, ERCP, and Infrared coagulation treatment for hemorrhoids.
Dr. Fernandez is board certified in Internal Medicine and Gastroenterology. His honors include being a fellow of the American College of Physicians. He has received several awards during his career that include: Jose Izquierdo Award (For excellence in anatomy and neuroanatomy - Universidad Central de Venezuela 1993), Award for excellence in ambulatory care at the University of Connecticut (2006), Award for outstanding medical services and commitment in Pueblo, CO (2011), and America Top Physician-Gastroenterologist awards by the Consumer's Research Council of America (2011/2013/2014). He has served as a Board Member in different institutions.
Dr Fernandez is a dedicated husband, son and father that enjoys his free time with his wife, his 2 daughters and his Labrador Retriever. He
loves to play tennis, hike and ski. He is bilingual and fluent in English and Spanish.

Henrique Fernandez, MD

Gastroenterology Fellowship Program Director

Phone: 719.584.4706
Fax: 719.595.7982

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400 West 16th Street, Pueblo, CO 81003

719.584.4000