Clinical Training

The primary mission of the fellowship program is to train the next generation of pediatric gastroenterology clinicians, educators, and researchers through rigorous clinical training, meaningful scholarly development, and progressive professional growth within an innovative, collaborative, and supportive educational environment.

Fellows primarily train at Duke University Medical Center, a nationally recognized academic medical center with outstanding clinical, procedural, educational, and research resources. 

Duke University Hospital is a tertiary and quaternary care center that provides highly specialized care for children with both common and rare medical conditions. Fellows care for a diverse and medically complex patient population referred from across North Carolina, throughout the United States, and internationally. 

The Duke academic environment encourages collaboration among clinicians, researchers, surgeons, pathologists, radiologists, statisticians, educators, and other healthcare professionals. This creates excellent opportunities for multidisciplinary patient care, clinical innovation, and meaningful research.

The Duke Division of Pediatric Gastroenterology, Hepatology, and Nutrition provides comprehensive care across the full spectrum of pediatric gastrointestinal, liver, pancreatic, nutritional, motility, and transplant-related conditions. A major strength of the program is the availability of advanced liver transplantation, intestinal transplantation, intestinal rehabilitation, and gastrointestinal motility services within one academic medical center. The hospital is consistently ranked among the leading hospitals in the United States and offers fellows exposure to a diverse and medically complex patient population. Additional information about Duke University Hospital, Duke Children’s, and the Department of Pediatrics is available on the Duke Pediatrics facts and figures page. 

The Duke Pediatric Gastroenterology Fellowship Program provides a structured, progressive training experience that prepares fellows for independent clinical practice, academic medicine, and careers in clinical, translational, or laboratory-based research. The curriculum is designed to provide intensive clinical training during the first year, followed by a greater emphasis on scholarly development and research during the second and third years.

Throughout all three years, fellows continue to develop their clinical judgment, procedural competence, teaching skills, leadership abilities, and understanding of quality improvement. Clinical responsibilities and research experiences are progressively tailored to each fellow’s level of training, career goals, and individual educational needs.

First Year: Building a strong clinical foundation with Intensive Clinical Training

The first year of fellowship is heavily focused on developing a strong foundation in inpatient pediatric gastroenterology, hepatology, and nutrition. First-year fellows spend the majority of their clinical time on the inpatient gastroenterology and hepatology consultation services, with additional exposure to outpatient clinics and procedural training.

During the inpatient rotations, fellows evaluate and manage children with a broad range of acute and chronic gastrointestinal, hepatic, pancreatic, nutritional, and feeding-related conditions. The diversity and complexity of patients seen at Duke provide fellows with extensive experience in both common and uncommon pediatric gastrointestinal and liver diseases.

The primary learning objectives of the first year are to:

• Develop a comprehensive approach to the evaluation of children with gastrointestinal, liver, pancreatic, and nutritional disorders.
• Formulate appropriate differential diagnoses based on the patient’s history, physical examination, laboratory findings, imaging, and other diagnostic studies.
• Develop evidence-based diagnostic and management plans for acute and chronic gastrointestinal and hepatic conditions.
• Recognize and respond appropriately to gastrointestinal and liver-related emergencies.
• Develop effective communication skills with patients, families, consulting teams, nursing staff, and other members of the interdisciplinary care team.
• Learn to prioritize clinical responsibilities and coordinate care for medically complex patients.
• Develop leadership skills while functioning as a consultant and as a leader of the pediatric gastroenterology inpatient team.
• Begin the transition from general pediatrician to pediatric gastroenterology specialist.

Fellows are supervised by board-certified or board-eligible pediatric gastroenterology faculty members. An attending pediatric gastroenterologist is available at all times, including nights and weekends, to provide clinical supervision and respond to questions or concerns. Faculty supervision is adjusted according to the fellow’s level of experience, clinical competence, and degree of independence.

First-year fellows also participate in outpatient clinical experiences to begin developing familiarity with the longitudinal management of children with chronic gastrointestinal and liver disorders. These experiences introduce fellows to continuity of care, outpatient diagnostic evaluation, medication management, nutritional interventions, and coordination with other pediatric subspecialists.

Longitudinal Procedural Training

Procedural education is an important and consistent component of fellowship training. Each fellow has a dedicated half-day procedural session every year of fellowship.

Whenever possible, fellows are assigned longitudinally to the same experienced faculty procedural educator. Working consistently with the same faculty member allows the fellow’s procedural development to be closely observed over time and provides continuity in teaching, supervision, assessment, and feedback.

This longitudinal model enables the faculty educator to:

• Assess the fellow’s baseline procedural knowledge and technical skills.
• Establish individualized procedural learning goals.
• Monitor progress throughout fellowship.
• Provide consistent instruction regarding procedural technique, patient safety, sedation, documentation, and post-procedure management.
• Identify areas requiring additional practice or focused instruction.
• Promote progressive independence based on demonstrated competence.

During procedural training, fellows gain experience in the indications, contraindications, performance, interpretation, and potential complications of pediatric gastrointestinal procedures. Training includes pre-procedure evaluation, informed consent, procedural planning, endoscopic technique, tissue sampling, recognition of normal and abnormal findings, communication of results, and post-procedure care.

Procedural autonomy is granted progressively and is based on the fellow’s clinical judgment, technical skill, procedural experience, and ability to perform the procedure safely.

Research Planning During the First Year

Although the first year is primarily clinically focused, fellows are introduced early to the program’s research opportunities and scholarly resources. During the first year of training, fellows work closely with the Program Director, division leadership, and faculty investigators to explore available research opportunities and identify a research mentor whose expertise aligns with their scholarly interests and long-term career goals. Fellows are exposed to a variety of research areas, including clinical research, translational research, basic science, quality improvement, medical education, and health outcomes research based on their interest.

During the first year, fellows are expected to:

• Explore potential areas of scholarly interest.
• Meet with prospective research mentors.
• Review available research projects and institutional resources.
• Develop familiarity with research methodology and responsible conduct of research.
• Identify a primary research mentor and scholarly oversight committee.
• Begin developing a focused, hypothesis-driven research question.
• Create an initial research plan that can be pursued during the second and third years.

This early mentorship process allows fellows to transition efficiently into the research-intensive portion of fellowship.

Second and Third Years: Research-Focused Training with Continued Clinical Development

The second and third years of fellowship are heavily focused on clinical, translational, laboratory-based, educational, or quality improvement research. Fellows are provided substantial protected time to develop and complete a meaningful scholarly project under the guidance of experienced faculty mentors.

The research pathway is individualized according to the fellow’s interests, prior experience, long-term career goals, and the nature of the selected project. Fellows may participate in clinical research, basic science, translational research, epidemiology, outcomes research, quality improvement, or medical education scholarship.

The major objectives of the second and third years are to:

• Define the fellow’s long-term academic and professional career goals.
• Develop and carry out a focused, hypothesis-driven research project.
• Gain practical experience in research design and methodology.
• Learn appropriate methods of data collection, data management, statistical analysis, and interpretation.
• Understand principles of research ethics, regulatory oversight, and responsible conduct of research.
• Develop skills in scientific writing, abstract preparation, and manuscript development.
• Present scholarly work at institutional, regional, and national meetings.
• Prepare manuscripts for submission to peer-reviewed journals.
• Learn the fundamentals of grant writing and research funding.
• Develop the skills needed to critically evaluate the medical literature.
• Work effectively with research mentors, statisticians, coordinators, laboratory personnel, and other members of a multidisciplinary research team.
• Prepare for an academic, clinical, educational, or research-oriented career following fellowship.

Each fellow’s scholarly progress is reviewed regularly by the fellow’s research mentor and Scholarship Oversight Committee. These meetings provide structured guidance, ensure that the project remains feasible, identify barriers to progress, and confirm that the fellow is meeting the scholarly activity requirements of the American Board of Pediatrics.

Continued Clinical Training During the Second and Third Years

Although research becomes the primary focus during the second and third years, fellows continue to develop their clinical expertise through structured inpatient, outpatient, and procedural experiences.

Second- and third-year fellows generally participate in:

• One half-day continuity clinic each week.
• One dedicated half-day procedural session each week.
• One to two additional half-days of outpatient clinical experiences, depending on the fellow’s rotation, research schedule, and educational goals.
• Inpatient gastroenterology and hepatology service rotations.
• Specialty clinics aligned with the fellow’s interests and training needs.

Outpatient experiences include the evaluation of new consultations and longitudinal follow-up of established patients. Fellows gain increasing independence in clinical decision-making while continuing to receive appropriate faculty supervision.

All new outpatient consultations evaluated by fellows are reviewed and discussed with the supervising faculty member. Faculty members also provide oversight for follow-up patients based on the complexity of the condition, the fellow’s level of training, and the clinical needs of the patient.

The outpatient curriculum provides experience in the diagnosis and management of a broad range of conditions, including:

• Inflammatory bowel disease.
• Celiac disease.
• Disorders of gut-brain interaction.
• Chronic abdominal pain.
• Constipation and other motility disorders.
• Eosinophilic gastrointestinal diseases.
• Gastroesophageal reflux and esophageal disorders.
• Pancreatic disease.
• Liver disease.
• Feeding disorders.
• Intestinal failure and nutritional disorders.
• Other general and complex pediatric gastroenterology conditions.

Fellows are expected to longitudinally follow a cohort of patients with inflammatory bowel disease. This experience allows fellows to develop expertise in long-term disease management, medication monitoring, nutritional assessment, interpretation of laboratory and imaging studies, endoscopic reassessment, coordination of multidisciplinary care, and transition planning.

Progressive Responsibility and Independence

Clinical responsibilities increase progressively throughout fellowship. As fellows demonstrate competence, they are given greater independence in clinical evaluation, medical decision-making, procedural performance, communication with families, supervision of learners, and leadership of the clinical team.

By the completion of fellowship, graduates are expected to be able to:

• Independently evaluate and manage common and complex pediatric gastrointestinal, hepatic, pancreatic, and nutritional disorders.
• Appropriately identify situations requiring additional consultation or multidisciplinary care.
• Safely perform the core procedures expected of a pediatric gastroenterologist.
• Interpret endoscopic, laboratory, radiographic, histologic, and other diagnostic findings.
• Lead inpatient and outpatient pediatric gastroenterology teams.
• Communicate effectively with patients, families, referring clinicians, and interdisciplinary team members.
• Practice evidence-based, patient-centered, and family-centered care.
• Incorporate quality improvement and patient safety principles into clinical practice.
• Critically evaluate medical literature and apply relevant evidence to patient care.
• Participate meaningfully in scholarly activity and lifelong professional learning.

Teaching and Educational Development

Teaching is integrated throughout all three years of fellowship. Fellows teach medical students, pediatric residents, advanced practice providers, nursing staff, and other learners in inpatient, outpatient, procedural, and conference settings.

Fellows are expected to develop skills in:

• Bedside and clinical teaching.
• Case-based teaching.
• Providing timely and constructive feedback.
• Supervising residents and medical students.
• Leading patient care discussions and interdisciplinary rounds.
• Presenting at divisional and departmental conferences.
• Adapting teaching to the learner’s level of knowledge and experience.
• Serving as a role model for professionalism, clinical reasoning, and patient-centered care.

As fellows progress through the program, they assume increasing responsibility for supervising and educating junior learners while remaining under the guidance of faculty members.

Interdisciplinary Care and Team Leadership

Fellows receive extensive experience working within interdisciplinary teams in both inpatient and outpatient settings. Depending on the clinical situation, these teams may include physicians, advanced practice providers, nurses, dietitians, pharmacists, psychologists, social workers, speech and feeding therapists, surgeons, radiologists, pathologists, and other pediatric subspecialists.

Through these experiences, fellows learn to coordinate complex care, clarify team roles, communicate recommendations effectively, address barriers to care, and incorporate the perspectives of patients and families into clinical decision-making.

Quality Improvement and Patient Safety

All fellows are expected to participate in a clinical quality improvement or patient safety project during fellowship. Projects may address inpatient care, outpatient care, procedural safety, medication use, clinical outcomes, access to care, communication, documentation, or other areas relevant to pediatric gastroenterology.

Through this work, fellows learn to:

• Identify a meaningful clinical or operational problem.
• Analyze the current care process.
• Select appropriate outcome, process, and balancing measures.
• Develop and implement an intervention.
• Evaluate the impact of the intervention.
• Use data to guide ongoing improvement.
• Present or disseminate the project locally or nationally when appropriate.

Overall Structure of Training

The fellowship curriculum is deliberately structured to provide:

• An intensive inpatient clinical foundation during the first year.
• Early exposure to mentorship and research planning.
• A longitudinal procedural experience with a dedicated half-day of procedures during each year of fellowship.
• Consistent procedural teaching from an experienced faculty educator whenever possible.
• Substantial protected research time during the second and third years.
• Continued outpatient, inpatient, and procedural training throughout all three years.
• Progressive responsibility and independence based on demonstrated competence.
• Structured development in teaching, leadership, quality improvement, and interdisciplinary care.

This combination of intensive clinical training, longitudinal procedural education, protected research time, and progressive professional development prepares Duke Pediatric Gastroenterology fellows to become skilled clinicians, effective educators, thoughtful investigators, and future leaders in pediatric gastroenterology.

The Pediatric Gastroenterology Fellowship curriculum is structured to provide intensive clinical training during the first year, followed by increased protected research time during the second and third years. Fellows continue to participate in outpatient clinics, procedural training, and inpatient service throughout all three years.

Rotation schedules may be adjusted based on the fellow’s educational needs, research responsibilities, clinical service requirements, and individualized career goals.

Fellows participate in a comprehensive series of regularly scheduled educational conferences. These sessions provide instruction in clinical pediatric gastroenterology, hepatology, nutrition, pathology, radiology, surgery, therapeutic endoscopy, research, and professional development.

These conferences complement fellows’ clinical and research experiences and promote progressive development in clinical reasoning, evidence-based practice, interdisciplinary collaboration, teaching, and scholarly inquiry.