30
SEP
2014
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The Arnold Palmer Hospital for Children (part of Orlando Health) offers a three-year fellowship training program in pediatric gastroenterology, hepatology and nutrition. The program, fully accredited by the Residency Review Committee of ACGME, is managed by the Center for Pediatric Digestive Health and Nutrition, directed by Dr. Karoly Horvath and participates in the National Resident Match Program (NRMP) and the Electronic Residency Application Service (ERAS) program.

Our goal for this program is to prepare the fellows for a career in pediatric gastroenterology and nutrition, with a strong emphasis on excellence in clinical care, teaching, and productive and independent research.

The normal physiology and development of the gastrointestinal tract and the pathophysiology, cellular and molecular events that underlie various disease processes, as well as clinical pharmacology and biotechnology, are stressed throughout the fellowship. Strong emphasis is placed on the scientific basis of disease, evidence-based disease management, instituting best practices and quality improvement, and refining clinical judgment, teaching, and interpersonal skills. The clinical activities of the first year are based at Arnold Palmer Medical Center (APMC), a 165-bed facility, which is the major pediatric teaching hospital in Central Florida. The Arnold Palmer Hospital for Children is currently the area's only stand-alone children's hospital and only level 1 Pediatric Trauma Center. The hospital has a newly built 44-bed PICU and step-down unit as well as a 33-bed Pediatric Emergency Department and Trauma Center, and a 30-bed cardiac unit. APMC has a strong Pediatric Residency Program with 42 residents.

The APMC is connected by a two-story sky bridge to Winnie Palmer Hospital for Women & Babies, an extraordinary facility designed to serve the unique healthcare needs of women and babies in a caring, family-centered environment. It houses a state-of the-art 112-bed Neonatal Intensive Care Unit, one of the largest in the United States. It is a large regional children's tertiary referral center. Fellows are involved in the management of the complex neonatal cases.

The Gastroenterology, Hepatology and Nutrition inpatient service consults on and manages an average of 20-30 inpatients every day, among them the number of direct GI admission is approximately 800 per year. The Center takes care of over 9,000 outpatient visits per year.

The average number of gastroenterology procedures performed per year are around 2000, including approximately 1,200 upper gastrointestinal endoscopies, 400 colonoscopies and flexible sigmoidoscopies, and other gastrointestinal procedures such as percutaneous endoscopic gastric tube placement, liver biopsy, motility studies, breath hydrogen analyses, esophageal pH and impedance studies, and video capsule endoscopy. The fellow will learn to perform and interpret not only the full range of diagnostic procedures, but will acquire skills in therapeutic procedures including polypectomy, esophageal variceal endosclerosis and ligation, pneumatic and non-pneumatic dilatation of strictures, removal of GI tract foreign bodies and percutaneous endoscopic gastrostomy tube and gastro-jejunal feeding tube placement.

The fellows will be exposed to the full range of gastrointestinal, liver, pancreatic, and nutritional problems, including acute and chronic diarrhea, peptic acid diseases, vomiting disorders, esophageal disorders, failure-to-thrive and nutritional problems, eosinophilic gastrointestinal disorders, inflammatory bowel disease, functional abdominal pain and dyspepsia, chronic constipation, abdominal pain, short gut syndrome, motility disorders, parenteral and enteral nutrition management, acute and chronic hepatitis, metabolic and genetic liver diseases, neonatal cholestasis, chronic cholestatic disorders, bile duct and gall bladder disorders, acute and chronic liver failure, acute and chronic pancreatitis, post-transplant cases, and others.

The first year of the fellowship is devoted primarily to clinical training including mastering endoscopic skills, managing complex inpatient cases and education. The aim of the first year of fellowship is to acquire clinical proficiency in management of the complex inpatient and outpatient cases. The inpatient service will provide ample opportunity to get confidence in performing procedures. It is expected that the first year fellow will develop a research plan at the end of first year and find a faculty mentor for the project. In the spring of their first year, the fellow will present his or her research plans to the Scholarly Oversight Committee for advice and approval. The Oversight committee will systematically monitor the fellow's progress during the next two years, assuring appropriate progress and success of the fellow.

The second and third years are mainly devoted to either clinical or basic research activities, continuity clinics, and limited inpatients care. One of the main goals of the second and third year fellowship is to conduct either clinical or basic research or both and able to present the results in the national meeting and submit it for publication. The Pediatric Gastroenterology and research Laboratory allows conducting bench research. The second goal is to master the procedural skills. They also rotate for 1-2 months in the inpatient service and follow their patients in their continuity clinic. The second year fellow spends a month at the Pediatric Hepatology and Transplant Service at the Shands Hospital for Children in Gainesville, FL. The director of the Service is Dr. Gonzalez-Peralta, who has part-time faculty appointment at our Center and has a full day hepatology clinic every 3 months in our facility. We also have the Miami Intestinal and Liver Transplant team to have clinic with us in Orlando when we evaluate the intestinal and liver transplant cases that underwent transplant in Miami but have been followed locally by our team. Fellows have the opportunity to have electives in the pathology and radiology departments.

About the Faculty

The Center for Digestive Health and Nutrition at the Arnold Palmer Hospital for Children is an academic clinically focused practice at the Arnold Palmer Medical Center in Orlando, Florida. The Division currently includes six board certified physicians; three nurse practitioners; six RNs, and two dieticians. Our faculty holds appointments through The Florida State University College of Medicine, the University Of South Florida College Of Medicine, and the University of Central Florida College of Medicine.

The Center for Digestive Health and Nutrition is part of the Arnold Palmer Hospital Pediatric Specialty Practice The Specialty practice is three blocks away from the Hospitals and the main location of the outpatient services.

All members of the Digestive Center are actively involved in clinical research. We have an experienced research coordinator to support projects. Regular journal clubs, weekly patient reviews, and QI activities are pursued. There is strong expertise in the division to provide an academically stimulating environment and nurturing environment for fellows in training. The hospital is enthusiastic about clinical and translational research. We have a long history of commitment to the education of pediatric residents and medical students. We are excited to have the opportunity to train and educate our own Pediatric gastroenterology fellows.