Fellowship Program

Non-Standard Fellowship Description
Endoscopic Ultrasound Fellowship
Indiana University Medical Center
Indianapolis, Indiana

Program Demographics:
Indiana University Hospital
Department of Medicine, Division of Gastroenterology/Hepatology
550 N. University Blvd. Suite 4100, Indianapolis, IN 46202
Program Director: Mohammad Al-Haddad, MD
Office: 317-278-8125
Fax: 317-278-8145
moalhadd@iupui.edu
Alternate Contact: Jane Schoening

The Endoscopic Ultrasound (EUS) fellowship at Indiana University Medical Center is affiliated with the Department of Internal Medicine and the Division of Gastroenterology at the same institution. This division was ranked 14 th overall in the 2010 US World and News Report magazine. All EUS procedures are performed at University Hospital, which is accredited by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). No additional certification currently exists for this fellowship program. All six of our faculty members who perform these procedures and teach fellows are members of the Division of Gastroenterology and have undergone additional EUS training during or after gastroenterology fellowship. These physicians therefore are highly qualified to lead and teach this program to trainees. Approximately 2400 EUS examinations are performed annually at this program, which is among the highest volume centers in the nation. While the majority of the patients come from Indiana and the surrounding states, a small portion (~10%) comes from other states. Since our hospital is a tertiary referral center, a wide spectrum of highly complex diseases are encountered which adds to the depth of training of our EUS fellows.

Candidates for advanced EUS training must have completed their general Gastroenterology fellowship, or be in their final year of training. We require that fellows remain for 12 months of training. Generally, an ideal applicant is a fellow who has demonstrated a desire to pursue a career at an academic institution or in a a region where advanced endoscopy skills are required but presently underserved. Typically, one fellow has been accepted to the program each year, although up to two fellows may be accepted in any given year. The program also provides the opportunity for a clinical EUS research fellowship for 6 or 12 months. This research fellowship does not include hands-on procedural training and may be more suitable for international physicians interested in learning more about EUS and conducting clinical research.

Trainees who come self-funded are given preference since the fellowship is not usually a funded position. Candidates who are funded by their home institution are also favored, although in exceptional circumstances, Indiana University may be able to provide financial assistance. For exceptionally qualified candidates we will consider providing internal funding in exchange for some general gastroenterology, inpatient service, and emergency endoscopy call responsibilities.

The goal of the fellowship program is to teach trainees interested in EUS who will further the field. We are therefore committed to training people who will pursue academic careers and/or returning to places where there is little or no advanced endoscopy skills present. In addition to clinical training in EUS, we help fellows build a long lasting interest in research that can help advance the field.

  1. Indications for EUS:
    • The trainee will learn to properly identify patients who could benefit from an EUS procedure based on the most common indications. He or she will also learn when EUS is not indicated or used for patient care. The trainee will learn to consent and discuss findings and results with patients and the family.
  2. Endoscopes used for EUS:
    • EUS uses different endoscopes including the radial and linear echoendoscopes and miniprobes. The trainee will learn which endoscopes are used for which indications and procedures.
  3. Procedures utilized for EUS:
    • The trainee will develop proficiency in the basic concepts of cancer staging, evaluation of submucosal masses, bile duct stones, and chronic pancreatitis.
    • Once proficiency with diagnostic EUS is achieved, the trainee will learn the skills of fine-needle aspiration, celiac plexus block and neurolysis.
    • Upon completion of a one-year fellowship, a trainee will have completed about 400-500 EUS examinations during their training interval. The trainee is will be independently proficient in diagnostic evaluation and fine-needle aspiration.
    • All procedures performed by the trainee will be done under the direction of one of the six staff physicians in the Division of Gastroenterology. As the more experience is acquired, more of each procedure will be performed by the trainee.
  4. Recognition and Management of acute complications after EUS:
    • Perforation of bowel wall
    • Pancreatitis
    • Bleeding
    • Pain control
    • Infection
    • Medication reaction or side effects
  5. Research:
    • All research is performed in compliance with the Institutional Review Board (IRB) and ethical conduct of research at Indiana University. All trainees are expected to pass the required institutional certification for human subjects’ research before starting. At least three months (or 25% of the time) in fellowship training should be dedicated for required research. The research component in the program is dedicated to developing new accessories and techniques, answering questions about the appropriateness of EUS, reducing the rates of complications, broadening the applications for EUS in the diagnosis and management of GI disroders. The advanced fellow would be expected to develop research projects, lead ongoing projects, and write chapters and manuscripts for books and journals, all under the supervision of the EUS staff. We also encourage fellows to seek funding for their research projects whenever possible. The expectation is to present no less than 2 abstracts at a national GI meeting and complete 2 or more manuscripts by the time of graduation. The trainee should develop the skills to carry out independent clinical research once they return to their home institution.

A new formal evaluation process of EUS fellows will be applied this year to assess the fellow's progress throughout the year. Performance of advanced endoscopic techniques is expected to progress according to the skill level previously demonstrated. By the completion of the training, fellows should be able to complete the majority of procedures independently, demonstrating a high skill level, with minimal if any staff assistance.

Due to our large volume and the nature of our practice, EUS and ERCP fellowships are exclusive. ERCP fellowship is one year. Most therapeutic endoscopy fellows spend the majority of their training doing ERCP or EUS, but not both. For information regarding an ERCP fellowship, please contact Evan Fogel, MD, the ERCP fellowship program director.

To be considered for a fellowship position, applicants should submit their CV, completed application form (available on this website), personal statement (on the last page of the application form), and three letters of recommendation to the program director's attention listed above. At least one of the letters of recommendation must be from the chairman or chief of the gastroenterology division and one letter must be from a therapeutic endoscopist.