a fellowship brochure - Cincinnati Children`s Hospital

Pediatric Gastroenterology
Fellowship Training Program
Division of Gastroenterology,
Hepatology and Nutrition
2014
http://www.cincinnatichildrens.org/education
MLC 2010 • 3333 Burnet Avenue • Cincinnati, Ohio 45229 • (513) 636-8948
Table of Contents
Welcome from Dr. Leonis
1
Overview
Program Leadership
History of the Division & Program
About Cincinnati Children’s
A Fellow’s Perspective
2
3
6
10
Applying to Our Fellowship Program
11
Frequently Asked Questions
What’s New?
Why Cincinnati?
12
13
Who Are We?
Current Fellows
Program Graduates
Current Location of Our Fellow Graduates
16
18
19
22
Program Organization & Curriculum
First Year
Second & Third Years
Advanced Training Opportunities
24
25
28
29
Teaching & Research Conferences
31
Elective Opportunities
Research Electives
Clinical Electives
33
35
Research
Research Opportunities
A Sampling of Faculty Research Summaries
41
42
Fellows’ Benefits
47
Resources for Fellowship Applicants
50
Thanks to Angela Cain for her assistance in preparing the booklet, and to the Greater Cincinnati Convention
and Visitors Bureau for providing pictures of area sites.
Graphic Design by Mayte Suarez
Downtown Cincinnati at dusk.
Photograph by Aaron Davidson used with permission of the Greater Cincinnati Convention and Visitors Bureau.
Welcome from Dr. Leonis
Welcome to the Fellowship Program of the Division of Gastroenterology, Hepatology and Nutrition
at Cincinnati Children’s Hospital Medical Center! We are committed to providing an outstanding
fellowship program for pediatricians who desire to become academic pediatric gastroenterologists.
Our program has a strong track record in preparing independent basic science researchers and clinical
investigators with the skills necessary for successful careers in academic medicine. The Division, the
Department of Pediatrics, and Cincinnati Children’s provide a setting of unusual strength, breadth,
and depth for training. Our 34 faculty, 20+ nurses, and 13 clinical fellows of our Division provide care
to more than 10,000 patients each year. In all of our clinical, research, and educational activities, we
strive to change the outcome for our patients.
The fellowship program is structured to include three years of training: one year is spent primarily
in clinical care and two years are primarily devoted to hypothesis-driven laboratory or clinical
investigation of gastrointestinal, hepatic and/or nutritional problems relevant to the care of infants
and children. The program is organized to result in successful preparation for certification in
pediatric gastroenterology by the American Board of Pediatrics. Opportunities for advanced
fellowship training beyond three years are also available.
To help you learn more about our program, we have prepared this booklet to provide information about
what is new in the division, the people of our training program, both now and in the past, the many
opportunities for your intellectual development in clinical care and research, and the advantages of a
dynamic, broad-based program in an affordable and very livable city.
We hope that you will strongly consider our program. Please contact us if you have questions.
Sincerely,
Mike Leonis, M. D., Ph. D.
Associate Professor of Pediatrics
Director, Pediatric Gastroenterology, Hepatology,
and Nutrition Fellowship Training Program
[email protected]
1
Angela Cain – Fellowship Administrative Coordinator
Program Leadership
The program is administered by an Education Council consisting of 4 faculty members, one
senior fellow and the fellowship administrative coordinator. Each faculty member has a
“portfolio” of responsibilities. The Education Council meets monthly and reports back at
divisional faculty meetings (to which fellows are invited). In addition, the Education Council
leads fellowship recruiting and hosts an annual retreat for faculty and fellows to discuss
issues in the program in a less formal setting.
Mike Leonis, MD, PhD – Fellowship Program Director ([email protected])
Overall administration, supervision of scholarship oversight committees, recruiting and exit
interviews
Scott Pentiuk, MD – Associate Fellowship Program Director ([email protected])
Fellow’s lecture series, endoscopy simulation, residency program liaison
Stavra Xanthakos, MD – Associate Fellowship Program Director ([email protected])
Supervision of research electives, research programs
Tom Lin, MD – Supervision of endoscopy/therapeutic endoscopy training.
Angela Cain – Fellowship Administrative Coordinator ([email protected])
2
History of the Division & Program
Pediatric Gastroenterology began to “formally” be recognized as a discipline
separate from adult gastroenterology in the 1960s when early practitioners,
having been trained in Internal Medicine divisions of gastroenterology, were
able to successfully adapt and extrapolate their skills, expertise, and
techniques to the care of children with GI diseases. The Division of Gastroenterology, Hepatology and Nutrition at CCHMC was founded in 1968 by
William K. Schubert, MD, who was then the director of the Clinical Research
Center of Cincinnati Children’s. Dr. Schubert later served as chairman of the
Department of Pediatrics (1979-1993) and President and Chief Executive
Officer of Cincinnati Children’s (1983-1996).
William Schubert, MD
Dr. Schubert was also a role model and mentor, stimulating many pediatric
residents to careers in pediatric gastroenterology. He started the pediatric
gastroenterology fellowship in 1972 with Drs. William Balistreri and Philip
Bagnell as the first fellows.
After Dr. Schubert was appointed Chairman of the Department of Pediatrics,
he was succeeded as Division Director by John Partin, MD, who served from
1979-80, before departing to become Chairman of the Department of
Pediatrics at the State University of New York-Stony Brook.
In 1980, William Balistreri, MD, succeeded Dr. Partin as Division Director.
Under Dr. Balistreri’s leadership, the division flourished, growing from a
faculty of 3 to 17, and developed outstanding programs in clinical care,
research, and education.
In July 2005, Dr. Balistreri was succeeded as division director by Mitchell B.
Cohen, MD, who subsequently grew the division from a faculty of 17 to 35,
continuing the division’s emphasis on excellence in clinical care, research and
teaching.
William Balistreri, MD
In the fall of 2014, Dr. Cohen departed to become the Chairman of the
Department of Pediatrics at the University of Alabama at Birmingham. Our
Interim Division Director is Dr. James Heubi, who trained as a fellow in our
program and joined the faculty in 1981. A search committee has been
seated to begin a multinational search for our next Division Director, who
we anticipate will be in place by the end of 2015.
Throughout the division’s history, the division and its fellowship program
have continually produced leaders in pediatric gastroenterology, hepatology
and nutrition and academic pediatrics in general. We have always ranked
in the top three divisions of pediatric gastroenterology in the US News and
World Report annual survey.
Mitchell Cohen, MD
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Our mission is fourfold: Clinical Care, Research, Education, Advocacy
Improve the digestive health of children
Discover and apply new knowledge (Research clinical care)
Educate patients, providers, and families, and the field at large
Improve the clinical care delivery system so that it provides the best outcome at the
lowest possible cost
In order to accomplish our mission:
We partner with patients, families and care givers to deliver the safest, best patient
care and experience
We treat families and co-workers with integrity, courtesy and respect
We continuously improve & innovate through research and clinical care
We are constantly learning and sharing information as a team
We are passionate and motivated by the impact we have on others
We have a tradition of innovation and discovery:
We have the most world renowned recipients of awards for leadership and contribution to
the field (see below)
We are Tertiary, Quaternary and Community focused
We lead the most improvement networks
We have the only pediatric focused Digestive Disease Center funded by NIH
Awards and Highlights include:
Presidents and Officers of the North American Society for Pediatric Gastroenterology, Hepatology
and Nutrition (NASPGHAN) (Balistreri, Suchy, Sokol, Cohen, Heubi)
President of the NASPGHAN Foundation (Balistreri)
Presidents and Officers of the American Association for the Study of Liver Disease (Balistreri, Suchy,
Sokol, Bezerra)
Editor of the Journal of Pediatric Gastroenterology and Nutrition (Balistreri)
Editor of the Journal of Pediatrics (Balistreri)
Harry Shwachman Award of NASPGHAN (Balistreri, Suchy, Sokol, Cohen)
Murray Davidson Award of the American Academy of Pediatrics (Balistreri, Schubert, Kocoshis)
Founder’s Award of the Midwest Society for Pediatric Research (Heubi)
National Commission on Digestive Diseases, National Institute of Diabetes and Digestive and
Kidney Diseases (Cohen)
Members of the American Board of Pediatrics and the gastroenterology subboard (numerous)
National Institutes of Health study section members (numerous)
Department Chairs (Schubert, Partin, Suchy, Gremse, Bancroft)
CTSA directors (Heubi, Sokol)
Integrated Solid Organ Transplant Directors (Bucuvalas, Ng)
CCFA NSAC members: (Denson, Cohen)
AGA Growth and Development Section Chairs: (Cohen, Shroyer)
Division Directors (numerous)
NASPGHAN committee chairs & committee members (numerous)
Fellow Research Awards, Plenary Session presentations, Posters of Distinction (numerous)
4
References
Balistreri, William F. (2004). Presentation of the 2003 AAP Murray Davidson Award to Dr. William K. Schubert.
J Pediatr Gastroenterol Nutr 38:121-122.
Balistreri WF. Growth and development of a new subspecialty: pediatric hepatology. Hepatology. 2013
Aug;58(2):458-76. doi: 10.1002/hep.26580.
Cohen, Mitchell B. (2000). The Shwachman Award of the North American Society for Pediatric
Gastroenterology and Nutrition, 1999: Presentation. J Pediatr Gastroenterol Nutr 30:355-358.
Gerhardt, William J. (2002). Edward Lowell Pratt. Cincinnati: C.J. Krehbiel.
Walker-Smith, John & Walker, W. Allan (2003). The development of pediatric gastroenterology: a historical
overview. Pediatr Res 53:706-715.
Cincinnati Riverfront and Skyline at Night.
Photograph by Tim Jeffries used with permission of the Greater Cincinnati Convention and Visitors Bureau.
About Cincinnati Children’s
Cincinnati Children’s Hospital Medical Center (CCHMC) serves the medical needs of infants, children and
adolescents from the local Tristate area, the region, nationally, and internationally with family-centered
care, innovative research and outstanding teaching programs. Clinical procedures and treatments
pioneered at Cincinnati Children’s are used throughout the world. The impact of our medical research
breakthroughs has improved pediatric health today and will for generations to come.
CCHMC is a distinct legal, operational, financial, and research entity. The Academic Health Center includes CCHMC, Colleges of Pharmacy, Allied Health, and Nursing, the University of Cincinnati College of
Medicine (UC-COM), UC Physicians, University Hospital Medical Center and Westchester Hospital. UCCOM Affiliated faculty at CCHMC include the Departments of Pediatrics with 41 Divisions, Surgery with
11 Divisions, Anesthesiology and Radiology.
CCHMC was established in 1883 as The Children’s Hospital under the auspices of the Episcopal Diocese
of Cincinnati. William Cooper Procter, the grandson of William Procter, the co-founder of Procter &
Gamble Company, chaired the Board of Trustees from 1913-1934. He established the Children’s Research Foundation in 1931 with an endowment gift of $2.7M. He further stipulated in his bequest that
income from the endowment would support research and development. These principles continue to
form the philosophical approach to the relationship of the endowment and research today.
Cincinnati Children’s, a private, non-profit institution, has an active faculty of 874, mostly in the
Department of Pediatrics, and total employees of 13,000. It is the home of the Department of
Pediatrics of the University of Cincinnati College of Medicine. The college has an additional 885
full- and part-time faculty members outside of pediatrics. Faculty in the Department of Pediatrics also
participate actively in training and education, making us the third best pediatrics department and the
third ranked pediatric hospital in the country, according to U.S. News & World Report.
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Faculty in the Department of Pediatrics 1997-2012
Yet the institution is not standing pat; our mission is to:
improve child health and transform delivery of care through fully integrated, globally recognized
research, education and innovation. For patients from our community, the nation and the world,
the care we provide will achieve the best medical and quality of life outcomes, patient and family
experiences, and value, today and in the future.
Overall, our goal is to Change the Outcome for children near and far.
Clinical Care
State-of-the-art medical facilities at Cincinnati Children’s, including 530 licensed beds, an array
of diagnostic and therapeutic approaches, and specialists in all areas of pediatrics, allow us to provide
innovative care and advanced treatment for pediatric patients. Family-centered care initiatives
recognize, respect and support the family’s critical role in caring for patients. Overall, Cincinnati
Children’s has twelve patient care sites through the region providing more than 1.1 million patient
visits per year. Although services vary by location, Cincinnati Children’s outpatient centers offer
frequently used services, such as x-ray, laboratory testing, urgent care, specialty clinics and more.
CCHMC is an honor roll US News and World Report Hospital
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Nationally Ranked
#1 in Pediatrics: Cancer
#5 in Pediatrics: Cardiology & Heart Surgery
#6 in Pediatrics: Diabetes & Endocrinology
#3 in Pediatrics: Gastroenterology & GI Surgery
#14 in Pediatrics: Neonatology
#2 in Pediatrics: Nephrology
#4 in Pediatrics: Neurology & Neurosurgery
#3 in Pediatrics: Orthopedics
#2 in Pediatrics: Pulmonology
#3 in Pediatrics: Urology
We are working to continually improve the quality of our care and the safety of our patients.
Launched in January 2009, the Ohio Children’s Hospitals Solutions for Patient Safety learning network
is a partnership between the state’s eight children’s hospitals and the business community to improve
the quality of care delivered in Ohio and to reduce healthcare costs. To realize the shared vision, each
participating institution has committed to complete transparency and data sharing to foster an “all
teach, all learn” culture. Because of this approach, we now have a robust learning network focused on
eliminating harm at children’s hospitals across the state. This network, started by CCHMC, has now
become a national network of children’s hospitals.
Education
Cincinnati Children’s offers one of the largest pediatric training programs within a single institution
in the United States. In addition to residents in pediatrics (36 categorical pediatric residents/year),
combined residency programs, dentistry and psychology and fellows in pediatric subspecialties, rotating
residents in surgery and other fields learn the pediatric aspects of their fields at Cincinnati Children’s.
Further, we train medical and nursing students, PhD graduate students in Molecular and Developmental
Biology (65 students) and Immunobiology (32 students), post-doctoral fellows (58 programs, 149
fellows), and many others.
Aerial view of Cincinnati Children’s Hospital Medical Center.
Research
Cincinnati Children’s Research Foundation is one of the largest pediatric research programs in
the nation. Translational research results in innovations that have a direct impact on improving
patient care.
Margaret Hostetter, MD, chairs the Department of Pediatrics and directs the Cincinnati Children’s
Research Foundation, which is the umbrella organization under which the Department of Pediatrics
falls. The research budget of $259 million, and 950,000 square feet of research space make this one
of the largest pediatric research facilities. National Institutes of Health Funding of $111 Million
was 2nd in the US among all Children’s Hospitals or pediatric departments. The current research
endowment is ~$1.6 billion. There are ~100 Ph. D. Students and 136 post-doctoral research fellows.
Our faculty currently conducts research in Location S, a new 415,000 square foot research building
completed in the fall of 2007. The office and laboratory spaces for the entire Division of Gastroenterology, Hepatology and Nutrition is located in this new building. We will be moving to even newer, more
contiguous space in 2015 with the opening of the Clinical Sciences Research Building.
The Clinical Sciences Research Building (Location T)
A Fellow’s Perspective
My name is Anna Peters and I’m a first year pediatric GI fellow. When I interviewed for fellowship at
Cincinnati Children’s, I experienced the feeling that I was visiting a training program with a culture
of awesomeness-- the same feeling that I experienced during my interview day for pediatric residency
here several years earlier. We take excellent care of patients, we treat each other like family, and we
are committed to making discoveries that will improve patient care. Our fellowship program not
only has a great history and an outstanding track record for training leaders in the fields of pediatric
gastroenterology and hepatology, but the program leadership is focused on training the leaders of the
future. Whether your career goals lie in basic research, translational research, clinical research,
quality and process improvement, or becoming a clinical expert in whatever aspect of GI is most
interesting to you, you will have role models and mentors here to guide you. From general GI to
advanced endoscopic techniques, to intestinal failure, motility, and liver and intestinal transplantation,
and everything in between, every opportunity is available to you as a fellow. Although I interviewed
at several other pediatric GI fellowship programs, I could not find one that would offer better
opportunities for me than those at Cincinnati Children’s. And although I have been a fellow at
Cincinnati Children’s for only a few months, I have no doubt I will find my niche.
As for Cincinnati itself, it is a vibrant mid-sized city with distinct neighborhoods and plenty to keep
you entertained in your free time – professional and college sports, restaurants, cultural activities
including an orchestra and a professional ballet company – and more that I have not yet had time to
explore. What’s more is that these activities are accessible and affordable on a fellow’s salary.
My husband (whom I met after moving to Cincinnati for residency) and I can walk to two different
areas of town from our home, and drive to downtown Cincinnati in twenty minutes.
Please do not take my word for it – come and visit us, and see what we are all about. I’ll be happy to
answer any questions you have or help you in any way.
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Anna Peters, MD
1st year Pediatric Gastroenterology Fellow
10
Applying to Our Fellowship Program
We seek applications from outstanding pediatricians who want to develop their career in academic
pediatric gastroenterology, hepatology and nutrition. Because of the citizenship requirements of
our National Institutes of Health Gastroenterology and Nutrition T32 training grant, which funds on
average 3 out of our 4 fellowship slots a year, strong preference is given to candidates who are U.S.
citizens or permanent residents. On average, we can sponsor 1, and sometimes 2, foreign trainees a
year who have J1, H1B (or similar) visas.
For more information regarding application to our program, please contact Mike Leonis, MD, PhD
([email protected]) or Angela Cain, Fellowship Coordinator ([email protected]).
Application Process
We participate in the pediatric gastroenterology fellowship match program. To apply, please submit
your application to the following website:
www.aamc.org/eras
For fellowships beginning July 1, 2016, applicants can begin submitting their applications
December 1, 2014. We are currently offering 4 positions a year through the match.
Evaluation
We start reviewing applications in the middle of December of each year and invite outstanding
candidates to interview in Cincinnati during the first several months of the year. Candidates are
evaluated based on their record and potential as academic pediatric subspecialists, researchers, and
educators, and on their interpersonal qualities. We have a highly competitive program, so applicants
should make sure their applications (including their letters of recommendation) are uploaded in a
timely fashion to optimize review of their application.
It is the continuing policy of Cincinnati Children’s Hospital Medical Center to afford full equal
employment opportunity to qualified employees and applicants, regardless of their race, color,
religion, sex, national origin, age, physical or mental handicaps, military or veteran status, sexual
preference, or any other protected condition or characteristic in conformity with all applicable
federal, state and local laws and regulations.
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Frequently Asked Questions:
What’s New?
New faces, new roles
• New fellows – New fellows – We welcome Drs. Anna Catalina Arce-Cochlar, Marie Raphael Jean, Anna Peters and Justin Wheeler to the program as first year fellows!
• New faculty – The division’s faculty has increased in number to 35 during the 2013-2014 academic year.
Daniel “Danny” Mallon, M.D. joins the division from Boston, Massachusetts. His research interests include developing educational programs and communication modules that will allow subspecialists to improve education and communication with local pediatricians.
Monique Goldschmidt, M.D. joins the division as a clinician specialist from Cincinnati, Ohio.
Dr. Goldschimidt’s area of expertise is intestinal rehabilitation and the care of patients status post
liver/multiorgan transplantation.
New opportunities
•
Expanding research opportunities – A total of 61 faculty members at Cincinnati Children’s and the University of Cincinnati College of Medicine are currently listed on the divisional training grant as mentors for basic science and clinical research in the 2nd and 3rd years of fellowship. Other
mentors can be employed with approval of the program director if this makes sense based on the individual fellow’s research and career interests.
•
Fellows’ continuity experience – To enhance the development of skills in long-term outpatient
management, second and third year fellows receive about half of their outpatient clinic experience attending and participating in clinics at CCHMC satellite locations with a single faculty member for the entire year.
• New space – In the summer of 2015, the entire Division plans to move into a new 13-story research and office tower (ie. Location T) located next to the main Children’s Hospital and base outpatient clinics.
What’s the same?
• Our commitment to education –Despite all the changes, we remain committed to providing an outstanding environment to train outstanding individuals in clinical care, research, and education for fellows seeking careers in academic pediatric gastroenterology, hepatology and nutrition.
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Why Cincinnati?
Strength of the program
Our fellowship training has a long and strong history of providing an outstanding training environment
for fellows in Pediatric Gastroenterology, Hepatology and Nutrition. Our fellowship training program
is dynamic and always searching for ways to improve; indeed these are core features of our Division
as a whole. Additional strengths of our Division and fellowship training program, as outlined below,
are in part why U.S. News & World Report has consistently ranked our program in the top three of all
gastroenterology programs in the United States.
Focus on “Changing the Outcome” for pediatric digestive diseases, particularly for children with:
•
•
•
•
•
•
•
•
•
•
Inflammatory bowel disease
Eosinophilic gastrointestinal disorders
Chronic liver disease
Non-alcoholic steatohepatitis
Liver failure and transplantation
Intestinal Failure (Intestinal Rehabilitation)
Intestinal (Multivisceral) Transplantation
Neurogastroenterological and Motility Disorders
Pancreatic Disorders
Feeding Disorders
Track record of our graduates (see pages 19-22 for a listing of program graduates)
• Graduates are leaders in academic pediatrics and pediatric gastroenterology
• Recent graduates have obtained strong academic positions throughout the nation
Breadth & depth of clinical opportunities
• Busy services and strong programs in gastroenterology, hepatology and nutrition:
Statistics for fiscal year 2013
Outpatients Encounters21,889
Inpatients Encounters2077
Procedures
Upper endoscopies3060
Lower endoscopies735
Liver biopsies134
nometry procedures83
Other procedures669
• National and international referral population
13
• Strong transplantation program, including liver and small bowel transplants:
Isolated liver
Combined liver-small bowel
Isolated small bowel
Fiscal year 2013
18
0
0
Overall
>550 since 1986
>30 since 2003
>10since 2003
• Multiple subspecialty centers and services: Liver Care Center, Schubert-Martin Inflammatory Bowel Disease Center, Nutrition and Intestinal Care Center, Motility Center, Aerodigestive and Sleep Center, the Feeding Team, the Cincinnati Center for Eosinophilic Disorders, the Colorectal
Center for Children, HealthWorks! obesity treatment program, Pancreas Center, and the
Comprehensive Weight Management Center (bariatric surgery)
• Strong interactions with pediatric surgery, radiology, otolaryngology, pulmonary medicine, allergy and immunology, pathology, anesthesiology, nutrition therapy, and others
• Only hospital in Cincinnati for pediatrics
• Recently remodeled, kid-friendly clinic space
• Outpatient opportunities at the base, suburban satellites, and rural/small town sites
Breadth & depth of research opportunities
• 17 division faculty members have active grant support from the National Institutes of Health
• Division houses the NIH-supported Cincinnati Digestive Health Center (DHC), Clinical Center
for Cholestatic Liver Disease in Children, Immunosuppression Withdrawal for Stable Pediatric Liver Transplant Recipients, Pediatric Gastroenterology and Nutrition Training Grant, and Clinical
Research Network in Non-Alcoholic Steatohepatitis (NASH)
• Division participates in ImproveCareNow, the Acute Liver Failure Network, SPLIT (Studies in
Pediatric Liver Transplantation), and Predicting Response to Standard Pediatric Colitis Therapy: The PROTECT Study
• 61 potential mentors at Cincinnati Children’s and the University of Cincinnati College of
Medicine who are associated with the training grant; additional possibilities based on the
individual fellow’s career interests and educational needs (see pages 41-46)
• Cincinnati Children’s is second in the U.S. among pediatric institutions for receiving NIH support
• Strong thematic basic science programs in developmental biology, immunobiology, experimental hematology/gene therapy, and pulmonary biology
• Many core facilities to support laboratory-based and clinical research
The people
• Strong fellows that are supportive colleagues
• Supportive, diverse faculty
• Nurses and support staff in the division are an integral part of the fellows’ experience
and education
• Recently selected as Cincinnati’s “Best Place to Work” by the Cincinnati Business Courier
The institution
• One of the top pediatric institutions in the country; 3rd among departments of pediatrics and 3rd among children’s hospitals in U.S. News & World Report rankings
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• Outstanding support from the Edward L. Pratt Library of Cincinnati Children’s Hospital Medical
Center
• Strong pediatric residency program
• Generous pay scale and benefits package (see pages 47-49), particularly relative to the cost of
living in Cincinnati
• Community pride in Cincinnati Children’s
• Our division is well connected in the institution, with the Chief of Staff, Vice- Chair of Clinical Affairs, director of the CTSA, and director of the Integrated Solid Organ Transplant Program as well as faculty with joint appointments in basic science divisions among our Division’s faculty
Support of fellows
• Large, shared fellows’ office
• Each fellow has an individual computer and phone, access to printers and refrigerators
• Support for 3 years (and perhaps beyond)
• NIH training grant (see pages 26-29)
• Individual budgets for attending meetings and purchasing textbooks (see pages 48-49)
The city
• Friendly, family oriented
• Big small city/small big city
• Low cost of living
30-50% lower than major coast cities, based on comparisons using the cost-of-living
calculator at salary.nytimes.com
• Affordable housing in nice neighborhoods without a long commute
• Many cultural activities and museums
• Restaurants for all tastes and budgets
• Many opportunities for outdoor activities
• Professional & college sports: Reds, Bengals, University of Cincinnati, Xavier University
Great American Ballpark, home of
the Cincinnati Reds, with riverboats
on the Ohio River.
Photograph by George Soister
used with permission of the Greater
Cincinnati Convention and Visitors Bureau.
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Who Are We?
The Division of Gastroenterology, Hepatology and Nutrition is dedicated to the development of our
fellows as academic pediatric subspecialists, researchers, and educators. We take seriously our roles in
fellowship training. The breadth and depth of the experience of our large and diverse faculty allows
fellows the opportunity to learn from among many different clinical and interpersonal styles. The strength
of our research programs provides an atmosphere of inquiry and intellectual rigor. We take our roles as
educators seriously, as exemplified by our frequent receipt of the Divisional Teaching Award, voted on
annually by the graduating residency class. We are proud of our graduates (see pages 19-22), many of
whom have become leaders in academic pediatrics and pediatric gastroenterology both at Cincinnati
Children’s and at programs around the United States and internationally.
Faculty
Maisam Abu-El-Haija, MD
William Balistreri, MD, Associate Chair for Fellowship Training
Jorge Bezerra, MD, Director of Research
Kristin Bramlage, MD
John Bucuvalas, MD, Director of Integrated Solid Organ Transplants, CCHMC
Kathleen Campbell, MD, Medical Director, Liver Transplant
Conrad Cole, MD
Lee “Ted” Denson, MD, Fellowship Director, Director, Schubert-Martin Inflammatory Bowel Disease Center
Dana “Chelly” Dykes, MD
Michael Farrell, MD, Chief of Staff, Cincinnati Children’s
Lin Fei, PhD
Shekhar Gandhi, PhD
Monique Goldschmidt, MD
Yael Haberman Ziv, MD, PhD
Xiaonan Han, PhD
James Heubi, MD, Interim Division Director, Director of the General Clinical Research Center; Associate Chair for Clinical Research
Stacey Huppert, PhD
Ajay Kaul, MBBS, MD, Director, Motility Program
Samuel Kocoshis, MD, Director, Nutrition and Intestinal Care Center
Rohit Kohli, MD, MS, MBBS
Mike Leonis, MD, PhD, Fellowship Director, Gastroenterology, Hepatology and Nutrition Fellowship Program
Tom Lin, MD
Daniel “Danny” Mallon, MD
Alexander Miethke, MD, Fellowship Director, Transplant Hepatology Fellowship Program
Phillip Minar, MD
Sean Moore, MD
16
Vince Mukkada, MD
Joseph Palermo, MD
Scott Pentiuk, MD, Associate Fellowship Director (GI)
Philip Putnam, MD, Director of Endoscopy; Medical Director, Cincinnati Center for Eosinophilic Disorders
Michael Rosen, MD
Shehzad Saeed, MD, Director of Clinical Services
Pranav Shivakumar, PhD
Kris Steinbrecher, PhD
Cynthia Wetzel, PhD, Digestive Health Center Manager & Grant Specialist
Sandra Wright, MD
Stavra Xanthakos, MD, Associate Fellowship Director (GI); Medical Director, Comprehensive Weight
Management Center
Chunyue Yin, PhD
Admistrative Director
Terra Thompson, MS
Nurse Practioners
Bailey, Kim, MSN, RN, CNP, CCRN
Fitzharris, Leslie, CNP
Hatcher, Laura, NP
Heinzman, Christie, MSN, AC-PNP
Hochstrasser, Candy, APRN
Kochevar, Wendy, RN, APRN
Mayer, Michelle, MSN, CNP
Miller, Susan, MSN, CNP, PPCNP-BC, CPNP-AC
Paxton, Lisa, RN
Nursing Team
Anderson, Julie, RN, BSN
Arata, Katie, RN, BSN
Bailey, Rebecca, RN, BSN, CPN
Beck, Lee, RN, BSN
Brooks, Tina MSN, RN, CNL
Browning, Deborah, MSN, RN
Carmichael, Jen, RN, BSN, CPN
Cary, Linda, RN, BSN
Davis, Maria, RN
Dierig, Jackie, RN
Dietrich, Kim, RN
Duncan, Mary Kay, RN, BSN
Elfers, Julie RN, BSN
Ford, Jo MSN, RN
Grill, Deborah, RN
Nursing Team cont.
Harjo, Jeanne, RN, BSN, CPN
Hawke, Bill RN, BSN, MBA
Haynes, Joyce, RN
Hennies, Gerry, RN
Jacob, Jenny, RN, BSN
Klotz, Kim RN, MSN, CRNI
McNutt, Cyndy, RN
Mitchell, Joanne, RN, BSN
Morgan, Pam, RN, BSN
Morrow, Brittany, BSN, RN, CPN
Nicholas, Lynda, RN, BSN, CPN
Putnam, Terri, RN, CPN
Rengering, Becky, RN, BSN
Richardson, Terryll “Terry”, LPN
Roedersheimer, Nicole “Nikki”, RN, BSN
Siegle, Lois, RN, BSN, CPN
Snyder, Brandy, LPN
Staley-Haynes, Jennifer, RN, BSN
Turner, Angie RN, BSN, CPN
Wagner, Susan, RN
Weaver, Ann RN, BSN, CPN
Willoughby, Jennifer, RN, BSN, CPN
Yeary, Kathie, RN, CPN
Zigmond, Julie, RN, BSN, CCTC, CPN
Emilie Rupe
17
Current Fellows
Our current fellows come from a wide variety of backgrounds and have diverse academic and
research interests:
4th year Advanced Hepatology Fellow
James Squires, MD, completed his pediatric gastroenterology fellowship and pediatric residency
training at Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio.
3rd year fellows
David Galloway, MD, completed his pediatric residency at Phoenix Children’s Hospital, Phoenix,
Arizona.
Karla Hicks, MD, completed her pediatric residency at Cincinnati Children’s Hospital Medical
Center, Cincinnati, Ohio.
Ethan Mezoff, MD, completed his pediatric residency at Children’s National Medical Center,
Washington D.C.
Flora Szabo, MD, PhD, completed her pediatric residency at University of Kentucky, Lexington, KY
2nd year fellows
Ashish Dhawan, MD, completed his pediatric residency at Children’s Hospital of Monmouth
Medical Center, Long Branch, New Jersey.
Einar Hafberg, MD, completed his pediatric residency at University of Connecticut, Hartford
Connecticut.
Stephanie Oliveira, MD, completed her pediatric residency at the University of Medicine and
Dentistry of New Jersey, Newark, New Jersey.
Amy Taylor, MD, completed her pediatric residency at Cincinnati Children’s Hospital Medical
Center, Cincinnati, Ohio.
1st year fellows
Anna Catalina Arce Clachar, MD, completed her pediatric residency at the Cleveland Clinic,
Cleveland, Ohio.
Marie Raphael Jean, MD, completed her pediatric residency at the University of Medicine and
Dentistry of New Jersey, Newark, New Jersey.
Anna Peters, MD, PhD, completed her pediatric residency at Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio.
Justin Wheeler, MD, completed his pediatric residency at Phoenix Children’s Hospital, Phoenix,
Arizona.
18
Program Graduates
We are proud of the graduates of our program, who represent family in the pediatric GI community
around the country and around the world. Among them are three pediatric department chairs and
numerous division directors. They are:
2014
Yael Haberman-Ziv, MD, PhD., Assistant Professor, Cincinnati Children’s Hospital Medical Center and Sheba Medical Center,
Tel Hashomer, Israel
Alexandra Menchise, MD, Advanced Nutrition Fellow, Children’s Hospital of Philadelphia, Philadelphia, PA
James Squires, MD, Advanced Transplant Hepatology Fellow, Cincinnati Children’s Hospital Medical Center
Sandra Wright, MD, Staff Physician, Cincinnati Children’s Hospital Medical Center
2013
Kristin Bramlage, MD, Staff Physician, Cincinnati Children’s Hospital Medical Center
Monique Goldschmidt, MD, Staff Physician, Cincinnati Children’s Hospital Medical Center
Phillip Minar, MD, Assistant Professor, Cincinnati Children’s Hospital Medical Center
George Zacur, MD, Assistant Professor, University of Michigan Health System
2012
Frank Dipaola, MD, Assistant Professor, University of Michigan Health System
Dana “Chelly” Dykes, MD, Assistant Professor, Cincinnati Children’s Hospital Medical Center
Jaime Echartea-Gonzalez, MD, Assistant Professor, University of Texas Health Science Center, San Antonio, TX
2011
Stephanie Appleman, MD, Assistant Professor, Drexel University College of Medicine
Ben Kuhn, MD, Geisinger Health System, Danville, PA
Anna Trauernicht, MD, Boys Town National Research Hospital, Omaha, NE
Amy Tsai, MD, Kaiser Permanente Medical Group, Roseville, CA
2010
Sharon D’Mello, MD, Hackensack University Medical Center, Hackensack, NJ
Jose Garza, MD, GI Care for Kids, Atlanta, Georgia
Emily Kevan, MD, Greenville Health System, Greenville, SC
Cade Nylund, MD, Assistant Professor, Uniformed Services University of the Health Sciences, Bethesda, MD.
2009
Kathryn “Katie” Moyer, MD, Northwest Pediatric Gastroenterology, Portland, Oregon
Melanie Rhue, MD, Novant Health, Charlotte, North Carolina
Charles “Chip” Samson, MD, Assistant Professor, Washington University, St. Louis, MO
Bella Zeisler, MD, Assistant Professor, Connecticut Children’s Medical Center (University of Connecticut), Hartford, CT
2008
Jill Dorsey, MD, Nemours Children’s Clinic, Jacksonville, Florida
Alexander Miethke, MD, Assistant Professor, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
Brad Pasternak, MD, Assistant Professor, Phoenix Children’s Hospital, Phoenix, Arizona
Scott Pentiuk, MD, Assistant Professor, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
2007
Lynelle Boamah, MD, San Diego Naval Medical College, San Diego, California
Rebecca Carey, MD, Digestive Care Center, Evansville, IN
Monica Garin-Laflam, MD, Assistant Professor, Dartmouth-Hitchcock Medical Center, Lebanon, NH
Veena Venkat, MD, Assistant Professor, University of Pittsburgh, Pittsburgh, Pennsylvania
19
2006
Nissa Erickson, MD, Assistant Professor, University of Minnesota Amplatz Children’s Hospital, Minneapolis, MN
Michael Konikoff, MD, Children’s Hospital of the King’s Daughters, Norfolk, Virginia
Bankole Osuntokun, MD, Cook Children’s Medical Center, Fort Worth, Texas
2005
D. Rick Focht, MD, Geisinger Health System, Danville, PA
2004
Valérie McLin, MD, Assistant Professor, Geneva, Switzerland
Richard Noel, MD, PhD, Assistant Professor and Director, Duke University, Durham, NC.
Jennifer Strople, MD, Assistant Professor, Children’s Memorial Hospital, Chicago, Illinois
Stavra Xanthakos, MD, Associate Professor, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
2003
Kathleen Campbell, MD, Associate Professor, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
Valeria Cohran, MD, Assistant Professor, Children’s Memorial Hospital, Chicago, Illinois
Conrad Cole, MD, Associate Professor, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
2002
Stephen L. Guthery, MD, Professor, University of Utah, Salt Lake City, Utah
Mike A. Leonis, MD, PhD, Associate Professor, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
2001
Peter Lee, MD, Inova Medical Group, Fairfax, Virginia
John F. Pohl, MD, Professor, University of Utah, Salt Lake City, Utah
2000
Vicky Lee Ng, MD, Associate Professor, The Hospital for Sick Children, Toronto, Ontario, Canada
Jeffrey Rudolph, MD, Assistant Professor, University of Pittsburg, Pittsburg, PA
Jeffrey B. Schwimmer, MD, Professor, University of California, San Diego, San Diego, California
1999
Looi Ee, MD, Associate Professor, Royal Children’s Hospital, Herston, Brisbane, Australia
Praveen Goday, MBBS, Associate Professor, Medical College of Wisconsin, Milwaukee, Wisconsin
1998
Michael D. Bates, MD, PhD, Associate Professor and Division Director, Children’s Medical Center of Dayton, Dayton, OH
Ajay Kaul, MD, Professor, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
20
1997
Jay Hochman, MD, GI Care for Kids , Atlanta, Georgia
Michelle Kennedy, MD, Minnesota Gastroenterology, Minneapolis, Minnesota
David Wiechmann, MD, Minnesota Gastroenterology, Minneapolis, Minnesota
1996
Alfonso Martinez, MD, Assistant Professor, Medical College of Wisconsin, Milwaukee, Wisconsin
Nada Yazigi, MD, MedStar Georgetown University Hospital, Washington, D.C.
1995
Jane P. Balint, MD, Associate Professor, Columbus Children’s Hospital/Ohio State University, Columbus, Ohio
Susan F. Dellert, MD, Jersey City Medical Center, Jersey City, NJ
1994
James V. Higgins, MD, Associate Professor, Texas Tech University Health Sciences Center, Lubbock, Texas
L. Glen Lewis, MD, GI Care for Kids, Atlanta, Georgia
Michael J. Nowicki, MD, Professor, University of Mississippi Medical Center, Jackson, Mississippi
1993
Jorge A. Bezerra, MD, Professor, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
Farhat N. Khan, MD, Assistant Professor, Dayton Children’s Hospital, Dayton, OH
1992
Eric A. Argao, MD, Dallas, Texas
Drora Berkowitz, MD, Rambam Medical Center, Haifa, Israel
D. Wayne Laney, MD, Huntsville, Alabama
1991
H. Hesham A-Kader Hassan, MD, Division Director, Pediatric GI, University of Arizona, Tucson, Arizona
Susan Maisel, MD, Peyton Manning Children’s Hospital, Indianapolis, Indiana
1990
Robert Dillard, MD, Professor, University of Louisville, Louisville, Kentucky
David Gremse, MD, Professor and Chair of Pediatrics, University of South Alabama, Mobile, Alabama
Adam G. Mezoff, MD, Professor and Chief Medical Officer, Children’s Medical Center of Dayton, Dayton, OH
Deborah A. Neigut, MD, Associate Professor, University of Colorado, Denver, Colorado
1989
John D. Bancroft, MD, Chair, Pediatrics, Maine Medical Center, Portland, Maine
1988
Jeffrey Sipple, MD, St. Louis, Missouri
1987
Donald Novak, MD, Professor, University of Florida, Gainesville, Florida
1986
Mitchell B. Cohen, MD, Professor and Chair of Pediatrics, University of Alabama, Birmingham, AL.
Karen Crissinger, MD, Professor and Director, Pediatric GI, University of South Alabama, Mobile, Alabama
Marquelle Klooster, MD, Professor, Loma Linda Medical Center, Loma Linda, California
21
1985
John C. Bucuvalas, MD, Professor, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
M. Susan Moyer, MD, Professor, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio (deceased)
1984
William Belknap, MD, Troy, Michigan
1983
Ronald J. Sokol, MD, Director, Pediatric GI, University of Colorado, Denver, Colorado
1982
Phillip Lichtenstein, MD, Covington, KY
1981
Robert Rothbaum, MD, Professor, Washington University, St. Louis, Missouri
Frederick J. Suchy, MD Professor, University of Colorado, Denver Colorado
1979
Michael K. Farrell, MD, Professor and Chief of Staff, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
Donna M. Volk, MD, Louisville, Kentucky
1978
James E. Heubi, MD, Professor and Interim Director, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
Jeffrey J. Kline, MD, Charleston, South Carolina
1975
Robert Bobo, MD, Medical College of Ohio, Toledo, Ohio (deceased)
1974
Philip Bagnell, MD, Dean of Medicine, East Tennessee State University, Johnson City, Tennessee
William F. Balistreri, MD, Professor, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
Current locations of our program graduates:
22
Flora Szabo, MD
Karla Hicks, MD
3rd Year Fellow
3rd Year Fellow
Ethan Mezoff, MD
3rd Year Fellow
David Galloway, MD
3rd Year Fellow
Program Organization & Curriculum
Our training program is structured so that three years are spent in clinical care and hypothesisdriven investigation relevant to gastrointestinal, hepatic, and nutritional problems in infants
and children, with responsibilities increasing over the three years. The goals and objectives of
our program are aligned with requirements of the American Board of Pediatrics for certification
in pediatric gastroenterology and with guidelines of the North American Society for Pediatric
Gastroenterology, Hepatology and Nutrition (NASPGHAN) regarding training and education:
Leichtner, A. M, Gillis, L. A., Gupta, S. et al (2013) NASPGHAN Guidelines for Training in Pediatric Gastroenterology.
J Pediatr Gastroenterol Nutr 56 Suppl 1: S1-38.
Skills in clinical gastroenterology, hepatology, and nutrition are learned through experience with the
diagnosis and management of the wide range of acute and chronic, major and minor, conditions that
characterize our specialty, and through increasing responsibilities over the course of the program. The major
clinical exposure comes in the first year of fellowship (9 months of clinical service and three months of research
electives). In the second and third years, this knowledge is consolidated in the outpatient setting, including
the endoscopy suite, and in less intensive inpatient experiences. Their developing knowledge and experience is
respected by the faculty, allowing fellows to have increasing autonomy in preparation for their own
practice. Additional exposure to billing, coding, process improvement, and other issues in systems-based
practice are provided through experience in the clinics, morning lectures, or noon-time Division weekly rounds.
Overall, the program provides the fellow with supervision and mentoring to develop clinical judgment and skills,
medical knowledge, humanistic qualities and professional attitudes and behaviors to develop as a competent
sub-specialist.
The development of research skills is another major goal of the program. Fellows begin to explore their
interests during first year research electives. This experience is used to identify faculty mentor(s) and develop
a hypothesis-driven project in basic science or clinical research relevant to pediatric gastroenterology,
hepatology and nutrition, one that can be used as the basis for the fellows’ career development. This project
is then the primary focus of the second and third years.
Teaching is an important component of divisional activities. Informal, patient-centered teaching occurs daily
on inpatient rounds and in outpatient clinics. In addition, the divisional schedule includes a variety of teaching
conferences (described on pages 31-33). Fellows play an important role in teaching through presentations at
some of these conferences, along with formal and informal teaching of pediatric residents and medical students.
Fellows participate actively in the evaluation and
improvement of the division and program. Program
issues are dealt with as they arise. The monthly fellows’
meeting with the program director allows exchanges of
information and discussion of newly arising issues.
Fellows are also welcome to attend faculty meetings held
every other week throughout the year. Fellows and faculty
review the program globally in an annual evening retreat.
Dr. Balistreri makes his point at GI Grand Rounds.
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First Year
In the first year, fellows primarily immerse themselves in clinical pediatric gastroenterology,
hepatology, and nutrition, establishing a firm foundation for future learning. Fellows spend three
separate months each on the gastroenterology inpatient (“lumen”) service, hepatology inpatient
(“liver”) service, gastroenterology consult service, and research/clinical electives. During this year,
they also work with assigned faculty members in treating outpatients in the Pediatric
Gastroenterology Center and in learning endoscopic and other procedural skills in the care of both
inpatients and outpatients.
Rounds & inpatient care. Our fellows assume primary responsibility (with faculty supervision) for
the work-up and management of all patients and consultations to the inpatient services, as well as
supervision of rotating residents and students. Rounds are made daily by faculty, fellows, residents,
nurse practitioners, and inpatient nursing staff on all inpatients, generally in the patients’ rooms, as
family-centered care is emphasized at Cincinnati Children’s Hospital Medical Center. During this time,
new patients are presented, clinical progress is reviewed, plans for patient care are developed, and
informal teaching takes place. Because all of the division’s inpatients are cared for by a single PL-2
resident team, lumen and liver rounds are held successively during the morning. Rounds on consult
patients are made by a separate consult attending and fellow. Sign-out rounds, particularly to review
the most ill patients, are held in the late afternoon or early evening
Call. First year fellows take overnight call from home. Responsibilities include evening/ nighttime
admissions and emergency procedures and parent phone calls. On-service attendings provide backup
and support. Weekends are covered by fellows from all three years. Two fellows are on call: one each
for the lumen/consult service and the liver service, with each responsible for parent calls for half of
the weekend. The on-call experience is arranged so as to be in compliance with ACGME requirements
for work hours.
Outpatient experience. First year fellows spend one-half day per week evaluating patients in
an outpatient setting. Every year, each fellow has three-month rotations in four different faculty
members’ outpatient clinics, providing fellows the opportunity to see a wide variety of clinical
problems as well as to learn a variety of styles. Fellows are encouraged to participate in further
evaluation, such as endoscopy, of the patients that they encounter.
Procedure experience. Fellows participate in specialty evaluation and treatment of inpatients and
outpatients through diagnostic and therapeutic endoscopies, suction rectal biopsies, and liver biopsies
that are performed on a routine or emergency basis. Fellows also have the opportunity to participate
in the care of children needing enteroscopy and ERCP.
Electives. During the first year, fellows have the opportunity to have up to three one-month electives. Two elective months will be a rotation in a basic science laboratory to learn the approaches and
vocabulary of bench research that are integral to modern medicine. These elective months provide an
opportunity to “taste” the laboratory before a two-year commitment. The third elective month can
be used for a clinical research or an outcomes research experience. It is expected that the fellow will
again have an in depth tutorial experience but may also develop a short project. During the third
25
Endoscopy is a vital part of
diagnosis and treatment
in pediatric gastroenterology.
elective month, fellows take a clinical elective.
Elective opportunities are listed on pages 33-38.
retrospective project.
Choosing a research project. One purpose of the research elective months is to allow fellows to
develop a research focus in the light of their intended career path. Besides working on a
laboratory-based or clinical research project, fellows have the opportunity to interview potential
mentors for their two year research training experience from among faculty both inside and outside
of the Division. Fellows are required to propose a hypothesis-based research project in the area of
basic science, patient-oriented, or outcomes research, in the form of a 2-3 page concept sheet before
the final quarter of their first year of fellowship
This concept sheet, which is to be reviewed by the mentor prior to submission to the Education
Council, includes:
• Title of the proposal
• Mentor: a faculty member with significant extramural funding in the general area of the
proposed research (usually an NIH R01 grant or the equivalent, but other funding in which the mentor is a PI will be considered)
• Hypothesis to be tested
• Significance to pediatric gastroenterology
• Relevant background information, intellectual and physical resources available locally
• Specific research plan (specific aims) including outcome parameters, sample size and statistical plan, and/or laboratory assay endpoints as appropriate
• References
• Coursework to be taken (if any) and its relevance
• Timeline for completion of the project
• Brief statement about career goals: “Where do you see yourself in 5 years?”
• Brief statement regarding your commitments to other academic activities including scientific projects, chapters and reviews, etc.
• Source of proposed funding for this project: training grant or other
• An NIH biosketch for both the mentor and trainee
• Tentative roster of the proposed Scholarship Oversight Committee (SOC) that will review
research progress at least twice a year
• A brief statement from the proposed mentor indicating his/her commitment to help refine and interpret this project and meet with you on a regular basis. If relevant resources or reagents beyond that indicated in the proposal will be provided by the mentor or the mentor’s laboratory, these should be indicated. The number of other trainees for which the mentor will be
responsible during the time of the proposed project should be included.
These proposals are reviewed by the Division’s Education Council for suitability for the fellows’ career
development. Subsequently, each fellow creates a unique Scholarship Oversight Committee to help
26
design and monitor their academic program.
Anna Catalina Arce Clachar, MD
Marie Raphael Jean, MD
1st Year Fellow
1st Year Fellow
Anna Peters, MD
Justin Wheeler, MD
1st Year Fellow
1st Year Fellow
Second & Third Years
In the second and third years, fellows spend the major part of their effort on hypothesis-driven
investigation that will provide the basis for their academic careers as well as meeting requirements
of the American Board of Pediatrics for certification in pediatric gastroenterology, hepatology and
nutrition.
Pursuing a research project. Each fellow works closely with a mentor(s) to carry out a
hypothesis-driven research project and to learn relevant academic skills, including time
management, oral presentations, and manuscript and grant writing. Divisional conferences provide
venues for presenting their latest research findings and their future directions. Research projects
may involve basic science or clinical research, but they must pursue the rigorous testing of a
hypothesis. Fellows may enroll in coursework at the University of Cincinnati that is relevant to their
research project and career goals. In particular, many fellows who are pursing clinical research
enroll in master’s degree programs in epidemiology and biostatistics, molecular epidemiology, or
other disciplines, for formal training in methods relevant to clinical research..
Continued development of clinical skills. During the second and third years, clinical
responsibilities are limited so that research can be the primary focus. Upper level fellows hone their
clinical skills in a variety of settings. Fellows spend one-half day per week in the care of outpatients,
with various faculty members in their clinics at the base Pediatric Gastroenterology Center, and
with a single faculty member each year in their bimonthly or monthly clinics at off-campus sites in
the region. A “Fellow’s Clinic” has been developed to provide the fellows with the continuity of care
experience of managing patients with chronic conditions. Fellows also continue to develop their
endoscopy skills, particular on patients that they see in the outpatient clinics. The clinical experience is rounded out with a limited amount of weekend call and opportunities for clinical electives.
Opportunities to teach. Teaching is an important skill for academic pediatric gastroenterologists.
Upper level fellows continue to have opportunities to gain teaching experience through formal and
informal teaching of residents and medical students and presentations at various conferences.
Monitoring of academic progress. All pediatric gastroenterology fellows are required to form an
individual Scholarship Oversight Committee (SOC) from among relevant faculty members in and out
of the division in order to meet the requirements of the American Board of Pediatrics (ABP). The
purview of each SOC includes close monitoring of academic progress, providing career guidance,
and certifying the trainee to sit for the pediatric gastroenterology board examination. Fellows meet
formally with their committee at approximately 6 month intervals. These committee meetings are
conducted much like a PhD thesis committee, with a mixture of thoughtful probing by the faculty to
determine the progress of the trainee and suggestions by the faculty to ensure proper guidance. In
addition to presentations to their SOC, fellows present their research at divisional conferences and in
institutional venues such as Fellows’ Grand Rounds.
Scientific & clinical meetings. Fellows are provided a budget for academic needs, including
attending and participating in national meetings. Fellows are encouraged to submit abstracts
and prepare poster or platform presentations of their work in these venues. Practice sessions are
scheduled in advance of major national meetings to allow clinical and research fellows and faculty
members who are giving presentations to practice and receive feedback from division members.
28
NIH training grant. Most second and third year fellows are supported by our National Institutes of Health
training grant (T32 DK007727). The primary objective of the program is to give intensive, mentored research
training to pediatricians with clinical training in gastroenterology and nutrition that is essential to prepare
clinician-scientists for productive and independent careers in academic and investigative medicine. The
entire training grant faculty remains thematically related in the broad research categories of Immunobiology
of the Digestive Organs, Absorption and Secretion and Development of the Digestive Organs, and/or Clinical
Research. See pages 41-46 for information on research mentors.
Advanced Training Opportunities
In many cases, three years of fellowship training are insufficient for launching independent careers in
clinical or laboratory investigation, or as master clinicians in sub-subspecialty areas such as transplant
hepatology and motility. A variety of opportunities exist at Cincinnati Children’s for such advanced
(“third-tier”) training. Our fellows interested in advanced research training have been very competitive
in obtaining institutional William Cooper Procter Scholarships and fellowships from the National Institutes
of Health and foundations. We also offer a ACGME-accredited pediatric transplant hepatology fellowship
to comply with the requirements of the American Board of Pediatrics to obtain a Certificate of Added
Qualification in Transplant Hepatology. We will be happy to provide more details to you based on your
particular interests.
Aronoff Center for the Arts, downtown Cincinnati.
Photograph used with permission of the Greater Cincinnati Convention and Visitors Bureau.
29
Ashish Dhawan, MD
Einar Hafberg, MD
2nd Year Fellow
2nd Year Fellow
Stephanie Oliveira, MD
Amy Taylor, MD
2nd Year Fellow
2nd Year Fellow
Teaching & Research Conferences
A number of conferences are held every week within the Division and throughout the institution.
The schedule of divisional rounds and conferences includes:
Tuesday
Therapeutic Endoscopy Service (TES) Conference, organized by Scott Pentiuk and Tom Lin. Morning
conference held the second Tuesday of each month. Faculty and fellows review therapeutic cases from the
last month including discussion of hemostasis, complicated foreign bodies, ERCP, and intestinal strictures.
Digestive Health Center Seminar Series, organized by Cindy Wetzel, PhD. These weekly Tuesday noon
conferences are given by researchers who are members of the NIH-funded Cincinnati Digestive Health
Center (DHC), and by their trainees, including clinical fellows in the division. In addition, investigators
from other institutions present their research.
Wednesday
Wednesday Morning Conferences
Wednesday morning conferences focus mostly on clinical topics, including:
Clinical Fellow Basics Conference, organized by Scott Pentiuk, MD. These conferences are held early in
the academic year to cover the practical aspects of various areas of patient care.
Pediatric GI Grand Rounds, led by William Balistreri, MD. Fellows participate in this conference by
preparing an unknown case presentation. They are also called upon to discuss physiology, pathophysiology, differential diagnosis and case management of these particularly interesting, difficult or unusual
cases.
Pediatric GI Topic Conference, organized by Scott Pentiuk, MD. These include didactic lectures on
clinical topics and career development topics by faculty and visiting professors.
IBD Conference, organized by Ted Denson, MD. Faculty and staff discuss patient specific issues
including in-house patients and case presentations alternating with more general discussions of
new therapies and current research projects.
Meeting practice & review, led by divisional faculty and fellows. In advance of major society
meetings, fellows and faculty have the opportunity to practice publicly and receive constructive
feedback on their presentations. After these meetings, attendees from the division highlight
important findings and trends that were discussed.
Lumen Rounds, organized by weekly Attending
The conference enables a faculty-fellow dialogue about chronic care issues for patients on the lumen
service and provides an additional educational opportunity for issues related to pediatric gastroenterology
and nutrition.
Thursday
Thursday Morning Conferences
Fellows Education Conference, organized by Scott Pentiuk, MD, focuses on didactic lectures on clinical
topics tailored to the core curriculum of the fellowship training program.
31
Journal Club, organized by Joe Palermo, MD. Fellows select and discuss recent journal articles with
an emphasis on papers providing new insights into disease pathogenesis, discuss major advances in
therapeutics or identify new technologies that may alter the clinical practice of or scientific approach
to medicine. Faculty mentors help in the selection and preparation for this conference.
Liver/Intestinal Transplant Rounds, organized by John Bucuvalas, MD, and Kathy Campbell, MD.
Fellows participate in this noon-time conference by presenting patients to be discussed. This conference
addresses both patient management issues as well as research and outcome issues related to liver
transplantation. It is attended by the members of the Pediatric Liver Care Center and the Division of
Pediatric and Thoracic Surgery.
Pediatric Pathology Conference, organized by Kevin Bove, MD, Division of Pathology
This afternoon conference is held on alternate weeks throughout the year. Fellows participate in this
conference by selecting and presenting the clinical history of the patients whose biopsies are reviewed.
Outside specimens received by division faculty are also reviewed.
Pediatric/Internal Medicine Conferences, organized by Mike Leonis, MD, PhD, & Donald Schoch, MD,
gastroenterology training program director in the Division of Digestive Diseases, Department of Internal
Medicine, University of Cincinnati College of Medicine.
This afternoon conference, held every other week from September to June, alternates between:
Clinical Concepts Conference. First year fellows along with a faculty preceptor prepare a detailed case
discussion (20 to 30 minutes) to illustrate a core concept in gastroenterology. One presentation is
made by a pediatric trainee and one by an internal medicine trainee at each conference.
Physiology/Pathophysiology Conference. Second and third year fellows prepare a 45-minute discussion
of a core concept in the teaching curriculum centered around a clinical pathological correlate (CPC).
An assigned faculty member provides an unknown case to the assigned fellow for this presentation.
Recent topics include cholestatic liver disease, disorders of acid secretion, disorders of gastrointestinal
absorption, gastrointestinal immunology, gastrointestinal motility, infectious disease of the liver, inflammatory disorders of the pancreas, inherited disorders of the gastrointestinal tract, molecular basis
of gastrointestinal malignancy, and obesity.
Division Faculty Meetings, occur every other week. Fellows are welcome and encouraged to attend.
Friday
Pediatric Radiology Conference, organized by Mike
Leonis MD & Department of Radiology.
Fellows participate in this once a month conference
by selecting the cases to be seen and by presenting
the clinical history of the patients whose imaging
studies are to be viewed.
IBD Pathology Conference,
organized by Ted Denson, MD
This afternoon conference, held twice monthly,
focuses on biopsy specimens from patients with
Hepatology
inflammatory bowel disease and eosinophilic disorders of the gastrointestinal
tract. attendings
Fellows participate in
32
this conference by selecting and presenting the clinical history of the patients whose biopsies are reviewed.
Outside specimens received by division faculty are also reviewed.
Pancreas Multi-disciplinary Conference, organized by Tom K. Lin, MD
This twice a month conference provides the opportunity for increased exposure to pediatric pancreatic
disorders, with the involvement of key faculty from GI, surgery and radiology. It includes an open
discussion on past, current and future patients, including unique patients that are referred specifically to
our pediatric pancreas program.
Elective Opportunities
A number of research and clinical opportunities are available for first year fellows for their three
elective months
Research electives
Introduction to Laboratory of Liver Research (Jorge A. Bezerra, MD, Stacey Huppert, PhD,
Rohit Kohli, MD, Alexander Miethke, MD, Pranav Shivakumar, PhD or Chunyue Yin, PhD)
Minimum duration: 4 weeks
Goals & objectives: 1. Exposure to routine laboratory protocols.
2. Participate in weekly laboratory meetings.
3. Develop a basic science hypothesis based on preliminary or published data.
The laboratories of Liver Research studies genetic and inflammatory mechanisms of diseases of the liver
and biliary tract. Key ingredients for a successful laboratory experience include the acquisition of technical
expertise, the ability to exchange ideas with colleagues, and the development of a hypothesis that is based
on preliminary experiments or published data. Therefore, the overall goal of the elective is to provide gastroenterology residents/fellows with an introduction to these ingredients through a hands-on experience in
the laboratory setting. Specifically, the fellow will learn initial laboratory skills by joining a laboratory assistant or post-doctoral fellow in the execution of a set of assays to answer a specific biological question.
Introduction to data acquisition, interpretation, and informal group discussion will be emphasized. The
fellows are expected to learn the basis of a molecular assay, to engage in a focused review of published
data, and to propose one hypothesis-driven experiment.
Quality Improvement Elective (John Bucuvalas, MD or Dana “Chelly” Dykes, MD)
Minimum duration: 4 weeks
Goals & objectives: 1. Learn general principles of quality improvement.
2. Apply these principles to clinical care in pediatric gastroenterology,
hepatology and nutrition
Research in health care delivery and in quality improvement are an integral part of the strategic plan for
Cincinnati Children’s and for the Division of Gastroenterology, Hepatology and Nutrition. A safe and reliable health care delivery system is critical for best care and also provides the foundation for gaining new
knowledge through translational and clinical research. Several members of the division are involved in
efforts to improve delivery systems at the Divisional, hospital and national level. Efforts are focused
33
on increasing outpatient access, preventing errors, developing interdisciplinary care teams to best
deliver care, and improving patient flow through the acute care settings. These efforts are aligned
with national and local efforts and Cincinnati Children’s Hospital is considered a leader in this field.
This one-month elective will provide a structured curriculum and hands on experience with an
ongoing quality improvement effort in the area of liver transplantation or IBD.
Basic/Translational Research in Inflammatory Bowel Disease (IBD) (Ted Denson, MD,
Xiaonan Han, PhD or Michael Rosen, MD)
Minimum duration: 4 weeks
Goals & objectives: 1. Exposure to routine laboratory protocols.
2. Participate in weekly laboratory meetings.
3. Develop & test a hypothesis based on preliminary or published data.
The JAK/STAT signal transduction pathway mediates the cellular response to both inflammatory
cytokines & potentially beneficial growth factors. The Denson lab is investigating mechanisms by
which alterations in JAK/STAT signaling lead to growth failure and impaired mucosal healing in
children with IBD. Collaborative studies are ongoing with colleagues in rheumatology, oncology, and
immunology. The aims of these studies are to define specific aspects of the gut mucosal immune
system that cause chronic inflammation and cancer in IBD. This work is currently employing tissue
culture systems, murine models of colitis, and patient based studies. During the four week rotation,
the fellow will: attend weekly lab meetings & discuss one paper from the literature in this forum;
learn one or more molecular techniques; and design a series of experiments to test a hypothesis
related to an ongoing project in the lab. This rotation will provide exposure to ongoing basic/
translational research in IBD and will help to determine whether a longer-term laboratory based
research project is desired.
Basic Research in Gastroenterology (Sean Moore, MD or Kris A. Steinbrecher, PhD)
Minimum duration: 4 weeks
Goals & objectives: 1. Participation in an ongoing research project.
2. Exposure to and
experience with lab research protocols.
Fellows will be introduced to the basic science
research methods. A hands-on approach will be
taken so that the fellow can learn one or more
techniques relevant to the study of interactions
between intestinal bacteria, Toll-like receptors, and
the regulation of gene expression through NF-kB.
Introduction to data acquisition, interpretation and
Spectacular Labor Day fireworks on the Cincinnati
riverfront are provided by a local company that also does
the fireworks at DiseyWorld
34
literature review of relevant published data will be emphasized.
Clinical electives
Liver Consultation Clinic (William Balistreri MD and Jorge Bezerra MD)
Minimum duration: 3 months
Goals & objectives:
To train pediatric GI fellows in their 2nd or 3rd year in the evaluation and care of children with
chronic liver disease. The clinic provides consultation to children with a wide spectrum of liver
diseases, including genetic syndromes, metabolic defects, inflammatory injury, viral infection,
vascular abnormalities, biliary diseases, and neoplasias. During the elective, fellows are involved in:
• Pre-clinic review of case material (history, exams, histology)
• Clinic consultation
• Post-clinic review
• Quality of care benchmarks
The clinic provides an ideal forum for education regarding the pathogenic basis of hepatobiliary diseases, state-of-the-art approach to diagnostics, novel therapies, and monitoring of disease
progression.
The clinic is held each Wednesday afternoon.
Longitudinal elective “Rural GI” (Michael K. Farrell, MD)
Minimum duration: Attend 4-6 monthly Portsmouth clinics
On this elective, we focus on making diagnoses with limited resources. We will explore why some
disorders are more common, e.g., H. pylori. Included would be readings about the Appalachian
culture, the organization of rural medicine, etc.
Clinical Obesity Elective Clinical Obesity Elective (Stavra Xanthakos, MD)
Minimum duration: 2- 4 weeks
Goals & objectives:
1. Understand the epidemiology of pediatric obesity and spectrum of obesity-related comorbid conditions.
2. Learn current evidence-based screening and treatment guidelines for obesity and related comorbid conditions and be able to interpret results of screening tests.
3. Understand principles of pediatric weight management (behavioral, nutritional, exercise and surgical).
The fellow will have an opportunity to achieve these objectives by means of informal outpatient
observation and teaching and a syllabus of required reading. Attending and participating in
the once monthly Obesity Journal Club (4th Wed each month) is also a required component.
Fellows will attend a variety of obesity-related clinics and associated clinical multi-disciplinary
conferences, including those in the Steatohepatitis (NASH) Clinic, Surgical Weight Loss Program
for Teens (SWLPT) clinic, Center for Better Health and Nutrition clinics (Healthworks!, Advanced
Metabolic Clinic) and as available, the Hypertension and Lipid Clinic, Sleep Apnea Clinic, and
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Diabetes Clinic. Observing specialty dietician consultations and child-focused exercise sessions held at
the HealthWorks! facility will also be an integral part of the learning experience.
GI Motility Disorders Elective (Ajay Kaul, MD)
Minimum duration: 4 weeks
Goals & objectives:
To familiarize pediatric GI fellows with the evaluation and management of children with motility
disorders.
During this period the fellow’s primary responsibility will be to take every available opportunity to learn
about motility disorders. They will be expected to:
1. Participate in the motility disorders clinic on Monday mornings.
2. Attend the weekly motility meetings on Mondays from 2-3 pm. During this time new referrals and current patients are reviewed, plans for patient care are developed and informal teaching takes place.
3. Learn the basic principles of manometry and its indications and participate in the endoscopic and/or fluoroscopic placement of manometry catheters.
4. Review and interpret manometry recordings and correlate the findings to the patient’s symptoms. Based on the results the fellow would be expected to formulate a plan of care for the patient.
5. Assume primary responsibility for any patient admitted to the GI service for evaluation and management of motility disorders. The fellow will take this opportunity to teach the
pediatric house staff taking care of the patient as well as being the liaison to the primary GI inpatient service team.
6. Attend the monthly didactics (second Monday at noon) on GI motility disorders.
7. Present cases during daily morning rounds, Lumen, Pathology, and Radiology conferences.
Nutrition Elective (Samuel A. Kocoshis, MD and Conrad Cole, MD)
Minimum duration: 2 weeks
Goals & objectives:
1. Know how to assess nutritional status by anthropometrics, balance studies, body composition analysis, and measurement of energy expenditure.
2. Recognize the clinical and biochemical manifestations of nutrient deficiencies and
nutrient excess.
3. Understand the special nutritional needs of patients with IBD, short bowel syndrome, cholestatic liver disease, end stage liver disease, renal disease, neoplasia, immunodeficiency, and infection.
4. Become competent in nutritionally rehabilitating patients who are undernourished.
The fellow will have an opportunity to learn pediatric nutrition by means of a combination of formal
didactic exercises and informal bedside teaching. Problem-based, integrative case studies will
constitute and important aspect of the didactic process. Hands-on experience answering nutrition
consults, rounding with specialty dieticians, attending the Comprehensive Nutrition Center clinic, and
observing both the outpatient HealthWorks! (obesity) clinic and the eating disorders program.
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Didactic Exercises:
1. Hospital-wide nutrition rounds, 1st & 3rd Mondays, 2-3 pm
2. Regional Center for Neonatal Intensive Care (RCNIC) rounds, 2nd & 4th Mondays, 2-3 pm
3. Lumen rounds, Wednesdays, 12-1 pm
4. Integrated case studies with Dr. Kocoshis, Tuesdays & Fridays, 3-4 pm
Topics include: nutritional assessment, nutrient biochemistry, macronutrient deficiency, micronutrient deficiency, short gut, IBD, liver disease, and renal failure/immunodeficiency
Clinical Experiences:
1. Round with subspecialty dietician (gastroenterology, cystic fibrosis, hematology-oncology, transplant, nephrology), to be determined weekly, Mondays, Tuesdays, Thursdays, Fridays
early morning
2. Answer nutrition consultations to be precepted by dietician and Dr. Kocoshis, all week
3. HealthWorks!, Tuesday afternoons
4. Nutrition and Intestinal Care Center, Wednesdays all day
5. Eating Disorders Clinic, Thursday afternoons
Aerodigestive and Sleep Center (ADSC) Elective (Philip E. Putnam, MD, & Ajay Kaul, MD)
Minimum duration: 4 weeks
Goals & objectives:
To acquaint pediatric GI fellows with the evaluation and management of complex patients (most with
primary airway anomalies) who may have GI disorders that complicate or contribute to multi-system
disease.
Components of the elective include:
1. Attending the ADSC clinic (Tuesday afternoon 2-5) and see any other ADSC new patients who are scheduled outside of clinic time.
2. Attending the ADSC conference Wednesday Morning 8:30-9.
3. Participation in all ADSC-related endoscopies (diagnostic and therapeutic).
4. Attending Feeding Team clinic and conferences with Dr. Kaul (specific Tuesdays
and Thursdays AM)
5. Reviewing and interpreting results from all ADSC tests and procedures including radiology, histology, and pH and impedance probes from ADSC patients.
6. Following ADSC patients admitted for GI studies.
7. Performing the GI portion of ADSC consults on in-house patients.
8. Observing at least one Flexible Endoscopic Evaluation of Swallowing (FEES) study and one Video Swallowing Study (VSS) during the ADSC elective.
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Endoscopy Elective (Robert Weesner, MD, Division of Digestive Diseases, University of Cincinnati College of
Medicine)
Minimum duration: 2 weeks
Goals & objectives:
1. Improve skills in endoscopic technique in adult patients
2. Perform at least 10 colonoscopies over a 2-week period.
Pediatric GI fellows may rotate through the outpatient clinics and the endoscopy suite at the Cincinnati V.A.
Medical Center, a teaching hospital of the University of Cincinnati. During these rotations, fellows will be
provided with additional training and endoscopy experience. Other elective experiences are also available.
This elective must be scheduled at least 30-60 days in advance.
38
James Squires, MD
4th Year Advanced Hepatology Fellow
Current 3rd years at NASPGHAN’s
1st Year Fellows Conference
39
Inside the rotunda at Cincinnati Museum Center at Union Terminal.
Photograph used with permission of the Greater Cincinnati Convention and Visitors Bureau.
Research Opportunities
Potential faculty research mentors include investigators from within the Division of Gastroenterology,
Hepatology and Nutrition, Cincinnati Children’s, and the University of Cincinnati College of Medicine:
Division of Gastroenterology, Hepatology and Nutrition
William F. Balistreri, MD
Jorge A. Bezerra, MD
John C. Bucuvalas, MD
Lee (Ted) A. Denson, MD
James Franciosi, MD
Xiaonan Han, PhD
James E. Heubi, MD
Stacey Huppert, PhD
Rohit Kohli, MD, MS
Mike A. Leonis, MD, PhD
Sean Moore, MD
Michael Rosen, MD
Pranav Shivakumar, PhD
Kris A. Steinbrecher, PhD
Stavra A. Xanthakos, MD
Chunyue Yin, PhD
Other divisions at Cincinnati Children’s
Bruce J. Aronow, PhD – Bioinformatics
Jay L. Degen, PhD – Developmental Biology
Kasper Hoebe, PhD – Allergy and Immunology
Simon P. Hogan, PhD – Allergy and Immunology
Kevin A. Hommel, PhD – Behavioral Medicine & Clinical Psychology
Thomas H. Inge, MD, PhD – Pediatric and Thoracic Surgery
Uma Kotagal, MBBS, MSc – Health Policy and Clinical
Effectiveness
Anil Mishra, PhD – Allergy and Immunology
Ardythe L. Morrow, PhD – Epidemiology and Biostatistics
S. Steven Potter, PhD – Developmental Biology
Scott W. Powers, PhD – Behavioral Medicine and Clinical Psychology
Marc E. Rothenberg, MD, PhD – Allergy and Immunology
Lori J. Stark, PhD – Behavioral Medicine and Clinical
Psychology
Gregory M. Tiao, MD – Pediatric and Thoracic Surgery
James M. Wells, PhD – Developmental Biology
Jeffrey A. Whitsett, MD – Pulmonary Biology
David P. Witte, MD – Pathology and Laboratory Medicine
Basilia Zingarelli, MD, PhD – Critical Care
Aaron Zorn, PhD – Developmental Biology
Faculty within other departments of the University of Cincinnati College of Medicine
are available to fellows to serve as potential research mentors. Please explore the Digestive Disease
Center website and read more about faculty research mentors available to fellows:
www.cincinnatichildrens.org/research/divisions/d/dhc
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A Sampling of Faculty Research Summaries
Potential faculty advisors include investigators from within the Division of Gastroenterology,
Hepatology and Nutrition, Department of Pediatrics, and throughout the University of Cincinnati
College of Medicine:
Jorge A. Bezerra, MD
Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition
Director, Biliary Atresia Research Center; Associate Director, Digestive Diseases Research Development
Center
Dr. Bezerra investigates pathogenic mechanisms of biliary atresia, the most common cause of chronic liver
disease in children. His experimental approach begins at the bedside with collection of clinical data and
tissues at diagnosis and at different phases of disease progression to search for molecular pathways regulating
progression to cirrhosis. To directly test whether these pathways control pathogenesis of disease, his laboratory
performs mechanistic experiments using cell co-culture systems and unique mouse models of biliary atresia
that recapitulates the human disease. Using these complementary systems, Dr. Bezerra has discovered molecular
signatures that identify subtypes of disease, stage liver and biliary injuries at diagnosis, and predict long-term
outcome. The biological relevance of these signatures has been validated by a strong liver-specific
pro-inflammatory response, which requires intact interferon-dependent circuits, NK cells, and cytotoxic
lymphocytes. These discoveries mapped previously unrecognized stages of disease, beginning with mucosal injury
soon after birth, followed by rapid progression to lumenal obstruction and duct atresia. Ongoing studies seek
to understand mechanisms by which antigen-presenting dendritic cells directly interact with NK cells, control
their activated phenotype, and modulate an adaptive response that disrupts mucosal continuity and leads to
obstruction of bile ducts.
John C. Bucuvalas, MD
Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition
Assoc. Medical Director Pediatric Liver Care Center
Director, Disease Specific Innovation and Outcomes Project
Dr. Bucuvalas’ research focuses on improving outcomes for children with liver disease before and after liver
transplantation. As part of this effort, he has sought to identify areas where there are gaps in knowledge and
where research efforts might be rapidly translated to better care processes. Dr. Bucuvalas is a member of the
senior steering committee of the Pediatric Acute Liver Failure Study Group (PALFSG) funded by NIDDK. The
PALFSG is comprised of clinical leaders and scientists from 20 centers in North America and the United Kingdom
dedicated to advancing knowledge in pediatric acute liver failure, a catastrophic, rapidly evolving clinical
syndrome. The study group seeks to improve outcomes through better risk classification, better understanding of
the mechanisms of disease and more directed medical therapies targeted at defined phenotypes. As part of this
effort, Dr. Bucuvalas has led a research effort working in collaboration with Dr. Yazigi and they have identified
subgroups of patients with evidence of immune dysregulation whose outcome is influenced by timely recognition
of the condition and targeted medical therapy. Additionally, Dr. Bucuvalas also seeks to improve outcomes for
pediatric liver transplant recipients through interventions that will simultaneously ensure excellent allograft
function and minimize complications of immunosuppression. He has worked with Dr. Campbell on a multi-center
project funded by NIDDK to define the prevalence and risk for post transplant renal insufficiency.
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Lee (Ted) A. Denson, MD
Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition; Director, Fellowship
Training Program
The primary focus of Dr. Denson is to determine the mechanisms by which the chronic inflammation associated
with inflammatory bowel disease (IBD) inhibits normal childhood growth and mucosal healing. Ongoing studies
are investigating cytokine regulation of growth hormone dependent JAK-STAT signaling in the intestinal tract
alone, and as a critical com-ponent of the growth hormone circuit involving the liver, muscle, and colon. This
work has recently led to the identification of mechanisms involving down-regulation of the growth hormone
receptor by tumor necrosis factor alpha and up-regulation of a post-receptor inhibitor protein, SOCS-3, by IL-6.
These mechanisms may serve as targets for new therapies. Complementary studies have recently identified
novel anti-inflammatory effects of growth hormone that promote mucosal healing in colitis. Ongoing studies
in children with IBD and in experimental models of colitis will determine the effectiveness of blocking specific
cytokines versus administration of growth factors in improving growth and intestinal healing
Xiaonan Han, PhD
Assistant Professor of Pediatrics, Division of Gastroenterology, Hepatology, & Nutrition
The primary focus of Dr. Han’s research is to determine the mechanisms by which pediatric Crohn’s disease (CD)
causes dysfunction of the gut barrier. Ongoing studies are identifying the immune modulation of STAT5b on
colonic epithelial cells, macrophages and regulatory T cells in the gut mucosa; moreover, the studies involve
the possible therapeutic mechanism of growth hormone (GH) and anti-TNFα in pediatric CD patients. This work
has recently indicated that STAT5 may play an anti-inflammatory role in CD by regulating PPARγ inhibition of
NFκB activation. Furthermore, both anti-TNFα and GH have improved experimental colitis by up regulating the
activity of STAT5b. Taken together, STAT5b may be employed as a novel biologic maker of future therapy and
drug development in inflammatory bowel disease; meanwhile, the recognition of these novel STAT5b functions
will enrich the classic JAK-STAT pathway in signal transduction.
James E. Heubi, MD
Professor and Associate Chair of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition;
Associate Dean for Clinical and Translational Research; Co-Director, Center for Clinical and Translation
Science and Training
Dr. Heubi actively pursues a variety of patient-oriented projects that relate to liver disease and nutrition. He
is investigating the pathogenesis of inborn errors of bile acid metabolism, including peroxisomal disorders.
As new defects have been identified, he actively investigated the development of specific therapies directed
toward the underlying abnormalities. He is participating in the Cholestatic Liver Disease Consortium (CLiC)
funded by NIH to study rare cholestatic liver diseases in 10 centers throughout the U.S. One current line of
investigation focuses on exploring the role of intraluminal contents, such as the composition of bile acids and
phospholipid content, on cholesterol absorption and synthetic rate in adults utilizing stable isotope technology.
He is also exploring the physiologic basis for variable responses to statins and cholesterol absorption inhibitors
as well as exploring the roles of specific intestinal transporters of cholesterol on cholesterol absorption. In
another area of research Dr. Heubi is developing a novel non-invasive method to measure fat excretion in
humans, and is pursuing a number of projects related to bone metabolism in health and disease.
43
Kasper Hoebe, PhD
Assistant Professor of Pediatrics; Division of Molecular Immunology
Dr. Hoebe’s research is focused on a better understanding of the genes required for a normal immune system.
Specifically, his work focuses on the interaction between NK cells and their role in the onset of adaptive
immune responses including CD8+ T CD4+ T and B cell responses. NK cells are able to recognize a variety
of target cells, including tumor cells, stressed cells or infected cells, via receptor –mediated interactions
involving “missing self”, “induced self” or recognition of pathogen-derived molecules. Upon administration
of antigen-expressing cells that exhibit “missing self”, NK cells induce cell death and subsequently prompt a
strong CD8+ T, CD4+ T and B cell response. Dr. Hoebe’s laboratory applies a forward genetic approach using
ENU mutagenesis to identify key components in NK cell function and subsequent CD8+ T cell responses
via the above described cell death pathway. Using this approach, his laboratory has identified a number of
germline mutants that are NK and/or CD8+ T cell-deficient. As part of this approach he identified a mutant—
designated sphinx—that exhibited a complete lack of peripheral NK and CD8+ T cells. In addition, these mice
developed liver disease and colitis and had an overall poor survival. His laboratory aims to identify the genetic
basis for such severe immunological phenotypes and ultimately gain important insight into gene function and
their relation to disease development.
Simon Hogan, PhD
Associate Professor of Pediatrics; Division of Allergy and Immunology
Dr. Hogan’s research is focused on cellular and molecular networks that underlie the development of
gastrointestinal inflammation and associated dysfunction in gastrointestinal disorders. Current projects
focus on the role of individual Th2 cytokines and eosinophils in disease pathogenesis and characterization of
the downstream signaling pathways employed by these molecules and cells to induce disease. Dr. Hogan’s
experimental approach is integrative, employing state-of-the-art molecular genetic techniques in association
with model systems to identify the role of inflammatory cells and molecules in the events that underpin
disease
Kevin Hommel, PhD
Associate Professor; Department of Pediatrics; Division of Behavioral Medicine and Clinical Psychology
Dr. Hommel’s research centers on the measurement and promotion of treatment adherence in children and
adolescents, with inflammatory bowel disease (IBD). He currently has a K23 Career Development Award and
a R03 from NIH/NIDDK. These studies are focused on development, testing (via randomized clinical trial),
and optimizing a behavioral treatment protocol for nonadherence in IBD. Additionally Dr. Hommel is a
co-investigator on a multisite study aimed at developing and testing a patient-provider collaborative clinical
care network to improve treatment outcomes. He is also the site PI on a study (NIH/NIDDK) testing the
efficacy of a low magnitude mechanical stimulus intervention to improve bone mineral density in children
with Crohn’s disease and is a co-investigator on a study (NIH/NIDDK) examining effects of a novel lipid
matrix supplement on choline status in children with cystic fibrosis. Finally, Dr. Hommel is a co-investigator
on a study (CDHNF) focused on developing a disease-specific measure of health-related quality of life in
eosinophilic esophagitis.
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Kohli, Rohit, MD, MS
Associate Professor of Pediatrics; Division of Gastroenterology, Hepatology and Nutrition
Dr. Kohli’ primary research focus is to study the pathophysiology of non-alcoholic steatohepatitis (NASH),
including the potential role of mitochondria generated mitochondrial reactive oxygen species (mROS). Dr.
Kohli recently identified the specific role of the mROS - hydrogen peroxide, as signaling molecule stimulating
the Protein Kinase B (PKB) intracellular signaling pathway. He reported that in response to high fat nutritional
supplementation hepatocytes produce increased mROS which in turn signal through PKB to produce elevated
hepatocellular TG levels. He is currently involved in establishing an animal model of surgical weight loss to
study its effects on the pathogenesis of NASH in collaboration with investigators at the Obesity Research
Center of the University of Cincinnati. He is funded for this project by the Children’s Digestive Health and
Nutrition Foundation. The key question for this proposal is the degree to which the beneficial effects of
surgical weight loss surgery are associated with less hepatic steatosis and to test several hypotheses about
how this change in GI anatomy affects liver function. He is specifically looking to investigate the role of mROS
and the PKB cell signaling pathway in this model in-vivo and carry forward his previous work regarding the
generation of hepatic steatosis in response to high fat nutritional supplementation in-vitro.
Ardythe L. Morrow, PhD
Professor of Pediatrics; Director, Center for Epidemiology and Biostatistics
Dr. Morrow’s research focuses on the epidemiology of breastfeeding and human milk factors in relation to child
health outcomes. The human milk program project (P01 HD 13021) is designed to understand the role of innate
immune factors. She has previously been able to show that human milk oligosaccharide moieties, which are
synthesized by fucosyltransferases encoded by the Lewis-Secretor genes, inhibit the binding of certain enteric
pathogens (noroviruses, campylobacter, stable toxin of E. coli, and V. cholerae) to host cell receptors and
thereby preventing diarrhea in breastfed infants. Dr. Morrow is testing the hypothesis that these specific fucosyl
human milk oligosaccharides can be isolated, characterized, synthesized, and administered to prevent diarrheal
disease. In another grant (HD 059140), Dr. Morrow is studying the role of salivary fucosyl oligosaccharides
expressed in very low birthweight (VLBW) infants as biomarkers for risk of necrotizing enterocolitis and death.
Marc E. Rothenberg, MD, PhD
Professor of Pediatrics; Director, Division of Allergy and Immunology; Director, Cincinnati Center for
Eosinophilic Disorders
Dr. Rothenberg investigates the mechanisms of allergic responses especially in mucosal tissues with a primary
focus on the gastrointestinal tract. The goal of the research is to develop the best treatment strategy for
allergic disorders (especially eosinophilic gastrointestinal disorders (EGIDs) based on mechanism-driven
research. He uses multiple approaches involving analysis of the cellular and molecular processes in vitro and
in vivo, often utilizing genetically engineered mice. In addition, several novel models of antigen-driven allergic
gastrointestinal disorders have been developed and these provide the experimental framework for identifying
mechanisms of disease. Furthermore, translational research involving several aspects of patient-based research
including innovative drug intervention clinical trials, genome wide expression profiling of intestinal tissue, and
genetic analysis using candidate gene approaches and genome wide analysis studies (GWAS) are underway.
For example, the first set of GWAS results for eosinophilic esophagitis has identified the thymic stromal
lymphopoeitin (TSLP) locus as a disease risk variant. As a key regulatory checkpoint in initiating allergic
sensitization, the laboratory is now focused on understanding the biology and contribution of TSLP.
45
Kris A. Steinbrecher, PhD
Assistant Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition
The broad goal of Dr. Steinbrecher’s laboratory is to understand how regulation of intestinal gene expression
influences the pathogenesis of enteric inflammation and cancer. Specifically, his lab studies a transcription
factor family called NF-κB and has shown that it has a critically protective function in the intestine during
acute inflammation. In addition, they are investigating the role of a cellular signaling protein called GSK-3
in coordinating the interplay between NF-κB and other transcription factors such as AP-1 and -catenin. They
have demonstrated that GSK-3 is important for proper expression of genes associated with the development
of intestinal inflammation and cancer. Ongoing efforts utilize both in vitro molecular studies as well as
tissue-specific, gene targeted animal models to investigate the manner in which these signaling pathways and
transcription factors cooperate to dictate the development of inflammation and tumorigenesis of the intestine.
James M. Wells, PhD
Professor of Pediatrics, Division of Developmental Biology
Dr. Wells’ research focuses on the molecular pathways that regulate development of the gastrointestinal tract
and its associated organs. The lab has discovered that the FGF pathway is involved in establishing the foregut,
midgut and hindgut early in development. It has identified that the biliary system shares a common origin
with the pancreas, and not the liver, and that these organs arise from a common progenitor. Segregating this
progenitor into the pancreas and biliary system requires the transcription factor Sox17 and the notch signaling
pathway. In colon cells, he has shown that Sox17 promotes the degradation of beta-catenin and T-cell specific
transcription factors in a non-canonical fashion. He has found that Sox17 is expressed in crypt cells of the
gut and by basal cells of the conducting airway in the lung. Currently Dr. Wells is investigating is using the
signals and genes that direct normal development of the GI and associated organs in the embryo to direct the
differentiation of human embryonic stem (ES) cells into therapeutically important endoderm derivatives, such
as insulin-producing beta cells and liver hepatocytes. The goal of this work is to generate cells that could
be used in a transplantation-based therapy to treat Type 1 diabetes and liver diseases. Ultimately, he plans
to study the therapeutic potential of embryonic stem cell-derived gastrointestinal cells in animal models of
gastrointestinal disease.
Stavra A. Xanthakos, MD
Associate Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition
Dr. Xanthakos’ primary research focus is to identify the biologic determinants of non-alcoholic steatohepatitis
(NASH), including potential gene-environment interactions with dietary intake during childhood and
adolescence. Dr. Xanthakos recently characterized the histologic spectrum of non-alcoholic fatty liver disease
(NAFLD) in morbidly obese adolescents undergoing bariatric surgery at Cincinnati Children’s Hospital Medical
Center in a collaborative study with Dr. Thomas Inge. These studies revealed that the histologic spectrum
of NASH in morbidly obese adolescents differs considerably from the features of NASH described in adults,
with more portal inflammation and fibrosis than is seen in adults. The etiology of the difference in histologic
pattern between children and adults is not known. Importantly, nearly 20% of morbidly obese adolescents
do not develop NASH, despite similar degrees of morbid obesity and insulin resistance. Long-term research
goals include 1) determining the biological factors that regulate hepatic susceptibility to inflammation and
fibrosis in response to obesity, 2) analyzing how genetic polymorphisms in key cytokines and adipokines
alter the expression of genes that regulate inflammation and fibrogenesis, 3) identifying dietary factors that
may predispose genetically-susceptible individuals to develop the NASH and 4) developing and applying
mechanistically based therapies for NASH in childhood and adolescence.
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Fellows’ Benefits
The Division of Gastroenterology, Hepatology and Nutrition offers an excellent benefits package
to its fellows, particularly in relationship to the cost of living in Cincinnati. For Fiscal Year 2014
(7/1/14 – 6/30/15), benefits are:
Salary Schedule
PLIV $55,200
PLV $56,700
PLVI $58,200
PLVII $59,700
Moving Expenses
First year fellows will receive $1750 in the form of a Visa checkcard to apply towards the expenses
associated with moving to Cincinnati. Checkcards will be mailed to fellows at the end of May prior to
their expected matriculation in our program.
Discretionary Allowance Guidelines
Fellows are granted $2,375 during the fiscal year (7/1 through 6/30) that can be used to cover
appropriate expenditures related to fellowship training. These expenses must be applicable to your
training needs (relevant books, dues, conferences, etc.). Funds may not be carried over from one fiscal
year to another. All expenses incurred in June must be submitted no later than the third week of June
to insure they are reconciled within the appropriate fiscal year. Expenses submitted after that time
will be counted in the following fiscal year allowance. Expenses must be related to the time that you
are in your fellowship training.
For those fellows on the training grant, additional items may be covered, such as course books, tuition,
etc.
Conference/Travel
Each fellow may use some or all of the discretionary allowance to attend one Division supported
educational conference or scientific meeting per fiscal year (7/1 through 6/30). Saving on travel,
sharing a room, and other appropriate cost saving measures may permit you to attend a second
conference and stay within your discretionary allowance budget. If there is a specific conference
beyond this budget that a fellow feels would be beneficial to his/her research or career, a meeting
prior to registering and/or submitting an abstract to this conference must be held with the Division
Director and/or Dr. Mike Leonis to make sure funding is available. While all reasonable requests will
be considered, support cannot be guaranteed.
The Division has a strong commitment to fellow education but needs to remain fiscally accountable.
This conference allowance includes the cost of registration for the course, housing, transportation and
a food allowance. Rental cars are not a covered expense for routine conference/travel. If you travel
with a spouse/significant other for a conference, the expenses of that second person are the traveler’s
responsibility and receipts must be itemized to exclude expenses of that person. If you exceed the
amount, you will be expected to cover the difference.
47
Procedure:
Prior to any travel, the travel must be discussed and approved by either the Fellowship Training
Director (Dr. Leonis) or Division Director. A travel request must be completed prior to making any
travel arrangements. The fellows’ secretary (Angela Cain) will provide assistance for the fellows in
regards to travel arrangements. You are strongly encouraged to make travel arrangements as soon in
advance as possible.
Upon return from a conference, expenses must be submitted for reimbursement within 7 working
days of the conference. You need to keep all original receipts associated with travel and document
on the receipt the nature of the expense. The fellows’ secretary will review all submitted expense
reports to ensure accuracy and submit for authorization and reimbursement. Reimbursement takes
approximately 10 working days.
Society Dues
Fellows are encouraged to use their discretionary funds to join the AGA (First year is free; $95 for
following years) and, if appropriate, the AASLD (Trainee dues $90). First year trainee membership in the
NASPGHAN is free, and you should be automatically added to the roster and receive notification of this
early in your first year.
Slides/Posters/Artwork
Charges for posters, etc., will be accrued to your discretionary fund or to a specific laboratory fund of
your mentor.
Malpractice
Coverage is provided through the CCHMC’s self-insured policy for the duration of the fellowshiptraining program for fellowship related activities. Coverage for activities not associated with the
training program is not provided. A certificate of such coverage will be provided to all fellows.
Vacation
Each fellow is given 20 days of vacation time (includes CCHMC holidays) to use during the fiscal year
(7/1 – 6/30). There is no carryover of vacation time from year to year. Please schedule your vacations
during your elective time.
Health Care Benefits
The selections of providers for health care and dental benefits change on an annual basis. For incoming
fellows this decision is made during orientation. Open enrollment for the Medical Center is typically in
the spring, when you can make changes to your plan.
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Group Term Life Insurance
Group Term Life Insurance of $50,000 is provided without cost, effective the first day of employment.
Disability Insurance
Disability Insurance is provided without cost as detailed in the annual contract.
Travel Accident Insurance
Travel accident insurance is provided without cost as detailed in the annual contract.
Cincinnati Museum Center
at Union Terminal at dusk.
Photograph used with
permission of the Greater
Cincinnati Convention and
Visitors Bureau.
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Resources for Fellowship Applicants
The Division of Gastroenterology, Hepatology and Nutrition at Cincinnati Children’s recommends the following
web sites to fellowship applicants:
Information about Cincinnati
Cincinnati.com
http://www.cincinnati.com/
http://www.cincinnati.com/discover
The Cincinnati Guide
http://www.thecincinnatiguide.com/
Greater Cincinnati Convention and Visitors Bureau
http://www.cincyusa.com/
Cincinnati Arts links:
http://www.wguc.org/links/index.asp
Cincinnati Arts Association
http://www.cincinnatiarts.org
Multiple Listing Service from the Cincinnati Area Board of Realtors
http://www.cincymls.com/
Multiple Listing Service from the Northern Kentucky Association of Realtors
http://www.nkymls.com/
University of Cincinnati
University of Cincinnati Medical Center
http://medcenter.uc.edu/
Division of Digestive Diseases
http://intmed.uc.edu/divisions/digestivediseases/about.aspx
Professional societies
North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN)
http://www.naspghan.org/
American Gastroenterological Association (AGA)
http://www.gastro.org/
American Association for the Study of Liver Diseases (AASLD)
http://www.aasld.org/
American Society of Transplantation
http://www.myast.org/
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History of pediatric gastroenterology, hepatology and nutrition
Walker-Smith, John & Walker, W. Allan (2003). The development of pediatric gastroenterology: A historical overview.
Pediatr Res 53:706-715.
Balistreri, W. F. (2013). Growth and development of a new subspecialty: pediatric hepatology. Hepatology 58:458-76.
Cincinnati Downtown & Ohio River
Photograph used with permission of the Greater Cincinnati Convention and Visitors Bureau.
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