About the Transplant Hepatology Fellowship Program
Welcome to the VCU Transplant Hepatology Fellowship Training Program website. We are very proud of our city, university, program, faculty, and our trainees. The VCU medical campus boasts state-of-the-art clinical, research, educational, and simulation facilities. But, what makes the VCU experience so rich and the learning climate optimal is the supportive, experienced faculty and the collegiality of the fellows. We invite you to explore our website and learn more about what VCU has to offer you educationally. Throughout the site you will find perspectives from our fellows to give your insight into the VCU Transplant Hepatology Fellowship Training Program. We offer both the traditional 4th year program as well as offer participation in the ABIM Transplant Hepatology Pilot Program for select candidates.
Fellows in the VCU Transplant Hepatology Training Program are members of and contributors to an academic medical community in which there is a commitment to learning the art and science of medicine while providing the highest quality medical care to a diverse patient population.
- To produce compassionate physicians capable of delivering the highest quality medical care to patients in a variety of settings.
- To create a collegial and supportive setting for intellectual growth.
- To partner with our fellows in contributing to the science of medicine through mentorship, research opportunities and dissemination of information.
- To contribute to the science and art of medical education through innovation in training methods.
- To partner with our housestaff in gracefully accepting the challenges of providing care to the medically underserved.
- To promote lifelong learning in the context of a rapidly changing healthcare environment.
Our housetaff and faculty are guided in our work by our commitment to:
- Clinical excellence
- Intellectual curiosity
- Scientific Discovery
The Transplant Hepatology fellowship at VCU is an ACGME approved 1-year training program designed to satisfy the ABIM requirements for the Transplant Hepatology subspecialty board examination.
The 1-year curriculum is designed to provide the fellow to acquire core knowledge above and beyond what they received during their Gastroenterology fellowship. This is done through both ambulatory and in-patient consult rotations combined with specific experiences in transplantation. Our ambulatory rotations include dedicated pre- and post- liver transplant, hepatocellular carcinoma, cirrhosis, viral hepatitis, non-alcoholic fatty liver disease, and HIV-liver disease clinics in addition to general Hepatology clinics.
We offer 2 pathways. The traditional 4th year program for those who have completed a 3 year Gastroenterology Fellowship and the 3rd year Transplant Hepatology Pilot Program for select individuals already in our GI Fellowship. The clinical experiences are similar with the exception of the research requirement and expectation for those in the 4th year track.
Ambulatory Clinics(these will be attended on a rotational basis to provide a broad experience)
|Morning||• Team Meeting
• Liver Transplant
• HBV clinic
|• Liver Transplant
|• Liver Transplant
• General Hepatology
|• HCV Treatment
|Afternoon||• General Hepatology||• HCC||• General Hepatology||• General Hepatology
|• HCV Treatment
In Patient Clinics
|Morning||• Team Meeting
|Liver Biopsy Rounds||Liver Biopsy Rounds||Liver Biopsy Rounds||Rounds|
The MCV Hospital Inpatient Hepatology service provides an opportunity for fellows to participate in the care and management of adult patients admitted to the hospital with acute and chronic liver diseases.
The fellow operates within the context of a multi‐disciplinary team, managing conditions that include, but are not limited to, acute liver failure, decompensated cirrhosis, evaluation of abnormal liver tests or imaging, and post-transplant care.
Additionally, the rotation affords the opportunity for the fellow to engage directly in the subspecialty-specific oversight and education of GI Fellows, internal medicine housestaff and medical student learners rotating on the service. All of this occurs under the supervision of the responsible ward attending faculty members from the Division of Gastroenterology, Hepatology and Nutrition.
Every Monday morning the Hepatology and Liver transplant teams at the VCU Medical Center meet to discuss all patients currently hospitalized at this institution. The transplant hepatology fellow will attend this meeting every week while on the VCU Medical Center rotation. This meeting keeps the entire Hepatology and Liver Transplant teams, including the Medical Director, informed regarding the current health of all patients being followed by the transplant program and potential new patients to the program. The management of all hospitalized patients is discussed, especially those with cirrhosis and their potential candidacy for liver transplantation. Liver transplant coordinators, who also attend the meeting, are informed regarding status changes of patients already on the liver transplant waiting list. A treatment plan is developed for all hospitalized patients.
Liver biopsy procedures are performed at either the VCU Medical Center 4 mornings per week. All patients who require a liver biopsy for evaluation of acute or chronic liver disease, all post-liver transplant recipients who require liver biopsy and all potential living liver donors who require liver biopsy as part of their donor evaluation are performed during this time. All biopsies will be reviewed by the fellow with an attending once weekly.
Fellows are trained in VCTE (Fibroscan).
The transplant hepatology fellow will participate in Endoscopy 1 half day each week to maintain competency. The fellow will be responsible for performing elective upper and lower endoscopy and variceal band ligation as indicated in patients with cirrhosis who are being evaluated for or awaiting liver transplantation, as well as other patients with cirrhosis. The transplant hepatology fellow will perform these endoscopic procedures under the direction of an attending Gastroenterologist/Transplant Hepatologist. The fellow will not participate in any advanced endoscopic procedures such as ERCP or endoscopic ultrasound.
Liver transplant clinic is held 5 mornings each week at the VCU Medical Center. The transplant hepatology fellow will participate in the care of patients seen in this clinic. Patients with cirrhosis being evaluated for liver transplantation, patients already on the liver transplant waiting list and post-transplant recipients are all seen during this clinic. This will provide the transplant hepatology fellow with a broad experience in caring for both pre-and post-transplant recipients. Patients with ascites may require paracentesis during their clinic appointment. The hepatology/liver transplant clinic has a procedure area where large volume or diagnostic paracentesis can be performed if required during the out-patient clinic visit without requiring that the patient be hospitalized for this procedure.
The transplant hepatology fellow at VCU will participate in In-Patient rounds every day. Rounds begin at 8 am on the dedicated Digestive Disease Service. This service is staffed by interns, residents, and 1 GI Fellow. Consults and patients not on the DHS are seen in the afternoon. All patients cared for by the Hepatology and Liver Transplant team will be seen each day during In-Patient rounds. This will include patients with acute or chronic liver failure being evaluated for liver transplantation, patients who are currently on the liver transplant waiting list and who developed complications which required them to be hospitalized, patients who have recently had a liver transplant and patients who underwent liver transplantation some time ago and are hospitalized for post-transplant complications or another medical reason. The Transplant Fellow will help supervise and help teach the GI fellow and medical house staff during this rotation.
There are dedicated clinics for those with cirrhosis, HCC, viral hepatitis, NAFLD, HIV-liver diseases, and those on HCV treatment.
The Transplant Hepatology Fellow will have access to the AASLD Learning site, ACG Universe, and Up-To-Date.
Liver Histology Conference
A scheduled liver histology conference is held once each week at VCU. During this conference all slides from the liver biopsies performed during the previous week will be reviewed. This will include liver biopsy specimens from patients with chronic liver disease and post-liver transplant patients who underwent liver biopsy to assess for possible acute or chronic allograft rejection or recurrent disease. During this conference the liver histology findings will be utilized to formulate a treatment plans for these patients. Various management issues will also be discussed based upon the liver histology findings. The transplant hepatology fellow will attend this conference every week. There is also a pathology conference held with pathology residents every other month.
This meets every Monday in conjunction with the liver histology conference. The Transplant Hepatology fellow will present 1 article in depth for discussion among the faculty and GI fellows.
Liver Transplant Patient Selection Committee
The liver transplant patient selection committee meets once each week at VCU. The members of the committee represent a diverse group involved in the long term care of the patient. This includes transplant hepatologists, liver transplant surgeons, liver transplant coordinators and the liver transplant financial coordinator, social workers and psychologists. The transplant hepatology fellow will attend and actively participate in this weekly conference. During each meeting all patients currently undergoing liver transplant evaluation testing are discussed and decisions regarding the ability of these patients to be accepted for liver transplantation and placed on the active liver transplant waiting list are made. The current health and MELD scores of all patients on the liver transplant waiting list are reviewed. Patients who are no longer candidates for liver transplantation are either inactivated or removed from the liver transplant waiting list.
Case management conference
Case management conferences are held weekly. The case management conference is a teaching conference during which patients with difficult and or unusual management issues are discussed in a multidisciplinary environment. The conference is attended by gastroenterologists, transplant hepatologists, general and transplant surgeons and radiologists. Each patient’s case is presented by a fellow or resident and various attendings lead the multidisciplinary discussion. The Transplant Hepatology fellow will attend this conference each week and present the cases of difficult pre- and/or post-liver transplant patients.
Gastroenterology Grand Rounds
Formal didactic lectures by the gastroenterology fellows, attendings and visiting professors are presented to the members of the division of gastroenterology. The transplant hepatologists and the transplant hepatology fellows will attend this conference each week. During the academic year each fellow will provide one formal lecture on a topic related to liver transplantation. A list of topics presented at this conference is attached (appendix # 2) Once each month a journal club will substitute for the didactic lecture. The transplant hepatology fellow will participate in journal club and be asked to review recent articles from the medical literature related to liver transplantation.
Conducted every Thursday from 12:30-1:30 PM. In this conference topics related to transplant are discussed.
HCC Tumor Board and Multidisciplinary HCC clinic
This tumor board meets weekly on Tuesdays before our multidisciplinary HCC clinic. It is attended by transplant hepatology faculty, transplant surgeons, medical oncologists, radiation oncology, interventional radiology, and imaging radiology. All HCC cases as well as benign liver tumors are reviewed and treatment plans discussed.
All fellows are expected to actively engage in scholarly activities. Essential to success is providing the tools necessary to foster the fellows’ intellectual development as investigators. These tools are provided through participation in VCUHS graduate medical education research series, which is conducted at the start of the academic year and is mandatory for all Transplant Hepatology fellows.
As a sign of our commitment to the scholarly efforts of the fellows, the Department of Internal Medicine has designated funding which is set aside specifically to offset the travel cost for fellows who are presenting their work at regional, national, and international scientific and academic meetings. The division is similarly committed to assisting with costs associated with presenting and publishing scholarly efforts. The commitment to our fellows is evident by the fact that our department chair, Dr. John Nestler, an NIH-funded investigator himself, personally meets with all fellows in advance of presenting at national and international meetings to offer additional mentorship and guidance. At VCU, we honor your education and professional growth as our greatest achievement and are proud to send our residents and fellows as our ambassadors.
Look at pubmed for the following: Mohammad Shadab Siddiqui, Scott Matherly, A. Paredes, N. Dharel, Vaishali Patel, Amon Asgharpour, and Robert Vincent
Each fellow is allowed three weeks of vacation per training year. The time is generally taken as either one of the following:
- Three 7-day vacations
- One 7-day vacation and one 14-day vacation.
Additionally, each fellow is given five days off for attending meetings
Other healthcare providers provide in-house coverage of the patients admitted to the inpatient services at night as well as after hours calls from patients and providers.
Fellows are not required to come in on weekends.
Class of 2019
Medical School: University of Alabama School of Medicine
Residency: Internal Medicine at University of Texas Southwestern
Medical School: Pandit Deendayal Upadhyay Medical College – Rajkot
Residency: Internal Medicine at Icahn School of Medicine at Mount Sinai
Class of 2018
Kavish Patidar, DO - ABIM Pilot Fellow
Medical School: West Virginia School of Osteopathic Medicine
Residency: Internal Medicine at Virginia Commonwealth University
Class of 2017
Amon Asgharpour, MD
Medical School: Ross University
Residency: Internal Medicine at SUNY Health Science Center – Brooklyn
Robert Vincent, MD, PhD
Medical School: University of Wisconsin
Residency: Internal Medicine at Virginia Commonwealth University
Class of 2016
Vaishali Patel, MBBS
Medical School: Seth G.S. Medical College
Residency: Internal Medicine at Wayne State University
Class of 2015
Narayan Dharel, MBBS, PhD - ABIM Pilot Fellow
Medical School: Institute of Medicine - Tribhuvan University
Residency: Internal Medicine at Wycoff Heights Medical Center
Transplant Hepatology selects from among eligible applicants on the basis of their preparedness and ability to benefit from the program in which they are appointed. Aptitude, academic credentials, personal characteristics, and ability to communicate should be considered in the selection. Programs must not discriminate with regard to sex, race, age, religion, color, national origin, sexual orientation, disability, or veteran status. Eligibility shall be determined according to the ACGME requirements as stated in the Institutional Requirements.
The Transplant Hepatology Fellowship Program is now an ACGME accredited position. All fellows selected for education at the Virginia Commonwealth University will meet the following selection criteria:
All fellows must have passed all parts of the United States Medical Licensing Exam (USMLE), FLEX, NBDE, NBOME/COMLEX, or the FMGEMS prior to their first day of employment.
All applicants must have three letters of reference from United States or Canadian physicians/dentists who have personal knowledge of the applicant’s clinical abilities, and an additional letter from their program director.
All applicants must be within seven years of graduation from medical school, or direct patient care activity (either as an independent practitioner or a resident in an ACGME, AOA, or ADA accredited residency). Non-clinical graduate work, e.g., research, in the United States or Canada does not meet this requirement.
All applicants must have documentation of a minimum of three months of direct patient care activity in the United States or Canada. Clinical rotations during medical school will suffice for U.S. and Canadian students. For international medical graduates, U.S. or Canadian medical school clinical rotations or externships of direct patient care in the United States or Canada will suffice.
Any ECFMG certified applicant who has not been in a United States or Canadian residency program within eighteen months of being issued their ECFMG certificate must take the Test of English as a Foreign Language Exam (TOEFL) and obtain a score of at least 600 before beginning their residency. The Test of Spoken English (TSE) and Test of Written English exams are also required.
For those applying to the 4th year track, they must have successfully completed a 3 year fellowship from an ACGME accredited GI Fellowship.
For those applying to the 3rd year Pilot Program, they must have successfully completed the first 2 years of their 3 year GI Fellowship and be a trajectory to competence in GI. They must have full endorsement of both the GI PD and the Transplant Hepatology PD.