How will the COVID-19 pandemic affect my training?
It goes without saying that the pandemic COVID-19 has been extremely disruptive to every aspect of our lives, especially our country’s health care system. Despite the challenges, we remain committed to providing our fellows with excellent, well-rounded and diverse training.
During the COVID-19 Pandemic, fellowship training has continued to be of greatest priority for our department, and we have made efforts to sustain the high caliber of teaching quality. The inpatient consult service continues to have a high volume of consults. The volume of elective procedures decreased transiently with shelter-in-place orders, but we are now returning to a more typical schedule with pre-procedural COVID-19 screening for all patients to ensure the safety of all staff and trainees. The outpatient continuity and specialty clinics in (Regional IBD and Liver Clinics) have transitioned to predominantly virtual (video) visits, with in-person visits reserved for patients with severe illness or otherwise requiring an in-person assessment. The virtual visits are staffed by attendings and fellows via a 3-way video encounter to facilitate valuable learning gained from observing direct patient-provider interactions. We hope to transition back to in-person office appointments when COVID-19 restrictions are eased.
When is interview season? What will be different this year in view of the COVID-19 pandemic?
In accordance with the recommendations from The Coalition for Physician Accountability Work Group, and in an effort to promote an equitable and safe interview season, we will be conducting only online interviews and virtual visits during the upcoming interview season; there will be no in-person interviews or visits. We are committed to creating a robust virtual experience that will inform applicants about our program and culture. Rest assured that we remain dedicated to performing a holistic review of applicants.
I’m going to be so busy during fellowship. How will the program help me take care of myself and thrive?
Resident and fellow wellness is an integral part of our culture at Kaiser San Francisco. As a fellow at Kaiser San Francisco, you will have access to a robust Wellness Curriculum developed by the Resident Wellness Committee and led by one of our Lifestyle Medicine faculty, Dr. Rakesh Jotwani. The curriculum includes monthly didactics and experiential learning, drawing on concepts from Tending the Flame, a course developed by the Remen Institute for the Study of Health and Illness (RISHI©) to combat the epidemic of physician burnout.
We believe that the capacity to find joy and meaning in one’s work correlates with professional and personal resiliency and, to that effect, our wellness curriculum aims to connect trainees with the meaning of their work through narrative medicine and storytelling.
We also believe that physicians cannot operate at their full potential unless they attend to their own physical, psychological, and emotional wellbeing. Our residents and fellows participate in activities such as group hikes, intramural team sports, and free boot camp or yoga classes on campus. They also receive a stipend to join a gym of their choosing, and each year, the gastroenterology fellows receive departmental funding for their own full-day retreat. There is a full range of free counseling and mental health services available to fellows, and we provide education about physician burnout and specific techniques, such as a personal mindfulness practice, to build one’s resiliency. Lastly, all fellows are matched with a faculty advisor to provide additional career counseling and support.
How does the program promote a diverse and inclusive trainee workforce?
Equity, inclusion, cultural competency, and diversity are core tenets of the gastroenterology fellowship program and Kaiser Permanente. We seek fellows from a variety of backgrounds, life experiences, and nontraditional paths as we hold the strong belief that training the next generation of diverse and culturally competent health care providers is vital to addressing the health disparities that exist today. Our application review process employs a holistic approach that considers all aspects of the individual’s background, including academic and clinical achievements, race/ethnicity, gender, socioeconomic background, and unique experiences that have shaped the person they have become.
KP has a longstanding tradition and is a national leader in the promotion of diversity, inclusion, and culturally competent medical care. We are fortunate to have a robust Diversity, Inclusion and Equity Committee that facilitates local and regional physician education opportunities, including the recently launched Culturally Responsive Care & Inclusion Educational Series. Our Associate Program Director, Dr. Nizar Mukhtar, serves as Diversity Liaison for our program to facilitate diverse fellow and faculty recruitment and lead their diversity, inclusion, and cultural competency training.
How often will I be on call?
First-year fellows take 2-3 days of weekday call each week, including overnight call that is taken from home, such that you will only come in to the hospital at night for urgent or emergent procedures. Second- and third-year fellows will provide back-up weekday call coverage when the first-year fellow is away but will otherwise not take weekday call. Weekend call coverage is distributed across all fellows, such that you will only be required to provide weekend call coverage once per month.
I’m interested in conducting research during my training, but I don’t have a lot of experience and am worried that I won’t have time. How can I accomplish this?
All fellows are required to pursue research projects during their training. We pride ourselves on providing the flexibility necessary to enable these efforts. Jeff Lee, MD, MPH is the research lead for the fellowship program; he will help each fellow identify a clinical research project of their interest by the end of their first year and connect them with an appropriate research mentor. To help ensure completion of the research project by the end of fellowship, we will provide >6 months of dedicated time for research activities spread throughout your 3 years of fellowship; educational opportunities (e.g., online educational materials focused on clinical epidemiology along with support for coursework at UCSF); assistance from a dedicated GME Research Program Manager; and dedicated programming support from the Biostatistical Consulting Unit for cohort development and data analyses. Aida Shirazi, Ph.D., is our GME Research Program Manager, who will help assist fellows at each phase of a research project from research protocol development to statistical analyses to manuscript preparation. Dr. Shirazi also serves as a liaison with the Kaiser Division of Research, including its researchers, scholars, and the Biostatistical Consulting Unit. Lastly, many of our faculty members at Kaiser Permanente Northern California are national leaders in gastroenterology and hepatology; have published in numerous high impact journals (e.g., NEJM, JAMA, JAMA Internal Medicine, Annals of Internal Medicine, Gastroenterology, etc.); co-authored several clinical guidelines; and have extensive experience mentoring residents and fellows on research projects. Taken together, our program has the resources and personnel to help each fellow complete their research project by the end of their fellowship.
How much time off will I have? How much vacation time do I get?
Compliance with the ACGME clinical and educational work hours requirements is a top priority. All fellows have a minimum of one day in seven free of clinical work and required education when averaged over four weeks, and at least eight hours off between all scheduled periods of clinical work and education.
All fellows have 20 days of paid vacation. Vacation time is taken during elective rotations or a prearranged time with the program director. There is also 1 week of educational leave for Fellows that can be used towards attending medical conferences, courses, or medical boards preparation.
Can I afford to live in San Francisco on a resident salary?
Kaiser fellows enjoy very competitive salaries and generous benefits. The fellowship program pays for fellow parking fees, medical licensing fees , gym membership, and provides a $500 educational stipend.
As a highly desirable place to live and work, the Bay Area has always had a relatively high cost of living. To help offset this, Kaiser Permanente San Francisco fellows receive an additional housing stipend of up to $3500 each year.
How can I contact the Program Director or the Chief Fellows?
We encourage potential fellowship applicants to speak with one of our program leaders or chief fellows. Please contact Victoria McManimen, our fellowship interim coordinator, via email Victoria.D.McManimen@kp.org to be connected.
How much procedural training is available to the fellows?
Our gastroenterology group provides 10,000 gastrointestinal procedures a year. To facilitate an effective early endoscopic training experience, we dedicate one of the procedure rooms to fellow instruction. We limit the number of procedures in this room to 3 per half-day to allow faculty to spend more time training the fellows on fundamentals of endoscopy in a non-rushed environment. We gradually increase the volume of patients scheduled in the fellow’s room as their skills progress, and fellows are also invited to scope in any of the other endoscopy unit rooms under the supervision of a staff physician. Last year, each of our first-year fellows completed approximately 800 endoscopic procedures. The “ramp-up” approach allowed them to master endoscopic skills effectively such that they are able to complete entire procedures efficiently rather than having interrupted scoping experiences due to time constraints.
How much specialty procedures are available to the fellows?
Kaiser San Francisco is a regional advanced endoscopy referral center. The fellows work directly with our advanced endoscopists to gain exposure to a wide variety of disease pathology and procedures, including endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS), endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), luminal stenting, and pancreatic cyst drainage. During their time at Kaiser Oakland, a center for excellence in esophageal and chest pathology, fellows will receive extensive training in esophageal motility and advanced esophageal therapies, including peroral endoscopic myotomy (POEM). During the third year, fellows rotate at Kaiser Vallejo where they will be trained in pelvic pathology, manometry and balloon expulsion examinations as well as receive instruction on percutaneous gastrostomy tube placement.
How does Kaiser Permanente provide liver transplant training for the fellows?
During your time at Kaiser San Francisco, you will evaluate patients seen in the weekly Regional Liver Clinic, which is staffed by transplant hepatologists and deigned to provide you exposure to the pre- and post-transplant management of patients with end-stage liver disease and liver cancer. As a second-year fellow, you will also spend two dedicated months working with the Liver Transplant Service at the University of California, San Francisco, our affiliated center of excellence and a world-renowned leader in the field of solid organ transplantation with whom we have enjoyed a decades-long working relationship. KP patients comprise a large proportion of the liver transplants performed at UCSF, and you will gain excellent experience in the management of our shared patients in both the inpatient and outpatient settings.
How many medical centers do fellows rotate through during fellowship?
Fellows are predominantly at Kaiser San Francisco, where the entire first year of fellowship rotations are based. During the second year of fellowship training, fellows will spend two months at UCSF working with the Liver Transplant Service and four months at Kaiser Oakland gaining additional general gastroenterology and advanced esophageal endoscopy exposure. During the third year of fellowship, fellows will rotate at Kaiser Vallejo for one month to receive dedicated training in the management of lower gastrointestinal motility disorders and percutaneous gastrostomy tube placement.
Do I have an opportunity to rotate to other institutions?
Fellows have elective time, including 1 month during their second year and 2-3 months during their third year, that can be devoted to away rotations. We are very supportive of fellows getting unique experiences during their training that will help them achieve their career aspirations and will do our best to facilitate such opportunities.