The overall educational goals of the Bariatric Endoscopy Fellowship Program are to prepare fellows to practice competently and independently as endoscopists specially trained to care for patients with obesity and bariatric surgery history. Specifically, fellows will learn both cognitive and technical aspects of a variety of endoscopic procedures ranging from primary treatment of obesity to management of complications of bariatric surgery. They will also learn how to manage this patient population pre- and post-procedurally. Furthermore, fellows will be utilizing a multidisciplinary approach by working with other specialists in the Center for Weight Management and Wellness (CWMW) including obesity medicine physicians, bariatric surgeons, dietitians and psychologists.
Goals of Training
The fellowship programs should provide all trainees with a general understanding of the following topics.
Obesity and Its Pathophysiology. Trainees should understand the definition, classification, and social impact of obesity. The pathophysiology of obesity and its related comorbidities should be emphasized. Additionally, trainees should learn to recognize and manage gastrointestinal diseases that are more common in patients with obesity.
Principles of Obesity Management. Trainees should develop a basic understanding of lifestyle modification, pharmacotherapy, and endoscopic and surgical interventions for the treatment of obesity and its comorbidities, and should know when to appropriately refer patients for each treatment modality. The importance of an interdisciplinary team strategy should also be emphasized.
Endoscopy in Patients with Obesity with or without Previous Bariatric Surgery. Trainees should understand challenges related to sedation and airway management in patients with obesity. Goals of endoscopy before bariatric surgery should also be emphasized. Additionally, they should understand and be able to recognize surgical anatomy for bariatric procedures and be able to diagnose and manage common complications.
Ethics and Professionalism. Trainees should learn to be mindful of obesity-related psychosocial issues and be able to obtain weight-related history in a neutral and nonstigmatizing way. Careful attention should be given to selecting and using weight-friendly equipment.
Comprehensive Medical Evaluation for Patients with Obesity. Trainees should be able to obtain a complete weight-related history and physical examination. They should also be competent in the evaluation of secondary causes of obesity and related nutritional deficiencies. Additionally, they should be capable of performing a thorough prebariatric surgical evaluation, including preoperative endoscopy as indicated.
Competence in Lifestyle and Medical Management of Obesity. Trainees should be able to advise patients on specific diet plans and exercise programs with appropriate Eating disorders and relevant psychiatric conditions should also be addressed. Trainees should be familiar with medications that promote weight gain and know alternative medications to suggest to the prescribing physicians. Comprehensive knowledge of and ability to prescribe weight loss medications (US Food and Drug Administration–approved and off label) should also be achieved.
Understanding the Cognitive Aspects of and Achieving Technical Proficiency in Endoscopic Bariatric and Metabolic Therapies. Trainees should have a comprehensive understanding of the US Food and Drug Administration–approved and investigational endoscopic bariatric and metabolic therapies (EBMTs). Patient selection, risk–benefit profile, adverse events and their management should also be emphasized. Additionally, the sedation plan, preprocedural assessment, and postprocedural instructions should be a part of the bariatric Furthermore, programs may offer a variety of procedures, including various primary EBMTs and specific complication management techniques. If a program does not perform a certain class of procedure, access to relevant content experts should be arranged.
American Board of Obesity Medicine Certification. For trainees who plan on subspecializing in bariatrics, programs should be prepared to provide a path that allows them to become board certified in obesity medicine. As of 2018, there are 54 gastroenterologists who are board certified in obesity medicine, representing 2% of all ABOM diplomates. This number is however expected to increase.
ABIM-certification in Internal Medicine, projected successful completion of ACGME-certified Gastroenterology Fellowship Program and GI board-eligibility. Currently clinically active. Must have prior, documented clinical research experience.