Advanced Subspeciality Fellowship Training Programs
The GI training program at SickKids provides opportunities for advanced clinical and research training in specific domains of paediatric gastroenterology. The advanced subspecialty fellowship training programs include inflammatory bowel disease, hepatology /liver transplantation and intestinal failure. See below for additional details.
A one-year advanced IBD clinical and research training fellowship is available for interested trainees and is supported through the SickKids IBD Centre.
Canada has among the highest incidence rates for IBD worldwide. Ontario health administrative data suggest that the incidence is continuing to increase, particularly in children. IBD care is centralized within the Gastroenterology, Hepatology and Nutrition (GHN) Division, such that three IBD specialists provide ambulatory care in six “half-day” IBD clinics weekly with over 2000 patient visits annually. IBD patients also account for the majority of inpatient days on the “GHN” ward. Ten to twelve patients are newly diagnosed each month and remain under follow-up care until the time of transfer to adult care by age 18 years. The SickKids IBD Program is hence responsible at any given time for the care of 900 children and adolescents with Crohn’s disease and ulcerative colitis, making it one of the largest paediatric IBD programs worldwide.
The IBD ambulatory program includes three specialty clinics. Dr. Alex Muise, co-lead of the international NEOPICS consortium, which has been very successful in identifying monogenic forms of IBD, runs a very-early onset IBD clinic. There is an alternate weekly “anti-TNF” therapy clinic exclusively for patients being treated with biologics, and a periodic joint clinic with Drs Ling and Kamath, for the care and study of patients with PSC-IBD.
All fellows in the GI/Hepatology/Nutrition training program are given multiple opportunities for small group learning including new patient IBD rounds, challenging IBD patient rounds, IBD teaching rounds for fellows, and Magnetic Resonance Imaging rounds, all held once in every two weeks.
The IBD program aspires always to integrate state of the art clinical care with meaningful patient-based and translational research. The program has had remarkable opportunities to train the next generation of paediatric IBD specialists, and in networking internationally to advance IBD research and clinical care. The Canadian Children IBD Network: a joint partnership of CIHR and the CH.I.L.D. Foundation is led by the SickKids IBD program.
Advanced training in intestinal failure and rehabilitation is provided by the SickKids intestinal rehabilitation program (GIFT – Group for Improvement of Intestinal Function and Treatment). The GIFT program is the largest of its kind in Canada and one of the leading intestinal rehabilitation programs in the world with 20 to 25 new patients every year. The program follows a large variety of patients with intestinal failure ranging from short bowel syndrome to severe motility disorders and congenital diarrheas in an inpatient and outpatient setting. The inpatient service is an independent service with daily census of 5 to 10 patients / day. A multi-disciplinary team of paediatric gastroenterologists, paediatric surgeons, nurses, dieticians, physiotherapists, oral therapists, social workers and others provide comprehensive daily care. Clinical, translational and basic research is an integral part of the program activities and multiple opportunities exist for interested trainees under the supervision of Dr. Paul Wales, general surgery, and Dr. Yaron Avitzur, paediatric gastroenterology.
Intestinal failure training is focused on clinical and research training in the field of intestinal failure and rehabilitation. Training is offered for a one year period for fully trained general gastroenterologists or general surgeons and is recognized by the University of Toronto. Funding is provided on a competitive basis through SickKids Transplant Centre.
Advanced training in paediatric hepatology and liver transplantation is provided by the Division of Paediatric Gastroenterology, Hepatology and Nutrition and the Liver Transplant program at SickKids*.
Our one-year program provides flexible training to meet the needs of each individual fellow, whether their focus is advanced hepatology training, training in liver transplantation, or research training. Our overall aim is to train the future leaders in this field across the world. SickKids currently performs between 25 and 40 paediatric liver transplants per year, and has completed more than 500 paediatric orthotopic liver transplants, including over 150 from live donors, since the first SickKids paediatric liver transplant in 1986. Our clinical service includes four paediatric hepatology clinics, a liver transplant clinic each week and a busy inpatient liver transplant service. We work closely with our partners at the University of Toronto Transplant Institute and Toronto Liver Centre.
During this year of training, the Hepatology and Liver Transplant Fellow will gain clinical mastery in a wide range of general acute and chronic liver conditions, including care of patients with neonatal cholestasis, abnormal liver tests, end-stage liver failure, fulminant liver failure, hepatic neoplasms, metabolic liver conditions, portal hypertension, viral hepatitis, biliary diseases, vascular malformations of the liver; diagnosis of immune-mediated liver diseases and cholestasis syndromes; assessment of the candidacy of patients for liver transplantation; management of paediatric patients pre- and post-liver transplantation; and long-term post-liver transplantation care. Fellows will interact closely with subspecialists in other divisions, including critical care medicine, interventional radiology, pathology, metabolic genetics, and transplant surgery. Fellows will develop diagnostic and therapeutic expertise in areas of hepatology and nutritional disorders and develop proficiency in the performance of diagnostic and therapeutic procedures (ie. endoscopic variceal band ligation); observation of procedures (including liver transplantation, percutaneous cholangiography), and non-transplant hepatobiliary surgeries (including Kasai portoenterostomy, partial external biliary diversion, shunt surgery); interpretation of liver histopathology; organizational structure and administration of a liver transplant program.
Clinical, translational and basic research is an integral part of the program activities and multiple opportunities exist for interested trainees under the supervision of faculty hepatologists within the Division of Paediatric Gastroenterology, Hepatology, Nutrition and Liver Transplantation to complete a mentored concise clinical or translational research project.
* Note to US Citizens: This one-year training program is not yet RCPSC or ACGME-accredited and training therefore may not be accepted towards the Certificate of Added Qualification (CAQ) from the American Board of Pediatrics.