Graduate Medical Education (GME): Gastroenterology
National Institutes of Health - Bethesda, MD

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Graduate Medical Education (GME): Gastroenterology

Stephen Wank, MD
Entry Id: TP-58

Eligibility Criteria
Must have successfully completed a training program in internal medicine. No residents are taken.

The Digestive Diseases Branch of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) offers fellowships in gastroenterology in a combined program with University of Maryland School of Medicine. Three years of training in the combined program provides excellent research experience and clinical training for physicians who wish to pursue a career in academic gastroenterology.

Structure of the Clinical Training Program
Individuals spend one year in the clinical training program at NIH, with rotations in gastroenterology and hepatology at University of Maryland School of Medicine. This year is designed so that the Fellow becomes proficient in all standard gastroenterological procedures (such as upper gastrointestinal endoscopy, sigmoidoscopy, colonoscopy, and polypectomy), and develops expertise in making clinical decisions involving all common gastrointestinal diseases.
Structure of the Research Training Program

Clinical and Basic Research Projects
During the second and third years of the fellowship, the Fellow is based full-time at the Digestive Diseases Branch at the NIH working with either Dr. Jensen or Steve Wank, Senior Investigator, Digestive Diseases Branch. Of this two-year period, eighteen months are devoted to training in laboratory research, and six months are devoted to training in clinical research. Basic science areas currently investigated in these laboratories include:

The cellular basis of action of gastrointestinal hormones on various gastrointestinal cells including chief cells, pancreatic acinar cells and isolated gastric muscle cells.

Characterization of receptors by development of selective radiolabeled agonists or antagonists.

Detailed pharmacological studies to develop selective, high-affinity agonists or antagonists for various gastrointestinal hormone receptors.

Molecular characterization of the receptors for gastrointestinal hormones.

Detailed characterization of intracellular processes mediating the action of gastrointestinal hormones.

Clinical areas investigated are studies of the Zollinger-Ellison syndrome including:

Novel methods of tumor location.

Ability of surgery to cure these patients long-term.

Natural history of the disease, including long-term gastrin effects.

Newer modalities to control metastatic disease.

Molecular basis of gastrinoma growth.

Conferences and Courses
The fellows participate in weekly research conferences, clinical conferences and research training sessions. They are also provided with short, intensive courses dealing with basic principles on topics such as radioimmunoassay, radioreceptor assay, strategies for radiolabeling peptides, preparation of isolated cell systems and subcellular components, liquid scintillation counting, computer programming, use of radioactive tracers, column chromatography and mathematical analysis of experimental data.
Program Faculty and Research Interests

Dr. Robert T. Jensen, Chief, Digestive Diseases Branch. Dr. Jensen also directs the Gastroenterology Section and his basic science research interest focuses on the cellular basis of gastrointestinal hormones. His clinical research focuses on developing improved methods for diagnosis and treatment of pancreatic endocrine tumors, primarily Zollinger- Ellison syndrome.

Dr. Fathia Gibril, Staff Physician, Digestive Diseases Branch. Performs clinical research focusing on elucidating natural history and developing new treatments for patients with Zollinger-Ellison syndrome.

Dr. Stephen A. Wank, Senior Investigator, Digestive Diseases Branch. Dr. Wank’s research interests are in the hormonal regulation of secretion and motility in response to a meal. He has taken a molecular approach with specific attention to the interaction of gastrin, cholectystokinin and pituitary adenylate cyclase activating polypeptide with their cognate G protein-coupled receptors in the GI tract, brain and kidney.

Examples of Papers Authored by Program Faculty

Roy P, Venzon DJ, Shojamanesh H, et al. Zollinger-Ellison syndrome: clinical presentation in 261 patients. Medicine 2000; 79: 379-411.

Norton JA, Fraker DL, Alexander HR, et al. Surgery to cure the Zollinger-Ellison syndrome. N Engl J Med 1999; 341: 635-644.

Serrano J, Goebel SU, Peghini PL, et al. Alterations in the p16 INK4a/CDKN2A tumor suppressor gene in gastrinomas. J Clin Endocrinol Metab 2000; 85: 4146-4156.

Tokita K, Hocart SJ, Katsuno T, et al. Tyrosine 220 in the fifth transmembrane domain of the neuromedin B receptor is critical for the high affinity selectivity of the peptoid antagonist PD168368. J Biol Chem 2001; 276: 495-504.

Benya RV, Kusui T, Katsuno, T, et al. Glycosylation of the gastrin-releasing receptor and its effect on expression, G protein coupling, and receptor modulatory processes. Mol Pharmacol 2000; 58: 1490-1501.

Program Graduates
The following is a list of recent program graduates including their current positions:

Completed Program 1995-1999

Richard Benya, MD. Department of Gastroenterology, University of Florida, Gainsville, Florida.

Joseph Pisegna, MD. Department of Gastroenterology, University of California, Los Angeles, California.

H. Christian Weber, M.D., Boston University, Boston, Massachusetts.

Jose Serrano, M.D., Ph.D, NIDDK, Extramural Branch, Bethesda, Maryland.

Charmaine Stewart, University of Pennsylvania, Philadelphia, PA.
Application Information

The NIH-University of Maryland Combined Program Fellowship in Gastroenterology is accredited by the Accreditation Council for Graduate Medical
Education. This program prepares fellows for board certification in gastroenterology.

Qualified candidates must have successfully completed a training program in internal medicine. This is a fellowship program only; no residents are taken, and the training is similar for all individuals accepted. There are two positions available per year, and candidates should apply two years in advance. The expected length of stay for trainees is three years.

Electronic Application

The quickest and easiest way to find out more about this training program or to apply for consideration is to do it electronically.

The NIH is dedicated to building a diverse community in its training and employment programs.

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