The Pediatric Gastroenterology and Nutrition Fellowship program has been training fellows since 1984, is fully accredited by the Accreditation Council for Graduate Medical Education (ACGME), and is designed to prepare physicians for careers in either clinical or academic pediatric gastroenterology. It consists of three years of post-graduate medical education, which include both clinical and research experience. Applicants must have completed, or anticipate successful completion of, a pediatric residency, and be either board-certified or eligible to sit for the certifying examination in general pediatrics. The program exists in affiliation with the combined National Capital Consortium (NCC) pediatric residency program at Walter Reed National Military Medical Center (WRNNMC), Bethesda, MD. The fellowship, which comes under the umbrella of the NCC, is based within the Departments of Pediatrics at WRNMMC and the Uniformed Services University of the Health Sciences (USUHS).
The fellowship consists of 18 months of clinical training and 18 months in which to design and implement a basic science or clinical research scholarly project. An ongoing comprehensive three-year curriculum of clinical and didactic conferences completes the fellowship curriculum, and the pediatric gastroenterology faculty is augmented by pediatric radiologists, pediatric surgeons, pathologists, pediatric nutritionists, a gastrointestinal research and motility technician, a nurse practitioner, a pediatric gastroenterology nurse, and an endoscopy technician. Fellows are required to participate in the design and implementation of a scholarly project. In addition to the clinical research opportunities afforded by the diversity of patients, basic science research opportunities exist at the USUHS, Walter Reed Army Institute of Research, the National Institutes of Health (NIH), the Joint Pathology Center (formerly known as AFIP: the Armed Forces Institute of Pathology), WRNMMC, and the University of Maryland. The pediatric gastroenterology fellowship is closely allied with the NCC fellowship in Internal Medicine Gastroenterology, which offers a wealth of research knowledge and productivity as well as clinical expertise. The fellows and staff in the pediatric gastroenterology program participate in a number of joint conferences with this group.
The program is sponsored by the NCC, with clinical practice mainly located at its primary affiliated hospital WRNMMC, and other affiliated hospitals in the National Capital Region to include the Johns Hopkins Hospital, MedStar Georgetown University Hospital and INOVA Fairfax Children's Hospital. The diversity of clinical and scholarly experience is designed to produce academic pediatric gastroenterologists ready to serve as military pediatric subspecialists and educators. Active duty in one of the Uniformed Services of the United States (Army, Navy, Air Force, or Public Health Service) is required. Information on incurred obligations, pay, and allowances may be obtained from the Office of Graduate Medical Education (GME). Applicants must apply through, and be sponsored by, the GME office of their respective branch of service for postdoctoral training. Requests for training should list the Pediatric Gastroenterology Fellowship Program of the NCC at USUHS as their site of choice. Application deadlines are usually in September and are determined by the individual services. Where feasible, applicants are encouraged to visit the USUHS and WRNMMC facilities and arrange personal interviews with faculty members. If a visit is not practical, applicants should contact the program director and submit an updated CV and letter of intent.
The clinical experience provides intensive exposure to all aspects of the practice of pediatric gastroenterology, including inpatient and outpatient evaluation of patients with a wide diversity and severity of conditions. The pediatric GI service performs approximately 400 procedures annually including upper endoscopies, esophageal stricture dilations, esophageal motility studies, foreign body extractions, intraesophageal pH and impedance monitoring, breath hydrogen studies, percutaneous endoscopic gastrostomies, percutaneous liver biopsies, colonoscopies, polypectomies, anorectal manometry, rectal biopsies, capsule endoscopy, control of upper and lower GI bleeding, and varicocele banding. ERCP is performed with the support of the adult gastroenterology staff. Endoscopic procedural and teaching capabilities are enhanced by a fully equipped, dedicated pediatric endoscopy unit, as well as access to the state-of-the-art USUHS simulation center.
The program is sponsored by the NCC, with clinical practice mainly located at its primary affiliated hospital, WRNMMC, Bethesda, MD. Other training locations in the National Capital Region include Georgetown University School of Medicine, Washington, DC (one month), Children's Hospital at Johns Hopkins, Baltimore, MD (one month) and Inova Fairfax Children's Hospital, Fairfax, VA (two months). The fellowship program benefits from the clinical and academic synergy of four other Pediatric Subspecialty fellowships that are part of the NCC, as well as a full representation of Pediatric and Pediatric surgical subspecialties.
Military Unique Training
The program is designed to graduate competent, caring pediatric gastroenterologists who pursue careers as physician-educators and/or academicians. Graduates are prepared to become future leaders in the military pediatric and medical community.
The program provides training in unique military aspects of taking care of dependent children with chronic disease, to include navigating military systems of care and unique concerns for the child with a deployed active duty family member. The military pediatric gastroenterologist responds to consults from a wide range of geographic areas to include OCONUS. The program provides training in responding to these consults within the context of the inherent capabilities of the outlying facilities. The NCC Pediatric Gastroenterology program co-developed the Military Medical Humanitarian Assistance Course, uniquely focused on the military humanitarian response capability of the military medical corps across the uniformed services. Military and humanitarian opportunities/training that the Fellowship has participated in over the past five years include:
Humanitarian support to Education and Training programs Haiti
Humanitarian support to USNS Comfort
Military Medical Humanitarian Assistance Course
Battlefield Acupuncture Training
Unique fellow military research opportunities include International Enteric Vaccine Development with Naval Medical Research Unit No. 6 (NAMRU-6) and collaboration with the Walter Reed Army Institute of Research (WRAIR).
Both clinical and basic science research opportunities are available. Opportunities for clinical research are provided through the outpatient clinics and inpatient services at WRNMMC, and basic science research is conducted primarily at USU, WRAIR, or the University of Maryland.
The basic science laboratories at USUHS include 2000 square feet of space. The laboratories are well equipped for animal studies, general biochemistry, cell culture, and molecular biology. Extractions of RNA and DNA, Northern, Western, and Southern blotting and polymerase chain reaction analysis are performed. Gene synthesizers, automated nucleic acid sequencers, and protein sequencing are also available. Research Administration provides research review services, computerized data analysis, statistical support, and publication pre-review and approval. Funding and education opportunities through the WRNMMC Department of Research Programs and the USUHS Office of Research are available to help funding the fellows in their research. The USUHS Department of Pediatrics also has a corps of faculty mentors skilled in clinical research in the areas of observational, outcomes/comparative effectiveness, and health services research.
The combined NCC pediatric subspecialty fellowships are founded among a rich scientific research community. This facilitates flexibility in choosing a high impact fellowship research project and providing the experienced mentoring required for success. Recent and ongoing research projects and areas of interest of the Pediatric Gastroenterology faculty and fellows currently include:
- Eosinophilic esophagitis in children
- Mucosal transport regulation in inflammatory bowel disease
- Vaccine development for enteric E coli infections
- Adherence and virulence factors in Helicobacter pylori infections in children
- Clinical aspects of pediatric inflammatory bowel disease
Additional information for the specialty can be found on the Council of Pediatric Subspecialties website.
Program Director: Cade M. Nylund, LtCol, USAF, MC
Division Chief, Pediatric Gastroenterology, WRNMMC: Steve Min, LTC, MC, USA
Additional Program Faculty
Kevin O'Meara, CAPT, MC, USN
Philip L. Rogers, COL (Ret), MC, USA; Pediatric Hospital-Based Service Chief, WRNMMC
Carolyn A. Sullivan, COL (Ret), MC, USA; Associate Professor of Pediatrics, USUHS
Additional information, application instructions, and program requirements are available through:
Program Coordinator: Ms. Theresa Kiefer
Cade M. Nylund, LtCol, USAF, MC
Pediatric Gastroenterology, Hepatology, & Nutrition Fellowship Director
Associate Professor of Pediatrics
Department of Pediatrics
F. Edward Hébert School of Medicine - "America's Medical School"
Uniformed Services University of the Health Sciences
4301 Jones Bridge Road
Bethesda, MD 20814
USU Department Fax: (301) 295-3898