Hepatology Fellowship Program Structure

The Hepatology Fellowship Program is a clinical and research fellowship that is offered for a period of 2-3 years depending upon the applicant’s career goals and research projects. The program includes

• Hepatology Outpatient Clinic
• NIH Clinical Center Hepatology Consultation Service
• NIDDK Liver Diseases Branch Inpatient Hepatology Service
• Didactic conferences, clinical meetings, and journal club
• Research projects including clinical trials, natural history or observational studies, biomarker studies, and other translational studies
• Duke/NIH combined Master’s degree in clinical research (M.H.Sc.) (for selected fellows)

Hepatology Outpatient Clinic

Under faculty supervision, fellows will develop skills in evaluating and managing patients with chronic liver diseases in the outpatient clinic setting.

Chronic liver diseases may include

• viral hepatitis
• metabolic dysfunction-associated steatotic liver disease (MASLD)
• autoimmune liver diseases (including autoimmune hepatitis, primary sclerosing cholangitis, primary biliary cholangitis)
• non-cirrhosis portal hypertension
• alcohol-associated liver disease
• Fontan associated liver disease

Three outpatient clinics occur on Monday, Wednesday, and Friday from 8:30 am to 12:00 pm. The clinics evaluate and manage patients participating in ongoing clinical trials or observational studies in the Liver Diseases Branch or patients that are referred for clinical care with complex or complicated liver diseases.

NIH Clinical Center Hepatology Consultation Service

Under faculty supervision, fellows will perform inpatient and outpatient clinical consultations at the NIH Clinical Center while rotating on the Hepatology Consultation Service. Fellows will rotate on the consultation service approximately three-four months each year during their fellowship (on-call months). Fellows participate in

• daily bedside evaluation of patients during clinical work rounds
• daily didactic teaching by full-time faculty members
• weekly clinical hepatology case conference
• development of procedural competency including percutaneous liver biopsy and fibroscan
• development of proficiency in real-time interpretation of hepatic venous pressure gradient measurements

Fellows may supervise medical residents or students doing a hepatology subspecialty rotation.

NIDDK Liver Diseases Branch Inpatient Hepatology Service

Under faculty supervision, fellows will learn to conduct and manage clinical research protocols that require intensive patient/investigator participation on the NIDDK Liver Diseases Branch Inpatient Hepatology Service. On this service, patients are primarily admitted for protocol-driven studies. Fellows will be responsible for inpatient hepatology services during their on-call months. Fellows participate in

• management of complex research protocols
• development of procedural competency including percutaneous liver biopsy, fine needle aspiration, subcutaneous adipose tissue biopsy, and fibroscan
• development of proficiency in real-time interpretation of hepatic venous pressure gradient measurements
• management of patients and interpretation of metabolic data obtained in the NIH Clinical Center’s Metabolic Clinical Research Unit

Didactic Conferences, Clinical Meetings, & Journal Club

Fellows can join Liver Diseases Branch didactic conferences, weekly clinical meetings, and journal club.

• Work Rounds and Hepatology Lecture Series/work in progress (Mondays)
• Journal Club (biweekly every Wednesday)
• Clinical Hepatology Case Conference (joint with FDA) (Thursday am)
• Liver Pathology Rounds (Thursday pm)
• Liver Diseases Branch Lab Meeting (Fridays)

Research Projects

Fellows may participate in a diverse range of clinical research protocols, including natural history or observational studies, biomarker studies, and translational treatment trials. Protocols may explore various liver diseases and conditions, including

• viral hepatitis - HCV, HBV, HDV
• metabolic dysfunction-associated steatotic liver disease
• non-cirrhosis portal hypertension
• primary sclerosing cholangitis
• Fontan-associated liver disease
• primary biliary cholangitis
• alcohol-associated liver disease

The Liver Diseases Branch maintains a large biospecimen repository from patients with acute and chronic liver diseases seen at the NIH Clinical Center for natural history studies or clinical trials. Fellows may have the opportunity to participate in translational research studies.

Duke/NIH Combined Master’s Degree in Clinical Research (M.H.Sc.) (For Selected Fellows)

Interested fellows have the option to apply and earn a Master’s of Health Sciences in Clinical Research (M.H.Sc.). The Master’s program is designed for part-time study, which allows fellows to integrate the program into their clinical training.

Courses include but not limited to:

• research design and management
• medical genomics
• proteomics and protein biology in medicine
• statistical analysis
• health services research
• systematic reviews and meta analysis
• artificial intelligence
• bioethics

Courses are taught by the faculty of the School of Medicine at Duke University with participation of NIH investigators in dedicated video conference classrooms at the NIH Clinical Center.