Introduction

a. Overview of the Program

The care of patients with digestive diseases addresses a range of conditions including celiac disease, carbohydrate intolerance, short bowel syndrome, intestinal failure, inflammatory bowel disease, pancreatic insufficiency, motility disorders (chronic idiopathic pseudo-obstruction), gastroesophageal reflux disease and eosinophilic esophagitis, dysphagia and functional disorders such as irritable bowel syndrome, functional dyspepsia and constipation. In many cases, symptom control and treatment of the underlying condition require modification and optimization of the patient’s diet and nutritional status. Furthermore, nutrition management is important, not just for ambulatory care patients but, also, for hospital in-patients with bowel obstruction, dysphagia, short bowel syndrome and malnutrition.

The optimization of care for gastroenterology patients entails the need for objective assessment of their dietary intake and nutritional status, the identification of adverse consequences by clinical examination and investigations and the development of appropriate short- and long-term nutritional management plans. With the growing recognition of the importance of diet and its interactions with the microbiome and host physiology, there is a critical need for rigorously-trained gastroenterologists who can provide expert care in this area.

The Division of Gastroenterology provides comprehensive, tertiary and quaternary level care for patients with digestive diseases with specialty clinics for inflammatory bowel disease, celiac disease, intestinal failure, home parenteral nutrition, motility disorders and Barrett’s esophagus. The Division also provides an inpatient consultation service to address the provision of parenteral and enteral nutrition.

b. Clinical Care

The gastroenterology nutrition service at Hamilton Health Sciences includes a specialty adult celiac disease clinic (recognized by the Society for the Study of Celiac Disease), a regional home parenteral nutrition program, an intestinal failure clinic and an IBD-nutrition clinic; the McMaster Medical Centre site is home to facilities for breath testing (SIBO, carbohydrate intolerance) and indirect calorimetry. In addition, there is an in-patient nutrition consultation service with weekly rounds at the Juravinski Hospital and the Hamilton General Hospital.

c. Education

We offer a competency-based training program that will allow fellows to assess patients’ diet and nutritional health in a variety of settings using standardized techniques and decide on optimal treatment in a multidisciplinary environment with the goal of formal certification as a Certified Nutrition Support Clinician (CNSC). The program will include outpatient medical clinics, participation in the Home Parenteral Nutrition Program and an inpatient consultation service. Fellows are encouraged to tailor their training to their needs and career goals; they are, also, encouraged to attend and present at national and international conferences. The fellowship is available to candidates who have completed their core training in adult gastroenterology (FRCPC or equivalent) and are eligible for medical licensure in the Province of Ontario.

d. Research

GI nutrition fellows are encouraged to participate in new or ongoing research projects related to celiac disease, nutrition in inflammatory bowel disease and outcomes in patients with intestinal failure and to attend weekly research-in-progress rounds. There will be an emphasis on quality improvement projects related to the delivery of nutrition care and the development of a patient-centred approach to the delivery of nutritional advice. The GI Clinical Nutrition service works closely with the Farncombe Family Digestive Health Research Institute, one of the premier international gastroenterology research groups, for translational research.

Certification Outcome

Successful completion of the fellowship will grant a Fellowship McMaster Certification. Fellows are encouraged to write nutritional board exams through ASPEN to become Certified Nutrition Support Clinicians (CNSC).

Entry Requirements

The fellowship program is intended for recent graduates of a core training program in adult gastroenterology (FRCPC or equivalent). Recent graduates are required to submit an application form and comply with McMaster University Postgraduate Medical Education requirements for residents and fellows.

Application Deadline

Applications are requested at least 9 months before the program start date on July 1st, 2022.

Goals of Training

Upon completion of training, the fellow is expected to be competent in the following:

• Nutrition Pathophysiology
  • Understand the physiology of the absorption and digestion
  • Recognize the signs and symptoms of malnutrition
  • Recognize the pathophysiology of malnutrition in specific disease states
• Nutritional Assessment
  • Perform evidence-based screening for malnutrition
  • Perform evidence-based assessment of nutrition status
  • Conduct body composition assessment
  • Assess caloric needs, including indirect calorimetry
• Nutritional Therapy
  • Understand the principles and implementation of key GI-focused diets
  • Work in a multidisciplinary team to facilitate the adoption of dietary advice
  • Recognize the indications for parenteral and enteral nutrition
  • Understand the principles and composition of nutrition support regimens
  • Prescribe, monitor and manage the outcomes of different nutrition support regimens

Length of Training

This is a 12-month training program that will include participation in relevant specialty clinics (celiac disease, home parenteral nutrition, intestinal failure, inflammatory bowel disease, cystic fibrosis) and inpatient consultations. Fellows will participate in weekly home parenteral nutrition rounds, complex care rounds, weekly GI rounds and weekly research-in-progress rounds with the opportunity to attend national and international meetings related to nutrition in gastroenterology.

Funding

Limited internal funding is available but candidates are encouraged to apply for external funding or to provide their own funding from their parent institutions.