Hepatology | Workflow

The hepatology fellow will present new consults to the attending by the following day for routine consults and as soon as possible for emergencies. Fellows will evaluate each patient and will make initial recommendations regarding diagnostic tests and treatments. They will make arrangements for appropriate interventions after discussing the final management plan with the attending. The fellows will follow each patient on service on a regular basis, will make further recommendations to the primary team as indicated. All active patients on hepatology service will be discussed with attending on a daily basis. Fellows are responsible for communicating with the procedure fellow for all endoscopic studies required for patients on hepatology service. Fellows are responsible for communicating the recommendations to the primary consulting team either in the form of a timely note or a phone call for urgent matters.

Disease and Patient Mix:

CRMC is a tertiary referral center for the Central Valley and allows the fellows to be exposed to the entire spectrum of liver disease during the one-year hepatology fellowship. Diagnoses range from acute viral hepatitis (A, B and C), drug induced liver injury, acute/fulminant liver failure, chronic viral hepatitis (B and C), alcohol-related liver disease, compensated and decompensated cirrhosis and its complications, autoimmune liver disease (AIH, PBC, PSC, and overlap conditions), hepatocellular carcinoma and cholangiocarcinoma. There is ample opportunity to evaluate abnormal liver function tests, manage fluid overload syndromes in decompensated liver disease (including intractable ascites and hepatic hydrothorax), hepatorenal syndrome, hepatopulmonary hypertension, portopulmonary syndrome and portal hypertensive bleeding (including TIPS and high risk TIPS consideration). Patient population is very diverse, both from an ethnic and socioeconomic standpoint.


Fellows’ evaluations are based on the above outlines milestones. The evaluations occur in the following forms:

  • Detailed, automated evaluations using the MedHub system are submitted on a monthly basis. These evaluations are reflective of the program’s curriculum requirements/milestones. Evaluation summaries become permanent part of the fellows’ and attendings’ promotional packets. Clinical Competency Committee, composed representative program faculty, meets at least twice a year to formally review all evaluations and come with remedial actions if necessary.