Gastroenterology Gastroenterology I. GOALS
Develop the attitudes, knowledge, and skills for competent care of ambulatory and hospital management of patients with gastroenterological disorder, including disease prevention, and recognition of disease presentation.
II. OBJECTIVES
A. PATIENT CARE
Objective 1: Demonstrate clinical skills of comprehensive medical interview, history and physical examination at the patient bedside, including functional assessment and mental status as needed.
Objective 2: Demonstrate clinical skills in the diagnosis and medical management of acute and chronic illness.
Objective 3: Generate a differential diagnosis and problem list in accepted format.
Objective 4: Perform and record procedures
a. Procedure Skills: List the indications, contraindications, and limitations of the following procedures:
B. MEDICAL KNOWLEDGE
Objective 1. Demonstrate understanding and application of key facets of the following diseases of the esophagus and their treatments:
a. Gastroesophageal Reflux Disease
b. Carcinoma
c. Esophagitis
1. Esophageal stricture
2. Barrett's esophagus
3. Infectious Esophagitis
d. Achalasia and other esophegeal motility disorders
e. Esophageal varices
Objective 2. Demonstrate understanding and application of key facets of the following diseases of the stomach and duodenum and their treatments:
a.Carcinoma and Lymphoma
b. Gastritis
1. Hypertrophic
2. Atrophic
c. Peptic Ulcer and Helicobacter Pylori
d. Angiodysplasia
Objective 3. Demonstrate understanding and application of key facets of the following diseases of the small intestine and their treatments:
a. Carcinoma of ampulla of water
b. Duodenal ulcer
c. Angiodysplasia
d. Malabsorption syndrome
1. Adult coeliac disease
2. Whipple's disease
3. Diverticula
Objective 4. Demonstrate understanding and application of key facets of the following diseases of the colon and rectum and their treatments:
a. Diverticulosis of colon
b. Carcinoma and polyps
c. Hirschsprung's megacolon
d. Angiodysplesia
Objective 5. Demonstrate understanding and application of key facets of the following inflammatory bowel diseases and their treatments:
a. Crohn's disease
1. Small intestine
2. Colon
b. Ulcerative colitis
1. Colon
c. Differential features of Crohn's Disease and ulcerative colitis
d. Medical and surgical treatment of inflammatory bowel disease
e. Microscopic colitis
Objective 6. Demonstrate understanding and application of key facets of the following diseases of the pancreas and their treatments:
a. Carcinoma
b. Pancreatitis
1. Acute
2. Chronic
3. Etiological factors
Objective 7. Demonstrate understanding and application of key facets of the following diseases of the liver and biliary track and their treatments:
a. Hepatic malignancy
b. Hepatitis
1. Acute Hepatitis, e.g. A, B, C, D, E, etc.
2. Chronic Hepatitis C, B, etc.
c. Cirrhosis
1. Alcoholic
2. Viral Hepatitis
3. Primary biliary cirrhosis
d. Hemochrometosis
e. Carcinoma of gallbladder
f. Cholelithiasis and Cholecystitis
g. Cholangitis
h. Differential diagnosis of jaundice
i. Congenital abnormalities of biliary system
Objective 8. Demonstrate understanding and application of key facets of the following infectious diseases of the gastrointestinal tract and their treatments:
a. Enteric pathogens
b. Parasitic infestations
Objective 9. Demonstrate understanding and application of key facets of the following hormonal gastrointestinal diseases and their treatments:
a. Islet cell tumors of the pancreas
b. Insulinoma
c. Gastrinoma
d. "Pancreatic cholera" VIPoma
Objective 10. Demonstrate understanding and application of key facets of the functional gastrointestinal disease and treatments.
Objective 11. Recognize the gastrointestinal manifestation of Acquired Immunodeficiency Disorder.
C. PRACTICE-BASED LEARNING AND IMPROVEMENT
Objective 1: Demonstrate evidenced based practice through appraisal and assimilation of scientific information, e.g. scientific journals, related to patient care
Objective 2: Demonstrate ability in medical decision making, which incorporates medical assessment and patient values and preferences.
D. INTERPERSONAL AND COMMUNICATION SKILLS
Objective 1: Create an atmosphere of positive regard for the patient and family to promote the best medical outcome through accessibility, affability and continuity.
Objective 2: Incorporate psychosocial and ethical concerns of the patient and family in the development of the care management plan.
Objective 3: Dictate timely, comprehensive patient care notes, including admission and discharge summaries, and write thorough, succinct daily progress notes in accepted format.
E. PROFESSIONALISM
Objective 1: Demonstrate compassionate use of medical skills for patients. This includes high-quality care and technology and, in the event of terminal illness, an awareness of the limits of medical intervention and the obligation to provide humane care.
Objective 2: Recognize the legal requirements of advanced directives and describe the process of assessing a patient's advance directives, including the patient's perspective.
Objective 3: Model appropriate professional attitudes and behaviors of time management and punctuality, reliability, peer support, community teaching, and ethical behavior.
Objective 4: Demonstrate teaching and organizational skills by organizing gastroenterology conferences and assisting in the teaching of the fourth-year medical students assigned to the elective clerkship in gastroenterology
Objective 5: Model effective leadership qualities for residents, staff, and nursing, i.e., conflict resolution, and problem identification and resolution.
F. SYSTEM-BASED PRACTICE
Objective 1: Recognize financial issues of heath care, with emphasis on understanding acute and chronic care, and medication coverage and the role of the Centers for Medicare and Medicaid Services (CMS), and other third party payers.
Objective 2: Actively participate in the multidisciplinary approach to caring for patients, including appropriate recognition of other health professional and paraprofessionals' roles and demonstrate competence in team interactions, i.e. medical students, residents, pharmacist, physician's assistant, advanced practice nurse, nurses, occupational and physical therapist, social worker.
III. METHODS
The Gastroenterology roationis a four-week experiences supervised by faculty members of the University of Illiois College of Medicine at URbana-Champagin. All faculty members are certified by the American Board of Intenal Medicine.
The rotation includes the continual care of 10 to 15 inpatients. The resident performs the history and physical examination; develops a treatment plan and participates in management with attending supervision. Residents see consultations requested of the GI service. S/he performs the appropriate history and physical examination and make recommendations which are staffed with the attending gastroenterologist. Residents are expected to prepare through reading and review of appropriate references from medical literature. On-call is as assigned within the ACGME guidelines for work hours. The resident will receive exposure to the endoscopic procedures of gastroenterology, e.g. esophagogastroduodenoscopy, ERCP, colonoscopy, polypectomy, and flexible sigmoidoscopy.
Core Conference Curriculum :
The core conference curriculum is an 18 month curriculum including a core conference in Gastroenterology. Topics addressed on the 18 month rotating calendar include Abnormal Liver Function Tests (LFTs), Cholestatic Liver Disease, Colon Neoplasms, Crohn's Disease, Diarreha, Irritable Bowel Syndrome, Malabsoprtion, Pancratitis, Peptic Ulcer Disease, Ulcerative Colitis, and Viral Hepatitis.
IV. EVALUATION
ACGME Competencies According to Accreditation Council of Graduate Medical Education (ACGME), training and evaluation must include the following competencies: Patient Care, Medical Knowledge, Practice – Based Learning and Improvement, Interpersonal and Communication Skills, Professionalism, and System-Based Practice.
Patient Care will be evaluated by global assessment and chart audit per the attending physician. Procedures performed will be documented.
Medical Knowledge will be evaluated by global assessment and chart audit per the attending physician,
Practice-Based Learning and Improvement will be evaluated by chart audit per the attending physician.
Interpersonal and Communication Skills will be evaluated by global assessment per attending physician and additional information from nursing staff, patients and families.
Professionalism will be evaluated by global assessment per attending physician and additional information from nursing staff, patients and families.
System-Based Practice will be evaluated by global assessment of attending, and attending-reviewed chart audit.
The evaluation method is primarily accomplished electronically. Residents' performance in Gastroenterology is evaluated by the attending physician. Evaluations are reviewed with the residents for formal feedback. Face to face interaction between the attending physician and the resident is the required method. At the midway point of the rotation, the resident/intern team is encouraged to approach the attending to assess and discuss performance. In addition, ongoing feedback is provided related to residents' patient care responsibilities and activities.
Residents will document the Gastroenterology rotation in portfolios, e.g. procedures performed, peer-reviewed chart audit. This tool will provide individual learning, reflection and assessment. Additionally, residents will evaluate the Gastroenterology rotation.
Residents provide input on the Gastroenterology core lecture series, which is used in scheduling future topics and speakers. Periodically, residents are surveyed to evaluate the curriculum and teaching faculty.
V. REFERENCES
Harrison's Principles of Internal Medicine, "Disorders of the Gastrointestinal System"
Cecil's Textbook of Medicine, "Gastrointestinal Diseases"
Sheila Sherlock, Diseases of the Liver
Rev 11/1/05, 7/1/06, 7/1/07
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The Gastroenterology Curriculum is a four week experience provided by faculty members who are Assistant Professors of Clinical Medicine at the University of Illinois College of Medicine - Urbana. Ideally, the resident has more than 9 months Residency training.
Immediately following morning report, the resident should present at Station 9 for clinic, or meet with the gastroenterologist as the specified location. Except for Thursday conferences days, residents are expected to be present and available from 0745 to 1700, or later if clinical or teaching situations are on-going. Residents are to be present even if no clinical responsibilites. The DVAIHS Chief Resident is authorized to approve early quitting time during normal work hours. Selected topics from the GI curriculum are presented
MONDAY |
TUESDAY |
WEDNESDAY |
THURSDAY |
FRIDAY |
|
| 0745 |
Mini-Morning Report
| Morning Report |
Morning Report |
Mini-Morning Report |
Morning Report |
0830 1200 |
GI Clinic/Liver Clinic
|
GI Clinic |
1. Watch Endoscopy 2. Procedures 3. GI Clinic if second GI attending present
|
GI Clinic |
1. Watch Endoscopy 2. Consults 3. Paracentesis |
1300 1700 |
Continuity Clinic as Assigned |
1. Consults 2. Paracentesis Training |
1. Consults 2. Paracentesis Training |
Core Conference |
1. Watch Endoscopy 2. Consults 3. Paracentesis |
Day 1 of rotation, after morning report, the resident is to page the GI attending to meet and discuss the objectives and expectations of the rotation.
GI Consults are to be seen as soon as possible with immediate staffing. The resident performs the history and physicial and immediately staffs the patient with the supervising attending. Ms. Jackie McCallister, Building 58, Room 326, Extension 5290 is the contact person, and the white board must be checked each hour. In the event of stat consults, the team pages and Ms. McCallister pages the GI resident.
Morning report is conducted Monday through Friday 0800 to 0855 in Building 58, Conference room 248. Every alternate Tuesday , 0815-0900, the GI resident is expected to present a patient and a short review of literature to fellow residents. The resident must be conversant in the patient's history. The resident is to discuss the teaching presentation and format with the supervising attending prior to the conference. Additionally, the resident is to present a 45 to 60 minute GI presentation two to three times per week with a GI attending.
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PROVENA COVENANT MEDICAL CENTER
Duties and Expectations