82 GASTROENTEROLOGY Contact: Kristi Livesay, 955-4142 When to ...
GASTROENTEROLOGYContact: Kristi Livesay, 955-4142When to Contact: 2 weeks prior to rotationPreceptors: Fernando Zapata, MD; Sharad Kunnath, MD; Ruben Quiros, MD; Ryan Fischer, MDWhere to Meet: 3rd floor of Scott Pavilion at Children’s Hospital – GI Clinic, 9:00 AM first day of rotationTrainee Level: Available to all residentsGOALS Become broadly familiar with gastrointestinal pathophysiology in infants, children and adolescents; Assist in evaluation of patients with gastrointestinal, hepatobiliary, and nutritional disorders; Participate in gastrointestinal procedures; and Gain some expertise in interpretation of gastrointestinal histopathology.OBJECTIVESCORE COMPETENCY: PATIENT CARE • Residents will help see patients in outpatient clinic and in the hospital on the inpatient consultation service. • Teaching rounds are performed on a daily basis. The resident will work closely with students and fellows as well as the attending. • The resident will be able to obtain a focused history and perform a directed physical exam. In addition, the resident will select the correct laboratory tests and procedures which support the diagnosis of common gastrointestinal disorders. • Attend all reguarly scheduled continuity clinics and cross-cover call.HO-I • First year residents on this rotation are expected to be able to take a pertinent history from the patient and to perform an appropriate focused exam. • First year residents will work with the attending to discuss management and treatment options.HO-II • Second year residents who take the rotation will be expected to perform appropriate focused history and physical skills and propose appropriate management plans and goals.HO-III • Third year residents who take this rotation should be able to take ownership for the patients and discuss appropriate management plans and goals with attending as well as take an active role in patient education and discussions.CORE COMPETENCY: MEDICAL KNOWLEDGE • Residents will learn to evaluate and treat pediatric patients with common gastrointestinal disorders such as constipation, formula allergy, and abdominal pain without consultation with the pediatric gastroenterologist except in unusual cases. • The resident will be able to construct a differential diagnosis for an infant or child presenting with the following signs and symptoms among others: 1. Chronic vomiting 2. Acute bilious vomiting 3. Abdominal distention 4. Acute abdominal pain and tenderness 5. Chronic abdominal pain 6. Acute vomiting and diarrhea 7. Chronic constipation with or without fecal soiling 8. Abdominal mass on physical examination 82
9. Direct hyperbilirubinemia in an infant 10. Jaundice in an older child. • The resident will be able to institute treatment for each eventual diagnosis. • The resident should know and understand the appropriate use of both standard and therapeutic infant formulas. • The resident should be able to use appropriately and effectively prokinetic drugs, H2 receptor antagonists, laxatives, and anti-inflammatory drugs.CORE COMPETENCY: PRACTICE-BASED LEARNING & IMPROVEMENT • Residents will learn the appropriate time for referral for more severe or difficult gastrointestinal and hepatobiliary disorders. • Demonstrate ability to acquire and access new knowledge, interpret evidence, and then apply it to an specialty outpatient setting. Residents must demonstrate an awareness of responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.CORE COMPETENCY: INTERPERSONAL & COMMUNICATION SKILLS • Create therapeutic relationships with patients. Develop listening skills and work effectively as part of a health care team. • Residents are expected to work with primary care physicians and ancillary services such as social work and visiting nurses, to ensure quality long term care.CORE COMPETENCY: PROFESSIONALISM • Professionalism is demonstrated through a foundation of clinical competence, communication skills, and ethical understanding. Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to a diverse patient population. • Residents are expected to: 1. Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society that supersedes self-interest; accountability to patients, society and the profession; and a commitment to excellence and on-going professional development. 2. Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent and business practices. 3. Demonstrate sensitivity and responsiveness to patients’ culture, age, gender and disabilities.CORE COMPETENCY: SYSTEMS-BASED PRACTICE • Understand interaction of the resident’s practice within a larger system. • The resident should know about practice and delivery systems and practice cost effective health care. • Advocate for patients within the health care system and partner with primary care physicians and ancillary staff to coordinate and improve health care.EVALUATION Exceeds Expectations: The resident demonstrates exceptional knowledge of common gastrointestinal disorders and treatment. Participation in discussions and response to questions demonstrate evidence of outside reading and good understanding. Resident actively contributes to patient discussions during rounds and clinics. Meets Expectations: The resident demonstrates interest and understanding of the goals and objectives of the elective. Participation in discussions demonstrates evidence of outside reading. Below Expectations: The resident has more than two unexcused absences from clinics or conferences or consistently refuses to participate in discussions. The resident demonstrates no evidence of outside reading and/or understanding. 83