IM VA Gastroenterology and Hepatology Consult Curriculum.doc.doc


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IM VA Gastroenterology and Hepatology Consult Curriculum.doc.doc

  1. 1. Gastroenterology and Hepatology Consult Curriculum KUMC and KCVAThe Residency Review Committee requires that the resident and attending have a face-to-face meetingat the beginning of the rotation to review the learning objectives.Educational Purpose for Rotation: The goal of the elective rotation in gastroenterology is to provide the resident withinpatient and outpatient consultative experience and to introduce them to themanagement of GI problems. The resident will be exposed to a number of core topicsin gastroenterology and hepatology during the clinical conferences. Clinical experiencewill include opportunities to observe and manage patients with a wide variety ofdigestive disorders on both inpatient and outpatient basis. The residents will be givenopportunities to assure continuing responsibility for both acute and chronically illpatients in order to learn the natural history of gastroenterologic disorders, as well asthe effectiveness of therapeutic programs. There will be an emphasis on thepathogenesis, manifestations and complications of gastrointestinal disorders, includingthe behavioral adjustments of their patients to their problems. This elective is offered atboth KU Medical Center and the KCVA Medical Center.Teaching Methods: • Each patient seen by a resident in both the clinic and the inpatient consult setting is reviewed in detail with the attending physician, including discussion of history and physical examination findings, differential diagnosis, and diagnostic and therapeutic management plans. • Residents are expected to attend all regularly scheduled program conferences, including morning report, core conference, journal club, morbidity and mortality conference, and clinicopathological conference. In addition, resident attendance is expected at GI Grand Rounds on Tuesdays from 5 to 6:30 in B018 SON. • There is a course of reading with selected clinical review literature in gastroenterology presented to the resident for reading and discussion. • The resident will also be able to observe endoscopic procedures, specifically diagnostic and therapeutic EGD and colonoscopy. The resident can arrange to participate in motility studies, endoscopic ultrasound, ERCP, stent placement and other advanced GI procedures if there is interest.Clinical Experience and Level of Resident Supervision:CLINICS: 1
  2. 2. The resident will attend general GI clinic for 2-3 half-days per week, and inaddition will assess and help manage patients with liver disease in general hepatologyand Liver Transplant clinics.IN- HOSPITAL CONSULTATIONS:The resident will participate in the evaluation and management of inpatients withgastroenterological and liver disease on the medical and surgical services. Commonreasons for GI consultation include inflammatory bowel disease, gastroparesis andother GI motility disorders, upper and lower GI bleeding, and abdominal pain. TheHepatology service is often consulted for concurrent management of patients with end-stage liver disease undergoing workup for liver transplantation, in addition to patientswith acute and chronic liver failure requiring diagnostic workup.PROCEDURES:The resident will observe or participate in the following during a 4-week elective: • Liver biopsy • Colonoscopy • Capsule endoscopy • Upper endoscopy with banding/sclerosis for varices • Abdominal paracentesis Residents on the GI/Hepatology consult service are supervised closely by theattending physician, who is available in-house by pager for questions and personallyevaluates each new consult following discussion with the resident. GI/Hepatologyfellows are also available to the resident for supervision during procedures and otherclinical duties.Competency-Based Educational Goals and Objectives by Level of Training andEvaluation Methods:Medical Knowledge: • PGY-1: • Demonstrate growth in basic knowledge of the following areas of gastroenterology and hepatology: o Appropriate prescription of dietary modifications such as high fiber, low residue, lactose-free, gluten-free, and low-protein o Appropriate prescription of H2 blockers, surface-acting drugs and proton pump inhibitors for peptic ulcer disease o The pathophysiology, presentation and management of:  Gastrointestinal bleeding  Gastrointestinal neoplasms  Drug induced and viral liver disorders  Functional GI disorders 2
  3. 3.  Pancreatic and biliary diseases  Inflammatory bowel diseases  Infections of the GI tract  Acute and chronic viral hepatitis  Autoimmune hepatitis  Cholestatic liver disease (primary biliary cirrhosis, primary sclerosing cholangitis, drug-induced, ect)  Fatty liver and non-alcoholic stcatohepatitis (NASH)  Hemochromatosis  Wilson’s disease  α1-antitrypsin deficiency  Alcoholic liver disease o The evaluation, differential, and basic management of diarrhea o The treatment options and management of constipation o The evaluation and management of abdominal pain • PGY-2: All of the above, and: • Demonstrate growth in knowledge base in the above areas of gastroenterology and hepatology • Successfully complete the Internet-based training module assigned for the rotation • PGY-3: All of the above, and: • Demonstrate advanced understanding of the above areas of gastroenterology and hepatology, indicative of successful performance on the GI portion of the ABIM certification examinationEvaluation Methods: Attending evaluation, performance on Internet-based trainingmodulePatient Care:PGY-1: • Take a history emphasizing the following elements: • Recognizing and understanding the importance of the characteristic features of abdominal pain • Distinguishing the acute abdomen from the benign conditions • Distinguishing between upper and lower gastrointestinal bleeding • Evaluating jaundice and the importance of distinguishing surgical causes • Obtaining family history for suspected inflammatory bowel disease, ulcer disease, liver disease, and gastrointestinal malignancies • Knowing the importance of obtaining past medical and surgical intervention and their association with the current illness. • Perform a physical examination emphasizing the following elements: • Clinical stigmata of chronic liver disease 3
  4. 4. • Clinical features of early and late hepatic encephalopathy • Clinical signs of portal venous hypertension • Cutaneous, mucous membrane and joint involvements in digestive diseases • The findings on abdominal examination, including abdominal distention and organ enlargement, bowel sounds, and rectal examination • Be able to prioritize a patients problems • Be able to prioritize a day of work • Monitor and follow up patients appropriately • Recognize limits in clinical experience and knows when to ask for help. • Contribute to development and completion of management plans.PGY-2: All of the above, and: • Understand the clinical indications for, contraindications to, and significance of performing: • Upper gastrointestinal endoscopy • Endoscopic retrograde cholangiopancreatography • Colonoscopy • Esophageal manometry • Endoscopic measures to control gastrointestinal bleeding • Needle biopsy of liver. • Demonstrate appropriate use and interpretation of the following laboratory data and diagnostic studies: • Liver function tests • Serologic tests for hepatitis A, B, C, Delta agent, E, F, G • Fecal leukocytes • Barium studies • Abdominal ultrasound • CT scan of the abdomen • Nuclear studies • MRI • Liver biopsy • Esophageal motility studies • Understand evidence-based management of the complications of end-stage liver disease and portal hypertension (e.g. ascítes, spontaneous bacterial peritonitis, encephalopathy and variceal bleeding) • Gain experience in evaluating patients for liver transplantation and in managing the medical aspects of patient care following liver transplantation.PGY-3: All of the above, and: • Reason well in ambiguous situations • Spend time appropriate to the complexity of the problem • Anticipate potential deterioration in clinical condition, and take appropriate diagnostic and therapeutic steps. 4
  5. 5. Evaluation Methods: Attending evaluation, mini-CEXProfessionalism: • PGY-1: • Maintain credibility and rapport with colleagues, patients, and patients’ families. • Show regard for opinions and skills of colleagues. • Consistently attend and participate in rounds and conferences. • Establish trust with patients and staff. • Be honest, reliable, cooperative and accept responsibility. • Demonstrate respect, compassion and integrity. • Demonstrate sensitivity to patient culture, gender, age, preferences and disabilities. • Acknowledge errors and work to minimize them.PGY-2: All of the above, and: • Display initiative and leadership. • Be able to delegate responsibility to others. • Demonstrate commitment to ethical principles pertaining to the provision or withholding of care, patient confidentiality, informed consent and business practices.PGY-3: All of the above, and: • Demonstrate commitment to on-going professional development.Evaluation Methods: Attending evaluationSystems-Based Practice:PGY-1: • Advocate for quality patient care • Demonstrate ability to adapt to change.PGY-2: All of the above, and: • Apply knowledge of how to partner with hospital-based health care team members, consultants, and primary care physicians to assess, coordinate and improve patient care. • Use systematic approaches to reduce errors. • Participate in developing ways to improve systems of practice and health management.PGY-3: All of the above, and: • Provide cost effective care. • Understand how individual practices affect other health care professionals, organizations and society. • Demonstrate knowledge of types of medical practice and delivery systems. 5
  6. 6. • Practice effective allocation of health care resources that does not compromise the quality of care.Evaluation Methods: Attending evaluationPractice-Based Learning and Improvement: • PGY-1: • Be able to determine own lack of experience and limitations of knowledge or skills, and obtains assistance where needed. • Show willingness to learn from mistakes. • Be self-motivated to acquire knowledge. • Accept feedback and develop self-improvement plans.PGY-2: All of the above, and: • Undertake self-evaluation with insight and initiative. • Facilitate the learning of students and other health care professionals. • Be able to access and apply multiple sources of information to practice evidence-based patient care.PGY-3: All of the above, and: • Analyze personal practice patterns systematically, and look for ways to improve.Evaluation Methods: Attending evaluationInterpersonal and Communication Skills: • PGY-1: • Deal compassionately and effectively with functional GI disorders and GI disorders in which there are common psychologic overtones (i.e., IBD). • Present cases in clear, concise manner • Behave compassionately with patients families and colleagues • Provide effective communications: 1. Able to discuss difficult diagnoses like cancer with patient and family. 2. Able to present therapeutic options including surgery to patients and their families. • Respect patients need for information and personal preferences. • Explain rationale, risks and benefits of treatment plans to patients in understandable language • Conclude patient visits by asking if the patient has any questions • Facilitate effective patient care by communicating issues and treatment recommendations to colleagues, consulting physicians, nursing and ancillary staff • Note contents appropriate and completePGY-2: All of the above, and: • Provide education and counseling to patients, families and colleagues. • Be able to discuss end of life care with patient/families with skill and compassion. 6
  7. 7. • Work effectively as a leader of the health care team.PGY-3: All of the above, and: • Be able to communicate with referring physicians with confidence and clarity.Evaluation Methods: Attending evaluation, mini-CEX 7
  8. 8. Review of Goals and Objectives with ResidentBlock ______ Rotation_________________________________Resident statement:The above goals and objectives were reviewed with me at the beginning of my rotation, and Iunderstand the expectations for the rotation and how I will be evaluated.Resident Signature: ______________________________________________________Printed Name: ______________________________________________________Date: ______________________________________________________Staff Signature: ______________________________________________________I have discussed with my staff my need for a Mini-CEX during this block.  8