Program Requirements for Residency Education in ...
Program Requirements for Residency Education in GastroenterologyI. Educational ProgramA subspecialty education program in gastroenterology must beorganized to provide training and experience at a sufficient levelfor the resident to acquire the competency of a specialist in thefield. It must be 3 years in duration.II. Key Clinical FacultyThe program must provide a minimum of four institutionally basedfaculty members, including the program director. In addition, atleast one key clinical faculty member should have demonstratedexpertise and primary focus in hepatology.III. Facilities and ResourcesA. Modern facilities to accomplish the overall educational programmust be available and functioning at the primary training site.Specifically, there must be a procedure laboratory completelyequipped to provide modern capability in gastrointestinal procedures.This equipment must include an up-to-date array of completediagnostic and therapeutic endoscopic instruments and accessoriesplus esophageal motility instrumentation. Facilities forparasitology testing should be provided. Supporting servicesincluding pathology, diagnostic radiology, interventional radiology,medical imaging and nuclear medicine, general surgery, and oncologyalso must be available.B. Facilities for the intensive care of critically ill patientswith gastrointestinal disorders must be provided, including a workingrelationship with surgery, oncology, pediatrics, radiology, andpathology services.IV. Specific Program ContentA. Clinical Experience1. The training program must provide opportunities for residentsto develop clinical competence in the field of gastroenterology,including hepatology, clinical nutrition, and gastrointestinaloncology.2. At least 18 months of the clinical experience should be in 1
Program Requirements for Residency Education in Gastroenterologygeneral gastroenterology, including hepatology, which should compriseapproximately 30% of this experience. The additional 18 months oftraining must be dedicated to elective fields of training oriented toenhance competency.3. Residents must have formal instruction, clinical experience, oropportunities to acquire expertise in the evaluation and managementof the following disorders:a. Diseases of the esophagusb. Acid peptic disorders of the gastrointestinal tractc. Motor disorders of the gastrointestinal tractd. Irritable bowel syndromee. Disorders of nutrient assimilationf. Inflammatory bowel diseasesg. Vascular disorders of the gastrointestinal tracth. Gastrointestinal infections, including retroviral, mycotic, andparasitic diseasesi. Gastrointestinal and pancreatic neoplasmsj. Gastrointestinal diseases with an immune basisk. Gallstones and cholecystitisl. Alcoholic liver diseasesm. Cholestatic syndromesn. Drug-induced hepatic injuryo. Hepatobiliary neoplasmsp. Chronic liver diseaseq. Gastrointestinal manifestations of HIV infectionsr. Gastrointestinal neoplastic diseases. Acute and chronic hepatitist. Biliary and pancreatic diseases4. Residents must have formal instruction, clinical experience,and opportunities to acquire expertise in the evaluation andmanagement of patients with the following clinical problems:a. Dysphagiab. Abdominal painc. Acute abdomend. Nausea and vomitinge. Diarrheaf. Constipationg. Gastrointestinal bleedingh. Jaundicei. Cirrhosis and portal hypertensionj. Malnutritionk. Genetic/inherited disorders 2
Program Requirements for Residency Education in Gastroenterologyl. Depression, neurosis, and somatization syndromesm. Surgical care of gastrointestinal disordersB. Technical and Other Skills1. The program must provide for instruction in the indications,contraindications, complications, limitations, and (where applicable)interpretation of the following diagnostic and therapeutic techniquesand procedures:a. Imaging of the digestive system, including(1.) Ultrasound(2.) Computed tomography(3.) Magnetic resonance imaging(4.) Vascular radiography(5.) Nuclear medicineb. Percutaneous cholangiographyc. Percutaneous endoscopic gastrostomyd. Gastric, pancreatic, and biliary secretory testse. Other diagnostic and therapeutic procedures utilizing enteralintubation and bougienagef. Enteral and parenteral alimentationg. Liver transplantationh. Pancreatic needle biopsyi. ERCP, including papillotomy and biliary stent placement2. Opportunities also must be provided for the resident to gaincompetence in the performance of the following procedures. A skilledpreceptor must be available to teach and to supervise them. Theperformance of these procedures must be documented in the residentsrecord, giving indications, outcomes, diagnoses, and supervisor(s).a. Esophagogastroduodenoscopy; residents should perform a minimumof 100 supervised studies.b. Esophageal dilation; residents should perform a minimum of 15supervised studies.c. Proctoscopyd. Flexible sigmoidoscopy; residents should perform a minimum of25 supervised studies.e. Colonoscopy with polypectomy; residents should perform aminimum of 100 supervised colonoscopies and 20 supervised 3
Program Requirements for Residency Education in Gastroenterologypolypectomies.f. Percutaneous liver biopsy; residents should perform a minimumof 20 supervised studies.g. Percutaneous endoscopic gastrostomy; residents should perform aminimum of 10 supervised studies.h. Biopsy of the mucosa of esophagus, stomach, small bowel, andcoloni. Gastrointestinal motility studiesj. Nonvariceal hemostasis (upper and lower); residents shouldperform 20 supervised cases, including 10 active bleeders.k. Variceal hemostasis; residents should perform 15 supervisedcases, including five active bleeders.l. Enteral and parenteral alimentationm. Liver biopsyC. Formal InstructionThe program must include emphasis on the pathogenesis,manifestations, and complications of gastrointestinal disorders,including the behavioral adjustments of patients to their problems.The impact of various modes of therapy and the appropriateutilization of laboratory tests and procedures should be stressed.Additional specific content areas that must be included in the formalprogram (lectures, conferences, and seminars) include the following:1. Anatomy, physiology, pharmacology, and pathology related to thegastrointestinal system, including the liver2. The natural history of digestive diseases3. Factors involved in nutrition and malnutrition4. Surgical procedures employed in relation to digestive systemdisorders and their complications5. Prudent, cost-effective, and judicious use of specialinstruments, tests, and therapy in the diagnosis and management ofgastroenterologic disorders6. Liver transplantation7. Sedation and sedative pharmacology8. Interpretation of abnormal liver chemistriesACGME: June, 1998 Effective: July, 1999 4