Specific Requirements for Osteopathic Subspecialty Training ...
Specific Requirements for Osteopathic Subspecialty Training in Gastroenterology This is part of the Basic Standards for Fellowship Training in Internal MedicineSubspecialties, which govern and define training in the subspecialties. The Basic Standards are incorporated into this document by reference. I. Educational Program Duration A. The gastroenterology fellowship program shall be three (3) years in duration. The program must provide an intellectual environment for the development of cognitive, attitudinal, ethical, and mechanical skills essential for a gastroenterology practice. II. Facilities and Resources A. The institution must provide sufficient patient load with diversified pathology to properly train a minimum of two (2) fellows in gastroenterology and must indicate the methods by which patients are incorporated into the teaching program. B. The institution must provide modern or state- of- the- art equipment that is kept in good working order to ensure attainment of the program’s stated objectives. C. The institution must provide an endoscopic suite or its equivalent. D. The institution must have departments of pathology and radiology that cooperate or participate in the training of gastroenterology fellows. II. Specific Program Content A. Clinical Requirements: 1. Integration of osteopathic principles and practice appropriate to gastroenterology 2. 24 months of training devoted to clinical gastroenterology with major emphasis on acquiring the required technical and clinical skills. 3. Up to 3 months of the 24 months may be in full time gastroenterology research. The research must address a gastroenterology related topic and the mentor must be a gastroenterologist. There must be evidence that the research contributes to the educational experience of the fellow. 4. Up to 12 months may be spent in GI electives such as inflammatory bowel disease, motility, nutrition, hepatology, oncology, biliary tract disease, pediatric gastroenterology or transplant medicine. Other types of electives would need specific justification.
5. At least one month of training in gastrointestinal motility disorders. This requirement can be met at outside institutions if necessary. 6. Training in the skills required to be the director of an endoscopy center. This includes training in the regulations (i.e. OSHA) regarding the protection of health care workers, universal precautions, and other regulatory requirements pertinent to the operation of an endoscopy lab. The training must also include the processes involved in the use and maintenance of equipment, handling of contaminated and hazardous materials, and sharing of information (HIPAA). There must also be training in the business practice of gastroenterology, and accreditation processes. 7. During the first year, training to attain thorough knowledge of: a. Diagnoses requiring gastrointestinal procedures b. Histopathology c. Initial management of gastrointestinal disorders d. Management of gastrointestinal disorders that have failed initial treatment e. Gastrointestinal disease processes f. Treatment of gastrointestinal disorders g. Interpretation of radiographic imaging of the gastrointestinal system including barium studies, computerized tomography scans, magnetic resonance imaging, endoscopic retrograde cholangiopancreatography, and nuclear medicine scansB. Technical Skills Requirements 1. The fellow must be knowledgeable about the risks, benefits, indications and contra- indications of procedures learned. 2. By completion of the fellowship, the resident must have acquired proficiency in the performance of the following procedures: esophageal dilatation, esophagogastroduodenoscopy, small bowel endoscopy, colonoscopy, polypectomy, paracentesis, percutaneous liver biopsy, percutaneous endoscopic gastrostomy, variceal and nonvariceal hemostasis, and biopsy of the stomach, esophagus, small bowel and colon. 3. The fellow must know the indications, contraindications, risks and benefits of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography and of endoscopic ultrasound.C. Ambulatory requirements 1. An ambulatory clinic experience must be incorporated within the training program. The duration and time spent in the ambulatory clinic will be determined by each institution. During this time, the fellow will become proficient in long-term assessment, treatment variation,
natural history of gastrointestinal disorders, and establishing physician/patient relationships.D. Specific program content for knowledge areas 1. Diagnosis and treatment of the following conditions: a. Disorders of the esophagus including cancer, gastroesophageal reflux and strictures b. Non-cardiac chest pain c. Gastrointestinal bleeding including upper, lower, and anorectal bleeding d. Disorders of the stomach including peptic ulcer disease, cancer and gastroparesis e. Severe malabsorption f. Disorders of the pancreas including acute and chronic pancreatitis and cancer g. Complications of endoscopic procedures h. Disorders of the hepatobiliary system including cancer, biliary obstruction, hepatitis and cirrhosis i. Infectious diseases of the gastrointestinal system j. Irritable bowel syndrome k. Disorders of the small intestine including obstruction and cancer l. Inflammatory bowel disease m. Disorders of the colon including cancer n. Intra-abdominal abscesses o. Acute and chronic malnutrition p. Mesenteric insufficiency and its complications q. Gastrointestinal disorders in relation to systemic diseases 2. Proficiency in the following knowledge areas: a. Normal gastrointestinal physiology b. Gastrointestinal pharmacology c. Enteral and parenteral alimentation d. Ethics and public policy in relation to gastrointestinal disorders