Endoscopy All Sites


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Endoscopy All Sites

  1. 1. Curriculum TemplateEndoscopy – All sites (BWH, FH, VAH)The mission of the Brigham and Womens Hospital Gastroenterology FellowshipProgram is to train physician-investigators and future academic leaders inGastroenterology.Training of all fellows in gastrointestinal endoscopy Level 1 Training (see AGA CoreCurriculum 3rd Ed. May, 2007, page 19) is coordinated by the Director of EndoscopyEducation, a faculty member appointed by the BWH Director of Endoscopy. Facultytrainers specifically for each 2nd and 3rd year fellow are appointed by the Program SiteCoordinator at each training site, subject to the approval of the BWH Director ofEndoscopy Education. The curriculum and evaluation process comply with the CoreCurriculum and the subspecialty – specific requirements of the ACGME. Training iscentered at BWH, 850 Boylston, the Stratus Center and, the CHMC Simulator Centerwith adjunctive training at the endoscopy centers of the VAH system (Jamaica Plain andWest Roxbury), FH and LSH.All 2nd and 3rd year fellows will participate in one on-call month/year until they havecompleted their esophageal dilation, variceal banding and Bravo pH probe placementtrainingGoals:1. The mastery of procedural skills as well as their indications, complications andinterpretation to insure patients always receive safe and quality care.2. The use of endoscopy as it applies to clinical problem solving, not an isolated technicalactivity.3. Proficiency in the quality assurance process by self – evaluation of adverse outcomes.Training Year OneThe fellow will understand the basic function of, and applications for all routineendoscopy equipment including biopsy, hemostasis, polypectomy, variceal banding anddilation.The fellow will learn the proper pre – operative assessment of the patient including theASA and Mallampati grading systems, the management of peri- and post-operativeanticoagulation technique, and the use of antibiotic prophylaxis.The fellow will learn the mode of action and complications of all medications used forintravenous conscious sedation.The fellow will know all ASGE guidelines for the use of endoscopic equipment for theevaluation and treatment of common gastrointestinal disorders.The fellow will be able to regularly enter the duodenum and perform all basic maneuverswith the gastroscope.The fellow will begin learning to manage loop formation during colonoscopy andintubating the right colon. 1
  2. 2. Training Year TwoThe fellow will be able to apply all standard diagnostic and therapeutic maneuvers withthe gastroscope and colonoscope with moderate assistance from faculty.The fellow will be able to perform hemostatic therapy for acute GI bleeding in the upperand lower GI tract with moderate assistance from faculty.The fellow will be able to intubate the cecum in 90 % of patients and the terminal ileum75 % of the time without assistance.The fellow will have a working understanding of the ongoing areas of endoscopicresearch and innovation and will formulate an independent quality assurance project to becompleted by graduation.Training Year ThreeThe fellow will be able to function independently in all Level 1 diagnostic andtherapeutic endoscopy.The fellow will complete a quality assurance project that is presented to the Division.The fellow will be qualified to apply for Level 2 endoscopic training including a 4thtraining year.Patient CareGoalFellows must be able to provide patient care that is compassionate, appropriate, andeffective for the treatment of health problems and the promotion of health. Fellows areexpected to:Competencies1. Deliver compassionate appropriate and effective care.Objectives1. The fellow will perform competently all gastrointestinal endoscopy and other invasiveprocedures as summarized in the ACGME Gastroenterology Program RequirementsSec XIV B1. a-l.“ACGME Program Requirements Sec XIV B1. a-l”.B. Technical and Other Skills1. Fellows must have formal instruction, clinical experience and must demonstratecompetence in the performance of the following procedures. A skilled preceptor mustbe available to teach and supervise the fellows in the performance of theseprocedures, which must be documented in each fellows record, giving indications,outcomes, diagnoses, and supervisor(s). Assessment of procedural competenceshould not be based solely on a minimum number of procedures performed, but ona formal evaluation process. These evaluations should include objectiveperformance criteria (e.g., rate of successful cecal intubation for colonoscopy):a) esophagogastroduodenoscopy (fellows must perform a minimum of 130supervised studies);b) esophageal dilation (fellows must perform a minimum of 20 supervisedstudies);c) flexible sigmoidoscopy (fellows must perform a minimum of 30 supervised 2
  3. 3. studies);d) colonoscopy with polypectomy (fellows must perform a minimum of 140supervised colonoscopies and 30 supervised polypectomies);e) percutaneous liver biopsy (fellows must perform a minimum of 20supervised studies);f) percutaneous endoscopic gastrostomy (fellows must perform a minimum of15 supervised studies);g) biopsy of the mucosa of esophagus, stomach, small bowel, and colon;gastrointestinal motility studies and 24-hour pH monitoring;h) nonvariceal hemostasis, both upper and lower (fellows must perform 25supervised cases, including 10 active bleeders);j) variceal hemostasis (fellows must perform 20 supervised cases, includingfive active bleeders);k) other diagnostic and therapeutic procedures utilizing enteral intubation;andl) moderate and conscious sedation.Medical KnowledgeGoalFellows must demonstrate knowledge of established and evolving biomedical, clinical,epidemiological, and social-behavioral sciences, as well as the application of thisknowledge to patient care. Fellows are expected to:Competencies1. Understand the appropriate application and complications of endoscopy in themanagement of acute and chronic illness, including those procedures restricted to Level 2Training (ERCP, EUS, EMR, PDT, stent placement, endoscopic GERD therapy andlaporoscopy).2. Compare the clinical usefulness of standard endoscopic procedures to those in otherrelated fields such as CAT, MRI, interventional radiology, angiography and surgery.3. Be aware of future innovations in endoscopy technology and their potential relevanceto clinical care.Objectives 1. The cognitive skill to choose and utilize correctly the appropriate endoscopic procedure for the management of illness.Practice- Based Learning and ImprovementGoalFellows must demonstrate the ability to investigate and evaluate their care of patients, toappraise and assimilate scientific evidence, and to continuously improve patient carebased on constant self-evaluation and life long learning. Fellows are expected to developskills and habits to be able to :Competencies • Identify strengths, deficiencies and limits in one’s knowledge and expertise; • Set learning and improvement goals 3
  4. 4. • Systematically analyze practice, using quality improvement methods, and implement changes with the goal of practice improvement • Incorporate formative evaluation feedback into daily practiceObjectives1. The acquisition of sound technical skill in Level 1 endoscopic training with thoseprocedures identified by the ACGME, as measured by standard evaluation by specifically- appointed faculty.2. Continuous self – evaluation and review of adverse occurrences to improve patientcare.Systems Based PracticeGoalFellows must demonstrate an awareness of and responsiveness to the larger context andsystem of health care, as well as the ability to call effectively on other resources in thesystem to provide optimal health care. Fellows are expected to:Competencies • Work in interprofessional teams to enhance patient safety and improve patient care quality • Participate in identifying systems errors and in implementing potential systems solutionsObjectives 1. Skill in the quality-assurance process by learning to analyze, present, and to prevent adverse occurrences in the performance of endoscopy.ProfessionalismGoalFellows must demonstrate a commitment to carrying out professional responsibilities andan adherence to ethical principles. Fellows are expected to demonstrate:Competencies • Compassion, integrity, and respect for others • Responsiveness to patient needs that supersedes self-interest • Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientationObjectives 1. Humane and ethical treatment of patients and their families during the preparation for, performance of, and recovery from endoscopy. 4
  5. 5. Interpersonal and Communication SkillsGoalFellows must demonstrate interpersonal and communication skills that result in theeffective exchange of information and teaming with patients, their families, andprofessional associates. Fellows are expected to:Competencies • Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds • Communicate effectively with physicians, other health professionals, and health related agencies • Work effectively as a member of leader of a health care team or other professional group • Act in a consultative role to other physicians and health professionals • Maintain comprehensive, timely, and legible medical recordsObjectives 1. Effective communication of procedure findings and their interpretation to patient, their families and the health care team.Teaching Methods1. Faculty – mentored simulator training.2. Hands – on performance of procedures with continuous faculty observation.3. Endoscopy didactic conferencesAssessment Method (Fellows)1. Global faculty evaluations.2. Standardized (ASGE) evaluations performed three times a year.3. OSCEFellowship Year 1A. 1st Segment (July – October)Makes clinical decisions based on well-established rules and communicates them clearlyand succinctly to all members of the healthcare team and referring physicians.B. 2nd Segment (November – February)Grasps situational aspects of knowledge, particularly the major GI illnesses. Understandsprogram mission and future role as consultant, educator and investigator.C. 3rd Segment (March – June)Recommendations are based on a firm understanding of pathophysiology. Discriminatesbetween data. Pathway to physician-investigator/academic leader is better defined.Fellowship Year 2Reasons more intuitively in decision – making. Increasing mastery of core curriculum 5
  6. 6. and relevant literature. Thinks more independently and creatively as teacher and rolemodel.Fellowship Year 3Provides subtle discriminations in clinical observations and immediate intuitive analysis.Relishes challenge clinical challenges. Mastery of an area as teacher and investigator.Next career step firmly established. after Dreyfuss, H. 2007Assessment Method (Program Evaluation) 1. Fellows anonymous evaluations at end of rotations 2. Annual program retreat 3. Annual anonymous education surveyLevel of Supervision1. Continuous observation by faculty and nursing staffEducational Resources1. Simulator training, faculty training, online search enginesCreated 07/01/07Revised 07/20/0710/30/08FLM/cb 6