GASTROENTEROLOGY ROTATIONS
Goals & Methods of Instruction/Assessment
For Residents and Medical Students
Contact Information-- On the first weekday of your rotation, please report to Sharon Young in room M580 at 8:00 am for your schedule and rotation materials (phone number 882-7758). The GI rotation educational directors are Dr. Jamal Ibdah and Dr. John Marshall, whom you may also contact if you have questions.
Clinical and Educational Expectations-- The following are the clinical and educational expectations of residents and medical students rotating on the GI service:
1. Residents and medical students will be assigned to GI clinics, as well as to either the inpatient GI consultation service at University Hospital or the VA Hospital. During days or half-days that you are not in clinic (assigned GI clinics or your Continuity Clinic) you will be expected to participate in the activities of either the University or VA inpatient consult services.
2. On the inpatient consult service and in clinic, you will see and evaluate patients, read about their problems, and present them to the GI fellow and/or teaching attending.
3. Residents and medical students should also attend all endoscopic procedures done on the patients they follow on the inpatient service.
4. In addition, residents and medical students should attend a sampling of outpatient procedures done each week in the endoscopy center of the hospital they are assigned to.
5. Residents and medical students are also expected to attend all GI conferences held during their rotation, as well as Internal Medicine Grand Rounds and M&M Conference. They are also encouraged to attend Internal Medicine morning report.
6. Residents and medical students will be expected to give one formal presentation during their rotation. The specific assignment will be made by the attending faculty member on the consult service, or by one the educational directors of the GI Division (Dr. Marshall and Dr. Ibdah).
Educational Purpose-- The following are the educational purposes of these rotations:
1. Trainees will gain exposure and acquire experience in the evaluation and management of adult patients with a broad range of acute and chronic GI problems in the supervised hospital and clinic settings.
2. Trainees will develop an appreciation of standard GI endoscopic procedures, such as how they are done, indications, contraindications, potential findings, how to act upon the findings, limitations, and complications.
3. Medical knowledge of residents and medical students is enhanced in a number of ways-- through patient care contacts, by attending teaching rounds, by reading about the problems and conditions their patients have, and through teaching conferences they attend and participate in during the rotation.
4. The rotation will provide residents with exposure to practice-based learning and improvement that involves the investigation and evaluation of care for their patients, the appraisal and assimilation of scientific evidence, and improvement in patient care. The rotation will also provide residents with exposure to systems-based practice as manifested by actions that demonstrate an awareness and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.
5. As residents and medical students go about their supervised clinical duties they will develop improved communication skills that result in effective exchange of information and collaboration with patients, their families, and other health professionals.
6. The rotation will provide residents and medical students with the ability to develop competence in professionalism, manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to patients of diverse backgrounds.
Teaching Methods-- The principle teaching method is case-based discussions by the resident or medical student with the fellow and attending physician on the consult service or in the clinic. Residents and medical students initially evaluate the patient, including performing a history and physical exam, and gathering appropriate laboratory and x-ray data. The trainee often does preliminary educational reading about the case at this point (particularly on the inpatient consult service). The case is then presented to the GI fellow and/or attending. The fellow/attending verify key portions of the history and physical exam. The fellow and attending also provides teaching and discussion on pertinent clinical and pathophysiologic aspects of the case. [The teaching method used by supervisory attendings in the GI clinic attended by residents and medical students is similar, except that the trainee is also taught the importance of time management.]
Residents and medical students are also expected to attend various endoscopic procedures as described above. This will provide an overview of common procedures such as EGD, esophageal dilation, PEG placement, colonoscopy, capsule endoscopy, and ERCP.
Teaching on this rotation is also supplemented by conference attendance, by conference presentations and discussions, and by independent self-learning.
Lines of Supervision-- The inpatient service has a designated GI fellow and attending physician who are responsible for the supervision of the resident or medical student. The GI fellow will assign inpatient consults for the resident or medical student to see. Cases will generally first be presented to the GI fellow, and then later to the attending on teaching rounds. In the GI clinic, the assignment of patients is usually made by the GI attending physician. Presentations in clinic are usually made directly to the attending physician.
Patient Characteristics-- The inpatient (and GI Clinic) population on this rotation is diverse and provide residents and medical students with exposure to the vast array of GI and liver illnesses that define the subspecialty. Patients also encompass a broad age range, including geriatric patients, and diverse range of socio-economic and educational backgrounds.
Reading Lists and Educational Resources to be Used-- Residents and medical students are encouraged to read the entire GI-liver sections of the internal medicine textbook they own and use. In addition, GI division libraries contain a number of GI-liver textbooks and other educational resources. The University of Missouri Health Sciences Library contains a vast array of helpful reference books, journals, interlibrary loan services, and the like. Medline searches can be conducted on-line (via the internet) through the Health Sciences Library website. Many journals and other resources are increasingly becoming available on-line. The medical library at the VA Hospital is also quite useful. UpToDate Online is available to all residents and medical students, and is a tremendous clinical and educational resource (covering gastroenterology and internal medicine).
Methods of Evaluation for Resident and Medical Student Performance-- Ongoing feedback is provided to the resident during the rotation (e.g. the fellow and inpatient/clinic attending critique case presentations, clinical and scientific literature understanding, and management recommendations of the trainee on a case-by-case basis). At the end of the rotation, a formal written evaluation will be prepared by the inpatient attending, in conjunction with the GI fellow with whom the resident/medical student worked with.
Description of Six Core Competencies for Residents on the Gastroenterology Rotation:
1. Patient Care
A. Goals-- The resident must be able to provide patient care that is appropriate, effective and compassionate. This includes, but is not be limited to: history-taking (including family, genetic, psychosocial and environmental histories), and the ability to perform a comprehensive and accurate PE. The resident must be able to arrive at an appropriate differential diagnosis, outline a logical plan for specific and targeted investigations pertaining to the patients’ complaints, and formulate a plan for management and follow-up treatment. The resident must also be able to effectively present and defend their consultations orally and in writing.
B. Instructional Methods
1. Attending physicians provide important role models and mentoring in these areas.
2. Point-of-care patient interactions, rounds and discussions in the clinic, on the wards and the GI lab.
3. Conferences.
C. Assessment Methods
1. Direct observation by faculty during work and teaching rounds; patient history-taking and PE; procedures; and conferences.
2. Patient care record review.
2. Medical Knowledge
A. Goals-- The resident must demonstrate a core fund of current knowledge in GI and liver physiology, pathophysiology, clinical pharmacology, radiology and surgery. The resident must be able to demonstrate an analytical approach and use appropriate investigations, including the practice of evidence-based medicine.
B. Instructional Methods
1. Point-of-care patient interactions, rounds and discussions, including with faculty and allied health care providers.
2. Reading about the conditions of current patients seen in clinic, on the wards, and in the GI lab. UpToDate, books, journal searches are readily available ways to facilitate this.
3. Conferences.
C. Assessment Methods
1. Direct observation by faculty during work and teaching rounds; patient history-taking and PE; and conferences.
2. Patient care record review.
3. Practice-Based Learning & Improvement
A. Goals-- The resident must be able to investigate, evaluate, and improve their patient care practice by analyzing and assimilating both scientific evidence as well as their own prior experience into their practices. They should be able to apply knowledge of statistical methods to critically appraise clinical studies and be able to use information technology to support their own education. They must be involved in teaching and be able to facilitate the learning of other students and health care professionals.
B. Instructional Methods
1. Attending physicians provide important role models and mentoring in these areas.
2. Point-of-care patient interactions, rounds and discussions, including with faculty and allied health care providers.
3. Division of Gastroenterology and Department of Internal Medicine conferences.
4. Reading the monthly quality improvement update that Barbara Boshard publishes for the Department of Internal Medicine.
C. Assessment Methods
1. Direct observation by faculty during work and teaching rounds; patient history-taking and PE; procedures; and conferences.
2. Patient care record review.
3. Portfolios.
4. Interpersonal & Communication Skills
A. Goals-- The resident must be able to demonstrate interpersonal and communication skills that result in effective information exchange with their patients, families, and other health care professionals. This would include, but not be limited to accurate and timely verbal and written communication as a consultant. Residents must be able to work effectively as members and leaders of the health care team.
B. Instructional Methods
1. Attending physicians provide important role models and mentoring in these areas.
2. Point-of-care patient interactions, rounds and discussions, including with faculty and allied health care providers.
C. Assessment Methods
1. Direct observation by faculty during work and teaching rounds; patient history-taking and PE; and conferences.
2. If the program director receives complaints or compliments from colleagues, nurses, support staff, patients or families, these are also considered.
5. Professionalism
A. Goal-- The resident must demonstrate an understanding of and commitment to all elements of professionalism, including respect, compassion and integrity toward their patients, patients’ families, and other health care professionals. They must demonstrate ethical behavior, responsiveness, and sensitivity to a diverse gender, ethnic, socioeconomic and aging patient population.
B. Instructional Methods
1. Attending physicians provide important role models and mentoring in these areas.
2. Point-of-care patient interactions, rounds and discussions, including with faculty and allied health care providers.
3. Division of Gastroenterology and Department of Internal Medicine conferences.
C. Assessment Methods
1. Direct observation by faculty during work and teaching rounds; patient history-taking and physical examination; and conferences.
3. If the program director receives complaints or compliments from colleagues, nurses, support staff, patients or families, these are also considered.
6. Systems-Based Practice
A. Goal-- The resident must demonstrate an understanding of, awareness of, and responsiveness to the larger context and system of health care delivery. The resident should understand how their patient care practice impacts other health care professionals, the larger health care system, and society in general. They should be able to practice cost-effective health care without compromising quality of care for their patients. The resident should be able to advocate for timely, quality patient care, and know how to partner with other health care providers to provide the optimal health care for their patients.
B. Instructional Methods
1. Attending physicians provide important role models and mentoring in these areas.
2. Point-of-care patient interactions, rounds and discussions, including with faculty and allied health care providers (e.g. anesthesiology, pathology, radiology, dieticians, outside healthcare companies like Option Care).
3. Conferences.
C. Assessment Methods
1. Direct observation by faculty during: work and teaching rounds; patient history-taking and PE; procedures; and conferences.
2. Patient care record review.
3. Portfolios.
