Adult Gastroenterology Training Program

General Objectives: First Year

General Objective

The first year of training emphasizes knowledge and experience in clinical Gastroenterology. The trainee is expected to fulfil all of the CanMEDS roles described above. Additional goals and objectives specific to the first year of training in Adult Gastroenterology include:

Specific Objectives

Medical Expert

The residents must be able to:

  • Perform a consultation, including the presentation of well-documented assessments and recommendations in written and/or verbal form in response to a request from another health care professional
  • Identify and appropriately respond to relevant ethical issues arising in patient care
  • Demonstrate knowledge of the anatomy, embryology, physiology, pharmacology, pathology and molecular biology related to the gastrointestinal system, including the liver, biliary tract and pancreas
  • Demonstrate knowledge of surgical procedures employed in relation to digestive system disorders and their complications
  • Demonstrate competence in the prevention, evaluation and management of common diseases affecting the digestive system, pancreas and liver (epidemiology, pathophysiology, methods of diagnosis, management and prognosis). This will include both primary gastrointestinal disorders (acid peptic disorders of the gastrointestinal tract, achalasia, celiac disease, inflammatory bowel disease, irritable bowel syndrome, infectious gastroenteritis, angiodysplasia, hemorrhoids, anal fissures, gastrointestinal malignancy, acute and chronic pancreatitis, cholelithiasis, acute and chronic liver diseases) and systemic disorders involving the gastrointestinal tract (diabetes mellitus, scleroderma)
  • Demonstrate knowledge of the indications, contraindications, limitations, complications, techniques and interpretation of results of those diagnostic and therapeutic procedures performed on the digestive tract, including the appropriate indication for and use of screening tests / procedures
  • Take a history that is relevant, concise and accurate to context
  • Perform a focused physical exam that is relevant and accurate
  • Select medically appropriate investigative methods in a resource-effective and ethical manner, including:
    • Laboratory investigations (bloodwork)
    • Imaging modalities (barium studies, ultrasound, CT, MRI, radioisotope scan, ERCP, EUS, capsule endoscopy)
    • Tests commonly employed in gastrointestinal function laboratories (breath tests, motility studies)
    • Biopsies of the gastrointestinal tract and liver
    • Diagnostic and therapeutic endoscopy of the upper and lower gastrointestinal tract
  • Recognize, evaluate and manage gastrointestinal emergencies (e.g. acute gastrointestinal hemorrhage, acute abdominal pain, fulminant colitis, biliary obstruction, liver failure, ingested foreign bodies)
  • Implement an effective management plan in collaboration with patients, families and  health care professionals
  • Demonstrate proficiency in the performance of basic diagnostic endoscopy under supervision, including:
    • Upper gastrointestinal endoscopy with biopsy
    • Flexible sigmoidoscopy with biopsy
  • Demonstrate proficiency at diagnostic and therapeutic paracentesis
  • Recognize the limits of their expertiseand seek help appropriately

Communicator

The residents must be able to:
 

  • Establish positive therapeutic relationship with patients and their families that are characterized by understanding, trust, respect, honesty and empathy
  • Understand the principles of patient-centred care by considering patient’s beliefs, concerns, expectations and illness experience,  and by synthesizing relevant information from other sources, such as patient’s family, caregivers and other professionals
  • Convey information about diagnosis, prognosis, risks/benefits of tests and treatment options to patients and families, colleagues and other professionals accurately and effectively 
  • Engage patients, families and members of the multidisciplinary health care team in shared decision-making  to optimize patient care
  • Compose succinct, accurate and comprehensive consultation letters, discharge summaries, progress notes, and test reports with appropriate support from the supervising consultant

Collaborator

The residents must be able to:
 

  • Understand and implement multidisciplinary care of patients with gastrointestinal diseases, with appropriate input and support from allied health professionals (e.g. surgeons, radiologists, pathologists, nurses, dieticians, social workers, occupational therapy, physical therapy, speech language pathologists, pain control services, primary care physicians)
  • Participate effectively in interdisciplinary team meetings that contribute to the collaborative investigation, management and disposition of patients
  • Demonstrate a respectful attitude towards other colleagues and members of an interprofessional team
  • Establish effective and successful collaborations in research

Manager

The residents must be able to:
 

  • Understand the structure and function of regional, provincial and federal health care systems
  • Show confidence and competence in directing management of urgent and emergent clinical scenarios
  • Demonstrate skills in negotiating, allocating and managing finite heath care resources (e.g. bed booking, referral triaging, pharmacy budgets)
  • Set priorities and manage time to balance patient care, practice requirements, outside activities and personal life
  • Access and apply information technology appropriately for patient care
  • Institute efficient management plans for patients with gastrointestinal disease by utilizing the available resources
  • Participate effectively in interprofessional team meetings

Health Advocate

The residents must be able to:
 

  • Identify opportunities for advocacy, health promotion and disease prevention with the individual patients that they serve
  • Understand the role of screening and surveillance tests (colorectal cancer,  hepatocellular carcinoma, Barrett’s esophagus, portal hypertension)
  • Understand the key determinants of health in common gastrointestinal diseases (e.g. socioeconomic, psychosocial, lifestyle-induced and biologic)
  • Be able to assess the impact of gastrointestinal disease on individual patients’ social function, relationships, productivity and access to health services
  • Understand the role of a gastroenterologist in advocating for patients’ access to care through private insurers, hospital/provincial formularies and wait lists

Scholar

The residents must be able to:

  • Recognize the importance of self-assessment to identify gaps in knowledge
  • Demonstrate efficiency and competence in searching, appraising and applying medical literature to address a clinical question
  • Demonstrate effective teaching of students and junior house staff and allied health professionals
  • Understand the role of research in advancing the understanding of gastrointestinal disease
  • Pose a scholarly question and develop a research proposal

Professional

The residents must be able to:

  • Exhibit appropriate professional behaviours in practice, including maintaining appropriate professional boundaries and relationships with other physicians and other health care team members, and avoiding conflicts of interests
  • Balance personal and professional priorities to ensure personal health and a sustainable practice
  • Evaluate one’s own abilities, knowledge, skills and limitations of professional competence
  • Participate in peer review
  • Recognize and respond to others’ unprofessional behaviours in practice, taking into account local and provincial regulations