Adult Gastroenterology Training Program

General Objectives: Second Year

General Objective

The second year of training consolidates and extends experience gained in the first year, and allows the trainee to gain confidence as a consultant in Gastroenterology. The trainee is expected to fulfil all of the CanMEDS roles described above. In addition, the second-year trainee is also expected to assimilate knowledge gained in the first year to function as a consultant gastroenterologist. Goals and objectives specific to the second year of training in Adult Gastroenterology include:

Specific Objectives

Medical Expert

The residents must be able to:

  • Recognize and respond to the ethical dimensions in medical decision-making
  • Demonstrate medical expertise in situations other than patient care (e.g. presentations, medico-legal cases)
  • Recognize common problems affecting children and adolescents in transition (inflammatory bowel disease, celiac disease, cystic fibrosis, functional abdominal pain, irritable bowel syndrome, chronic liver diseases) and special technical aspects of pediatric endoscopy including special needs for sedation (Adult Gastroenterology residents are not expected to possess the cognitive database of a resident in a pediatric program and are not expected to be expert in pediatric endoscopy)
  • Recognize women’s health issues in digestive diseases
  • Discuss and integrate new advances in the management of gastrointestinal disorders (biologic therapies, organ transplantation, therapeutic endoscopy)
  • Critically assess controversies in the management of gastrointestinal disorders, integrating the available best evidence and best practices
  • Discuss the performance (accuracy/efficacy), risks and complications of gastrointestinal tests and procedures, with recognition of current controversies and alternative approaches
  • Implement a personal program to keep up-to-date, and enhance areas of professional competence
  • Demonstrate effective problem-solving skills and judgment to address patient problems, including interpreting available data and integrating information to generate extensive differential diagnosis for presenting problems and comprehensive management plans for gastrointestinal diseases
  • Demonstrate effective, appropriate, and timely application of preventive and therapeutic interventions relevant to Gastroenterology, including, but not limited to:
    • Screening colonoscopy
    • Upper endoscopy for Barrett’s esophagus
    • Upper endoscopy for portal hypertension
    • Surveillance for hepatobiliary malignancy
  • Demonstrate proficiency at advanced diagnostic and therapeutic endoscopy under supervision, including:
    • Colonoscopy and polypectomy
    • Endoscopic hemostasis (including injection, thermal therapy, clips and band ligation)
    • Luminal dilation
    • Foreign body removal
    • Percutaneous endoscopic gastrostomy
  • Identify and interpret endoscopic findings with confidence, including those that are uncommon or elusive (Dieulafoy lesions, eosinophilic esophagitis, celiac disease, gastric antral vascular ectasia, solitary rectal ulcers, discrimination of Crohn's disease and ulcerative colitis)
  • Demonstrate effective, appropriate and timely consultation of another health professional as needed, recognizing the limits of their expertise  

Communicator

The residents must be able to:

  • Communicate with patients and/or families independently without the immediate supervision of the consultant
  • Communicate and cooperate effectively and independently with physicians, allied health professionals and health related agencies in the care of individual patients
  • Demonstrate effective consultation skills in presenting well-documented assessment and recommendations in written and/or verbal form including:
    • Procedural and specialty test reports
    • Responses to requests by other health professionals and health parties
  • Demonstrate skills to provide effective medical information to the general public and scientific communities about gastrointestinal illness

Collaborator

The residents must be able to:

  • Demonstrate confidence in leading a multidisciplinary health care team
  • Employ collaborative negotiation to resolve conflicts with and between other members of the health care team
  • Establish effective and successful collaborations in research, educational work, program review, or administrative responsibilities
  • Understand how health care governance influences patient care, research and educational activities at a local, provincial, regional, and national level

Manager

The residents must be able to:

  • Demonstrate leadership (e.g. in organizing junior trainees) to maximize clinical care and educational opportunities
  • Demonstrate understanding of the principles of health care financing, including physician remuneration, budgeting and organizational funding
  • Understand the operational aspects of an endoscopy unit, such as planning, budgeting and evaluation
  • Understand the administrative aspects of an outpatient practice and inpatient hospital service
  • Make career decisions related to:
    • Practice environment (academic vs. private, location)
    • Practice emphasis (advanced endoscopy, specific disorders, motility)
    • Teaching
    • Research
  • Tailor the structure and content of the second year elective and/or research rotations to accommodate and facilitate career decisions
  • Show an ability to advocate for individual patients yet recognize societal needs when monitoring and allocating resources
  • Demonstrate leadership in administrative roles (education, clinical, research, educational work, or program review)

Health Advocate

The residents must be able to: 

  • Identify opportunities for advocacy, health promotion and disease prevention with the practice communities that they serve
  • Understand current public policies that affect gastrointestinal health
  • Identify key controversies in the Canadian health care system that affect gastrointestinal illness and advocate for policy that reduces the burden of illness
  • Understand the advocacy roles of professional society, patient groups and private organizations in reducing the burden of gastrointestinal disease
  • Appreciate the possibility of conflict inherent in their role as a health advocate for a patient or community with that of a manager
  • Understand the cost-benefit relationship of emerging therapies for chronic gastrointestinal disorders (e.g. inflammatory bowel disease, viral hepatitis)

Scholar

The residents must be able to: 

  • Develop and demonstrate strategies for implementing life-long continuing education and personal practice audit
  • Integrate advanced critical appraisal skills into clinical care
  • Synthesize and present knowledge to local rounds and provincial/national symposia through effective teaching strategies and content to facilitate others’ learning
  • Critically analyse and disseminate the findings of a research study in oral and written format with presentation in local rounds and provincial /  national symposia, and preparation of a manuscript suitable for journal submission

Professional

The residents must be able to: 

  • Demonstrate strategies to maintain and advance professional competence
  • Recognize and appropriately respond to ethical issues in practice (e.g. informed consent, patient confidentiality, PEG placement)
  • Understand the professional, legal and ethical codes of practice to which physicians are bound
  • Strive to heighten personal and professional awareness and insight