Adult Gastroenterology Training Program

Community GI Rotation

OVERVIEW

Health care reforms have significantly changed the practice of medicine, resulting in a continuing expansion of medical care delivery through community-based programs. The classical teaching hospital may deal with a filtered patient population that may not reflect the ultimate practice pattern of the graduate. The introduction of community experiences to our training program curriculum serves to address these needs within the current teaching system. In Canada, the Royal College of Physicians and Surgeons of Canada (RCPSC) mandates community-based learning experiences as either stand along rotations (equivalent to one block or four weeks) or mandatory half day clinics outside of the academic health sciences centre that would constitute an equivalent experience.

The community Gastroenterology experience will encompass and expand upon the core training elements employed by the Gastroenterology residency training program at McMaster University. The main focus of this rotation will be to address the CanMEDS directed role in the context of community based Gastroenterology. The primary purposes of this rotation are to:

  1. Offer residents an opportunity to experience practice in an area where they may subsequently wish to settle and may also enable them to tailor their subsequent training rotations to meet the needs required in a future area of practice
  2. Provide opportunities for learning which are not available in the conventional teaching environment
  3. Provide opportunities for residents to practice autonomy with independent decision-making with limitations of technological resources / medical resource personnel that are more readily available in tertiary care environments. Self-learning for the resident would be emphasized, and local physicians and mentors serve as role models

The rotation is carried out in Oakville, ON, supervised by the GI practice group (Drs. N. Arya, D. Bair and J. Pham), where GI consultation care is given to residents in the local and surrounding communities of Oakville. Oakville has a catchment population over 150,000 people. The Gastroenterology practice is very diverse and consists of inpatient hospital service, outpatient clinics and as well as outpatient endoscopy. Residents will have the opportunity to be exposed to a wide range of therapeutic endoscopy procedures that include endoscopy, colonoscopy, ERCP, ampullectomies, Zenker's diverticulectomies, endoscopic mucosal resections, a full metal stenting program and diagnostic and therapeutic endoscopic ultrasound.

During this four week rotation, second year Gastroenterology trainee will be working directly with established community-based GI physicians in ambulatory clinics and inpatient hospital settings, and the performance of endoscopic procedures in relation to these consultations. This rotation will consist of 2 or 3 weeks of ambulatory GI clinics and 1 or 2 weeks of inpatient hospital service. During the ambulatory blocks, there will be three and a half days of clinics and one and a half day of endoscopy. While on inpatient service, residents will perform endoscopy on their patients and outpatient endoscopy lists when possible.

Alternatives to Rotation in Oakville

It is highly encouraged that residents undertake their community GI rotation in Oakville as the rotation goals and objectives are structured and tailored to the Second Year GI residents. However, residents are free to identify and choose other community based settings for this rotation in keeping with their individual training objectives, subject to approval by the Program Director and Residency Program Committee. Residents must identify a supervisor responsible for monitoring and evaluating his / her performance. If an alternative community site is chosen for this rotation, an elective form with CanMEDS based goals and objectives of this experience will need to be formalized and submitted to the Program Director and the rotation supervisor for review 4 weeks prior to the start of this rotation.

Residents on this rotation are not exempted from on-call duties.

Responsibilities of the Resident

Inpatient and Outpatient Experience
The community rotation is 4 weeks in duration and includes patient care activities in both an inpatient and outpatient setting, as well as educational and scholarly activities outside a teaching hospital. This rotation is only for Second Year GI residents. Residents should contact Dr. J. Pham (Community GI Rotation Coordinator, 905 849 7426) 4 weeks prior to the start of the rotation to obtain hospital privileges and to confirm schedule of activities.

Educational and Scholarly activities
Educational activities, which are a priority for the GI resident, include both scheduled rounds and other academic sessions. The resident is expected to attend the Gastroenterology Residents’ academic half-day, including the Farncombe noon rounds, on a weekly basis. In addition, the resident is expected to identify a practice management topic of interest to review with the attending physician on a weekly basis.

Trainees are welcome to attend the local monthly journal club in Oakville that includes the surgical and radiology teams.

Evaluation of the Resident

An orientation session (with Dr. J. Pham) will take place during the first week of the rotation to discuss the goals and description of this rotation with the resident. The specific objectives of the resident will be discussed and an attempt made to integrate these objectives into the overall objectives of the rotation.

Residents are encouraged to seek informal verbal feedback throughout the rotation concerning their proficiency at managing clinical problems and performing endoscopic procedures. A formal evaluation session with the resident will take place at the end of the rotation with the Rotation Coordinator (Dr. J. Pham) at the end of the 4-week rotation. Input is sought from other members of the clinic team who have worked with the resident (e.g. gastroenterologists, nurses, nurse practitioners, other allied health professionals). The Rotation Coordinator should be informed a few days prior to the end of the rotation to collate comments from all supervisors and health professionals. Based on all feedback received, at the end of the rotation, a formal web-based CanMEDS compliant ITER is compiled by the supervisors. Final evaluations are discussed with the resident.

Evaluation of the Rotation

Residents are encouraged to provide feedback on how the rotation and teaching are structured. If issues arise during the rotation, the resident is encouraged to bring these to the attention of the rotation supervisor and the Site Coordinator. A mechanism for dealing with any shortcomings will then be discussed with the resident and subsequently at the Residency Program Committee meeting. As with all rotations, an anonymous rotation evaluation is handled by the One 45 WebEval System. Each teaching faculty is evaluated separately in a similar manner. The Residency Program Committee meets semi-annually to compile a collective rotation and faculty evaluation, respecting anonymity. This has been important to maintaining feedback.