Adult Gastroenterology Training Program

Goals and Objectives of the Community GI Rotation (Year 2)

Rotation-Specific Objectives

The Community GI Rotation centres on consolidating and extending clinical skills acquired during the first year, and allows the resident to gain confidence as a consultant in Gastroenterology in a community-based setting. The overall goals of this experience are to develop consultancy and time management skills required to practice Gastroenterology, as well as to allow the resident experience in community-based medicine. The resident is expected to fulfil all of the CanMEDS roles described in the first year. In addition, the second year resident is expected to assimilate knowledge gained in the first year to function as a consultant gastroenterologist in a community-based setting.

In addition to the general objectives outlined above, rotation-specific goals and objectives for the Second Year of Training in Adult Gastroenterology at McMaster University are listed below.

Medical Expert

Key Competencies: Physicians are able to

  1. Function effectively as consultants, integrating all of the CanMEDS Roles to provide optimal, ethical and patient-centered medical care
  2. Establish and maintain clinical knowledge, skills and attitudes appropriate to Gastroenterology
  3. Perform a complete and appropriate assessment of a patient
  4. Use preventive and therapeutic interventions effectively
  5. Demonstrate proficient and appropriate use of procedural skills, both diagnostic and therapeutic
  6. Seek appropriate consultation from other health professionals, recognizing the limits of their expertise

Specific Requirements: Gastroenterology residents are able to

  1. Demonstrate knowledge in the following general areas, including the ability to:
    • Understand the spectrum and limitations of practice in a community setting based on resources and geography
    • Appreciate the structure of health care in a community setting including:
      • Access to quaternary care, stabilization and investigation of patients for transfer
      • Function effectively within a multi-disciplinary setting
      • Resource allocation and health care infrastructure
      • Practice management
    • Demonstrate a confident approach to the management of common GI disorders seen in both an outpatient and inpatient setting, with a specific focus on community health related issues and practices. This will include acute GI bleeding, acute/chronic diarrhea, inflammatory bowel disease, motility and functional bowel disease, chronic and end-stage liver disease, acute liver disease, obscure GI bleeding, gastrointestinal cancers, malnutrition, pancreatitis, gallstone disease, and complications of endoscopy.
  2. Assess and investigate patients with common gastrointestinal conditions:
    • Identify and explore issues to be addressed in a patient encounter effectively
    • Select medically appropriate investigative methods in a resource-effective and ethical manner in a community-based setting, including:
      • Laboratory investigations (bloodwork)
      • Imaging modalities (ultrasound, CT, MRI, angiogram, ERCP, EUS, capsule endoscopy)
      • Biopsies of the gastrointestinal tract and liver
      • Diagnostic and therapeutic endoscopy of the upper and lower gastrointestinal tract
    • 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
  3. Demonstrate effective, appropriate and timely consultation of another health professional as needed, recognizing the limits of their expertise
  4. Recognize and appropriately respond to relevant ethical issues arising in the investigation and care of patients with common gastrointestinal conditions involving the digestive system, liver and pancreas
  5. Demonstrate the ability to perform 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
    • Identification and interpretation of 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)

Communicator

Key Competencies: Physicians are able to

  1. Develop rapport, trust, and ethical therapeutic relationships with patients and families
  2. Accurately elicit and synthesize relevant information and perspectives of patients and families, colleagues, and other professionals
  3. Convey relevant information and explanations accurately to patients and families, colleagues and other professionals
  4. Develop a common understanding on issues, problems and plans with patients, families, and other professionals to develop a shared plan of care
  5. Convey effective oral and written information about a medical encounter

Specific Requirements: Gastroenterology residents are able to

  1. Establish effective relationship with patients and their families in order to obtain a meaningful history, conduct a relevant physical examination, and to properly manage a patient’s medical problem without the immediate supervision of the consultant
  2. Convey information about diagnosis, prognosis, risks/benefits of tests and treatment options to patients and families, and referring physicians accurately and effectively without the immediate supervision of the consultant
  3. Communicate and cooperative effectively with allied health professionals and medical colleagues in the care of individual patients without the immediate supervision of the consultant
  4. Demonstrate effective consultation skills in presenting well-documented assessment and recommendations in written and/or verbal form with minimal support or revision by the consultant, including:
    1. Procedural reports
    2. Consultation letters, progress notes and discharge summaries

Collaborator

Key Competencies: Physicians are able to

  1. Participate effectively and appropriately in an interprofessional health care team
  2. Work with other health professionals effectively to prevent, negotiate, and resolve interprofessional conflict

Specific Requirements: Gastroenterology residents are able to

  1. Demonstrate an ability to collaborate with health care professionals by interacting directly and effectively with other physicians, and developing a management plan for patients in collaboration with various members of an interdisciplinary team within and between hospitals, other health care facilities and collaborative groups
  2. Understand the type of collaboration between specialists and general practitioners in a community setting
  3. Demonstrate a respectful attitude towards other colleagues and members of an interprofessional team
  4. Understand how provincial and hospital governance influence the ability to provide health care in the community setting

Manager

Key Competencies: Physicians are able to

  1. Participate in activities that contribute to the effectiveness of their health care organizations and systems
  2. Manage their practice and career effectively
  3. Allocate finite health care resources appropriately
  4. Serve in administration and leadership roles, as appropriate

Specific Requirements: Gastroenterology residents are able to

  1. Investigate and manage patients with GI disorders in a cost effective manner, while ensuring the optimal patient care and outcome
  2. Recognize limitation of resources in a community setting, and develop judgment for when transfer to a larger centre is necessary for optimal patient care
  3. Demonstrate time management skills necessary to balance inpatient consultations, outpatient procedure, clinic and educational opportunities
  4. Demonstrate the ability to balance personal and professional activities and use their time to optimize patient care and continuing professional development
  5. Understand office administration, practice management and billing
  6. Understand the operational and administrative aspects of an inpatient hospital service and a private endoscopy centre in a community setting
  7. The community rotation provides an excellent arena to teach and discuss practice management along with other managerial skills. Topics for review in this area include:
    • Negotiation skills
    • Committee responsibility
    • How to get references
    • Practice efficiency
    • Managing length of stay and waitlist
  8. Appreciate the differences in patient population and their management between quaternary care and community care in a tertiary centre

Health Advocate

Key Competencies: Physicians are able to

  1. Respond to individual patient health needs and issues as part of patient care
  2. Respond to the health needs of the communities that they serve
  3. Identify the determinants of health for the populations that they serve
  4. Promote the health of individual patients, communities, and populations

Specific Requirements: Gastroenterology residents are able to

  1. Understand the advocacy role of a community gastroenterologist in provision of high quality care to citizens of the community where GI consultation is provided by a single group of specialists
  2. Develop an appreciation of the health determinants that may influence patient adherence and outcome in a community setting
  3. Appreciate a balance between cost and benefit of investigations and therapies of GI disorders in a community setting
  4. Identify opportunities for advocacy, health promotion and disease prevention with the individual patients and communities that they serve

Scholar

Key Competencies: Physicians are able to

  1. Maintain and enhance professional activities through ongoing learning
  2. Critically evaluate medical information and its sources, and apply this appropriately to practice decisions
  3. Facilitate the learning of patients, families, students, residents, other health professionals, the public and others
  4. Contribute to the development, dissemination, and translation of new knowledge and practices

Specific Requirements: Gastroenterology residents are able to

  1. Demonstrate the ability to assess, appraise, acquire and contribute to lifelong learning (local talks, journal clubs, conferences, online resources)
  2. Recognize the need for a broad spectrum of knowledge when practicing in the community; as well as a strategy for Continuing Professional Development
  3. Understand the contribution of the consultant in the lifelong learning of the general practitioners and other health providers

Professional

Key Competencies: Physicians are able to

  1. Demonstrate a commitment to their patients, profession, and society through ethical practice
  2. Demonstrate a commitment to their patients, profession and society through participation in profession-led regulation
  3. Demonstrate a commitment to physician health and sustainable practice

Specific Requirements: Gastroenterology residents are able to

  1. Balance personal and professional priorities to ensure personal health and a sustainable practice
  2. Deliver highest quality care with honesty, integrity and compassion
  3. Exhibit appropriate personal and interpersonal professional behavior
  4. Be courteous and punctual
  5. Follow-up on patients evaluated and arrange additional investigations, as appropriate for patient problems
  6. Evaluate one’s own abilities, knowledge, skills and limitations of professional competence
  7. Demonstrate strategies to maintain and advance professional competence
  8. Understand the importance of quality assurance in endoscopy with the identification of quality indicators and methods to collect, analyze, and report endoscopy data in a community setting