Adult Gastroenterology Training Program

Medical Ethics and Quality Assurance

MEDICAL ETHICS

Each rotation incorporates informal teaching in ethics around clinical cases and scenarios. Formal teaching in ethics also occurs during Multidisciplinary Academic Half-Days organized by the Postgraduate Medical Education Office. These are scheduled five times per year, and are attended by all core and subspecialty trainees in internal medicine, including residents in the GI Training Program. Ethics Grand Rounds are co-organized by the Hamilton Health Sciences Clinical Ethics Committee and McMaster University Faculty of Health Sciences on a monthly basis. In addition, several sessions of the GI Academic Half Day are devoted to topics relevant to medical ethics. Every three months, one case discussion at the GI Academic Half-Day is devoted to a Morbidity and Mortality format. Here, an adverse treatment outcome or procedure complication is discussed, with review of ethical issues related to consent and disclosure. The ethical issues surrounding the use of diagnostic and therapeutic endoscopy are reviewed in the annual First Year GI Residents’ Endoscopy Training Course. All trainees are encouraged to access the Royal College of Physicians and Surgeons of Canada Bioethics Education Project online.

For research ethics, trainees are encouraged to access the McMaster University’s web-based tutorial that reviews the implications of Ontario’s Health Information Protection Act legislation and the National Institutes of Health web-based tutorial on Protecting Human Research Participants (PHRP) course.

QUALITY ASSURANCE

Gastroenterology residents acquire experience and skills in quality assurance through various aspects of their training. Orientation to the regional endoscopy units addresses the appropriate use and maintenance of endoscopy equipment and the proper function of an endoscopy unit. Trainees are introduced to the principles underlying quality assurance in endoscopy including the Global Rating Scale (an endoscopy quality assurance program) and key performance indicators (e.g. cecal intubation rate, adenoma detection rate) during the First Year Residents’ Endoscopy Training Course. The Resident Practice Audit Gastro-Enterology (RPAGE) program provides our trainees with a powerful, real time peer-comparator practice audit tool for continuing professional development and quality improvement in endoscopy training. The concepts of quality assurance in endoscopy are reinforced during residency by the RPAGE program and through review of performance of local endoscopy units with the Global Rating Scale during the Hamilton Association of Gastroenterology meetings. Many clinical research projects undertaken by trainees include detailed review of local practices and outcomes relative to national standards and/or published guidelines. At pathology rounds, biopsy and autopsy results are discussed in the context of clinical diagnoses and overall case management. At M & M rounds, adverse outcomes are discussed and possible improvements in the delivery of care are reviewed. Quality assurance is also a component of the weekly Journal Club, where new evidence is assessed and evaluated, and current practices are reconsidered. Finally, quality assurance is a common component of discussions on clinical ward rounds at all sites.