Adult Gastroenterology Training Program

Goals and Objectives of the McMaster Outpatient Clinic Rotation (Year 2)

Rotation-Specific Objectives

The second-year McMaster Site Outpatient Clinic Rotation consolidates and extends experience gained in the first year, and allows the resident to gain confidence as a consultant in Gastroenterology. 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 an outpatient 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 in-depth knowledge in the following general areas, including the ability to:
    • Demonstrate a confident approach to the management of common gastrointestinal disorders seen in an outpatient setting. This will include dyspepsia, peptic ulcer disease, esophageal disease, maldigestion and malabsorption, celiac disease, pancreatic and gallstone disease, irritable bowel syndrome, inflammatory bowel disease, colon polyps and colon cancer screening, iron deficiency anemia, viral hepatitis, alcoholic liver disease, autoimmune liver disease, metabolic liver disease, non-alcoholic fatty liver disease, autoimmune liver disease, metabolic liver disease, non-alcoholic fatty liver disease, hepatocellular carcinoma, portal hypertension, assessment for liver transplantation.
    • 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
    • Demonstrate sound knowledge of surgical procedures for the diagnosis and treatment of gastrointestinal disease
    • Demonstrate medical expertise in situations other than patient care (e.g. presentations, medico-legal cases)
    • Discuss the performance (accuracy/efficacy), risks and complications of gastrointestinal tests and procedures, with recognition of current controversies and alternative approaches
  2. Assess and investigate patients with common gastrointestinal conditions:
    • 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 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. 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
  4. Demonstrate the ability to perform advanced diagnostic and therapeutic endoscopy under supervision, including:
    • Colonoscopy and polypectomy
    • Luminal dilation
    • Accurate identification and interpretation of endoscopic findings, 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)
  5. Interpret esophageal manometry

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
  2. Convey information about diagnosis, prognosis, risks/benefits of tests and treatment options to patients and their families, and referring physicians accurately and effectively without the immediate supervision of the consultant
  3. Communicate and cooperative effectively with clinical staff, allied health professionals and medical colleagues in the care of individual patients
  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:
    • Procedural and specialty test reports
    • Consultation and follow-up assessment letters

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. Develop strategies to manage complex chronic disease in an outpatient setting, including optimal use of multidisciplinary support systems (e.g. nutrition, psychiatry, social work, and pain management).
  2. Demonstrate confidence in leading a multi-disciplinary health care team, and contribute effectively to interdisciplinary team activities within and between hospitals, other health care facilities and collaborative groups.

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. Understand and demonstrate skills necessary to effectively manage an outpatient Gastroenterology clinic
  2. Understand the operational aspects of an endoscopy unit, such as planning, budgeting and evaluation
  3. Ensure timeliness and appropriateness of referrals (triaging of referrals on the basis of apparent urgency) and follow-up appointments
  4. Demonstrate understanding of cost/benefit ratios of diagnostic and therapeutic interventions, cost containment and evidence-based principles of cost-efficacy as they relate to quality assurance

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. Identify opportunities for advocacy, health promotion and disease prevention with the individual patients and the practice communities that they serve
  2. Understand current public policies that affect gastrointestinal health
  3. Identify key controversies in the Canadian health care system that affect gastrointestinal illness and advocate for policy that reduces the burden of illness, including colorectal cancer screening, immunization for viral hepatitis, biologic medications for inflammatory bowel disease, and wire capsule endoscopy for obscure GI bleeding
  4. Understand the advocacy roles of professional society, patient groups and private organizations in reducing the burden of gastrointestinal disease
  5. Understand the cost-benefit relationship of emerging therapies for chronic gastrointestinal disorders (e.g. inflammatory bowel disease, viral hepatitis)

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. Apply advanced critical appraisal skills to the medical literature
  2. Develop a basic understanding of clinical trials research methodology
  3. Appreciate the practical aspects of clinical trials conducted locally by the Division of Gastroenterology, including patient screening and enrolment, process of informed consent, performing structured follow-ups and appropriate documentation
  4. Identify the learning needs of others (e.g. junior residents, nurses, allied health professionals) and select and demonstrate effective teaching strategies
  5. Develop, implement and monitor a personal continuing education strategy. To facilitate this objective, at least one half day is set aside per week for self-directed learning of topics and diseases encountered in the clinics.

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. Deliver highest quality care with honesty, integrity and compassion
  2. Exhibit appropriate personal and interpersonal professional behavior
  3. Be courteous and punctual
  4. Follow-up on patients evaluated and arrange additional investigations, as appropriate for patient problems
  5. Evaluate one's own abilities, knowledge, skills and limitations of professional competence
  6. Demonstrate strategies to maintain and advance professional competence