Adult Gastroenterology Training Program

Hepatology Rotation


The overall goal of the Hepatology curriculum is to train gastroenterologists who are competent to manage the broad spectrum of liver-related problems encountered in a typical Gastroenterology practice. To obtain the core knowledge required for the Hepatology curriculum, residents will be required to attend lectures during academic half day on Hepatology topics, as well as complete selected readings. The clinical experience will be provided by a rotation in outpatient clinic dedicated to Hepatology patients and problems, and through interaction with Hepatology physicians.

Residents will acquire a broad knowledge of the physiology of the liver and a thorough knowledge of the management of patients with hepatobiliary diseases obtained through teaching rounds, outpatient clinic experience, lectures and personal reading / research. The curriculum will ensure exposure to the following aspects of Hepatology:

  1. Basic science knowledge relevant to Hepatology including genetic markers of liver disease, immunology, virology, and other pathophysiological mechanisms of liver injury; the basic biology and pathophysiology of the liver and biliary systems
  2. Knowledge and skills in the diagnosis and management of common and uncommon disorders of the liver, and the management of patients with end stage liver disease
  3. Selection and management of liver transplant patients
  4. Skills in the performance of diagnostic and therapeutic paracentesis
  5. An appreciation of the indications and use of a number of diagnostic and therapeutic procedures that are needed to manage hepatobiliary disorders

It is anticipated that all Gastroenterology fellows in the McMaster University Gastroenterology Training Program will be a participant. To allow early exposure to Hepatology and to help with career choice, a one-month rotation is mandatory for First Year residents. In addition, Second Year residents are encouraged to obtain additional training in Hepatology during their elective months and during the outpatient rotation.

Dr. Marco Puglia is the Hepatology Curriculum Coordinator.

Responsibilities of the Resident

Outpatient Experience
Rotation schedule is prepared by the Hepatology Curriculum Coordinator on a monthly basis. Residents are expected to attend each assigned clinic and endoscopy list, to be punctual, and to complete procedure notes and consultation notes on all patients seen in the clinic in a timely fashion. Clinical supervisors must be informed of vacation / professional leave 4 weeks prior to the start date of the rotation. In addition, clinical supervisors must be informed when residents are unable to attend clinic or endoscopy lists due to post-call reasons. Residents are expected to 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.


Rotation Schedule





Clinic (Puglia)

Endoscopy (Puglia)


Clinic (Witt-Sullivan)

Reading day


Academic Half Day

Endoscopy (Tsoi)


Clinic (Witt-Sullivan)



Paracentesis / Liver biopsy

Clinic (Tsoi)

* Multi-disciplinary hepatobiliary rounds (optional) on Friday 7-9 am

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 topic of interest to review with the attending physician on a weekly basis.

Residents are encouraged to gain exposure through participation in activities at the Hamilton Hepatology Clinical Research Unit. They are invited to collaborate with staff hepatology supervisors in available research opportunities, and in successful cases present in local, national and international conferences.

Evaluation of the Resident

Residents are encouraged to seek informal verbal feedback throughout the Hepatology outpatient experience concerning their proficiency at managing clinical problems and performing endoscopic procedures / paracentesis. A formal evaluation session with the resident will take place at the end of the rotation. Input is sought from other members of the clinic team who have worked with the resident (e.g. nurses, nurse practitioners, other allied health professionals). Based on all feedback received, at the end of the rotation, a formal web-based CanMEDS compliant ITER is compiled by the supervisor. 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. 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.