Adult Gastroenterology Training Program

Goals and Objectives of the Hepatology Outpatient Rotation (Year 1)

Rotation-Specific Objectives

In addition to the general objectives outlined above, rotation-specific goals and objectives for the First 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:
    • An approach to patients with abnormal liver enzymes, both transaminitis and cholestatic enzyme abnormalities
    • An approach to the management of common hepatobiliary disorders seen in an outpatient setting. This will include:
      • Viral hepatitis (A, B, C, D, E, Epstein-Barr Virus) with or without HIV coinfection
      • Alcoholic liver disease and alcoholic hepatitis
      • Non-Alcoholic Fatty Liver Disease (NAFLD) and Non-Alcoholic Steatohepatitis (NASH)
      • Autoimmune hepatitis, Primary Biliary Cirrhosis (PBC), Primary Sclerosing Cholangitis (PSC) and overlap syndrome
      • Inherited Liver Disease – hemochromatosis, Wilson’s Disease, Alpha-1 antitrypsin disease
      • Liver mass, both benign and malignant causes
      • Portal hypertension, compensated and decompensated liver cirrhosis
      • Assessment for liver transplantation
      • Post-liver transplantation complications
    • Epidemiology, pathophysiology, methods of diagnosis, management and prognosis of common hepatobiliary conditions
    • Pharmacology of drugs commonly used in Hepatology
    • The role of liver imaging modalities including computed tomography, magnetic resonance-based techniques (magnetic resonance imaging, magnetic resonance angiography, magnetic resonance cholangiography), hepatic angiography, and ultrasound (including Doppler evaluation of hepatic vasculature) in the evaluation of hepatic conditions
    • Surgical and interventional radiologic procedures employed in relation to hepatobiliary disorders and their complications
  2. Assess and investigate patients with common gastrointestinal conditions:
    • Establish a professional relationship and interact with patients
    • Take a history that is relevant, concise and accurate to context
    • Perform a focused physical exam that is relevant and accurate
    • Select medically appropriate investigative methods in a resource-effective and ethical manner, including:
      • Laboratory investigations (bloodwork)
      • Imaging modalities (ultrasound, CT, MRI, ERCP, EUS)
      • Biopsies of the gastrointestinal tract and liver
      • Diagnostic and therapeutic endoscopy of the upper and lower gastrointestinal tract
    • Use clinical databases appropriately to formulate problems and to correctly develop investigation and management plans
  3. Understand and appropriately respond to relevant ethical issues arising in the investigation and care of patients with common hepatobiliary conditions
  4. Demonstrate the ability to perform basic diagnostic endoscopy under supervision in the elective setting, including:
    • Upper gastrointestinal endoscopy with biopsy
    • Upper gastrointestinal endoscopy with banding ligation of varices
    • Flexible sigmoidoscopy with biopsy
  5. Demonstrate proficiency at diagnostic and therapeutic paracentesis

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 families, and referring physicians accurately and effectively under supervision
  3. Communicate effectively with clinic staff and discuss appropriate information with all members of the health care team
  4. Effectively present verbal reports of clinical encounters and plans
  5. Compose succinct, accurate and comprehensive consultation letter or procedure note with appropriate support from the supervising consultant

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. Contribute clinically useful management options on patients referred for consultation, including ordering and arranging for specific testing or procedures, administering required therapy, and conveying the results of the management options to referring physicians. This process involves integrating information from multiple sources to construct a clear diagnosis which is then used to guide the patient’s therapy. This may require integrating the results of haematological investigations, radiologic tests, endoscopic procedures with histopathological interpretation.
  2. Develop awareness of a multidisciplinary approach in the management of hepatobiliary diseases
  3. Consult and collaborate with hepatobiliary surgery, radiology, pathology, clinic staff, endoscopy unit staff, and other health care professionals, and contribute effectively to the collaborative investigation and management of patients
  4. Develop skills in managing patients in collaboration with another medical institution such as a liver transplant centre

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. Set priorities and manage time to balance patient care, practice requirements, outside activities and personal life
  2. Institute effective and efficient management plans for patients with hepatobiliary disease by utilizing the available resources in an outpatient setting
  3. Understand resource allocations in liver disease especially in liver transplantation
  4. Aware of community resources available to assist Hepatology patients
  5. Demonstrate good time management in an outpatient setting by assessing patients accurately, comprehensively and efficiently with timely diction of consultation notes and / or procedure notes

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. Demonstrate an understanding of the health care needs of patients with hepatobiliary diseases in an outpatient setting
  2. Identify opportunities for advocacy, health promotion and disease prevention with the individual patients that they serve, including helping patients obtain Limited Use medications, preparing documents for patients (insurance, disability, application for medications) that describe and outline the nature of the patient’s problem and the recommended treatments, arranging appropriate vaccinations, prophylactic antibiotics for spontaneous bacterial peritonitis, and the use of screening and surveillance tests (hepatocellular carcinoma, portal hypertension)
  3. Understand the role of a gastroenterologist in advocating for patients’ access to care through private insurers, provincial formularies and wait lists
  4. Appreciate complexity behind government funding process for financial support towards medications in treatment of viral hepatitis
  5. Develop an awareness of the process in the evaluation of candidacy of patients for liver transplantation

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. 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.
  2. Demonstrate efficiency and competence in searching, appraising and applying medical literature to address a clinical question
  3. Understand the role of research in advancing the understanding of hepatobiliary disease

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