Adult Gastroenterology Training Program

Goals and Objectives of the Juravinski Site Inpatient Rotation (Year 1)

Rotation-Specific Objectives

The first-year rotation at the Juravinski site centers on the inpatient GI service, but with weekly exposure to ambulatory clinic and endoscopy service. 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 the management of common gastrointestinal disorders seen in an inpatient setting. This will include acute gastrointestinal bleeding, acute diarrhea, inflammatory bowel disease, chronic and end-stage liver disease, acute liver disease, foreign body ingestion, pancreatitis and gallstone disease, functional bowel disease and complications of endoscopy.
    • Recognize, evaluate and manage gastrointestinal emergencies. This will include acute gastrointestinal bleeding, acute abdominal pain, fulminant colitis, biliary obstruction, ascending cholangitis, liver failure, and ingested foreign bodies.
    • Principles underlying enteral and parenteral nutritional support for patients with feeding difficulty, including the indications, risks and benefits
    • Recognize situations that require urgent or emergency endoscopy, and in employing hemostatic techniques in acute GI bleeding
    • Epidemiology, pathophysiology, methods of diagnosis, management and prognosis of common gastrointestinal conditions seen in an inpatient setting
    • Pharmacology of drugs commonly used in Gastroenterology
    • Indications, contraindications, limitations, complications, techniques and interpretation of results of the common diagnostic and therapeutic procedures performed on the digestive tract. This will include upper GI endoscopy, sigmoidoscopy, colonoscopy, ultrasound, CT, MRI, ERCP, EUS, and capsule endoscopy.
    • Surgical procedures employed in relation to digestive system disorders and their complications
    • Interventional radiology procedures employed in relation to digestive system disorders and their complications (e.g. Transjugular intrahepatic portosystemic shunt, transjugular liver biopsy, biliary stent, angiogram and embolization, percutaneous gastrostomy and gastrojejunostomy, drainage of abscess)
  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, angiogram, ERCP, EUS, capsule endoscopy)
      • 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 gastrointestinal conditions involving the digestive system, liver and pancreas
  4. Demonstrate the ability to perform basic diagnostic endoscopy under supervision in the inpatient setting, including:
    • Upper gastrointestinal endoscopy with biopsy
    • 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 a multi-disciplinary team to optimize patient care
  4. Communicate clearly, thoroughly and as frequently as needed with medical colleagues, particularly those who carry out diagnostic tests (e.g. radiologists, pathologists) and referring physicians to ensure the best outcome for the patient
  5. Effectively present concise and accurate verbal reports of clinical encounters including differential diagnoses and plans on daily ward rounds
  6. Compose succinct, accurate and comprehensive consultation letters, progress notes, discharge summaries and procedure notes 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 endoscopic procedures with histopathological interpretation, radiologic tests, and haematological investigations.
  2. Consult and collaborate with physicians, nurses, pharmacists, endoscopy unit staff, and other health care professionals (e.g. dieticians, speech language pathologists, physical and occupational therapists, social workers, pain specialists and psychiatrists), and contribute effectively to the collaborative investigation, management and disposition of patients
  3. Participate effectively in interprofessional team meetings
  4. Demonstrate a respectful attitude towards other colleagues and members of an interprofessional team

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. Reserve time for reading and keeping current with the literature to optimize patient care
  3. Demonstrate good time management in an inpatient setting by assessing patients accurately, comprehensively and efficiently with timely diction of consultation notes and / or procedure notes
  4. Access and apply various information sources of information in managing inpatients with gastrointestinal disorders
  5. Show confidence and competence in directing management of urgent and emergent clinical scenarios
  6. Institute effective and efficient management plans for patients with gastrointestinal disease by utilizing the available resources in an inpatient setting
  7. Demonstrate skills in negotiating, allocating and managing finite heath care resources (e.g. bed booking, referral triaging, pharmacy budgets)
  8. Exercise time management to optimize the investigation and treatment while minimizing length of stay
  9. Demonstrate knowledge of the different roles and responsibilities of patients, physicians, nurses, and allied health professionals in the inpatient management of gastrointestinal conditions
  10. Coordinate in-hospital care with ambulatory and community based resources for follow-up

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 gastrointestinal diseases in an inpatient setting
  2. Identify non-medical factors (e.g. ethnic, cultural, socioeconomic, psychosocial, life-style induced factors) that may influence the health and discharge planning of the patients
  3. Understand the importance of patient education in the management of many common GI conditions and facilitate such learning when possible
  4. Identify opportunities for advocacy, health promotion and disease prevention with the individual patients that they serve
  5. Understand the role of a gastroenterologist in advocating for patients’ access to care through private insurers, hospital / provincial formularies and wait lists

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. Recognize the importance of self-assessment to identify gaps in knowledge
  2. Attend and contribute to rounds, conferences, and other learning events
  3. Demonstrate ongoing learning by quoting recent reading and/or literature on topics related to patients
  4. Demonstrate efficiency and competence in searching, appraising and applying medical literature to address a clinical question
  5. Take an evidence-based approach to patient management
  6. Demonstrate effective teaching of students and junior house staff and allied health professionals
  7. Demonstrate an effective lecture or presentation
  8. Understand the role of research in advancing the understanding of gastrointestinal 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. 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. Recognize and respond to others’ unprofessional behaviours in practice, taking into account local and provincial regulations