Adult Gastroenterology Training Program

Goals and Objectives of the Juravinski Site Inpatient Rotation (Year 2)

Rotation-Specific Objectives

The second year Juravinski Site Inpatient Rotation centres on consolidating and extending clinical skills acquired during the first year, and allows the resident to gain confidence as a consultant in Gastroenterology. Second-year residents serve as senior GI residents and function as junior consultants to provide teaching and supervision of the day-to-day patient management for first-year GI residents, medical residents, and medical students rotating through the GI inpatient service, and allied health professionals. 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 inpatient 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 complex gastrointestinal disorders seen in an inpatient setting. This will include inflammatory bowel disease, motility and functional bowel disease, chronic and end-stage liver disease, acute liver disease, obscure GI bleeding, gastrointestinal cancers, short gut and malnutrition. This approach must include an understanding of: (a) current concepts of pathogenesis and pathophysiology; (b) clinical expression; (c) current and emerging therapies; and (d) support systems for patients and families.
    • 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 and interventional radiology 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:
    • Identify and explore issues to be addressed in a patient encounter effectively
    • 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
    • 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. Demonstrate effective, appropriate and timely consultation of another health professional as needed, recognizing the limits of their expertise
  4. 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
  5. Demonstrate the ability to perform advanced diagnostic and therapeutic endoscopy under supervision, including:
    • Colonoscopy and polypectomy
    • Endoscopic hemostasis (including injection, thermal therapy, clips and band ligation)
    • Luminal dilation
    • Foreign body removal
    • Percutaneous endoscopic gastrostomy
    • Identification and interpretation of endoscopic findings with confidence, 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)

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 without the immediate supervision of the consultant
  3. Communicate and cooperative effectively with 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:
    1. Procedural reports
    2. Consultation letters, progress notes and discharge summaries

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 inpatient setting, including optimal use of multidisciplinary support systems (e.g. dieticians, speech language pathologists, physical and occupational therapists, social workers, pain specialists and psychiatrists)
  2. Demonstrate confidence in leading a multi-disciplinary health care team as a junior consultant, and contribute effectively to interdisciplinary team activities within and between hospitals, other health care facilities and collaborative groups
  3. Work with other members of the health care team to prevent and resolve conflicts

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 the administrative aspects of an inpatient hospital service and outpatient practice
  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 from the emergency departments, other in-patient services and primary care physicians), and become adept at recognizing problems which require inpatient care in a tertiary care hospital and at triaging less severe problems to be managed in an ambulatory setting
  4. Organize junior trainees to maximize clinical care and educational opportunities
  5. Demonstrate understanding of cost/benefit ratios of diagnostic and therapeutic interventions, cost containment and 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. Counsel patients effectively on gastrointestinal disorders
  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 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)
  6. Appreciate the possibility of conflict inherent in their role as a health advocate for a patient or community with that of a manager or gatekeeper

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. Integrate advanced critical appraisal skills to the medical literature
  2. Demonstrate knowledge of new advances in the management of gastrointestinal disorders including but not limited to organ transplantation, therapeutic endoscopy, endoscopic ultrasound and capsule endoscopy
  3. Identify collaboratively the learning needs of others and desired learning outcomes of others, (e.g. junior residents, nurses, allied health professionals) and select effective teaching strategies and content to facilitate others’ learning
  4. Develop, implement and monitor a personal continuing education strategyand personal practice audit

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, recognize and respond to others’ unprofessional behaviours in practice