Adult Gastroenterology Training Program

Motility Rotation

OVERVIEW

The Functional GI Laboratory is located at the McMaster University Medical Center under the Directorship of Dr. Bercik. Motility, 24-hour pH-metry and combined pH-metry/impedance studies are conducted by specially trained nurses daily from Monday to Thursday, under the supervision of Drs. Bercik and Collins. Motility studies are performed using state of the art high-resolution manometry system, for both upper and lower GI tract examinations.

The overall goal of the Motility Curriculum is to acquire practical knowledge and skills in the diagnosis and management of GI motor disorders. The specific objectives include:

  1. To become familiar with the equipment and competent in the techniques used to measure esophageal motility, pH and electrical impedance, including Bernstein and bread provocation tests
  2. To become competent in the analysis and interpretation of esophageal motility tracings and pH recordings
  3. To become competent in the analysis and interpretation of pH and pH/impedance recordings
  4. To become familiar with the equipment and competent in the techniques used to measure anorectal motility
  5. To become competent in the analysis and interpretation of anorectal motility recordings
  6. To become familiar with the biofeedback training program
  7. To become competent in devising appropriate management strategies in patients with motility disorders

Dr. Premysl Bercik is the Coordinator for the Motility Curriculum.

Motility Curriculum

The Motility Curriculum includes the following components:

  1. Motility Rotation (4-week block):
    • Observation of esophageal pH and impedance studies
    • Observation of esophageal manometry studies
    • Observation of ano-rectal manometry studies
    • Observation of biofeedback training
    • Hands-on experience with the interpretation of manometry, pH and impedance tests
    • Clinics dedicated to motility and functional disorders
  2. Three academic half-day lectures focused on:
    • esophageal pH-metry and impedance tests
    • esophageal manometry and provocation tests
    • anorectal manometry and biofeedback.

The Motility Rotation can be incorporated into an Outpatient Rotation or an Elective Block in the Second Year.

Second Year residents can obtain additional experience in GI motility by participating in on-going clinical trials using novel techniques of videofluoroscopy image analysis and magnet tracking to assess gastroduodenal and small intestinal motility.

Responsibilities of the Resident

Rotation schedule is prepared by the Chief Residents on a monthly basis. However, the rotation schedule should be confirmed with the Motility Curriculum Coordinator 4 weeks prior to the start date of the rotation. Residents are expected to attend each assigned Motility Lab session, clinic and endoscopy list, to be punctual, and to complete procedure notes and consultation notes on all patients 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.

Residents are expected to attend Motility Lab sessions on Monday morning, Wed afternoon and Thursday morning. Tuesday afternoon is devoted to analysis of motility and pH recordings under the supervision of Dr. Bercik or Dr. Collins. Residents are also expected to assess patients in Dr. Bercik’s and Dr. Collins’ clinic which have a focus on motility and functional disorders on Tuesday morning. Residents will also have the opportunity to assess patients with complex motility disorders (second opinion referrals) on Friday morning.

Rotation Schedule

 

AM

PM

Monday

Motility Lab

Endoscopy

Tuesday

Clinic (Bercik / Collins)

Analysis of motility and pH recordings

Wednesday

Academic Half Day

Motility Lab

Thursday

Motility Lab

Endoscopy (Bercik)

Friday

Complex Motility Clinic

Reading day

Evaluation of the Resident

Residents are encouraged to seek informal verbal feedback throughout the Motility Rotation concerning their proficiency at interpreting functional GI investigations and managing clinical problems related to functional bowel / motility disorders. 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. motility nurse, 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.