Adult Gastroenterology Training Program

Goals and Objectives of the Motility Rotation (Year 2)

Rotation-Specific Objectives

Specific goals and objectives of the Motility Curriculum in CanMEDs format are as follows:

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 diagnosis and management of patients with common motility disorders. This will include:
      • Esophageal motility disorders (e.g. achalasia)
      • GERD and refractory GERD
      • Non-cardiac chest pain
      • Gastroparesis
      • Multi-system diseases and their effect on GI motility (e.g. scleroderma, diabetes)
      • Chronic constipation
      • Irritable bowel syndrome
      • Fecal incontinence
    • Pharmacology of drugs commonly used in patients with motility disorders
    • Detailed knowledge of anatomy, physiology and pathology of the digestive system, with special emphasis on esophagus, stomach and anorectum, focusing on motility, viscerosensitivity and acid secretion
  2. Assess and investigate patients with common motility disorders:
    • Establish a professional relationship and interact with patients
    • Perform a complete history and physical exam that is relevant, comprehensive and appropriate with particular emphasis on areas specific to patients with motility disorders.
    • Diagnose motor disorders of the esophagus and anorectum using high-resolution manometry, pH-metry, combined pH-metry/impedance and provocation tests.
    • Design effective treatment strategies in patients with motility disorders and acid secretion abnormalities.
    • Select medically appropriate investigative methods in a resource-effective and ethical manner, including:
      • Laboratory investigations (bloodwork)
      • Imaging modalities (ultrasound, CT, MRI)
      • Manometry, pH-metry and provocation tests
      • Upper GI endoscopy and colonoscopy
    • 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 motility disorders
  4. Demonstrate the ability to interpret esophageal manometry and pH-metry:
    • Recognize common patterns of esophageal motility disorders seen with esophageal manometry such as: achalasia, nutcracker esophagus, diffuse esophageal spasm and ineffective peristalsis
    • Interpret 24-hour esophageal pH and impedance studies and correlate the result to clinical outcomes

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 based on clinical correlation with manometry or pH-metry results
  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 specialty test reports 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. Appreciate the operation of a GI Motility Lab, and the contribution from its members: nurses and physicians
  2. Establish effective collaborations in clinical care, both within and between institutions
  3. Resolve conflicts with and between other members of the health care 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. Understand the role and limitation of the GI Motility Lab in the assessment and diagnosis of common motility disorders
  2. Set priorities and manage time to balance patient care, practice requirements, outside activities and personal life
  3. Institute effective and efficient management plans for patients with motility disorders by utilizing the available resources in an outpatient setting
  4. Demonstrate good time management in an outpatient setting by assessing patients accurately, comprehensively and efficiently with timely diction of consultation notes and / or subspecialty test reports

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. Understand the health determinants that may contribute to the symptoms and presentation of patients with GI motility disorders
  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, and the use of screening and surveillance tests
  3. Understand the role of a gastroenterologist in advocating for patients’ access to care through private insurers, provincial formularies and wait lists
  4. Understand the cost-benefit relationship of therapies for motility disorders

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 motility and functional disorders

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