Adult Gastroenterology Training Program

Motility Mini-Curriculum

The Functional GI Laboratory is located at the McMaster University Medical Center under the Directorship of Dr. Bercik. Motility and 24-hour pH-metry studies are conducted by specially trained nurses, under the supervision of Drs. Bercik and Collins, and are reported within 48hrs of completion. Motility and pH-metry studies are conducted daily from Monday to Thursday. Motility studies are performed using a state of the art high-resolution manometry system, for both upper and lower GI tract examinations.

Elective in functional GI investigations may be undertaken as a block in the second year. The residents are expected to attend a Monday morning session (0800h-1200h) focused on esophageal manometry and pH-metry probe placement and a Tuesday morning session (0800h-1200h) focused on anorectal manometry and biofeedback. Tuesday afternoon is devoted to analysis of motility and pH recordings from these two sessions under supervision of Dr. Bercik or Dr. Collins.

General Objectives

To acquire practical knowledge and skills in diagnosis and management of gastrointestinal motor disorders.

Specific Objectives

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

The motility mini-curriculum will also include three academic half-day lectures focused on 1) esophageal pH-metry and impedance tests, 2) esophageal manometry and provocation tests and 3) anorectal manometry and biofeedback.

Second-year trainees 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.

Specific goals and objectives of the motility mini-curriculum in CANMEDs format are as follows:

Medical Expert
Communicator
Collaborator
Manager
Health Advocate
Scholar
Professional

Medical Expert

General Requirements

  • Demonstrate diagnostic and therapeutic skills for ethical and effective care of the patient with motility disorders of upper and lower GI tract
  • Demonstrate effective consultation services with respect to patient care, education, ethical and legal opinions

Specific Requirements

  • 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.
  • Knowledge of new techniques and tests in the diagnosis of GI motor disorders.
  • Residents will demonstrate the following clinical and technical skills:
  • The ability to perform a complete history and physical exam that is relevant, elaborate and appropriate with particular emphasis on areas specific to the patient with motility disorders.
  • The ability to diagnose motor disorders of the esophagus and anorectum using high-resolution manometry, pH-metry and provocation tests.
  • The ability to design effective treatment strategies in patients with motility disorders and acid secretion abnormalities.

Communicator

  • Communicate with patients and/or family members without the immediate supervision of the consultant.
  • Communicate and cooperate effectively with allied health personnel and medical colleagues in the care of individual patients

Collaborator

  • Establish effective collaborations in clinical care, both within and between institutions
  • Resolve conflicts with and between other members of the health care team

Manager

  • Understand the administrative aspects of an outpatient practice
  • Show an ability to advocate for individual patients yet recognize societal needs when monitoring and allocating resources

Health Advocate

  • Understand current public policies that affect gastrointestinal health
  • Understand the cost-benefit relationship of therapies for chronic gastrointestinal disorders

Scholar

  • Develop, demonstrate and document skills for life-long continuing education
  • Apply advanced critical appraisal skills to the medical literature

Professional

  • Demonstrate strategies to maintain and advance professional competence.
  • Evaluate one’s own abilities, knowledge, skills and limitations of professional competence.
  • Identify and manage ethical challenges in gastroenterology practice