Adult Gastroenterology Training Program

Pediatric Gastroenterology Rotation

OVERVIEW

The Pediatric Gastroenterology Rotation at McMaster University Medical Centre is intended for Second Year Gastroenterology Residents. It is designed to meet the objectives of the Royal College of Physicians and Surgeons and to provide an experience that will facilitate the resident’s education in becoming a competent consultant in Gastroenterology. Increasingly, adult Gastroenterologists are expected to participate in a limited scope of care for pediatric patients when, in underserved areas, Pediatric Gastroenterology consultation is not available, or to assist pediatric colleagues with complex endoscopic procedures more common in adult patients.

This 2-week rotation will include outpatient consultative Pediatric Gastroenterology exposure, as well as ongoing outpatient clinical care. There are also opportunities to participate in inpatient Pediatric Gastroenterology activities relevant to the learning goals and objectives of the Adult Gastroenterology residents. In addition, Second Year residents are encouraged to obtain additional exposure to Pediatric Gastroenterology during their elective months and during the outpatient rotation. During this 2-week rotation, the Adult Gastroenterology resident will be expected to participate primarily in the care of Pediatric GI ambulatory consultation with the availability of daily clinics. The consultation service is broad-based with GI, nutritional and Hepatology consults, with focused clinics for IBD, Hepatology, Celiac disease, constipation, and Cyclic Vomiting Syndrome. The objectives outlined below represent topics that should be covered and discussed in the context of pathophysiology, clinical presentation and management. Many of the conditions are similar to Adult Gastroenterology (inflammatory bowel disease, celiac disease, cystic fibrosis, functional abdominal pain, gastroesophageal reflux disease, functional GI disorders, chronic liver disease), but the presentation, management and natural history may vary in patients under 18 years of age. There is also an opportunity to observe pediatric endoscopy, and participate if pediatric GI residents are not assigned to the list.

The goal of this limited rotation is NOT proficiency in Pediatric Gastroenterology but to understand the conditions unique to pediatrics, pediatric diseases which will impact adult life, and the similarities and differences in disorders found in both Adult and Pediatric Gastroenterology. The use of medications, radiological, and endoscopic investigations in children will be discussed. Through these activities, the resident will gain a pediatric perspective and an increased awareness of the important distinctions between Adult and Pediatric Gastroenterology including the overall approach to the evaluation of pediatric patients of varying ages and their families; the spectrum of disease in children; the need to adapt diagnostic tests and interventions to the age-specific needs of the pediatric patient; and the attention to therapeutics in the pediatric age groups, especially with regard to the mode of delivery, side effect profiles and long-term implications. In addition, this experience will increase understanding of the differences in practice, enhance collaboration and improve transition of care.

Responsibilities of the Resident

Outpatient Experience
Rotation schedule is prepared by the Pediatric Program Director on a monthly basis. The schedule will need to be confirmed prior to the start of the rotation. Residents meet with the Pediatric GI Division’s Educational Resource Person on the first day. Residents are expected to attend each assigned clinic, to be punctual, and to complete consultation notes on all patients seen in the clinic 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 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.

 

Rotation Schedule

 

AM

PM

Monday

Zachos (Constipation Clinic)

Brill (GI/Hepatology)

Tuesday

Sherlock

Issenman (IBD Clinic)

Wednesday

Academic Half Day

Adult / Pediatric Endoscopy / Celiac / CVS

Thursday

Brill (GI/IBD)

Issenman (GI Clinic)

Friday

Reading day / observe inpatient service

* Please contact Andrea Brydges (brydgea@mcmaster.ca), Administrative Assistant, Paediatric Gastroenterology & Nutrition, prior to the start of this rotation to confirm meeting time with the Educational Resource Person.

Educational and Scholarly activities
Educational activities, which are a priority for the GI resident, include both scheduled rounds and other academic sessions. The resident is expected to attend the Gastroenterology Residents’ academic half-day, including the Farncombe noon rounds, on a weekly basis. In addition, the resident is expected to actively participate in the Pediatric Teaching rounds / seminars on Monday from 1200 to 1300. During these educational sessions, essential topics in Pediatric Gastroenterology will be discussed. The resident is expected to present a topic of interest or a journal article during this session. Pathology rounds are held every Tuesday from 1200 to 1300 at McMaster Site.

Evaluation of the Resident

Residents are encouraged to seek informal verbal feedback throughout the Pediatric Gastroenterology outpatient experience concerning their proficiency at managing clinical problems. 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. nurses, nurse practitioners, 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.