Adult Gastroenterology Training Program

Goals and Objectives of the Pediatric Gastroenterology Rotation (Year 2)

Rotation-Specific Objectives

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 knowledge in the following general areas:
    • The effect of age on the pathophysiology of gastrointestinal disease and response to treatment
    • The unique aspects of Pediatric Gastroenterology and an awareness of the clinical problems of Pediatric Gastroenterology
    • Epidemiology, pathophysiology, methods of diagnosis, management and prognosis of common gastrointestinal conditions involving the digestive system, liver and pancreas in pediatric patients
    • Pharmacology of drugs commonly used in Pediatric Gastroenterology
    • Indications, contraindications, limitations, complications, techniques and interpretation of results of the common diagnostic and therapeutic procedures performed on the digestive tract in pediatric patients. This will include upper GI endoscopy, sigmoidoscopy, colonoscopy, barium studies, ultrasound, CT, MRI, radioisotope scan, ERCP, EUS, capsule endoscopy, pHmetry and liver biopsy.
    • An approach to the management of common gastrointestinal disorders seen in pediatric patients in an outpatient setting. This will include dyspepsia, constipation, maldigestion and malabsorption, celiac disease, cystic fibrosis, pancreatic and gallstone disease, functional GI disorders, inflammatory bowel disease, congenital hepatobiliary syndromes, chronic liver disease and portal hypertension.
    • An approach to the nutritional assessment techniques and nutritional disorders in pediatric patients
  2. Assess and investigate patients with common gastrointestinal conditions in a manner appropriate for the patient’s age, including the ability to:
    • Establish a professional relationship and interact with patients and their care-givers in order to obtain a relevant history
    • Take a history that is relevant, concise and accurate to context
    • Perform a focused physical exam that is relevant and accurate, demonstrating sensitivity to patient’s needs, modified according to patient’s age
    • Select medically appropriate investigative methods in a resource-effective and ethical manner, including:
      • Laboratory investigations bloodwork)
      • Imaging modalities (barium studies, ultrasound, CT, MRI, radioisotope scan, ERCP, EUS, capsule endoscopy)
      • Tests commonly employed in GI function laboratories (breath tests, motility studies)
      • Biopsies of the gastrointestinal tract and liver
      • Diagnostic and therapeutic endoscopy of the upper and lower gastrointestinal tract
    • 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 pediatric patients with common gastrointestinal conditions involving the digestive system, liver and pancreas, including the appropriate treatment of patients whose families hold religious or other beliefs that preclude the use of “standard medical treatments”

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 relationships with patients, their parents, legal guardians or other caregivers in order to obtain a meaningful history and to conduct a relevant physical examination
  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 follow-up note
  6. Understand the psychosocial aspects of caring for children with chronic disorders, and their families
  7. Understand the informed consent process and ability to apply this to obtain informed consent for diagnostic procedures and therapy in paediatric patients

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. Contribute clinically useful management options on patients referred for consultation, including ordering and arranging for specific testing or procedures, administering required therapy, and conveying the results of the management options to referring physicians. This process involves integrating information from multiple sources to construct a clear diagnosis which is then used to guide the patient’s therapy. This may require integrating the results of endoscopic procedures with histopathological interpretation, radiologic tests, and haematological investigations.
  2. Consult and collaborate with paediatric health care professionals including paediatricians, paediatric nurses, paediatric surgeons, and paediatric anesthesiologists, clinic staff and other health care professionals, and contribute effectively to the collaborative investigation and management of Paediatric patients

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. Set priorities and manage time to balance patient care, practice requirements, outside activities and personal life
  2. Institute effective and efficient management plans for paediatric patients with gastrointestinal disease by utilizing the available resources in an outpatient setting
  3. Demonstrate good time management in an outpatient setting by assessing patients accurately, comprehensively and efficiently with timely diction of consultation notes and / or procedure notes
  4. Demonstrate knowledge of the different roles and responsibilities of patients, caregivers, physicians, nurses, clerical staff and allied health professionals in the outpatient management of gastrointestinal conditions
  5. Appreciate the various factors involved in transition of care from paediatric to adult practitioners

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. Demonstrate an understanding of the health care needs of paediatric patients with gastrointestinal diseases in an outpatient setting
  2. Demonstrate an appropriate sensitivity to age related issues
  3. 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 biologic medications) that describe and outline the nature of the patient’s problem and the recommended treatments, arranging appropriate vaccinations)
  4. Understand the role of a gastroenterologist in advocating for patients’ access to care through private insurers, provincial formularies and wait lists
  5. Aware of ancillary resources to assist with delivery of care including but not limited to dietary, social services, psychiatric counselling and support groups (e.g. Crohn’s and Colitis Foundation, etc)

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, particularly as it applies to treatments of gastrointestinal disorders of children and adolescents, and for procedures, where randomized trials are difficult or impossible
  3. Understand the role of research in advancing the understanding of gastrointestinal disease

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
  7. Understand the professional obligations to the patient and parents when caring of patients below the age of consent compared to adult patients