Adult Gastroenterology Training Program

Medical Expert

Royal College of Physicians & Surgeons: Goals & Objectives for Training

Medical Expert

Definition:

As Medical Experts, Gastroenterologists integrate all of the CanMEDS Roles, applying medical knowledge, clinical skills, and professional attitudes in their provision of patient-centered care. Medical Expert is the central physician Role in the CanMEDS framework.

Key and Enabling Competencies: Gastroenterologists are able to…

1. Function effectively as consultants, integrating all of the CanMEDS Roles to provide optimal, ethical and patient-centered medical care
1.1. Perform a consultation, including the presentation of well-documented assessments and recommendations in written and/or verbal form in response to a request from another health care professional
1.2. Demonstrate effective use of all CanMEDS competencies relevant to Gastroenterology
1.3. Identify and appropriately respond to relevant ethical issues arising in patient care
1.4. Demonstrate the ability to prioritize professional duties when faced with multiple patients and problems
1.5. Demonstrate compassionate and patient-centered care
1.6. Recognize and respond to the ethical dimensions in medical decision-making
1.7. Demonstrate medical expertise in situations other than patient care, such as providing expert legal testimony or advising governments, as needed

2. Establish and maintain clinical knowledge, skills and attitudes appropriate to Gastroenterology
2.1. Apply knowledge of the clinical, socio-behavioural, and fundamental biomedical sciences relevant to Gastroenterology, including:
2.1.1. Anatomy, embryology, physiology and pathology of the digestive system including the pancreas and liver
2.1.2. Principles of biochemistry, molecular biology and genetics as they apply to the digestive system
2.1.3. Principles of metabolism, pharmacokinetics, pharmacodynamics and toxicity of drugs commonly used in Gastroenterology
2.1.4. Principles of endocrinology, intermediary metabolism and nutrition, oncology, microbiology and psychiatry as they apply to the digestive system
2.1.5. Principles of gastrointestinal surgery including the indications for and the complications of operations on the gastrointestinal tract
2.1.6. Diseases affecting the digestive system, pancreas and liver including the epidemiology, pathophysiology, methods of diagnosis, management and prognosis of such diseases
2.1.7. Indications, interpretations, limitations, and complications of diagnostic procedures performed on the digestive tract
2.1.8. Hazards of endoscopic procedures for the operator, assistants and patient, and the measures appropriate to minimize such hazards
2.1.9. Principles of fluoroscopy used during endoscopic procedures including the safe use of X-rays for both patient and operator
2.1.10. Advances in the management of gastrointestinal disorders, including organ transplantation, therapeutic endoscopy
2.2. Describe the CanMEDS framework of competencies relevant to Gastroenterology
2.3. Apply lifelong learning skills of the Scholar Role to implement a personal program to keep up-to-date, and enhance areas of professional competence
2.4. Contribute to the enhancement of quality care and patient safety in Gastroenterology, integrating the available best evidence and best practices

3. Perform a complete and appropriate assessment of a patient
3.1. Identify and explore issues to be addressed in a patient encounter effectively, including the patient’s context and preferences
3.2. Elicit a history that is relevant, concise and accurate to context and preferences for the purposes of prevention and health promotion, diagnosis and/or management
3.3. Perform a focused physical examination that is relevant and accurate for the purposes of prevention and health promotion, diagnosis and/or management, with particular emphasis on areas specific to the digestive system and its disorders including nutritional deficiencies
3.4. Select and interpret medically appropriate investigative methods in a resource-effective and ethical manner, including:
3.4.1. Imaging modalities (barium studies, ultrasound, computerized tomography (CT) scan, magnetic resonance imaging (MRI), radioisotope scan, endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound, capsule endoscopy) for the digestive system, pancreas and liver
3.4.2. Tests commonly employed in gastrointestinal function laboratories including breath tests and motility studies
3.4.3. Tissue biopsies of the gastrointestinal tract and liver
3.4.4. Endoscopic procedures including biopsies of the upper and lower gastrointestinal tract including, but not limited to, colonoscopy, upper endoscopy and sigmoidoscopy
3.4.4.1. Appropriate use and care of equipment used in endoscopic procedures
3.4.5. Appropriate use of clinical data to formulate problems and to correctly develop investigation and management plans to deal with the patient’s problem(s)
3.5. Demonstrate effective clinical problem solving and judgment to address patient problems, including interpreting available data and integrating information to generate differential diagnoses and management plans for gastrointestinal diseases
3.5.1. Demonstrate the ability to recognize, evaluate and manage gastrointestinal emergencies, including, but not limited to:
3.5.1.1. Acute gastrointestinal hemorrhage
3.5.1.2. Acute abdominal pain
3.5.1.3. Fulminant colitis
3.5.1.4. Biliary obstruction, including ascending cholangitis
3.5.1.5. Liver failure
3.5.1.6. Ingested foreign bodies

4. Use preventive and therapeutic interventions effectively
4.1. Implement an effective management plan in collaboration with a patient and their family
4.2. Demonstrate effective, appropriate, and timely application of preventive and therapeutic interventions relevant to Gastroenterology, including, but not limited to:
4.2.1. Screening colonoscopy
4.2.2. Upper endoscopy for Barrett’s esophagus
4.2.3. Upper endoscopy for portal hypertension
4.2.4. Surveillance for hepatobiliary malignancy
4.3. Ensure appropriate informed consent is obtained for therapies and transfusion of blood products
4.4. Ensure patients receive appropriate end-of-life care

5. Demonstrate proficient and appropriate use of procedural skills, both diagnostic and therapeutic
5.1. Demonstrate effective, appropriate, and timely performance of diagnostic procedures relevant to Gastroenterology including:
5.1.1. Upper gastrointestinal (GI) endoscopy and biopsy
5.1.2. Colonoscopy and biopsy
5.1.3. Esophageal manometry
5.1.4. Paracentesis (adult patients only)
5.2. Demonstrate effective, appropriate, and timely performance of therapeutic procedures relevant to Gastroenterology including:
5.2.1. Luminal dilation
5.2.2. Polypectomy
5.2.3. Endoscopic hemostasis
5.2.4. Foreign body removal
5.3. Ensure appropriate informed consent is obtained for procedures
5.4. Document and disseminate information related to procedures performed and their outcomes
5.5. Ensure adequate follow-up is arranged for procedures performed

6. Seek appropriate consultation from other health professionals, recognizing the limits of their expertise
6.1. Demonstrate insight into their own limits of expertise
6.2. Demonstrate effective, appropriate, and timely consultation of another health professional as needed for optimal patient care
6.3. Arrange appropriate follow-up care services for a patient and their family