McMaster University

McMaster University

Pediatric Gastroenterology Training Program — Goals & Objectives

Goals and Objectives: First Year

Medical Expert

  • Understand the anatomy, embryology, physiology and pathology of the digestive system including the pancreas and liver
  • Understand the principles of biochemistry, molecular biology and genetics as they apply to the digestive system
  • Understand the pharmacology (metabolism, pharmacokinetics, pharmacodynamics and toxicity) of drugs commonly used in gastroenterology
  • Understand the principles of endocrinology, intermediary metabolism and nutrition, oncology, microbiology and psychiatry as they apply to the digestive system
  • Understand the principles of gastrointestinal surgery including the indications for and the complications of operations on the gastrointestinal tract
  • Understand the diseases affecting the digestive system, pancreas and liver (epidemiology, pathophysiology, methods of diagnosis, management and prognosis). This will include both primary gastrointestinal disorders (peptic ulcer disease, gastritis, gastroesophageal reflux disease, achalasia, celiac disease, inflammatory bowel disease, infectious gastroenteritis, angiodysplasia, hemorrhoids, anal fissures, gastrointestinal malignancy, acute and chronic pancreatitis, cholelithiasis, acute and chronic hepatitis, hemochromatosis, autoimmune hepatitis, primary sclerosing cholangitis, alcoholic liver disease and hepatic decompensation) and systemic disorders involving the gastrointestinal tract (diabetes mellitus, metabolic disorders (alpha-1-antitrypsin deficiency mitochondrial disorders, etc.)
  • Understand functional gastrointestinal disorders from a physiologic, diagnostic,  and therapeutic perspective
  • Understand how different phases of maturation (infant, child, adolescent) impact on disease natural history, investigation, and management
  • Take a medical history that is relevant, concise, accurate and appropriate
  • Perform a physical exam that is relevant, sufficiently elaborate and appropriate
  • Use clinical databases appropriately to formulate problems and to correctly develop investigation and management plans to deal with the patient's problem(s)
  • Select medically appropriate investigative tools in a cost-effective, ethical and useful manner including:
    • Laboratory investigation
    • Imaging modalities (barium studies, ultrasound, CT, MRI, radioisotope scan)
    • Tests commonly employed in gastrointestinal function laboratories (breath tests, motility studies)
    • Biopsies of the gastrointestinal tract and liver
    • Diagnostic and therapeutic endoscopy of the upper and lower gastrointestinal tract
  • Understand the indications, interpretations, limitations, and complications of diagnostic procedures performed on the digestive tract
  • Understand the hazards of endoscopic procedures for the operator and assistants and the measures appropriate to minimize such hazards
  • Understand the principles of fluoroscopy and electrocautery used during endoscopic procedures, including their safety for both patient and operator
  • Understand the use and care of equipment used in endoscopic procedures
  • Recognize, evaluate and manage gastrointestinal emergencies (acute gastrointestinal hemorrhage, acute abdominal pain, fulminant colitis, ascending cholangitis, liver failure, perforated viscus, toxic megacolon)
  • Demonstrate proficiency at basic diagnostic endoscopy under supervision, including:
    • Upper gastrointestinal endoscopy with biopsy
    • Rigid and flexible sigmoidoscopy with biopsy
    • Demonstrate proficiency at diagnostic and therapeutic paracentesis under supervision.

Communicator

  • Compose succinct but comprehensive consultation letters, discharge summaries, progress notes, and test reports with appropriate support from the supervising consultant.
  • Communicate and cooperate with members of the multidisciplinary health care team to optimize patient care
  • Establish a therapeutic relationship with patients and their families based on trust, empathy and confidentiality
  • Communicate with patients at different ages and stages of development
  • Convey information about diagnosis, prognosis, risks/benefits of tests and treatment options to patients and families both understandably and effectively.

Collaborator

  • Understand and implement multidisciplinary care of patients with gastrointestinal disease, with appropriate input and support from allied health professionals (e.g. nursing, occupational therapy, physical therapy, social services, clerical staff, registered dieticians, pain control services, primary care physicians, surgeons and other specialists)
  • Demonstrate understanding of the unique roles and expertise of members of interdisciplinary teams caring for patients with motility disorders, inflammatory bowel disease, pancreaticobiliary disorders and chronic liver disease.
  • Participate in interdisciplinary team meetings that contribute to the collaborative investigation, management and disposition of patients
  • Establish effective and successful collaborations in research

Manager

  • Understand the structure and financing of regional, provincial and federal health care systems
  • Demonstrate skill in negotiating, allocating and managing finite heath care resources (e.g. bed booking, referral triaging, pharmacy budgets)
  • Institute efficient management plans for patients with gastrointestinal disease by utilizing the available resources.
  • Access and apply various information sources of information in managing in-patients with gastrointestinal disorders

Health Advocate

  • Understand key determinants of health in gastrointestinal disease (e.g. socioeconomic, psychosocial, lifestyle-induced and biologic)
  • Understand the role of gastroenterologists in advocating for patients' access to care through private insurers, hospital/provincial formularies and wait lists
  • Understand the public health challenges of identifying asymptomatic disease in at-risk populations (e.g. viral hepatitis, celiac disease)
  • Be able to assess the impact of gastrointestinal disease on individual patients' social function, relationships, productivity and access to health services

Scholar

  • Demonstrate efficiency and competence in searching, appraising and applying medical literature
  • Understand the role of research in advancing the understanding of gastrointestinal disease
  • Pose a research question and develop a research proposal
  • Synthesize and present knowledge to local rounds and provincial/national symposia
  • Teach and supervise students and junior house staff and allied health professionals

Professional

  • Display an attitude and demeanour consistent with professional standards
  • Demonstrate personal and professional awareness and resolve interpersonal conflicts
  • Balance personal and professional responsibilities
  • Recognize and deal with unprofessional behaviours in clinical practice

Goals and Objectives: Second year

Medical Expert

  • Identify extensive differential diagnoses for presenting problems and design comprehensive management plans
  • Critically assess controversies in the management of gastrointestinal disorders
  • Access, retrieve, assist and apply relevant information of all kinds to problem-solving
  • Recognize, understand discuss and integrate new advances in the management of gastrointestinal disorders (biologic therapies, organ transplantation, therapeutic endoscopy)
  • Demonstrate effective consultation skills in presenting well documented assessments and recommendations in written and/or verbal form including:
  • Procedural and specialty test reports
  • Allied health providers and third party request responses
  • Demonstrate medical expertise in situations other than those involving direct patient care (e.g. presentations, medical legal cases)
  • Discuss the performance (accuracy/efficacy), risks and complications of gastrointestinal tests and procedures, with recognition of current controversies and alternative approaches.
  • Demonstrate proficiency at advanced diagnostic and therapeutic endoscopy under supervision, including:
  • Colonoscopy and polypectomy
  • Endoscopic hemostasis (including injection, thermal coaptive therapy and band ligation)
  • Balloon and bougie dilation
  • Removal of ingested foreign bodies from the gastrointestinal tract
  • Percutaneous endoscopic gastrostomy
  • Identify and interpret endoscopic findings with confidence, including those that are uncommon or elusive (Dieulafoy lesions, gastric antral vascular ectasia, dysplasia associated lesions or masses, solitary rectal ulcers, discrimination of Crohn's disease and ulcerative colitis, metabolic liver disease)
  • Demonstrate sound knowledge of surgical procedures for the diagnosis and treatment of gastrointestinal disease
  • Demonstrate insight into his/her own limitations of expertise by self-assessment
  • Recognize common problems affecting children and adolescents in transition (inflammatory bowel disease, celiac disease, cystic fibrosis, functional abdominal pain, neonatal jaundice, viral hepatitis) and special technical aspects of pediatric endoscopy including special needs for sedation

Communicator

  • Communicate with patients and/or families without the immediate supervision of the consultant.
  • Communicate and cooperate effectively with allied health personnel and medical colleagues in the care of individual patients
  • Demonstrate skills to provide effective information to the general public about gastrointestinal illness
  • Demonstrate skills in conveying and discussing information about gastrointestinal illness to medical and scientific communities

Collaborator

  • Demonstrate confidence in leading a multidisciplinary health care team.
  • Establish effective and successful collaborations in research and/or clinical care, both within and between institutions
  • Resolve conflicts with and between other members of the health care team
  • Understand how health care governance influences patient care, research and educational activities at a local, provincial, regional, and national level

Manager

  • Show confidence and competence in directing management of urgent and emergent clinical scenarios
  • Understand the operational aspects of an endoscopy unit, such as planning, budgeting and evaluation.
  • Understand the administrative aspects of an outpatient practice and inpatient hospital service
  • Understand billing practices
  • Show an ability to advocate for individual patients yet recognize societal needs when monitoring and allocating resources
  • Understand how to function effectively in health care organisations, ranging from an individual clinical practice to the national level

Health Advocate

  • Understand current public policies that affect gastrointestinal health
  • Identify key controversies in the Canadian health care system that affect gastrointestinal illness and advocate for policy that reduces the burden of illness
  • Understand the advocacy roles of professional society, patient groups and private organizations in reducing the burden of gastrointestinal disease
  • Understand the cost-benefit relationship of emerging therapies for chronic gastrointestinal disorders (e.g. inflammatory bowel disease, viral hepatitis)
  • Demonstrate knowledge of confidentiality, consent, and capacity issues in children and adolescents

Scholar

  • Develop, demonstrate and document skills for life-long continuing education
  • Recognize the importance of self-assessment to identify gaps in knowledge
  • Apply advanced critical appraisal skills to the medical literature
  • Make career decisions related to:
  • Practice environment (academic vs. private, location)
  • Practice emphasis (IBD, hepatology, nutrition, motility)
  • Teaching of colleagues and junior housestaff in an effective, evidence-based manner
  • Development and execution of a research program
  • Tailor the structure and content of the second year elective and/or research rotations to accommodate and facilitate career decisions

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 (e.g. informed consent, patient confidentiality, PEG placement)
  • Understand legislation that guides health care practice

Rotation-Specific Goals and Objectives - Ward

Medical Expert

  • Develop an approach to the management of common GI disorders seen in an inpatient setting (acute gastrointestinal bleeding, acute and chronic diarrhea, inflammatory bowel disease, chronic and end-stage liver disease, acute liver disease, neonatal cholestasis, pancreatitis, short bowel syndrome, acute abdomen, functional bowel disease and complications of endoscopy)
  • Become familiar with the indications, technical performance, interpretation and implications of special gastrointestinal investigations including hydrogen breath testing, urea breath testing, esophageal pH-metry, esophageal and anorectal manometry, and capsule endoscopy.
  • Become familiar with enteral and parental nutritional support for patients with feeding difficulty, including the indications, risks and benefits
  • Recognize situations that require urgent or emergency endoscopy and in employing hemostatic techniques in acute GI bleeding (eg. Injection and thermal coagulation of bleeding ulcers, banding ligation of variceal bleeding)

Communicator

  • Construct succinct and comprehensive consultation letters, progress notes, discharge summaries, and endoscopy reports
  • Present concise and accurate case histories including full differential diagnoses on daily work rounds
  • Convey to patients and families an accurate and coherent understanding of the investigations, diagnosis, treatment plan, and prognosis with empathy and compassion.
  • Communicate clearly, thoroughly and as frequently as needed with medical colleagues, particularly those who carry out diagnostic tests (e.g. radiologists, pathologists) and referring physicians to ensure the best outcome for the patient.
  • Communicate effectively with a multi-disciplinary team to optimize patient care

Collaborator

  • Consult effectively other physicians and health care professionals when needed, including physical and occupational therapists, social workers, pain specialists and psychiatrists.
  • Demonstrate confidence in leading a multidisciplinary health care team.
  • Resolve conflicts with and between other members of the health care team

Manager

  • Exercise time management to optimize the investigation and treatment while minimizing length of stay
  • Develop efficiency and accuracy in clinical skills.
  • Reserve time for reading and keeping current with the literature to optimize patient care
  • Coordinate in-hospital care with ambulatory and community based resources for follow-up

Health Advocate

  • Identify ethnic, cultural and social factors that may influence the health and discharge planning of the patients.
  • Understand the importance of patient education in the management of many common GI conditions and facilitate such learning when possible

Scholar

  • Attend and contribute to rounds, conferences and other learning events.
  • Contribute to teaching of more junior housetaff on the team and general pediatrics ward.
  • Utilize the patient encounter as a stimulus to further reading and review of current literature.
  • Take an evidence-based approach to management problem

Professional

  • Demonstrate personal and professional awareness and resolve interpersonal conflicts
  • Balance personal and professional responsibilities
  • Recognize and deal with unprofessional behaviours in clinical practice

Rotation-Specific Goals and Objectives - Clinics

Medical Expert

  • Demonstrate a confident approach to the management of common gastrointestinal disorders seen in an out-patient setting (e.g. dyspepsia, gastroesophageal reflux, peptic ulcer disease, functional gut disorders, inflammatory bowel disease, chronic hepatitis, chronic diarrhea, obscure gastrointestinal bleeding, chronic abdominal pain, chronic pancreatitis, chronic abdominal pain, chronic constipation, malnutrition and malabsorption, failure to thrive, milk protein allergy, eosinophilic disorders, and celiac disease)
  • Demonstrate a confident approach to the management of inflammatory bowel disease including understanding of: (a) current concepts of pathogenesis and pathophysiology; (b) clinical expression; (c) current and emerging therapies and their potential side effects; and (d) support systems for patients and families
  • Demonstrate a confident approach to the management of motility disorders and functional gut disorders including understanding of current concepts of pathogenesis and symptom generation and current and emerging therapies

Communicator

  • Communicate with patients and/or families without the immediate supervision of the consultant
  • Communicate and cooperate effectively with allied health personnel and medical colleagues in the care of individual patients
  • Demonstrate skills to provide effective information to the general public about gastrointestinal illness
  • Demonstrate skills in conveying and discussing information about gastrointestinal illness to medical and scientific communities

Collaborator

  • Develop strategies to manage complex chronic disease in an out-patient setting, including optimal use of multidisciplinary support systems (e.g. nutrition, social work, psychiatry, and pain management
  • Demonstrate confidence in leading and working with a transdisciplinary health care team.
  • Resolve conflicts with and between other members of the health care team

Manager

  • Demonstrate skills necessary to run an out-patient gastroenterology clinic  
  • Show an ability to advocate for individual patients yet recognize societal needs when monitoring and allocating resources
  • Demonstrate an understanding of billing practices

Health Advocate

  • Identify key issues of concern to patients and families
  • Demonstrate knowledge of confidentiality, consent, and capacity issues in children and adolescents
  • Identify key controversies in the Canadian health care system that affect gastrointestinal illness and advocate for policy that reduces the burden of illness
  • Understand the cost-benefit relationship of emerging therapies for chronic gastrointestinal disorders (e.g. inflammatory bowel disease, viral hepatitis)

Scholar

  • Develop, demonstrate and document skills for life-long continuing education
  • Recognize the importance of self-assessment to identify gaps in knowledge
  • 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 (e.g. informed consent, patient confidentiality)

Rotation-Specific Goals and Objectives - Adult GI Consultation and Endoscopy

Medical Expert

  • Demonstrate a sound knowledge of functional gut disorders and the gastrointestinal complications of renal, rheumatologic and psychiatric disorders
  • Understand the management of outpatients with advanced neoplasia, motility disorders and advanced functional disease. This will include exploring issues to be addressed in the patient encounter including the patient-specific context and preferences
  • Ensure that patients with terminal disease receive appropriate end-of-life care.
  • Demonstrate initial competency in completing Upper and Lower endoscopic procedures

Communicator

  • Develop rapport and trust with patients and families with multisystem organ disease including end-stage renal failure.
  • Extract and synthesize information required to manage patients with a reduced ability to communicate due to psychiatric morbidity or organ failure (e.g. renal failure).
  • Obtain informed consent for procedures performed on patients with complex psychiatric, functional and motility disorders

Collaborator

  • Participate effectively in an interdisciplinary team to address end-of-life care in patients with terminal illness such as end-stage malignancy

Manager

  • Demonstrate effective use of unique electronic medical record of St Josephs Hospital.
  • Coordinate care of patients referred from other procedures for advanced procedures (e.g. laser, argon plasma coagulation)
  • Prepare and supervise the on-call rota for junior housestaff

Health Advocate

  • Identify specific health needs of groups of patients with chronic renal, musculoskeletal and other medical disorders
  • Recognize the broader health implications of gastrointestinal diagnoses (e.g. non-alcoholic fatty liver disease)

Scholar

  • Develop a personal plan for the maintenance of competence
  • Pose learning questions based on specific patient encounters

Professional

  • Demonstrate a commitment to physician health and sustainable practice
  • Respond appropriately to ethical issues in practice

Rotation-specific Goals and Objectives - Hepatology/Transplant

Medical Expert

  • Assess and manage patients with abnormal liver tests, distinguishing  between hepatitic and cholangitic liver disease. 
  • Evaluation and management of acute liver failure patients
  • Evaluation and management of chronic liver failure patients, such as patients with biliary atresia.
  • Complete full diagnosis and management of all inpatients and outpatients referred for liver transplant evaluation.
  • Understand the indications, risks, benefits, techniques and perform  inpatient and outpatients procedures: liver biopsy, paracentesis, esophageal band ligation.
  • Become knowledgeable in the area of organ donation.
  • Become knowledgeable regarding the technical aspects of liver transplantation in children and its complications.
  • Become knowledgeable in the long-term management of paediatric liver transplant recipients
  • Pathophysiology and Anatomy of the hepatobiliary system
  • diagnosis

Communicator

  • Obtain informed consent from patients or families for GI/Liver procedures.
  • Explain to patients and families the complexities of end stage liver disease and potential therapies including liver transplantation, complications of cirrhosis therapy.
  • Efficiently present inpatient consultations to other healthcare providers

Collaborator

  • Appropriately consult and interact with other hospital services specifically, transplant surgery and interventional radiology.
  • Identify the role and expertise of all members of interdisciplinary teams involved in the management of hepatobiliary disease and liver transplantation (e.g. nutritional services, physiotherapy, social work) to optimize patient care
  • Actively contribute to the plan of management proposed by the interdisciplinary team

Manager

  • Manage time between outpatient liver and liver transplant clinic and hospital patient duties
  • Utilize time and resources effecively to provide optimum care to patients

Health Advocate

  • Identify important determinanats of helaht in liver diseases that affect patients, including socio-economic status, social support systems, lifestyle, home living environment, pyschological and biological factors
  • Understand the opportunties and risk of living related liver transplant
  • Understand the mechanism of drug benefit programs and secondary insurance for patients requiring liver transplantation or chronic liver management

Scholar

  • Develop a personal plan for the maintenance of competence
  • Pose learning questions based on specific patient encounters
  • Appriase and evaluate the medical literature in the field of transplant hepatology as it applies to clinical practice
  • Teach junior housestaff covering inpatients about the management of liver disease on consulted patients
  • Participate actively in liver teaching rounds

Professional

  • Demonstrate a commitment to physician health and sustainable practice
  • Develop and demonstrate use of a framework for recognizing the dealing with ethical issues in clinical and/or research practice including truth-telling, consent, conflict of interest, resource allocation and end-of-life care
  • Ethically interact with members of the pharmaceutical industry

Rotation-Specific Goals and Objectives - Motility/GI Investigations

Medical Expert

  • Develop an approach to the management of common GI motility disorders (achalasia, esophageal spasm, chronic functional consipation refractory to laxatives, Hirschsprung's)
  • Become familiar with the indications, technical performance, interpretation and implications of special gastrointestinal investigations including hydrogen breath testing, urea breath testing, esophageal pH-metry, esophageal and anorectal manometry
  • Become familiar with interventions in the motility lab (biofeedback training)
  • Demonstrate 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.

Communicator

  • Construct succinct and comprehensive consultation letters and investigational reports
  • Present concise and accurate case histories including full differential diagnoses on patients seen
  • Convey to patients and families an accurate and coherent understanding of the investigations, diagnosis, treatment plan, and prognosis with empathy and compassion
  • Communicate effectively with a multi-disciplinary team to optimize patient care

Collaborator

  • Consult effectively other physicians and health care professionals when needed, including physical and occupational therapists, social workers, pain specialists and psychiatrists.
  • Resolve conflicts with and between other members of the health care team

Manager

  • Develop efficiency and accuracy in clinical skills.
  • Reserve time for reading and keeping current with the literature to optimize patient care

Health Advocate

  • Identify ethnic, cultural and social factors that may influence the health and management of the patients.
  • Understand the importance of patient education in the management of GI motility disorders

Scholar

  • Attend and contribute to rounds, conferences and other learning events.
  • Utilize the patient encounter as a stimulus to further reading and review of current literature.
  • Take an evidence-based approach to management problem

Professional

  • Demonstrate personal and professional awareness and resolve interpersonal conflicts
  • Balance personal and professional responsibilities
  • Recognize and deal with unprofessional behaviours in clinical practice

Nutrition

Medical Expert

  • Demonstrate knowledge of the anatomy, physiology and pathology of the digestive system (including the pancreas and liver) with respect to intake and absorption of macronutrients and micronutrients
  • Demonstrate an understanding of various nutritional formulas, including content, CHO, lipid, and protein sources, osmolality, indication, and potential side effects
  • Demonstrate an understanding of parental nutrition including type (e.g. lipid source—standard vs. fish oil), ordering principles, indications, potential side effects, and the principles of home parenteral nutrition.
  • Demonstrate an understanding of enteral nutrition therapy in IBD and Eosinophilic disorders including indications, ordering principles, selection of formula type, and potential side effects
  • Demonstrate knowledge of gastrostomy and nasogastric tube insertion, care, and management of complications
  • Assess caloric intake based on a food diary
  • Determine caloric needs at all age groups and adjust for clinical and physiological factors
  • Understand the effect of surgery on the gastroinestinal system, including the nutritonal management of patients who have had bariatric surgery

Communicator

  • Communicate with patients and/or families without the immediate supervision of the consultant.
  • Communicate and cooperate effectively with allied health personnel and medical colleagues in the care of individual patients
  • Demonstrate skills to provide effective information to the general public about gastrointestinal illness

Collaborator

  • Show effective working relationship with dietiticians, nurses, and occupational therapists
  • Resolve conflicts with and between other members of the health care team

Manager

  • Show competence in odering nutritional therapies in an out-patient setting and ensuring organizaiton of services to provide these therapies  
  • Show an ability to advocate for individual patients yet recognize societal needs when monitoring and allocating resources

Health Advocate

  • Identify key issues of concern to patients and families
  • Identify key controversies in the Canadian health care system that affect nutritional management of infants, children and adolescents
  • Understand the cost-benefit relationship of different nutritional therapies

Scholar

  • Develop, demonstrate and document skills for life-long continuing education
  • Recognize the importance of self-assessment to identify gaps in knowledge
  • 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

Rotation-Specific Goals and Objectives - Radiology/Pathology

Medical Expert

  • Demonstrate a knowledge of CT (+/- MRI) appearance of variety of GI disorders appropriate for a practicing Pediatric Gastroenterologist:
    • Knowledge of cross-sectional anatomy of the abdomen & pelvis
    • Knowledge of patterns of disease presentation and spread of disease
    • knowledge of abdominal pathologies and the capability of the exam to evaluate the pathology, including CT imaging of small and large bowel (CT colonography and CT +/- MR enterography) and MRI liver (+/- MRCP), pancreas and rectum.
    • Able to correlate findings with other imaging modalities and appropriate clinical information
    • Ability to develop appropriate differential diagnosis and suggest appropriate further imaging, therapy or clinical action required
  • Demonstrate a knowledge of barium study (Upper GI, small bowel follow-through, enteroclysis, barium enema) appearance of a variety of GI disorders appropriate for a practicing Pediatric Gastroenteorlogist including:
    • Esophageal disorders (stricture, achalasia)
    • Gastric disorders (peptic ulcer disease)
    • Crohn's disease and its complications (small bowel inflammation, colitis, fistulizing disease)
    • Neoplasia
  • Demonstrate a knowledge of plain film abdominal X-ray appearance of a variety of GI disorders appropriate for a practicing Pediatric Gastroenterologist (ileus, toxic megacolon, fecal loading, obstruction, necrotizing entercolitis)
  • Demonstrate an understanding of interventional GI procedures (percutaneous liver biopsy, esophageal dilatation, gastrostomy tube insertion, jejunostomy tube insertion, central line insertion)
  • Demonstrate an understanding of the histopathological and electron microscopy features of common GI disorders (IBD, Eosinophilic disorders, H. pylori infection, polyp neoplasia, liver disorders)

Communicator

  • Can orally describe relevant findings, diagnosis and recommendations.
  • Demonstrate effective communication skills when dealing with patients, during consent or procedures, as well as with consulting clinicians

Collaborator

  • Demonstrate good consulting skills when interacting with other physicians & health team members.
  • Interact appropriately with other radiology department staff, demonstrating a team approach to patient care

Manager

  • State the indications for various imaging tools for GI imaging investigation.
  • Consider advantages and disadvantages of available imaging modalities.
  • Consider available imaging resources when planning and recommending patient care, using them effectively and efficiently.
  • Demonstrate appropriate time management skills when completing assigned rotation duties

Health Advocate

  • Recognize and consider radiation doses when considering investigation modalities

Scholar

  • Set personal learning goals and reading plan during rotation.
  • Contribute to the learning of others, with teaching/supervision of junior residents on rotation, elective students, off-service residents

Professional

  • Demonstrate integrity, honesty and compassion and respect for others
  • Demonstrate professional appearance and communication
  • Demonstrate good work ethic, with enthusiasm and motivation for learning
  • Demonstrate professional work habits with punctuality, organization and efficiency
  • Demonstrate awareness of own limitations.
  • Incorporate feedback into improved personal performance

Rotation-Specific Goals and Objectives - Junior Attending

Medical Expert

  • Consolidate knowledge and experience into a comprehensive approach to GI disease and its manaagement at the level of a consultant pediatric gastroenterologist
  • Demonstrate the ability to recognize limitations in knowledge and ability and seek assistance from colleagues and other specialists
  • Communicator
  • Construct succinct and comprehensive consultation letters, progress notes, discharge summaries, and endoscopy reports
  • Present concise and accurate case histories including full differential diagnoses on daily work rounds
  • Convey to patients and families an accurate and coherent understanding of the investigations, diagnosis, treatment plan, and prognosis with empathy and compassion
  • Communicate clearly, thoroughly and as frequently as needed with medical colleagues, particularly those who carry out diagnostic tests (e.g. radiologists, pathologists) and referring physicians to ensure the best outcome for the patient
  • Communicate effectively with a multi-disciplinary team to optimize patient care

Collaborator

  • Consult effectively other physicians and health care professionals when needed, including physical and occupational therapists, social workers, pain specialists and psychiatrists
  • Demonstrate confidence in leading a multidisciplinary health care team.
  • Resolve conflicts with and between other members of the health care team

Manager

  • Exercise time management to optimize the investigation and treatment while minimizing length of stay
  • Develop efficiency and accuracy in clinical skills.
  • Reserve time for reading and keeping current with the literature to optimize patient care
  • Coordinate in-hospital care with ambulatory and community based resources for follow-up
  • Supervise more junior housestaff effectively and efficiently, including review of written notes and dictations

Health Advocate

  • Identify ethnic, cultural and social factors that may influence the health and discharge planning of the patients.
  • Understand the importance of patient education in the management of many common GI conditions and facilitate such learning when possible

Scholar

  • Attend and contribute to rounds, conferences and other learning events.
  • Contribute to teaching of more junior housestaff on the team and general pediatrics ward
  • Utilize the patient encounter as a stimulus to further reading and review of current literature
  • Take an evidence-based approach to management problem

Professional

  • Demonstrate personal and professional awareness and resolve interpersonal conflicts
  • Balance personal and professional responsibilities
  • Recognize and deal with unprofessional behaviours in clinical practice

Rotation-Specific Goals and Objectives - Longitudinal Clinic

Medical Expert

  • Demonstrate an independent approach to the management of common gastrointestinal disorders seen in an out-patient setting (e.g. dyspepsia, gastroesophageal reflux, peptic ulcer disease, functional gut disorders, inflammatory bowel disease, chronic hepatitis, chronic diarrhea, obscure gastrointestinal bleeding, chronic abdominal pain, chronic pancreatitis, chronic abdominal pain, chronic constipation, malnutrition and malabsorption, failure to thrive, milk protein allergy, eosinophilic disorders, and celiac disease)
  • Demonstrate a confident approach to the management of inflammatory bowel disease including understanding of: (a) current concepts of pathogenesis and pathophysiology; (b) clinical expression; (c) current and emerging therapies and their potential side effects; and (d) support systems for patients and families
  • Demonstrate a confident approach to the management of motility disorders and functional gut disorders including understanding of current concepts of pathogenesis and symptom generation and current and emerging therapies

Communicator

  • Communicate with patients and/or families without the immediate supervision of the consultant.
  • Communicate and cooperate effectively with allied health personnel and medical colleagues in the care of individual patients
  • Demonstrate comprehensiveness in assessment, impression and recommendations in wirtten communication to the referring physician
  • Demonstrate skills to provide effective information to the general public about gastrointestinal illness
  • Demonstrate skills in conveying and discussing information about gastrointestinal illness to medical and scientific communities

Collaborator

  • Develop strategies to manage complex chronic disease in an out-patient setting, including optimal use of multidisciplinary support systems (e.g. nutrition, social work, psychiatry, and pain management)
  • Demonstrate confidence in leading and working with a transdisciplinary health care team.
  • Resolve conflicts with and between other members of the health care team

Manager

  • Demonstrate skills necessary to run an out-patient gastroenterology clinic.  
  • Demonstrate an understanding of the goals of a consultation visit compared to a follow-up and recurring visit
  • Demonstrate skill in determing when patients can be discharged from the clinic and returned to the care of the referring physician
  • Show an ability to advocate for individual patients yet recognize societal needs when monitoring and allocating resources
  • Demonstrate an understanding of billing practices

Health Advocate

  • Identify key issues of concern to patients and families
  • Demonstrate knowledge of confidentiality, consent, and capacity issues in children and adolescents
  • Identify key controversies in the Canadian health care system that affect gastrointestinal illness and advocate for policy that reduces the burden of illness
  • Understand the cost-benefit relationship of emerging therapies for chronic gastrointestinal disorders (e.g. inflammatory bowel disease, viral hepatitis)

Scholar

  • Develop, demonstrate and document skills for life-long continuing education
  • Recognize the importance of self-assessment to identify gaps in knowledge
  • 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 (e.g. informed consent, patient confidentiality)
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