Date Issued: 06/05/2002
Prior Revision Date: 03/12/2007
Date Reviewed and Revised: 03/02/2009
Department: Internal Medicine
Faculty Coordinator: Rajeev Jain, M.D.
Hospital: Texas Health Presbyterian Hospital Dallas
Periods offered: All
Length: 4 Weeks
Max no. of residents: 2
First Day Contact: Ellen (214) 345-6999
First Day Time: 7:00 a.m.
First Day Place: GI Lab, Main Building-First Floor
Requirements: 7:00 a.m. to 7:00 p.m. Monday through Friday
Weekends: One weekend a month
- Course Description:
Residents will participate in comprehensive subspecialty consultations for
inpatients and outpatients with GI and Hepatobiliary disease. In addition,
the residents will observe basic and advanced endoscopic procedures.
- Course Goals and Objectives: (based on ACGME competencies for resident education.)
Residents are expected to provide care that is compassionate, appropriate and
effective for the promotion of health, prevention of illness, treatment of disease
and at the end of life.
- Gather accurate, essential information from all sources, including medical
interviews, physical examinations, medical records and diagnostic/therapeutic
procedures. Examples: History, including record review, physical exam
and results of pertinent tests for patients with elevated hepatic enzymes,
gastrointestinal bleeding, abdominal pain.
- Make informed recommendations about preventives, diagnostic and therapeutic
options and interventions that are based on clinical judgement, scientific
evidence, and patient preference. Examples: Patients with chronic viral
hepatitis C, abdominal pain, inflammatory bowel disease.
- Develop, negotiate and implement effective patient management plans and
integration of patient care. Examples: Patients with chronic viral
hepatitis, inflammatory bowel disease, cirrhosis.
- Perform competently the diagnostic and therapeutic procedures considered
essential to the practice of internal medicine. Examples: Evaluation
of elevated liver function tests, evaluation of heme positive stools.
Residents are expected to demonstrate knowledge of established and evolving
biomedical, clinical and social sciences, and the application of their knowledge
to patient care and the education of others.
- Apply an open-minded, analytical approach to acquiring new knowledge. Examples:
Reading about GI motility disorders in the patient with constipation determining
the cause of malabsorption, recognize patterns of liver function test abnormalities.
- Access and critically evaluate current medical information and scientific
evidence. Examples: Current recommendations for screening for hepatitis
- Develop clinically applicable knowledge of the basic and clinical sciences
that underlie the practice of internal medicine. Examples: Virology
of hepatitis viruses, mechanisms of drug and toxin induced liver diseases;
inheritance of and screening for genetic GI diseases.
- Apply this knowledge to clinical problem-solving, clinical decision-making,
and critical thinking. Examples: Knowing the cause of acetomenophen-induced hepatotoxicity and appropriate treatment; follow patients
with a family history of colon cancer.
Practice-Based Learning and Improvement:
Residents are expected to be able to use scientific evidence and methods to
investigate, evaluate, and improve patient care practices:
- Identify areas for improvement and implement strategies to enhance knowledge,
skills, attitudes and processes of care. Examples: Seek to improve
the knowledge, skills, attitudes and care of the patients with chronic diarrhea,
gastric dysmotility, chronic abdominal pain.
- Analyze and evaluate practice experiences and implement strategies to continually
improve the quality of patient practice. Examples: Evaluate compliance
with Hepatitis C guidelines and work to improve that compliance.
- Develop and maintain a willingness to learn from errors and use errors to
improve the system or processes of care.
- Use information technology or other available methodologies to access and
manage information, support patient care decisions and enhance both patient
and physician education. Example: Use Clinical Data Repository to provide
summary of the course of liver test abnormalities in patients with acute or chronic
Interpersonal and Communication Skills:
Residents are expected to demonstrate interpersonal and communication skills
that enable them to establish and maintain professional relationships with patients,
families and other members of health care teams.
- Provide effective and professional consultation to other physicians and
health care professionals and sustain therapeutic and ethically sound professional
relationships with patients, their families, and colleagues.
- Use effective listening, nonverbal, questioning, and narrative skills to
communicate the patients. Examples: Educating patients regarding transmission
of chronic viral hepatitis C, and risk associated with alcohol consumption.
- Interact with consultants in a respectful, appropriate manner. Examples:
Communicate efficiently and effectively with consulting physician regarding
one's recommendations for evaluation and treatment of the patient.
- Maintain comprehensive, timely, and legible medical records. Examples:
Thorough, dictated consultations; complete legible daily progress notes
pertaining to the GI disease.
Residents are expected to demonstrate behaviors that reflect a commitment to
continuous professional development, ethical practice, an understanding and
sensitivity to diversity and a responsible attitude toward their patients, their
profession, and society.
- Demonstrate respect, compassion, integrity, and altruism in relationships
with patients, families, and colleagues. Example: Demonstrate the above
with all patients, including those with behavior-induced diseases such as
alcoholic cirrhosis or hepatitis C. Demonstrate willingness to work up and
follow new patients.
- Demonstrate sensitivity and responsiveness to the gender, age, culture,
religion, sexual preference, socioeconomic status, beliefs, behaviors and
disabilities of patients and professional colleagues. Example: Respecting
beliefs regarding transfusions in Jehovas Witness; Respecting the privacy
of patients with HIV-related GI disorders.
- Adhere to principles of confidentiality, scientific/academic integrity,
and informed consent.
- Recognize and identify deficiencies in peer performance.
Residents are expected to demonstrate both an understanding of the contexts
and systems in which health care is provided, and the ability to apply this
knowledge to improve and optimize health care.
- Understand, access and utilize the resources, providers and systems necessary
to provide optimal care. Examples: Use of nutritional support services
for patients unable to eat.
- Understand the limitations and opportunities inherent in various practice
types and delivery systems, and develop strategies to optimize care for the
individual patient. Examples: Referral system/strategy to county hospital
for uninsured patients with HCV.
- Apply evidence-based, cost-conscious strategies to prevention, diagnosis,
and disease management. Examples: Screening for colon cancer. Screening
for Helicobacter pylori.
- Collaborate with other members of the health care team to assist patients
in dealing effectively with complex systems and to improve systematic processes
of care. Examples: Use of nurse educators on teaching patients about
their GI disease; Use of support groups such as inflammatory bowel disease
III. Methods of instruction:
- Didactic (schedule, topic, faculty)
Daily residents conference 12:00-1:00 p.m. - IM Training Room
Wednesday mornings 7:30-8:00 a.m. - Clinical Ground Rounds -
IM Training Room
Wednesday afternoons 12:15-1:00 p.m. - Internal Medicine Update - Haggar
Monday evenings 5:00 - 6:00 p.m. - Hepatopancreaticobiliary Conference - IM Training Room
Residents will perform in patient consultations and daily follow-up care. Each afternoon, residents will see outpatients with the attending. All residents should attend daily 12:00 Internal Medicine conference. Internal Medicine conference as well as the Medical Science for Physicians lectures series and Citywide Clinical conference on Thursday afternoons at UT Southwestern. One weekend of call duty is required.