Gastroenterology Curriculum

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

1. 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.

2. Course Goals and Objectives: (based on ACGME competencies for resident education.)

Patient Care:

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 C.

• 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.

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 hepatitis.

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 Jehova’s 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 support group.

III. Methods of instruction:

1. 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 Hall
Monday evenings 5:00 - 6:00 p.m. - Hepatopancreaticobiliary Conference - IM Training Room

2. Clinical