Gastroenterology Competencies Curriculum

 

 

Program:                        Internal Medicine, Sinai-Grace

                                          Detroit Medical Center/Wayne State University

 

Program Director:        Mohamed S. Siddique M.D.

 

GI rotation Director:     Manuel Sklar M.D.

 

Date:                                September 2007

 

 

 

 

Competency

 

Objectives

Specific

 

Educational Experiences

Knowledge/ Skills

Integration/Application

 

 

Assessment

Tools

 

 

Patient Care

That is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health

 

  1. Learner based and not teacher based education.
  2. Learners should be able to examine patients efficiently and accurately
  3. Learner should have respect for patient preferences
  4. Physician in training should develop and master the following skills:

§         Interviewing

§         Performance of routine physical exam

§         Performance of rectal examination

§         Counsel and Educate patients and families

§         Preventive health care

§         Work within a team

§         Know when to consult a Gastroenterologist

 

  1. GI consults and rounds with the GI attending
  2. Morning report
  3. M & M conference
  4. Clinical-pathological conference
  5. Medical grand rounds
  6. Ambulatory care clinic training – primary care and GI
  7. Learn flexible sigmoidoscopy
  8. PERKS (Promoting Excellence in Resident’s Knowledge and Skills) - OSCE

 

  1. Monthly rotation evaluation by attending
  2. Procedure logs
  3. Mini-CEX (ABIM)#
  4. Discussion of consults and supervision of procedural skill
  5. PERKS – Evaluated at the end of each session - OSCE
  6. Annual bed side exam
  7. Quarterly evaluation with the advisor

 

 

 

 

 

Medical Knowledge

About established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care

 

  1. Demonstrate working knowledge of initial therapy for common and serious medical problems
  2. Commitment to continuous learning
  3. Develop comprehensive understanding of complex medical problems
  4. Demonstrate analytical thinking

 

  1. GI consult and rounds with attending
  2. Morning report
  3. GI clinic with attending
  4. GI exam answer discussion
  5. Board review course for PGY-II and IIIs
  6. Medical grand rounds
  7. M & M
  8. Annual multidisciplinary medicine rotation (MDM)

 

  1. Monthly exam for all house staff
  2. Pre and post test
  3. Monthly PERKS program - OSCE
  4. Evaluation of MDM course
  5. In-Training exam
  6. Monthly rotation evaluation by attending
  7. Quarterly evaluation with the advisor
  8. Year-end Comprehensive exam

 

 

 

 

 

Interpersonal and Communication Skills

That result in effective information exchange and teaming with patients, their families, and other health professionals

 

  1. Communicate effectively with attending faculty
  2. Demonstrate effective patient/family interviewing skills
  3. Establish excellent relationships with patients/families
  4. Able to educate and counsel patient/families
  5. Improve listening skills
  6. Able to maintain comprehensive, timely, legible medical records
  7. Prepare and present effective medical presentations to peers

 

  1. Rounds on consult patients
  2. Councelling prior to endoscopies
  3. MDM course
  4. PERKS program - OSCE
  5. Oral/Poster presentation and discussion
  6. Peer-group discussion

 

 

  1. Monthly evaluations
  2. Mini-CEX (ABIM)
  3. PERKS program – OSCE
  4. Chart audits by faculty and CMR
  5. PERKS program - OSCE
  6. Quarterly evaluation with the advisor

 

 

 

 

 

 

Professionalism

As manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population

 

  1. Treat patient and families with respect and consideration
  2. Treat nursing and other health care professional with respect
  3. Understand issues of race, religion, sexual orientation, disability, age, culture, gender etc. in patients and other health care providers
  4. Always respect patients’ autonomy
  5. Serve the interest of the patients
  6. Maintain trust by managing conflicts of interest
  7. Always be honest with patients
  8. Always maintain patients’ confidentiality
  9. Strive to improve patients’ quality of care
  10. Maintain appropriate relations with patients

 

  1. MDM course
  2. Noon lectures by faculty
  3. ABIM case modules – Done during MDM course
  4. Daily interaction with health care professionals
  5. Peer-group discussion
  6. Faculty Role modeling

 

 

  1. Monthly rotation evaluation by attending
  2. ABIM Praise Cards and Early warning Cards
  3. Quarterly Advisor/Advisee meeting
  4. Mini-CEX (ABIM)#
  5. Quarterly evaluation with the advisor

 

 

 

 

 

 

 

Practice-Based Learning and Improvement

That involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care

 

  1. Learn and demonstrate knowledge of scientific study design and statistical methods
  2. Learn to accept feedback from others
  3. Regularly self-assess
  4. Use information technology to manage information, access on-line medical information and support their own education on a regular basis
  5. Facilitate learning of others

 

  1. Ambulatory lectures
  2. MDM course for all house staff
  3. Evidence Based Medicine course for all house staff
  4. Journal club, M & M exercises
  5. Book: Users’ guides to the Medical Literature (JAMA)
  6. Use of standard order sets/clinical pathways to promote optimal cost effective care
  7. Self-directed inquiry
  8. Interactive computer programs

 

 

 

  1. Residents’ Grand Round presentation
  2. Residents’ Update presentation
  3. Poster/Oral presentation at scientific meetings i.e. ACP-MI Chapter, National Meetings, annual OHEP research day, annual Departmental research day
  4. Awards at several scientific meetings
  5. Periodic chart audit for compliance with current guidelines and compare to NCQA benchmarks
  6. Quarterly evaluation with the advisor

 

 

 

 

 

Systems-Based Practice

As manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system for health care and the ability to effectively call on system resources to provide care that is of optimal value

 

  1. Participate efficiently in multidisciplinary discharge planning
  2. Practice cost-effective care
  3. Learn to minimize patient care errors
  4. Understand various types of health insurances and how it impacts patient care in both in-patient/out-patient settings i.e. LOS, UR and prescriptions
  5. Advocate for patients within the health care system

 

  1. Daily interaction with nurse care coordinator
  2. Multidisciplinary health care team rounds
  3. MDM course
  4. Net learning
  5. Medical Errors – Workshop
  6. M & M conference
  7. Noon lectures by faculty on the following topics:

§         Introduction to Managed Care

§         Insurances

§         Negotiating Managed Care Contracts

§         Economics of Managed Care Contracts

 

  1. Monthly rotation evaluation by attending
  2. Rounds with GI attending
  3. Weekly Interdisciplinary case conference
  4. Quarterly evaluation with the advisor

 

 

 

 

 

 

# Done intermittently by faculty. Compliance is about 50%

 

Gastroenterology Topics:

 

  1. Esophageal disorders – GERD, Dysphagia, Motility Disorders, Esophageal Cancer, Esophagitis, Diagnostic modalities, Indications for endoscopy.
  2. Stomach disorders – PUD, NSAID gastropathy, Dyspepsia, Gastroparesis, Gastric cancer, Indications for endoscopy.
  3. Gastrointestinal Bleeding
  4. Diarrheas – Acute, Chronic, Maldigestion, Malabsorption, Infectious, Functional, Osmotic and Secretory, Dysmotility, Steatorrhea
  5. Inflammatory Bowel disease
  6. Intestinal Ischemia and Irritable Bowel syndrome
  7. Colorectal Cancer – Screening, Prevention, Diagnosis, Management and Follow-up.
  8. Liver Disorders – Elevated liver enzymes, Acute hepatitis, NASH, Alcoholic liver diseases, Hepatitis A,B, C, D, E, Chronic hepatitis, Autoimmune hepatitis, Cirrhosis, Inherited Disorders: Wilson’s Disease, Hemochromatosis, Alpha1 antitrypsin deficiency, Primary Biliary Cirrhosis, Primary Sclerosing Cholangitis, Liver diseases in pregnancy, Hepatoma and Hepatic mass.
  9. Biliary disorders – Gallstones, Acute Cholecystitis, Cholangitis, Indications for ERCP, Cholangiocarcinoma
  10. Pancreas Disorders – Acute and Chronic Pancreatitis, Pancreatic cancer
  11. Indication for Liver Transplant and Post transplant follow-up

 

Recommended reading:

 

  1. Harrison’s Textbook of Medicine – GI Section
  2. MKSAP – GI Section

3.   Articles given by GI Attending