Gastroenterology Competencies Curriculum

Program: Internal Medicine, Sinai-Grace

Detroit Medical Center/Wayne State University

Program Director: Mohamed S. Siddique M.D.

GI rotation Director: Anthony Williams, M.D.

GI rotation Faculty: Anthony Williams, M.D., Ahmed Aburashed, M.D., Prince Eubanks, M.D., Edward Clay,

M.D., Manuel Sklar, M.D.

Date: February 2009

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	Learner based and not teacher based education. Learners should be able to examine patients efficiently and accurately Learner should have respect for patient preferences 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	GI consults and rounds with the GI attending Morning report M & M conference Medical grand rounds Ambulatory care clinic training – primary care and GI Learn flexible sigmoidoscopy PERKS (Promoting Excellence in Resident’s Knowledge and Skills)	Monthly rotation evaluation by attending Procedure logs Discussion of consults and supervision of procedural skill PERKS – Evaluated at the end of each session Annual bed side exam 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	Demonstrate working knowledge of initial therapy for common and serious medical problems Commitment to continuous learning Develop comprehensive understanding of complex medical problems Demonstrate analytical thinking	GI consult and rounds with attending Morning report GI lectures during rotation Board review course for PGY-II and IIIs Medical grand rounds M & M Annual multidisciplinary medicine rotation (MDM)	Monthly exam for all house staff GI pre and post tests In-Training exam Monthly rotation evaluation by attending Quarterly evaluation with the advisor Year-end Comprehensive exam
Interpersonal and Communication Skills That result in effective information exchange and teaming with patients, their families, and other health professionals	Communicate effectively with attending faculty Demonstrate effective patient/family interviewing skills Establish excellent relationships with patients/families Able to educate and counsel patient/families Improve listening skills Able to maintain comprehensive, timely, legible medical records Prepare and present effective medical presentations to peers	Rounds on consult patients Counseling prior to endoscopies MDM course PERKS program Oral/Poster presentation and discussion Peer-group discussion	Monthly evaluations PERKS program Chart audits by faculty and CMR 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	Treat patient and families with respect and consideration Treat nursing and other health care professional with respect Understand issues of race, religion, sexual orientation, disability, age, culture, gender etc. in patients and other health care providers Always respect patients’ autonomy Serve the interest of the patients Maintain trust by managing conflicts of interest Always be honest with patients Always maintain patients’ confidentiality Strive to improve patients’ quality of care Maintain appropriate relations with patients	MDM course Noon lectures by faculty ABIM case modules – Done during MDM course Daily interaction with health care professionals Peer-group discussion Faculty Role modeling	Monthly rotation evaluation by attending Resident interaction with patients, nurses, endoscopy unit staff during the rotation
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	Learn and demonstrate knowledge of scientific study design and statistical methods Learn to accept feedback from others Regularly self-assess Use information technology to manage information, access on-line medical information and support their own education on a regular basis Facilitate learning of others	Ambulatory lectures MDM course for all house staff Evidence Based Medicine course for all house staff Journal club, M & M exercises Book: Users’ guides to the Medical Literature (JAMA) Use of standard order sets/clinical pathways to promote optimal cost effective care Self-directed inquiry Interactive computer programs	Residents’ Grand Round presentation Residents’ Update presentation Poster/Oral presentation at scientific meetings i.e. ACP-MI Chapter, National Meetings, annual Departmental research day Periodic chart audit for compliance with current guidelines and compare to NCQA benchmarks
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	Participate efficiently in multidisciplinary discharge planning Practice cost-effective care Learn to minimize patient care errors 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 Advocate for patients within the health care system	Daily interaction with nurse care coordinator Multidisciplinary health care team rounds MDM course M & M conference	Monthly rotation evaluation by attending Rounds with GI attending Coordination of care by resident

Gastroenterology Core Topics:

Esophagus:

1. Dysphagia
2. GERD/Dyspepsia/Non cardiac chest pain
3. Barrett’s esophagus
4. Esophagitis

Stomach and Duodenum:

1. PUD and complications
2. Gastric polyps
3. Gastric surgical procedures and bariatric surgery

Colon/Small intestine:

1. Acute/chronic diarrhea
2. Malabsorption
3. Inflammatory bowel disease
4. Constipation
5. Intestinal vascular disease
6. Diverticular disease

Liver:

1. Approach to patient with abnormal liver tests
2. Viral hepatitis
3. Autoimmune hepatitis
4. Metabolic liver disease
5. Cholestatic liver disease
6. Chronic liver disease and complications
7. Liver disease and pregnancy
8. Liver disease and hepatotoxins (drugs, alcohol)
9. Hepatobiliary disease – acute cholecystitis, cholangitis

Gastrointestinal tumors

GI manifestations of HIV

GI Non Core topics:

1. Functional abdominal pain
2. Nausea/vomiting
3. Fecal incontinence
4. Irritable bowel syndrome
5. Portal hypertension management
6. C. difficile colitis

Recommended reading:

1. Slasenges & Foldtran Gastrointestinal disease, current edition
2. Zakim hepatology, current edition
3. Harrison’s Textbook of Internal Medicine, GI section, current edition
4. MKSAP – GI Section

3. Articles given by GI Attending

Rotation Schedule

	Monday	Tuesday	Wednesday	Thursday	Friday
7.00 – 9.00 am	Work Rounds	Work rounds	Work rounds	Work rounds	Work rounds
9.00 – 10.00 am	Morning Report	Morning report	Morning report	Morning report	Morning report
10.00 – 11.00 am	Consults	Consults	Consults	Board Review	Consults
11.00am – 12.00pm	Consults	Consults	consults	Board Review	Consults
12.00 – 1.00 pm	Noon conf/lunch	Noon Conf/Lunch	Noon conf/Lunch	Noon Conf/Lunch	Noon Conf/Lunch
1.00 – 2.00 pm	Core lecture		Core lecture		Core Lecture
2.00 – 3.00 pm	GI/pathology	GI radiology	Office	Office
3.00 – 4.00 pm	Office	Office	Office	Office
4.00 – 5.00 pm	Office	Office	Office	Office