Department of medicine

GI Consults Medical University

Educational Purpose:

The GI Consult service was established to give the resident physicians additional experience in the field of gastroenterology.  The resident performs consults on a broad range of patients with GI illnesses or complaints.  Additionally, residents gain experience in the performance of flexible sigmoidoscopy and observing colonoscopy and upper endoscopy.

Goals and Objectives:

PGY-1-

1. Learn presentation and management of common gastrointestinal conditions such as acute gastrointestinal bleeding, inflammatory bowel disease including crohns and ulcerative colitis, diarrheal illnesses, acute pancreatitis, chronic pancreatitis, gastrointestinal malignancies.

2. Learn indications, contraindications, and limitations of common gastroenterology procedures including esophagogastroduodoscopy (EGD), colonoscopy, endoscopiccholangiopancreatography (ERCP), as well as endoscopic ultrasound.

3. Learn and manage complicated inflammatory bowel disease including using immunosuppressants, immunomodulators, and biologics in treatment.

PGY-2&3-

1. Learn presentation and management of common gastrointestinal conditions such as acute gastrointestinal bleeding, inflammatory bowel disease including crohns and ulcerative colitis, diarrheal illnesses, acute pancreatitis, chronic pancreatitis, gastrointestinal malignancies.

2. Learn indications, contraindications, and limitations of common gastroenterology procedures including esophagogastroduodoscopy (EGD), colonoscopy, endoscopiccholangiopancreatography (ERCP), as well as endoscopic ultrasound, and percutaneous gastrostomy tubes. 

3. Learn and manage complicated inflammatory bowel disease including using immunosuppressants, immunomodulators, and biologics in treatment.

4. Develop short and long term treatment plans of care.

5. Supervise and manage team members including interns and medical students.

Teaching Methods:

Consult rounds with the GI fellow and the attending physician five days per week.  Direct education about procedures in the Medical University Hospital and Ashley River Tower endoscopy suites, as well as didactic sessions with the attending physician.

Mix of Diseases and Pathological Material:

The program incorporates two teaching hospitals:  The Medical University Hospital (MUH) and the Charleston VA Medical Center (VAMC).  Faculty expertise draws patients with a myriad of disease processes including inflammatory bowel disease, pancreaticobiliary disease, complex nutritional issues such as short bowel syndrome, achalasia, and other disorders of the esophagus, among many others.  In particular, MUH is a tertiary facility providing a high level of care in all aspects of Internal Medicine where renal, bone marrow, cardiac, lung, pancreas, and liver transplantation programs are ongoing.  In addition, the interests of the Gastroenterology faculty attract patients with biliary tract and liver disease, nutritional problems, gastrointestinal motility disorders, and malignancies. 

Patient Characteristics:

Residents care for a diverse patient population with respect to age, ethnicity, and gender.  The majority of the patients are older adults, but there are significant numbers of and young adult patients in some sites.  All have acute or chronic gastrointestinal diseases as well as chronic general medical conditions.

Types of Clinical Encounters:

The resident assigned to the Medical University consult service serves in the consultative role by initially reviewing the patient’s condition, presenting his/her evaluation to the GI fellow and the attending physician assigned to the medical university consult service, and formally writing recommendations in a consult report.  At the Medical University, there is an opportunity for the medial resident to perform flexible sigmoidoscopy.  The resident also attends the VAMC clinic on Wednesday afternoon.  New patients are evaluated, and management decisions are made under the direct supervision of the attending physicians.

Procedures and Services:

The resident has the opportunity to perform flexible sigmoidoscopy as noted.  The resident also observes upper endoscopies and colonoscopies. 

Supervision:

The attending physician supervises the fellow and the resident and the fellow help supervise the resident as follows:  attending physician of record, GI fellow, medical resident.

Educational Resources to be Used and Reading Lists:

The GI Division maintains an up to date library containing textbooks, journals, teaching slides, and video cassettes.  Computers are available for data base searches.  Materials compiled by the Division are available for distribution to residents that contain outlines and leading articles on important, mainstream, clinical topics in gastroenterology and hepatology. Most of the teaching of residents is patient-generated and supplemented by relevant reading material from relevant current and landmark evidence based literature.

Method of Evaluation of Resident Competence:

The attending physician provides formative feedback at the halfway mark of the rotation.  Residents are evaluated summatively using the global evaluation form.  The Mini-CEX is often administered on this service as well.  Patient Care is assessed based on direct observation and complete review of all records.  Medical Knowledge is assessed through direct questioning and observation.  Interpersonal Skills and Communication is assessed by observation of interactions with consulting physicians, patients, and families.  The attending physician evaluates Professionalism through direct interaction and observation of the resident.  Systems-Based Practice is evaluated based on interactions with the primary team and the ability to provide medical care in collaboration with consultants, and other specialists in the cares of the patients with emphasis placed on optimization of patient care. Practice-Based Learning is evaluated based on the ability to consult the literature and to improve their performance throughout the rotation.  The residents evaluate the rotation and the attending physician through the E*Value system.  The consult attendings review the rotation evaluations and each attending anonymously receives his or her evaluations

The resident evaluates the rotation and the attending physician.

 
 
 

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