Department of medicine

Gastroenterology Luminal Inpatient Service

Educational Purpose:

To provide instruction in the diagnosis and treatment of patients with a variety of gastrointestinal illnesses, exposure to basic and advanced flexible endoscopy, promote better understanding of the indications and contraindications of various endoscopic procedures.

Goals and Objectives:

PGY-1-

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

2. Learn indications, contraindications, and limitations of common gastroenterology procedures including esophagogastroduodenoscopy (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 Crohn's and ulcerative colitis, diarrheal illnesses, acute pancreatitis, chronic pancreatitis, gastrointestinal malignancies.

2. Learn  indications, contraindications, and limitations of common gastroenterology procedures including esophagogastroduodenoscopy (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:

Participation in the care of ambulatory patients with a variety of gastrointestinal ailments.  Bedside or “sit down” teaching rounds for in-hospital patients.  Formal, regularly scheduled clinical conferences (many of which are multidisciplinary in nature).  Direct supervision of care of ambulatory patients in GI clinics.

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.  The Division of Gastroenterology at the VAMC has an active outpatient colon cancer screening program and hepatitis C clinic in addition to the fellows’ continuity clinics.

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 adolescent 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:

Chronic gastrointestinal bleeding, alcohol and viral-related liver diseases, pancreatitis, and gastrointestinal malignancy.  To provide patient coverage:  MUH Luminal in-patient service, MUH Luminal consult service, MUH Liver in-patient consult service.

Procedures and Services:

The MUH and VAMC provide a full spectrum of flexible endoscopic procedures.  Over 6000 procedures are performed each year.  At MUH there are both in-patient and out-patient endoscopy suites.  Each endoscopy facility is equipped and staffed for upper endoscopy (EGD), colonoscopy, percutaneous endoscopic gastrostomy (PEG), esophageal dilation, esophageal banding, and the like. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) are performed in the inpatient endoscopy facility at MUH.

Supervision:

Attending physician of record supervises the GI fellow, medical resident, medical intern, and medical students.

Educational Resources to be Used and Reading Lists:

The residents and medical students assigned to the various services are required to attend the weekly GI fellows’ conference.  The Division maintains an up-to-date audiovisual library for self-directed learning containing textbooks, journals, teaching slides, and DVDs located adjacent to the Video Conference Room.  Weekly or bi-weekly conferences include:  GI Fellows’ Conference, Pancreaticobiliary Conference, Clinical Research Conference, various multidisciplinary tumor boards, Liver Biopsy Review as well as  teaching rounds by gastroenterology faculty members.

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.

 
 
 

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