VIEWS: 7 PAGES: 6 POSTED ON: 10/28/2011
GOALS AND OBJECTIVES Second Year Fellow GI Ward Service Mission Statement: To provide the opportunity for fellows to learn the art and science of clinical care in a tertiary hospital in the subspecialty discipline of Gastroenterology-Hepatology, to include the approach to patient diagnosis with or suspected of having gastrointestinal disease as well as the study of testing, procedures and drug therapy in the treatment of these diseases. Program Objectives: Patient Care: To improve clinical skills as applied to the evaluation of patients with known or suspected gastrointestinal disease. To develop to maximal utilization of diagnostic testing in the evaluation and management of gastrointestinal and liver disease. This includes integrating information provided by the diagnostic radiologists and pathologists into clinical care of patients. To utilize a multi-disciplinary approach in diagnosing and managing the patient with gastrointestinal and liver disease. This includes services of the physicians in different disciplines (surgery, diagnostic radiology, interventional radiology, pathology, critical care medicine, radiation oncology, medical oncology) and ancillary care staff (case managers, social workers) to optimally care for the patient. Medical Knowledge: To know the details of complex gastrointestinal problems requiring hospitalization to the GI Ward service To become proficient in procedures used in diagnosis and treatment of Gastrointestinal Disease. To learn the medical management of complex gastrointestinal disorders including chronic abdominal pain, inflammatory bowel disease, gastrointestinal bleeding, and pancreatitis To learn appropriate diagnostic testing for these disorders. By reading the recommended articles available on the UAB GI Fellowship website pertaining to the below topics. To learn better appreciation for the treatment of pain and end of life care. Supervise and teach House staff including provision of didactic sessions. Practice Based Learning: See Core Competencies Interpersonal Skills and Communication: See Core Competencies. Professionalism: See Core Competencies System Based Practice: See Core Competencies Program Components In this required 4 week rotation, fellows will spend time working on the GI Ward at University Hospital treating patients hospitalized with gastrointestinal disorders. Activities on this rotation will include: 30 minute lecture before rounds – minimum three times per week by fellow or attending. Review journal article topic pertaining to a patient on the ward service weekly Radiology rounds on new patients and as needed –review CT scans, ABD US, MRI, and HIDA scans etc with GI attending and radiologist In addition, the fellows will attend the various multi-disciplinary conferences (Radiology Conference, GI-Pathology Conference, Hepato-Billary Conference, Liver –Pathology Conference, GI Grand Rounds. Focused Areas for Study: Upper GI bleeding Lower GI bleeding Obscure GI bleeding Acid-Peptic disorders including peptic ulcer disease and Zollinger-Ellison Syndrome Acute pancreatitis – both simple and complicated Chronic pancreatitis Inflammatory Bowel Disease Chronic Diarrhea Infections of the GI tract Vascular disorders of the GI tract Acute and chronic abdominal pain Dysphagia Post-procedure complications Intractable nausea and vomiting Biliary tract disease including gallstones Gastrointestinal Neoplasms GI manifestations of HIV Educator Role The supervising attending in this rotation will act as a liaison between the physicians ordering specialized tests, or whose patient have developed problems so that clinical information needed to interpret tests can be communicated to the appropriate parties and results and significance of tests and physical findings will be accurately transmitted to the patient’s team. Evaluation and Feedback The supervising attending physician will provide direct and written feedback to the fellow based upon direct observation based on the following six competencies: Patient Care 1) Gathers essential and accurate information about the patient through interviews, examination and complete history; appropriately accesses additional sources of information, such as other health care facilities, non-UAB or VAMC physicians, and family members. 2) Interacts with other health-care professionals to facilitate the process of diagnosis and treatment planning. 3) Carries out patient management plans based on age, other co morbid conditions, psychosocial issues, including arranging appropriate follow-up of diagnostic tests. Medical Knowledge 1) Understands the approach to the patient with known or suspected gastrointestinal disease 2) Understands the principles of treatment drugs and or procedures and their administration 3) Understands the principles regarding gastrointestinal disease and related complications Practice-Based Learning 1) Uses feedback to identify areas of improvement 2) Seeks opportunities to strengthen deficits in knowledge/skills 3) Demonstrates initiative in researching current scientific evidence using modern information technology and applying it to problems encountered in daily practice. Interpersonal and Communication Skills 1) Communicates effectively with other members of a multi-disciplinary team 2) Maintains a comprehensive, timely and legible medical record 3) Communicates comprehensively and compassionately with patients and their family members 4) Provides accurate and timely feedback to the attending physician as well as to the referring physician Professionalism 1) Recognizes ethical dilemmas and utilizes appropriate consultation where needed 2) Adheres to laws and rules governing the confidentiality of patient information 3) Adheres to the institution’s Code of Conduct Systems-Based Practice 1) Demonstrates a commitment to the practice of cost-effective medical care and resource allocation 2) Partners with other members of the health-care team to manage complex patient issues 3) Advocates and facilitates patient advancement through the health care system In the interest of improving the quality of learning environment in fellowship, the fellows must confidentially provide a written evaluation of each teaching attending at the end of the rotation. We also require that the fellows complete a questionnaire critically assessing the completeness of their acquisitions of the knowledge expected for the rotation, and, if their knowledge acquisition is not adequate, their plans to “fill the gaps”. Reading List (See Gastroenterology Division Website - Resources http://gastro.dom.uab.edu/fellowshipprogram/currentfellows/ I. Topics commonly seen on GI Wards 1. Esophageal Disorders Barrett’s Esophagus- Updated Guidelines for the Diagnosis, Surveillance, and Therapy of Barrett’s Esophagus. AJG (2002) 97(8): 1888-1895. (Sampliner RE) Achalasia- Diagnosis and Management of Achalasia. AJG (1999) 94(12): 3406-3412. (Vaezi and Richter) Esophageal Cancer- Esophageal Cancer. AJG (1999) 94(1): 20-29. (Lightdale) Eosinophilic Esophagitis- Eosinophilic Esophagitis. Dig Dis Sciences. (2003) 48(1):22- 29. (Khan S) 2. GERD Updated Guidelines for the Diagnosis and Treatment of Gastroesophageal Reflux Disease. AJG (2005) 100: 190-200. (DeVault KR) 3. Feeding Tubes Tube Feeding in Patients with Advanced Dementia. JAMA (1999) 282(14): 1365- 1370. (Finucane TE) See PPT presentation by Steve McClave (Louisville, Kentucky). 4. Acute Pancreatitis Acute Necrotizing Pancreatitis. NEJM (1999), 340 (18): 1412-1417. (Baron) Idiopathic Acute Pancreatitis. J Clin Gastro (2003), 37(3):238-250. (Kim H J) 5. Chronic Pancreatitis Pathogenesis of Chronic Pancreatitis: An Evidence-Based Review of Past Theories and Recent Developments. AJG (2004), 99(11): 2256-. 6. Peptic Ulcer Disease- Helicobacter Pylori and NSAIDS Guidelines for the Management of Helicobacter pylori Infection. AJG (1998) 93(12): 2330-2338. (Howden CW) A Guideline for the Treatment and Prevention of NSAID-Induced Ulcers. AJG (1998) 93(11): 2037-3046. (Lanza) Gastrointestinal Toxicity of Nonsteroidal Anti-inflammatory Drugs. NEJM (1999) 340(24): 1888-1899. (Wolfe MM) 7. Zollinger-Ellison Syndrome Zollinger-Ellison syndrome: Pathogenesis, diagnosis, and management. AJG (1997) 92 (4 Suppl): S44-. (Hirschowitz) 8. Upper GI Bleeding Endoscopic Treatment Compared with Medical Therapy for the Prevention of Recurrent Ulcer Hemorrhage in Patients with Adherent Clots. Gastro Endo (2003) 58(5): 707-714 (Bini EJ) 9. Lower GI Bleeding Management of Adult Patients with Acute Lower Gastrointestinal Bleeding. AJG (1998) 93(8): 1202-1208. (Zuccaro) Colonoscopic Management of Lower Gastrointestinal Hemorrhage. Cur Gastro Reports (2001) 3:425-432. (Terdiman JP) Urgent Colonoscopy for the Diagnosis and Treatment of Severe Diverticular Hemorrhage. NEJM (2000) 342: 78-82. (Jensen) Hormonal Therapy for Gastrointestinal Angiodysplasia. Lancet (2002) 359:1630- 1631. (Hodgson H) 10. Occult GI Bleeding AGA Technical Review on the Evaluation and Management of Occult and Obscure Gastrointestinal Bleeding. Gastro (2000) 118: 201-221. (Zuckerman GR) 11. Ulcerative colitis Ulcerative Colitis Practice Guidelines in Adults (Update): American College of Gastroenterology Practice Parameters Committee. AJG (2004) attached. (Kornbluth A) Cyclosporin for Severe Ulcerative Colitis: A User’s Guide. AJG (1997) 92(9): 1424- 28. (Kornbluth A) 12. Crohn’s Disease Management of Crohn’s Disease in Adults. AJG (2001) 96(3):635-643. (Hanauer SB) 13. Diverticulosis Diagnosis and Management of Diverticular Diseases of the Colon in Adults. AJG (1999) 94(11): 3110-3121. (Stollman NH) New Developments in Diverticular Disease. Cur Gastro Reports (2001) 3: 420-424. (Cima RR) 14. Colon Cancer Polyp Guideline: Diagnosis, Treatment, and Surveillance for Patients With Colorectal Polyps. AJG (2000) 95(11): 3053-3063. The Hereditary Nonpolyposis Colorectal Cancer Syndrome: Genetics and Clinical Implications. Ann Intern Med (2003) 138: 560-570. (Chung DC) 15. Acute Diarrhea Guidelines for the Management of Acute Diarrhea in Adults. J of Gastro and Hep (2002) 17 (Suppl): S54-71. (Manatsathit and Dupont) 16. Clostridium Difficile Breaking the Cycle: Treatment Strategies for 163 Cases of Clostridium Difficile Disease. (2002 97(7): 1769-1775. (McFarland) The above has been discussed Fellow Attending Physician REV 062811
"2nd Year - Division of Gastroenterology _ Hepatology"