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2nd Year - Division of Gastroenterology _ Hepatology


									                                  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
   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
  2)       Understands the principles of treatment drugs and or procedures and their
  3)       Understands the principles regarding gastrointestinal disease and related

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
   4) Provides accurate and timely feedback to the attending physician as well as to the
       referring physician

   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
   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
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)
     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)
     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


Attending Physician
REV 062811

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