GOALS AND OBJECTIVES
GI Ward Service
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
To improve basic clinical skills as applied to the evaluation of patients with
known or suspected gastrointestinal disease.
To learn how to maximally utilize 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
To gain exposure to complex gastrointestinal problems requiring hospitalization
to the GI Ward service
To become familiar with procedures used in diagnosis and treatment of
To learn the medical management of complex gastrointestinal disorders including
chronic abdominal pain, inflammatory bowel disease, gastrointestinal bleeding,
To learn appropriate diagnostic testing for these disorders.
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
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
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
Acute pancreatitis – both simple and complicated
Inflammatory Bowel Disease
Infections of the GI tract
Vascular disorders of the GI tract
Acute and chronic abdominal pain
Intractable nausea and vomiting
Biliary tract disease including gallstones
GI manifestations of HIV
Specific Goals Specified Per Training Year for GI Wards
1. 1st Year: Trainees are expected to be knowledgeable of at least the topics outlined
below. It is likely that you will care for patients with each disease process at
some point during your 2-3 month GI Ward rotations.
2. 2nd Year: The corresponding articles provided and chapters in Sleisenger and
FORTRAN’s text should be read during the 2-3 month GI Ward rotations.
3. 3rd Year: Trainees are expected to advance their knowledge base with further
readings of the most current information in the field of GI and Hepatology
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
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:
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.
1) Understands the approach to the patient with known or suspected
2) Understands the principles of treatment drugs and or procedures and their
3) Understands the principles regarding gastrointestinal disease and related
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
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
4) Provides accurate and timely feedback to the attending physician as well as to the
1) Recognizes ethical dilemmas and utilizes appropriate consultation where
2) Adheres to laws and rules governing the confidentiality of patient information
3) Adheres to the institution’s Code of Conduct
1) Demonstrates a commitment to the practice of cost-effective medical care and
2) Partners with other members of the health-care team to manage complex
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”.
I. Topics commonly seen on GI Wards
1. Esophageal Disorders
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. AJG (1999) 94(1): 20-29. (Lightdale)
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.
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.
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
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