Gastroenterology
I.
Rationale
Family physicians deal with gastrointestinal problems as one of their most frequent complaints. As
such, family physicians need to know how to diagnosis and manage common gastrointestinal
conditions, in addition to treating emergency GI problems and the GI aspects of preventive health.
II.
Competencies
Medical Knowledge and Patient Care
Goal: Provide evidence based and medically competent care to patients with GI conditions.
Expose the resident to common gastrointestinal problems.
Provide the opportunity to learn the GI directed history and physical exam.
Learn common GI procedures and therapeutic modalities.
Objectives:
A. The resident will completely evaluate and manage common GI medical problems, including the
following:
Upper/Lower Gl bleeds
Abnormal LFTs
Hepatitis
Diverticulitis
Colon cancer and guaiac positive stool
Dyspepsia
PUD
GERD
Dysphagia
Diarrheal disease
Irritable bowel syndrome
Abdominal pain
Inflammatory bowel disease
Pancreatitis
Gallbladder disease
Ascites
B. The resident will list the indications for and limitations of EGD, ERCP, colonoscopy, flexible
sigmoidoscopy, barium enema, UGI studies, and various bleeding scans.
C. The resident will list common GI radiology studies, including Upper GI with SBFT, barium
enema and abdominal x-ray series.
D. The resident, when possible, will gain experience in flexible sigmoidoscopy, colonoscopy,
anoscopy, paracentesis, and other procedures commonly performed by gastroenterologists and
family physicians.
E. The resident will articulate proper use of GI consultations (inpatient and outpatient).
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Last Updated April 19, 2013
Research Conference
Ethics/Comm Conference
Specialty Conference
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
X
Sub-Specialty Conference
Morning Report
Didactics
Other
Evaluation Methods
X
Attending Evaluation
X
Program Director
Review
360 ᵒ evaluation
Other
X
X
Noon Conference
Faculty Supervision
Procedures
X
X
Directly Supervised Procedures
In-Training Exam
X
Videotape Review
X
X
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Interpersonal and Communication Skills
Goal: Residents will develop and demonstrate effective information exchange and teaming with patients,
their families and other health professionals.
Objectives:
A. Develop skills for interviewing patients that allow accurate, complete collection of information
regarding symptoms, and the community environment that affect the patients gastrointestinal
health.
B. Develop skills in communicating results, educating patients and their families, and dealing with
sensitive issues for patients and families, and negotiating a plan of treatment with the patient and
family.
C. Residents will understand the need for a multidisciplinary, integrated approach to cardiac prevention
and rehabilitation including: nutritionists, behavioral scientists, educators, gastroenterologists, and
family physicians.
D. Develop patient sensitive skills for interviewing that allow accurate and complete collection of
information regarding symptoms, the family and the community that affect the patient's health and
care.
E. Develop skills in communicating results to patients, their families, other health care providers.
F. Develop skills in educating patients and their families, in dealing with sensitive issues for patients
and families, and in negotiating a plan of investigation and treatment with the patient and family.
G. Develop professional relationships with co-workers, consultants, ancillary staff and other
professionals to enable assembling of health care teams and mobilization of community resources to
optimize care of the patient.
H. Develop an understanding of the role of the family medicine consultant, and is able to support the
patient through the process of consultation, medical evaluation, treatment, rehabilitation and longterm care.
J. Use professional language and demeanor when communicating with other residents, with Family
Medicine attending physicians, with physicians from other services, with non-physician clinical staff,
with non-physician non-clinical staff, and with patients and their families.
K. Create and sustain a therapeutic and ethically sound relationship with patients.
L. Use effective listening skills and elicit and provide information using effective nonverbal, explanatory,
questioning, and writing skills.
M. Work effectively with others as a member or leader of a health care team or other professional
group.
N. Improve skills for providing patient education regarding prevention of gastrointestinal disease
associated with other medical conditions.
O. Learn how to effectively and efficiently communicate and coordinate with GI consultants.
Last Updated April 19, 2013
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
X
Didactics
Other
Evaluation Methods
X
Attending Evaluation
X
Program Director
Review
360 ᵒ evaluation
Other
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
X
X
Directly Supervised Procedures
In-Training Exam
X
Videotape Review
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Systems-Based Practice
Goal: Demonstrate an awareness of and responsiveness to the larger context and system for health care
and the ability to effectively call on system resources to provide care that is of optimal value.
Objectives:
A. Understand how their patient care and other professional practices affect other health care
professionals, the health care organization, and the larger society and how these elements of
the system affect their own practice.
B. Know how types of medical practice and delivery systems differ from one another, including
methods of controlling health care costs and allocating resources.
C. Practice cost-effective health care and resource allocation that does not compromise quality of
care.
D. Advocate for quality patient care and assist patients in dealing with system complexities.
E. Know how to partner with health care managers and health care providers to assess,
coordinate, and improve health care and know how these activities can affect system
performance.
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
X
Didactics
Other
Evaluation Methods
X
Attending Evaluation
X
Program Director
Review
360 ᵒ evaluation
Other
Last Updated April 19, 2013
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
X
X
Directly Supervised Procedures
In-Training Exam
X
Videotape Review
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Professionalism
Goal: Residents will demonstrate a commitment to carrying out professional responsibilities, adherence to
ethical principles, and sensitivity to a diverse patient population.
Objectives:
A. Understand the need for continuing medical education to stay abreast of the constant changes
in therapy for infectious diseases.
B. Become familiar with resources available in the community for patients with chronic illness and
learn how to incorporate them into the treatment plan when needed.
C. Demonstrate integrity, honesty, respect and a commitment to excellence in all activities.
D. Demonstrate sensitivity, respect and adapt appropriately to the social and cultural issues of
each patient.
E. Display initiative and resourcefulness in patient care and in solving problems.
F. Be timely in attendance of activities and completion of tasks.
G. Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and
society that supersedes self-interest; accountability to patients, society, and the profession; and
a commitment to excellence and on-going professional development.
H. Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical
care, confidentiality of patient information, informed consent, and business practices.
I. Arrive at the rotation in a timely fashion.
J. Work effectively as a member of a team.
K. Respect patient privacy by guarding medical records and discussion of personal information
L. about patients.
M. Assist patients and their families in planning for future care needs and care decisions based
on prognosis for the disease.
N. Support the patient in their healthcare decisions.
O. Demonstrate professional, respectful demeanor when addressing team members, patients,
ancillary staff, and consultants.
P. Appear professionally dressed and well groomed
Q. Attends required conferences.
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
X
Didactics
Other
Evaluation Methods
X
Attending Evaluation
X
Program Director
Review
360 ᵒ evaluation
Other
Last Updated April 19, 2013
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
X
X
Directly Supervised Procedures
In-Training Exam
X
Videotape Review
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Practice-based Learning and Improvement
Goal: The resident should develop skills in evaluating their own patient care, appraising and assimilation of
scientific evidence to improve patient care.
Objectives:
A. Analyze practice experience and perform practice-based improvement activities using a
systematic methodology.
B. Locate, appraise, and assimilate evidence from scientific studies related to their patients' health
problems.
C. Obtain and use information about their own population of patients and the larger population
from which their patients are drawn.
D. Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and
other information on diagnostic and therapeutic effectiveness.
E. Use information technology to manage information, access on-line medical information; and
support their own education.
F. Learn to incorporate health promotion and disease prevention into patient care.
G. Use evidence-based medicine, evaluation of available evidence, and use of best-available
evidence at morning report meetings and during routine clinical care.
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
X
Didactics
Other
Evaluation Methods
X
Attending Evaluation
X
Program Director
Review
360 ᵒ evaluation
Other
III.
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
X
X
Directly Supervised Procedures
In-Training Exam
X
Videotape Review
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Instructional Strategies (see above)
The primary strategy will be precepted patient care and procedures on the GI rotation and in the
Family Medicine Clinic. This will be complemented by didactic presentations, videotapes on
endoscopy, slide sets on endoscopic lesions and outside readings. The primary text will be the Little,
Brown Manual of Clinical Problems in Gastroenterology.
IV.
Evaluation Strategies (see above)
A.
B.
C.
D.
Direct observation by GI and Family Practice preceptors
Chart review
Procedure documentation and procedure-specific evaluation forms.
End of rotation summative evaluation by GI preceptor
Last Updated April 19, 2013
E. Resident evaluation of rotation by evaluation form.
F. Resident-advisor meetings (before and after rotation). At the midpoint of each rotation (as
a minimum) and as frequently as possible throughout, the resident should be given specific
and constructive feedback by the GI preceptor on his/her progress, to include recommendations for improvement and personal growth.
G. If the resident does not receive this midpoint 2 week evaluation, he/she should request it
from his/her staff preceptor.
H. ABFP in-training exam
I. Resident self-evaluation
V.
Implementation Strategies
A. This is a PGY II/PGY III elective rotation. The rotation will be done in the clinics of:
Dr. Alan Fixelle
5669 Peachtree Dunwoody Road
Suite 270
Atlanta, GA
(404) 255-1000 ofc
(404) 847-0416 fax
Dr. Steve Morris
Atlanta Gastroenterology Assoc.
Emory Midtown Hospital
550 Peachtree Street, NE
Suite 1600
Atlanta, GA 30338
(404) 881-1094 ofc
B. PGY II residents will spend 6 half days/week for 1 four week block in the GI clinics and 4
half days/week in the Family Medicine Clinic. PGY III residents will spend 5 half
days/week and 5 half days/week in the Family Medicine Clinic.
C. Additional GI training will occur in the FPC, especially lower GI endoscopy during the PGYI
orientation month and during the Ambulatory Surgery rotation in the PGY III year.
D. 1 week of vacation is allowed during the GI rotation.
E. The GI Liaison is Dr. Fixelle or Dr. Morris.
F. Resident responsibilities:
1. Meet with GI advisor and know the GI rotation expectations.
2. Examine patients, formulate an initial plan for work-up, diagnosis and management,
and then present the patients to the preceptor.
3. Participate in at least 15 flexible sigmoidoscopies/colonoscopies before the end of the
GI rotation. In an ideal situation, this would include full insertion and removal of the
scope. This will vary dependent on the preceptor’s comfort level with the resident and
the resident’s own level of skill.
4. Attend FP morning report unless doing a procedure in GI Clinic.
5. Call will take place on the Family Medicine Service at Emory Dunwoody Medical Center.
6. Spend 4 half-days per week in FPC.
7. Document all procedures and diagnoses of patients managed.
8. Actively seek feedback from preceptors.
9. Complete rotation evaluation at the end of rotation.
Last Updated April 19, 2013
VI.
Selected Resources/Readings
1.
AFP Monographs
FP Essentials: Gastrointestinal Conditions #372 May 2010
FP Essentials: Lower GI Conditions #345 Feb 2008
FP Essentials: Upper GI Conditions #326 July 2005
2.
www.EndoAtlas.com (endoscopic lesions)
Last Updated April 19, 2013