CENTER FOR SWALLOWING DISORDERS
ELECTIVE ROTATION
GOALS AND REQUIREMENTS
1. Patient Care
a. Develop focused interview skills to record a detailed history and perform a complete
physical examination for patients with the following conditions
i. Dysphagia with emphasis on oropharyngeal and esophageal dysphagia
ii. GERD and its atypical manifestations involving the upper aerodigestive tract
iii. Eosinophilic esophagitis
iv. Post-surgical and post- chemo and or radiation treatment effects on the
swallowing mechanism and the esophagus
v. Unexplained chest pain
b. Develop a thorough assessment and differential diagnosis for the above mentioned
conditions.
c. Understand the pharmacology and appropriate dosing schedules for medications
indicated for esophageal disorders (for acid suppression, poorly absorbed oral steroids,
low dose antidepressants, smooth muscle relaxants).
d. Demonstrate the ability to understand the indications, appropriately order and interpret
esophageal and swallowing physiologic testing, radiographic imaging which include the
following:
i. 24 hour ambulatory single and dual channel esophageal pH studies
ii. 24 hour ambulatory combined esophageal pH and impedance studies
iii. Pharyngeal and esophageal motility
iv. Modified barium swallows with emphasis on the oropharyngeal normal and
abnormal physiology of swallowing
v. Barium and esophagram with emphasis on food bolus challenges
vi. Timed barium emptying study
e. The ability to competently perform and understand the nature and potential
complications for endoscopic procedures used to manage esophageal strictures or
dysphagia from other causes.
i. Dilation of strictures in the esophagus with various techniques
1. Bougienage with and without a guidewire and fluoroscopy
2. Hydrostatic or pneumatic balloon dilation
3. Retrograde dilation using Tucker dilators
4. Adjuncts to stricture management using stents or steroid injections
ii. Injection of Botulinum Toxin A into the esophagus for achalasia or
hypercontractile esophageal motility disorders.
f. The ability to properly insert esophageal manometry catheters and 24 hour pH probes.
2. Medical Knowledge
a. Develop knowledge base through participation in weekly multidisciplinary CSD Clinical
Care Conferences.
b. Develop the necessary knowledge base to identify the different causes of esophageal
and pharyngeal stenosis and dysfunction and in a collaborative team-based approach
develop a therapeutic plan to manage these conditions.
c. Develop the knowledge base to understand the gastroesophageal reflux disease and its
spectrum of clinical manifestations from typical esophageal symptoms to atypical upper
aerodigestive symptoms.
d. Develop the knowledge base to recognize the appropriate management among patients
with columnar-lined (Barrett) esophagus, develop appropriate plans for intervention in
patients with dysphagia.
e. Develop the knowledge to recognize the clinical, radiographic and endoscopic features
of pharyngeal and esophageal dysphagia referred to the Joy McCann Culverhouse
Center for Swallowing Disorders.
3. Practice Based Learning
a. The subspecialty resident will be provided with a compilation of PDF files of selected
articles and book chapter relevant to esophageal and swallowing disorders.
b. The subspecialty resident will be provided a list of web-based learning tools for
gastroenterology (general principles, radiology, pathology, case-based learning tools).
c. The subspecialty resident will develop a presentation about a topic/research endeavor
which will be presented during the last week of his/her rotation.
d. When the duration of the rotation is sufficient, the subspecialty resident will be
encouraged to pursue a research project in depth, which can be accomplished during or
immediately after the rotation.
4. Interpersonal and Communication Skills
a. Special emphasis will be placed on taking a comprehensive history related to dysphagia.
b. Demonstrate effective communication with patients, families, Center staff and
colleagues.
c. The subspecialty resident will receive and will be asked to give his/her feedback during
the mid-point of the rotation and at the end of the rotation.
5. Professionalism
a. Adherence to USF COM Department of Medicine Housestaff Policy of conduct and dress
b. The subspecialty resident will receive specific instructions about appropriate decorum
and professionalism in the endoscopy unit.
c. The subspecialty resident will participate actively in clinic appointments, laboratory and
endoscopic procedures with attention to responsibility and accountability in timely
completion of all necessary paperwork, electronic health record entries and reports.
d. The subspecialty resident will demonstrate an open and responsive attitude to feedback
from members of the multi-disciplinary team at the Joy McCann Culverhouse Center for
Swallowing Disorders.
6. Systems Based Practice
a. The subspecialty resident will participate actively in the multi-disciplinary (speech
pathologist, nursing staff, physician and nurse practitioner staff) patient care
conferences during which relevant clinical material (radiographs, endoscopic images,
photographic images, and physiologic studies) will be presented and discussed.
b. The cost effectiveness and the need to base recommendations on the best available
medical evidence will be given special emphasis during the multi-disciplinary team
meetings to formulate the combined therapeutic plan.
c. Feedback will be provided about the initial diagnostic and therapeutic plan initially
developed by the subspecialty trainee.