Revised February 18, 2008
GOALS AND OBJECTIVES
RESIDENT CURRICULUM FOR GASTROENTEROLOGY
Rotation Director:
Shahid Wahid, M.D.
700 Shadow Lane Suite 165A
Las Vegas, Nevada 89106-6415
OVERVIEW
Educational Purpose
Gastroenterology involves the assessment and management of patients with known or
suspected gastroenterology disorders. The general internist should have a substantial
understanding and wide range of competencies in the evaluation and management of GI
disorders.
The general internist must be able to do the following:







Be competent in completing a thorough physical exam including rectal and/or
pelvic exams.
Identify and manage initial assessment of acute bleeding in the gastroenterology
(GI) system.
Understand the risks and benefits of various GI imaging and diagnostic procedures
including upper and lower endoscopy, ERCP, abdominal MRI and CT scan, capsule
endoscopy, TIPSS, liver biopsy, paracentesis and nasogastric aspiration.
Gather accurate, essential information from the medical interview, physical
examination, laboratory tests including chemistry, stool, antibody, upper GI fluids
analysis and analysis for infections including Helicobacter pylori. Demonstrate
competency in interpretation.
Demonstrate competency in evaluating symptoms of liver disease, physical
assessment of the liver including physical signs of liver disease and the cause of and
complications of liver disease including, but not limited to ascites, GI bleeding,
encephalopathy and infections. Demonstrate competency in management of these
disorders.
Competency in identification, assessment and management of Bilary and Pancreatic
disorders with assistance for gastroenterologist.
Competence in assessment and management of specific GI identification disorders
to include:
a.
b.
c.
d.
e.
Disorders of the esophagus
Disorders of absorption
Inflammatory bowel disease
Irritable bowel syndrome
Common diseases of the colon and anorectum
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f. Vascular disorders of the GI system
g. Acute intestinal obstruction
h. Acute appendicitis and peritonitis

Competence in identification of :
a. Familial Mediterranean fever, and
b. Liver transplant complications
c.
Teaching Methods
The rotation will be under the supervision of the attending gastroenterologist. The
resident(s) will accompany the gastroenterologist to the Lied Specialty Clinic for
outpatient care and consultation and to inpatient consultations at UMC. The resident
will see consultations and patients as assigned by the attending gastroenterologist. The
resident will obtain the initial data, write a consultation note, and present the patient to
the attending physician. The attending will confirm the findings, teach about the case,
and with the resident, craft the final recommendations. The resident will see the patient
daily, write the follow up consult notes, and review them with the attending
gastroenterologist.
Daily rounds will occur with the attending physician at which time instruction in the
unique aspects of the consultative process will be provided. Residents will be required to
continue their regular morning report and noon conference core curriculum. The resident
and attending will review and discuss any required reading.
Mix of Diseases
Patients present a vast array of acute medical problems that a gastroenterology consultant
may be requested to evaluate. Specific areas which are emphasized include acute
gastrointestinal hemorrhage, chronic occult GI blood loss and anemia, abdominal pain,
acid peptic disease, gastroesophageal reflux, acute and chronic diarrhea, jaundice,
infectious hepatitis, toxin-induced liver disease, and biliary disease and obstruction.
Patient Characteristics
The patient population is diverse, male and female, of all ages from adolescent to
geriatric, representing most ethnic and racial backgrounds, from all social and economic
strata. The hospital serves primarily the indigent population of the city of Las Vegas.
Types of Clinical Encounters
All patient encounters are in the inpatient setting on a consultative basis from other
clinical services or from an ambulatory physician who has referred a patient for
admission.
Close interaction with various other healthcare team members including care managers,
discharge planners, home health agencies, inpatient nurses, respiratory therapists,
physical therapists, and patient care technicians occurs daily.
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Resident Supervision
Residents have constant on site supervision as well as daily personal supervision in their
patient care.
Procedures and Services
Procedures and services which the resident may observe and participate in include upper
endoscopy and colonoscopy, flexible colonoscopy, and biliary endoscopy and
intervention.
Didactic Teaching
Morning Report
Residents are required to maintain greater than 60 % attendance at morning
report. Morning Report begins at 8 a.m. on Monday through Thursday and at
8:30 a.m. on Friday.
Noon Conference
Residents are required to maintain greater than 60 % attendance at noon
conference. Noon conference occurs daily, Monday through Friday. These
sessions cover the basic core curriculum, and other curriculum topics such as
ethical issues, geriatrics, computer systems and informatics, health care systems,
occupational and environmental health issues, and other topics of concern. A
gastroenterology topic is presented at least once during each month.
Attending Rounds
Didactic discussions will be held regarding all patients seen in consultation
occurring during the month. Each resident and medical student will be required
prepare and discuss during teaching rounds one article or gastroenterology topic
each week. Teaching rounds by the attending physician will occur every day for
45 - 60 minutes after regular management rounds. Each resident is required to
review common gastroenterology topics.
Core Reading Materials
Harrison’s Principle’s of Internal Medicine, 16th ed., Kasper DL, ed. McGraw
Hill
Textbook of Gastroenterology, 4th ed., Yamada T, ed. Lippincott William &
Wilkins
The Washington Manual of Medical Therapeutics, 32nd ed.
The Washington Manual® Gastroenterology Subspecialty Consult, Gyawali CP,
ed. Lippincott William & Wilkins
Ancillary Educational Materials
Subspecialty Texts of Neurology, Pulmonary Medicine, Nephrology,
Endocrinology, Infectious Diseases, Rheumatology as well as General Medical
References (Harrison’s Principles of Internal Medicine, Cecil’s Textbook of
Medicine) are available 24 hours a day, seven days a week in the resident lounge.
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Savitt Medical Library On-Line
Residents have access to the on-line services of Savitt Library (the main library of
the University of Nevada - Reno) via their computer in the resident room, Suite
300 of the 2040 W. Charleston Building. Access to this room is available 24
hours a day, seven days a week.
Full text is available for many peer-review journals including, but no limited to:
ACP Journal Club
Annals of Internal Medicine
British Medical Journal
Cancer
Circulation
Journal of the American College of Cardiology
The Lancet
New England Journal of Medicine
Stroke
Also available on-line:
Harrison’s Principle’s of Internal Medicine, 14th ed.
Merck Manual, 17th ed.
Guide to Clinical Preventive Services, 2nd ed.
The Cochrane Library
Medline and Grateful Med Databases
Pathological Material and Other Educational Resources
Residents are encouraged to review the pathological reports on patients for whom they
have consulted and to follow the hospital care of those patients. If a patient with whom
the resident has consulted should die and have an autopsy, the resident is encouraged to
attend the post-mortem session.
Training Sites
University Medical Center
All of the inpatient gastroenterology consultation experience occurs at University
Medical Center (UMC) under the supervision of one of the full-time endocrine
faculty. The resident will also participate in the UMC outpatient gastroenterology
clinic weekly.
UNSOM Lied Specialty Care Clinic
The resident will participate in the UMC outpatient gastroenterology clinic
weekly.
Competency-based Goals and Objectives
Gastroenterology Rotation
Learning Venues
Evaluation Methods
1. Direct patient care/consultations
A. Attending evaluation
Level Specificity
R-1 = 1
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2.
3.
4.
5.
6.
Attending GI Rounds
Residency core lecture series
Self study
Endoscopy Suite
Morning Reports
B.
C.
D.
E.
F.
Competency Patient Care
Direct Observation
Nurse evaluations
Written Examination
Resident/Self Evaluations
Patient Evaluations
R-2 = 2
R-3 = 3
Learning
Venues
1, 2, 5
1, 2, 4
1, 2, 4
1, 2, 4
Evaluation
Methods
A, B, E, F
A, B, E
A, B, C, E
A, B, E
1, 2, 3
1, 2, 3
1, 2, 3
1, 2, 3
1, 2, 6
1, 2, 3, 4, 5, 6
A, B
A, B, E
2, 3
2, 3
1, 2
5
A
A
2, 3
1, 2, 3
Competency : Knowledge
Learning
Venues
Evaluation
Methods
Level
Know presentation of common GI
disorders and syndrome (GI bleeding,
vomiting, diarrhea, distension pain).
Demonstrate competency in assessment,
GI lab testing and imaging procedures.
Demonstrate knowledge of risk of GI
procedures and provide patient informed
consent information.
Demonstrate competency in management
of GI disorders and syndromes based on
scientific evidence and cost-effectiveness.
1, 3
A, B, D, E
1, 2, 3
1, 3
A, B, D, E
1, 2, 3
1, 2, 3, 4, 5
A, B, D, E
1, 2, 3
1, 2, 3, 4
A, D, E
1, 2, 3
Competencies: Interpersonal and
Communication Skills
Learning
Venues
Evaluation
Methods
Level
Interact in an effective way with primary
physician.
Demonstrate understanding of patient
preferences.
1, 2
A, B, E
1, 2, 3
1, 2, 5
A, B, C, E, F
1, 2, 3
Obtain complete history.
Perform GI focused physical exam.
Review prior medical records.
Generate differential diagnosis and
treatment plan.
Initiate treatment recommendations.
Teach physical exam with focus on GI
disorders.
Manage GI consult service with attending.
Observe/participate in GI
endoscopes/procedures.
Level
5
Maintain accurate medical records.
Treat patient, staff and colleagues in
respectful productive manner.
1, 2, 5
1, 2, 5
A, B
A, B, C, E, F
1, 2, 3
1, 2, 3
Competency: Professionalism
Learning
Venues
Evaluation
Methods
Level
1. Treat team members, primary caregivers, and patients with respect and
empathy.
2. Understand, practice and adhere to a
code of medical ethics.
3. Participate actively during rounds.
4. Attend and participate in all scheduled
conferences.
1, 2
A, B, C, E, F
1, 2, 3
1, 2
A, B, C, E
1, 2, 3
1, 2
3, 5
A, B, C
Attendance, A
1, 2, 3
1, 2, 3
Competency: Practice-Based Learning
Learning
Venues
1, 2, 4, 5
Evaluation
Methods
A, E
Level
1, 2, 4, 5
A, E
2, 3
1, 2, 4, 5
A, E
2, 3
1, 2, 4, 5
A, E
1, 2, 3
Learning
Venues
1, 2, 3, 4
Evaluation
Methods
A, E
Level
1, 2, 3
1, 2, 3, 4, 5
A, B, C, E
2, 3
1. Incorporate case studies with relevant
research outcomes and report those
findings during clinical rounds.
2. Review the outcomes of patient care in
order to reflect on the approach taken in
the delivery of care.
3. Utilize established practice guidelines
for individual diseases to devise care
strategies.
4. Identify limitations of one’s medical
knowledge in evaluation and management
of patients and use medical literature
(primary and reference) to address these
gaps in medical knowledge.
Competency: Systems-Based Practice
1. Understand need for effective
communication between multiple
caregivers (i.e. emergency room, critical
care unit, nurses, physicians, transporters,
outpatient clinic, radiology, chest pain
center, echo technicians).
2. Understand clinical trial design and the
statistical methods for evaluating
scientific studies, in cooperation with
2, 3
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attendings and research nurses/personnel.
EVALUATION
A. Of Residents
At the completion of each rotation, all clinical faculty are required to complete the
standard ABIM resident evaluation form. All clinical faculty are encouraged to
provide face-to-face feedback with the residents. The night-float resident is
evaluated by one of the three service attendings. In addition, residents may
receive interim feedback utilizing the ABIM’s Praise and Early Warning cards.
B. Of Rotation and Preceptor
All residents are encouraged to evaluate the rotation, and the clinical faculty
member, at the completion of the rotation. This evaluation form is included at the
end of this document. These evaluations are then converted to type and shared
anonymously with the clinical faculty.
The program director also discusses the rotation with the residents to ensure
rotation quality and satisfaction.
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Gastroenterology Rotation Intern/Resident Check List
___________ 1.Evaluation reviewed at mid-rotation end of rotation by the supervising
faculty member and resident.
___________ 2. Completed assigned readings
___________ 3. Attended all assigned clinical activities (excluding scheduled time
away, required clinics and emergencies).
___________ 4. Completed required case reports abstracts and/or posters assigned by
the supervising faculty member.
___________ 5. Demonstrated understanding of the essentials of gastroenterology.
___________ 6. Received verbal feedback from attending at end of rotation.
.
Intern/Resident Signature____________________________Date__________________
Supervising Faculty Signature_______________________ Date__________________
All items must be completed for rotation credit and checklist returned to the
Department of Medicine by the rotation’s end.
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