Continuity Clinic
Goals and Objectives
The continuity clinic experience is designed to develop a continuous healing
relationship between the gastroenterology fellow and the patients to whom
they provide ambulatory care. This provides the opportunity for
gastroenterology fellows to observe and learn the course of gastrointestinal
disease, develop communication skills, improve their outpatient care
practice including preventative care, develop an understanding and
commitment to professionalism, learn cost effective ambulatory health care,
and learn how to partner with other health care providers in an ambulatory
setting. Specific competency based goals and objectives are listed below:
Medical Knowledge:
Detailed knowledge of the pathophysiology of gastrointestinal disorders.
Knowledge of the utility of diagnostic tests in specific conditions.
Knowledge of the indications for, contraindications to, complications of,
and alternatives to diagnostic and therapeutic gastrointestinal endoscopy.
Knowledge of the utility and adverse effects of medical therapy for
gastrointestinal disease.
A knowledge of the indications for, and contraindications and alternatives to
surgical treatment of gastrointestinal disorders.
A knowledge of preventative care in patients with gastrointestinal disorders
including but not limited to colon cancer and polyp screening, polyp
surveillance, Barrett’s screening and surveillance, adult immunizations,
screening for hepatitis B and C, and screening for hepatoma.
Patient Care:
Demonstration of an acceptance of a personal accountability for patient care.
Ability to obtain an accurate and thorough history from the patient, and to
perform a complete and accurate physical examination.
Ability to generate a differential diagnosis and a working hypothesis based
upon the patient evaluation.
Ability to effectively and efficiently develop a diagnostic and therapeutic
plan.
Ability to educate and counsel patients and their families.
Ability to initiate a preventive health care plan for patients with
gastrointestinal disorders.
Practice Based Learning and Improvement:
Develops the ability to teach other fellows, residents and students.
Participates in quality assurance and improvement projects.
Incorporates QA guidelines into practice.
Utilizes online and other resources to educate himself/herself, and
incorporates information gathered from these resources into ongoing patient
care.
Professionalism:
Arrives for clinic sessions on time.
Notifies clinic personnel and patients when patient emergencies will cause
delays in providing services.
Interacts with patients and other health care personnel in a respectful and
courteous manner.
Demonstrates appropriate sensitivity to patients’ cultural, gender, age, and
disability status.
Dresses appropriately.
Systems Based Practice:
Provides cost-concious care.
Considers a patients health care coverage when developing a treatment plan.
Determines the need for system or community support.
Utilizes all resourses to provide care including dietary, social services,
support groups, and others.
Serves as a patient advocate.
Participates in development of system improvements to improve delivery of
care and patient outcome.
Specific knowledge, skills and attitudes to be attained for each year of
fellowship are outlined below.
Year One
First year gastroenterology fellows will acquire the following knowledge,
skills and attitudes through their continuity clinic experience in conjunction
with other rotations, and clinical and didactic conferences:
1. The ability to take a complete and accurate gastrointestinal history.
2. The ability to diagnose and treat common gastrointestinal disorders.
3. The ability to communicate effectively with patients and their
families.
4. The ability to make use of information technology to help manage
patients, obtain online medical information, and support their own
learning.
5. The ability to function as a member of an outpatient care team.
6. The ability to communicate with primary care providers and other
specialists.
7. The ability to effectively utilize the electronic medical record.
8. The ability to behave professionally at all times.
Year Two
Second year gastroenterology fellows will acquire the following knowledge
and skills through their continuity clinic experience in conjunction with
other rotations, and clinical and didactic conferences:
1. A knowledge and understanding of proper billing and coding
practices.
2. A knowledge of medical systems and the ways in which they
impact outpatient medical care.
3.The ability to diagnose and treat less common gastrointestinal and
liver disorders.
4. The ability to utilize outside resources to assist with outpatient
management.
5. The ability to counsel outpatients with chronic or life threatening
illnesses.
6. A knowledge of and ability to utilize preventative measures such as
vaccinations and screening to optimize care of outpatients with
gastrointestinal disease.
Year Three
Third year gastroenterology fellows will acquire the following knowledge
and skills through their continuity clinic experience in conjunction with
other rotations, and clinical and didactic conferences:
1. Competency to assume complete care of patients with
gastrointestinal or liver disease.
2. The ability to function in an organized and efficient fashion in the
outpatient setting.
3. The ability to lead an outpatient healthcare team.
4. The ability to communicate with referring physicians and other
health care providers as a gastrointestinal consultant and educator.
5. The ability to teach students and junior residents the principles of
gastroenterology.
6. The ability to serve as a patient advocate.
7. The ability to use a systematic approach to reduce errors and to
improve patient care.
8. A recognition of the necessity to participate in a lifelong learning
process.
Instructional Enviroment and Teaching Methods
All continuity clinics will be held at the USF Center for Advanced
Health Care. The patients at this facility are approximately 50% male,
and 50% female. They have a wide variety of gastrointestinal and
liver disorders representing the full spectrum of gastrointestinal and
hepatobiliary disease. The patient population will include both return
patients for follow up care, and new patients either referred for
consultation or self referred for gastrointestinal or liver problems. The
Center has an electronic medical record that can be accessed over the
internet. Computers are available in every room to facilitate access to
records, and information technology.
The gastroenterology fellow will work with one gastroenterology
attending, who will be a faculty member in the Division of Digestive
Diseases and Nutrition, for 18 months. The fellow will then rotate
with a second faculty member for the final 18 months of the
fellowship. Continuity clinic will be held one half day per week. The
fellow is excused from all other clinical and research responsibilities
to attend this clinic. Four to eight patients will be seen by the fellow
per half day session with no more than three new patients, and no
more than 6 return patients seen per clinic. The fellow sees each
patient independently, formulates a differential diagnosis, evlauation
and treatment plan. The fellow then presents the patient to the
gastroenterology attending who sees the patient and verifies key parts
of the history and physical findings, and approves the diagnostic and
treatment plan. This provides an opportunity for teaching, as well as
ensuring high quality patient care. Fellows order diagnostic testing
and write all orders and prescriptions on their patients. They then
follow these patients on subsequent visits. The fellows will be notified
if their patient is hospitalized, and will also be notified of the results
of any outpatient testing that they are not directly involved in (eg.
endoscopic procedures).
Fellows interact with the nursing staff, schedulers, and financial
counselors in the clinic; and the healthcare personnel at infusion
centers, and at home healthcare agencies. They communicate and
work with primary care providers and subspecialists referring patients.
They work closely with gastrointestinal surgeons to whom they refer
patients and from whom they receive consults.
Gastroenterology fellows have an opportunity and responsibility to
teach patients, referring physicians and other healthcare providers
about gastrointestinal disease. They are responsible for informing
patients about their problems and the care of these problems, as well
as appropriate preventative and health maintenance measures. They
periodically will have the opportunity to teach medical residents and
medical students rotating through a gastroenterology outpatient
experience.
Assessment of Performance
The gastroenterology fellow will get feedback on performance from
the attending gastroenterologist after each clinic session. A written
core competency evaluation will be given to the fellow every six
months by the attending physician. A mini-CEX evaluation will be
conducted every six months. Finally, patient evaluations of the fellow
will be obtained from at least two patients every six months. At the
end of the fellowship, the fellow will be competent to practice
outpatient gastroenterology without supervision.