Core Components for the First Year Fellow (PL-4)
A. Outpatient Continuity Care Clinic Experience:
The fellows will have a continuity clinic one half-day per week during the three years of their training. They will maintain their own panel of patients, and all faculty rotate through the clinic so fellows will have exposure to all the teaching attendings.
Goals and Objectives
- Develop skills in evaluation and managing outpatient gastroenterology and hepatology problems.
- Develop skills in managing outpatients receiving home central hyper-alimentation, including an understanding of indications for parenteral nutrition.
- Develop expertise in the management of patients with abdominal pain, vomiting and chronic diarrhea, especially as it pertains to interpretation of appropriate radiographs and key laboratory tests, in addition to a progressive knowledge of when to consider endoscopy or additional imaging studies.
- Develop expertise in the management of benign esophageal and gastrointestinal problems such as infantile esophageal reflux, constipation, and abdominal pain.
- Develop skills in evaluating and managing common gastrointestinal and hepatobiliary problems including inflammatory bowel disease, hematemesis, hematochezia, melena, failure to thrive, feeding and swallowing difficulties, acid-peptic disease, esophageal reflux disease (GERD), jaundice, abnormal liver function, coagulopathy, hypoalbuminemia, acute and chronic pancreatitis, gastroparesis, and colonic polyps, Hirschsprung’s disease, and intestinal dysmotility syndromes.
- Develop skills in diagnosing and treating infections of the disease and biliary tract.
- Develop skills in diagnosing and managing celiac disease and other malabsorption syndromes.
- Develop skills in diagnosing and managing acute and chronic liver failure and its complications, and describing indications for liver transplantation.
- Describe indications for the following procedures: Upper endoscopy, flexible sigmoidoscopy, colonoscopy, endoscopic retrograde pancreatico-cholangiography (ERCP), esophageal pH and impedence monitoring, esophageal and anorectal manometry, rectal suction biopsy, liver biopsy, paracentesis, esophageal dilation, and pancreatic stimulation test.
- Describe indications for the following ancillary studies: Upper gastrointestinal contrast study, CAT and MR Enterography studies, magnetic resonance cholangiography (MRCP), gastric emptying study, barium enema and abdominal ultrasound.
- Learn to safely perform the following procedures with proficiency including recognition and treatment of complications with appropriate consultation: Esophagogastroduodenoscopy, colonoscopy, and removal of foreign bodies from esophagus and gastrointestinal tract.
- Diagnose and treat severe gastrointestinal bleeding with proficiency in the following specialized therapeutic procedures: Esophageal variceal banding or sclerosis, polypectomy, use of gold probe, clipping and injection of a bleeding site.
- Learn to competently interpret the following specialized tests: prolonged pH impedence probe study, esophageal and anorectal manometry, wireless capsule endoscopy, and pancreatic stimulation test.
- Develop skills in managing patient referrals and communicating with referring physicians.
- Develop skills in delivery of appropriate telephone advice and telephone triage.
- Learn to interact effectively with the entire gastroenterology/hepatology division team including administrative staff and nursing staff.
- Learn to manage patients on a continuous long-term basis.
- Develop skills in integrating the collaboration of the clinical social workers and psychologists with emphasis on family stress, school issues, and financial issues.
- Develop skills in interacting with and integrating the support of child-life services and the pediatric GI nurses to prepare patients for invasive procedures or other stressful interventions.
- Develop leadership skills as a consultant and inpatient team-leader, with the entire multi-disciplinary patient care team
- Over the first year of fellowship, develop an area of academic interest including an understanding of research protocols and ethical issues in managing patients on divisional and institutional protocols.
Competencies Involved
Patient Care, Medical Knowledge, Practice Based Learning and Improvement, Communication and Interpersonal Skills, Professionalism, System-Based Practice.
Methods of Evaluation
Evaluation by all Faculty Attendings, Faculty and Fellow Self- Assessment, Feedback on Teaching Skills (Clinical Cases, didactic Lectures, small-group teaching during rounds) and Procedural Skills, Feedback from Nursing/ Support Staff, SITE exam score.
B. Pediatric Gastroenterology/Hepatology Ward Rotations/Consult Service
The first-year fellow manages patients on the general pediatric floors and performs consultations in the intensive care units (PICU, CICU, and NICU), the pediatric ward floors, and in the Emergency department, always with supervision by the faculty attending and after the fellow has an opportunity to independently assess the patient.
Goals and Objectives
- Develop skills re: the inpatient management of Pediatric Gastroenterology and Hepatology related problems
- Develop the ability to effectively educate parents and their hospitalized children about the diagnosis, treatment plan and prognosis.
- Learn to work effectively the gastroenterology and hepatology treatment team in clinical social workers, psychologist, child-life personnel and members by other subspecialty services.
- Learn to teach residents and medical students in the small-group setting
- Learn to expeditiously respond to consultations from general and other subspecialties services, the PICU and NICU.
- Learn to write inpatient TPN orders and recognize and manage the complications of parental nutrition.
- Learn to understand and request appropriate use of surgical therapy in managing patients with acute gastrointestinal and liver disease, e.g., for the timely management of the surgical complications of inflammatory bowel disease.
- Learn how to facilitate new patient referrals, especially outside hospital transfers.
- Learn how to provide appropriate phone advice while on-call.
- Continue development of evidence-based medicine skills as related to the inpatient.
- Understand and provide adequate nutrition to patients including use of nasogastric or nasoduodenal tube, gastrostomy tube placement and peripheral/central hyperalimentation.
- Learn how to function as part of a multidisciplinary team.
- Learn the skill of communicating and counseling patients and their parents.
- Continue to develop procedural skills in caring for the more ill pediatric inpatient.
Competencies Involved
Patient Care, Medical Knowledge, Practice-Base Learning and Improvement, Communication and Interpersonal Skills, Professionalism, Systems-Based Practice.
Methods of Evaluation
Evaluation by Faculty Attendings, Faculty and Fellow Self-Assessment of Clinical Skills and Procedural Skills, Feedback from pediatric house staff as to the fellow’s guidance and teaching abilities, SITE exam score.
Core Components for the Second and Third-Year Fellow
- Must fulfill all of the learning objectives of the first-year fellow
- Scholarly Project
Goals and Objectives
- Develop skills in organizing a research project, gathering and analyzing data, defending and presenting conclusions to a Scholarship Oversight Committee (and local and national meeting).
- Develop knowledge, understanding and skills in biostatistical methods.
- Develop a knowledge and understanding of ethics in research.
- Develop skills in writing manuscripts and eventually, grant writing.
- Learn to be skillful in the presentation of research data.
- Continue to develop a critical read of the biomedical literature.
- At the end of the first fellowship year, identify a research mentor and select a Scholarship Oversight Committee (SOC) composed of at least three faculty members with research experience. It is the responsibility of this committee to determine whether the fellow has selected a specific research project appropriate to meet the ABP guidelines for scholarly activity.
- Present research to the SOC at least twice each year.
- Present research data at local, regional and national meetings.
Competencies Involved
Medical Knowledge, Practice-Based Learning and Improvement, Communication and Interpersonal Skills, Professionalism.
Method of Evaluation
Regular review by faculty mentor; feedback from faculty and residents, review by SOC at least twice a year; Evaluation of research presentations at local and national meetings, SITE exam scores.