GI Consults Medical University Hospital

Educational Purpose:

The GI Consult service was established to give the resident physicians additional experience in the field of gastroenterology. The resident performs consults on a broad range of patients with GI illnesses or complaints. Additionally, residents gain experience in the performance of flexible sigmoidoscopy and observing colonoscopy and upper endoscopy.

Goal: Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

Residents are expected to:

PGY 1

PGY 2 and 3

1. Develop short and long term treatment plans of care.

Medical Knowledge Goals and Objectives:

Goal: Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care.

Residents are expected to:

PGY 1

1. Learn presentation and management of common gastrointestinal conditions such as gastrointestinal bleeding, inflammatory bowel disease, including Crohn’s nad ulcerative colitis, diarrheal illnesses, acute pancreatitis, chronic pancreatitis, gastrointestinal malignancies.
2. Learn indications, contraindications, and limitations of common gastroenterology procedures including esophagogastroduodoscopy (EGD), colonoscopy, endoscopiccholangiopancreatography (ERCP), as well as endoscopic ultrasound.
3. Learn and manage complicated inflammatory bowel disease including using immunosuppressants, immunomodulators, and biologics in treatment.

PGY 2 and 3

1. Learn presentation and management of common gastrointestinal conditions such as gastrointestinal bleeding, inflammatory bowel disease, including Crohn’s nad ulcerative colitis, diarrheal illnesses, acute pancreatitis, chronic pancreatitis, gastrointestinal malignancies.
2. Learn indications, contraindications, and limitations of common gastroenterology procedures including esophagogastroduodoscopy (EGD), colonoscopy, endoscopiccholangiopancreatography (ERCP), as well as endoscopic ultrasound and percutaneous gastrostomy tubes.
3. Learn and manage complicated inflammatory bowel disease including using immunosuppressants, immunomodulators, and biologics in treatment.

Practice-Based Learning and Improvement Goals and Objectives:

Goal: Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning.

Residents are expected to develop skills and habits to be able to:

PGY 1

PGY 2 and 3

Systems Based Practice Goals and Objectives:

Goal: Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.

Residents are expected to:

PGY 1

PGY 2 and 3

1. Supervise and manage team members including interns and medical students.

Professionalism Goals and Objectives:

Goal: Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. 

Residents are expected to demonstrate:

PGY 1

PGY 2 and 3

Interpersonal and Communication Skills Goals and Objectives:

Goal: Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. 

Residents are expected to:

PGY 1

PGY 2 and 3

Teaching Methods:

Consult rounds with the GI fellow and the attending physician five days per week. Direct education about procedures in the Medical University Hospital and Ashley River Tower endoscopy suites, as well as didactic sessions with the attending physician.

Mix of Diseases and Pathological Material:

The program incorporates two teaching hospitals:  The Medical University Hospital (MUH) and the Charleston VA Medical Center (VAMC). Faculty expertise draws patients with a myriad of disease processes including inflammatory bowel disease, pancreaticobiliary disease, complex nutritional issues such as short bowel syndrome, achalasia, and other disorders of the esophagus, among many others. In particular, MUH is a tertiary facility providing a high level of care in all aspects of Internal Medicine where renal, bone marrow, cardiac, lung, pancreas, and liver transplantation programs are ongoing.  In addition, the interests of the Gastroenterology faculty attract patients with biliary tract and liver disease, nutritional problems, gastrointestinal motility disorders, and malignancies. 

Patient Characteristics:

Residents care for a diverse patient population with respect to age, ethnicity, and gender. The majority of the patients are older adults, but there are significant numbers of and young adult patients in some sites. All have acute or chronic gastrointestinal diseases as well as chronic general medical conditions.

Types of Clinical Encounters:

The resident assigned to the Medical University consult service serves in the consultative role by initially reviewing the patient’s condition, presenting his/her evaluation to the GI fellow and the attending physician assigned to the medical university consult service, and formally writing recommendations in a consult report. At the Medical University, there is an opportunity for the medial resident to perform flexible sigmoidoscopy. The resident also attends the VAMC clinic on Wednesday afternoon. New patients are evaluated, and management decisions are made under the direct supervision of the attending physicians.

Procedures and Services:

The resident has the opportunity to perform flexible sigmoidoscopy as noted. The resident also observes upper endoscopies and colonoscopies. 

Supervision:

The attending physician supervises the fellow and the resident and the fellow help supervise the resident as follows: attending physician of record, GI fellow, medical resident.

Educational Resources to be Used and Reading Lists:

The GI Division maintains an up to date library containing textbooks, journals, teaching slides, and video cassettes. Computers are available for data base searches. Materials compiled by the Division are available for distribution to residents that contain outlines and leading articles on important, mainstream, clinical topics in gastroenterology and hepatology. Most of the teaching of residents is patient-generated and supplemented by relevant reading material from relevant current and landmark evidence based literature.

Method of Evaluation of Resident Competence:

The attending physician provides formative feedback at the halfway mark of the rotation. Residents are evaluated summatively using the global evaluation form. The Mini-CEX is often administered on this service as well. Patient Care is assessed based on direct observation and complete review of all records. Medical Knowledge is assessed through direct questioning and observation. Interpersonal Skills and Communication is assessed by observation of interactions with consulting physicians, patients, and families. The attending physician evaluates Professionalism through direct interaction and observation of the resident. Systems-Based Practice is evaluated based on interactions with the primary team and the ability to provide medical care in collaboration with consultants, and other specialists in the cares of the patients with emphasis placed on optimization of patient care. Practice-Based Learning is evaluated based on the ability to consult the literature and to improve their performance throughout the rotation. The residents evaluate the rotation and the attending physician through the E*Value system. The consult attendings review the rotation evaluations and each attending anonymously receives his or her evaluations

The resident evaluates the rotation and the attending physician.