Specific Areas of Training

Specific areas of training in the Division of Gastroenterology include:

  1. Medical knowledge
  2. Clinical and procedural skills
  3. Clinical and medical judgment
  4. Commitment to scholarship
  5. Professional attitude and humanistic qualities
  6. Moral and ethical standards

  1. Medical Knowledge

    Trainees will develop specialized knowledge in the areas of gastroenterology and hepatology to include the following areas:

    • An understanding of the physiology, pathophysiology, and natural history of disease
    • An understanding of the approach to the diagnosis of disease, to include the appropriate and cost-effective selection and interpretation of tests and procedures.
    • An understanding of the principles of appropriate therapy, to include pharmacologic principles, mechanisms of actions, and benefits and adverse effects of medical, surgical, and endoscopic therapies.

    Medical knowledge will be developed by both independent and directed study. Trainees are expected to display intellectual and clinical curiosity that results in self-motivated learning. Direct teaching will occur on a daily basis through interactions with faculty members in clinic, on rounds, and in informal teaching sessions. Formal teaching will also occur at daily conferences and grand rounds. Faculty members are available for additional directed study or individual teaching.

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  2. Clinical and Procedural Skills

    Trainees will develop the skills of a subspecialty consultant in both cognitive and procedural gastroenterology. Specifically, the following skills will be developed:

    Clinical Skills:

    • The performance of a directed history and physical examination
    • The ability to interpret clinical data, to include laboratory data, imaging studies, pathologic specimens, and specialized gastrointestinal studies
    • The ability to formulate an appropriate differential diagnosis and diagnostic plan based upon clinical findings
    • The ability to communicate clinical data in an organized, succinct, and intelligible fashion
    • Appropriate, safe, and cost-effective selection of laboratory and diagnostic modalities
    • The ability to formulate and carry out an appropriate therapeutic plan for gastrointestinal disorders
    • Humanistic, ethical, and conscientious patient care appropriate for both a primary care provider and a subspecialty consultant

    Procedural skills:

    • An understanding of the role of endoscopic and interventional procedures in gastrointestinal and hepatobiliary disorders
      • Be able to appropriately recommend endoscopic procedures based upon clinical findings, indications, contraindications, risk factors, potential benefits, and alternative approaches
      • Be able to interpret endoscopic findings, diagnose and treat potential complications/adverse outcomes from these procedures
    • Perform specific procedures safely, completely, and expeditiously. Although the skills of each trainee will vary, it is anticipated that trainee will perform at least the number of procedures listed below (as recommended by the ASGE) while supervised by a faculty member. Competence in the performance of each procedure will be determined by faculty members.
      • Esophagogastroduodenoscopy (diagnostic)
      • Esophagogastroduodenoscopy (for control of variceal bleeding): 15(5 active)
      • Esophagogastroduodenoscopy (for control of non-variceal bleeding): 20 (10 active)
      • Esophageal dilation (bougienage): 15
      • Esophageal dilation (wire guided): 15
      • Flexible sigmoidoscopy: 50
      • Colonoscopy (diagnostic): 100
      • Colonoscopy (with snare polypectomy): 20
      • Esophageal manometry: 10
      • Percutaneous endoscopic gastrostomy: 10
      • Percutaneous liver biopsy: 25
    • Appropriately document the indications, performance, and result of procedures. This includes the documentation of any complications or adverse events and their treatment, recognize personal and procedural limitations, and develop the ability to judge when to seek help or terminate procedures.

    Clinical skills will be developed through supervised patient care in clinics, inpatient settings and consultation rounds. All of these activities will occur under direct faculty supervision.

    Procedural skills will be taught in a step-wise fashion: An initial cognitive phase where the trainee develops an understanding of the indications, contraindications, risks, benefits, and technical aspects of the procedures. The trainee will observe, but not perform, procedures during this stage of training. This period ordinarily lasts approximately one to four weeks. The trainee then enters a second phase of supervision by a faculty member in which the trainee gradually starts performing procedures.

    After achieving clinical competence in the procedure, trainees will be expected to do procedures with an attending physician. For diagnostic procedures, this typically occurs within the first year, and for therapeutic in the third year. The general guidelines for the numbers of procedures required to achieve this goal are outlined above. Each trainee, however, will be independently evaluated to graduate to this level of training. The determination of clinical competence will be based upon skill and judgment, not the number of procedures performed. Faculty supervision will always be available for additional teaching or consultation.

    Fellows are expected to be on general GI call at home during the week after hours and during the weekend. The call schedule is shared by all six GI fellows. While on call, fellows will answer phone calls from patients or other health care providers. They will also perform consults and necessary endoscopic procedures with the assistance of an on call attending physician.

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  3. Clinical and Medical Judgment

    Each trainee will develop the ability to integrate medical facts and clinical data to formulate a differential diagnosis, and diagnostic and therapeutic plan. He or she should develop the ability to weigh alternatives and incorporate knowledge of risks and benefits in delivering comprehensive, compassionate, and cost-effective medical care.

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  4. Commitment to Scholarship

    A commitment to scholarship will be developed by regular attendance and participation in the conferences of the training program:

    • Clinical case conference
    • Research conference
    • Pathology conference
    • Radiology conference
    • Basic science/physiology/motility conference
    • Journal Club
    • Medical or Surgical Grand Rounds

    All trainees will participate in 6 months of research (clinical or basic science). Each trainee will submit a manuscript, abstract, or review resulting from this activity.

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  5. Professional Attitude and Humanistic Qualities

    Trainees are expected to be compassionate, caring, and respectful of the needs of patients and their families. A professional, cordial attitude must be displayed at all times.

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  6. Moral and Ethical Standards

    The highest moral and ethical behavior is demanded on the part of all trainees. Any activity or conduct detrimental to the profession will not be tolerated. Honesty, integrity, and dedication to the principles of the medical profession are expected at all times.

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