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Department of Internal Medicine

Department of Internal Medicine

Curriculum

CURRICULUM FOR FELLOWSHIP TRAINING
UC DAVIS MEDICAL CENTER
DIVISION OF GASTROENTEROLOGY AND HEPATOLOGY

Overview: Statement of Purpose

The Division of Gastroenterology and Hepatology is committed to providing trainees an educational experience in a nurturing environment that provides the opportunity to learn the clinical and procedural skills necessary to become a competent physician in the treatment of gastrointestinal diseases. The Division recognizes that each trainee has individual strengths, weaknesses and goals. The Curriculum is developed to provide educational opportunities for all types of learners; encompass the knowledge and skills required of all gastroenterologists; and remain flexible in its structure to allow trainees to pursue advanced knowledge and skills related to their career goals.

Faculty


Lorenzo Rossaro, M.D., Chief of Division
Christopher Bowlus, M.D., Program Director
Juan Carlos Garcia, M.D., Clinic Director
Anthony Albanese, M.D.
Amar Al-Juburi, M.D.
Loren Fefer, M.D.
Charles Halsted, M.D.
Randall Lee, M.D.
Joseph Leung, M.D.
Nirmal Mann, M.D.
Surinder Mann, M.D.
Thomas Prindiville, M.D.
Homayoun Shojamanesh, M.D.
Virmeet Singh MD
Celcilia Terrado, M.D.
Natalie Torok, M.D.
Walter Trudeau, M.D.
Shiro Urayama, M.D.
Anastasia Waechter, M.D.
Mark Zern, M.D.

Teaching Locations

University of California Davis Medical Center
VA Mather Medical Center

Educational Purpose

Providing care to patients with complex and advanced gastrointestinal and liver-related diseases is beyond the training that is provided by an Internal Medicine residency. Specific knowledge of gastrointestinal and liver diseases, diagnostic methods, treatment modalities and specialized procedural skills are necessary to provide care to these groups of patients. The purpose of this fellowship is to train physicians to become competent in the practice of gastroenterology.


Goals and Objectives

Develop competency in the care of gastrointestinal and liver related illnesses in the inpatient setting
By the completion of the program, the fellow will be able to:

Demonstrate mastery of gastroenterology and hepatology knowledge in the areas outlined by the ACGME and published by the American Gastroenterology Association (see appendix).

Demonstrate competency in endoscopic skills including EGD, colonoscopy, hemostasis, polypectomy, dilation and removal of foreign objects.

Demonstrate professionalism in attitudes with colleagues and peers, empathy in patient care and abilities to interact with other health care providers.

Develop competency in the care of gastrointestinal and liver related illnesses in the outpatient setting
By the completion of the program, the fellow will be able to:

Demonstrate knowledge of the approach to various gastrointestinal illnesses including general gastroenterology, inflammatory bowel disease, motility and liver disease through the presentation of cases.

Demonstrate competency in the performance of endoscopic procedures,liver biopsies and paracentesis.

Demonstrate professionalism in attitudes with colleagues and peers, empathy in patient care and abilities to interact with other health care providers.

Develop the ability to access medical information, critically assess new information and present a synthesis of this information to an audience of peers.
By completion of the program, the fellow will be able to;

Demonstrate the ability to access literature using computer databases.

Demonstrate the ability to critically review clinical trials and investigations.

Demonstrate the ability to present information to peers in small group discussions and didactic lectures.

Teaching Methods

A variety of teaching methods are used throughout the training program, including experiential learning, didactic lectures, group discussions, self-directed learning, oral case presentations and videotape review. Experiential learning occurs in research, outpatient and inpatient settings and is structured in specific rotations.

Outpatient experience occurs in continuity clinic rotations of 6-month duration throughout the training, include General GI, Hepatology, IBD, Biliary, Pancreatic and Motility clinics.

Inpatient and research rotations of 4-week duration include GI Consultations, Liver Consultations, VA Mather Consultations, ERCP and Research.

Details of the methods and venues used in each rotation are given in individual rotation curriculum. Teaching venues include:

Teaching Rounds

Tuesday Grand Rounds
Including research presentations

Endoscopy Rounds

Thursday Academic Conferences
  -Journal Review
  -Board (Pathophysiology) Review
  -Pathology Conference
  -Radiology Conference
  -Clinical Case Conference

Journal Club

CQI

Methods of Evaluation


Assessments of the six core competencies will be made throughout the training period. Specific benchmarks must be reached at each period of training in order to progress and complete the training program, i.e. be deemed competent in the practice of Gastroenterology. Progress will be reviewed with each fellow on a semi-annual basis with the Program Director. Remediation of any deficiencies will be addressed at that time and a corrective plan of action developed.

The following grid outlines the tools used to assess competencies throughout the training program.
 
Division of Gastroenterology Fellowship

Evaluation Tools

COMPETENCIES
TOOLS Interpersonal and
Communication Skills Medical Knowledge Patient Care Practice Based Learning Professionalism Systems Based Practice
Faculty Clinical Evaluations (e-value) X X X X X X
Nursing Evaluations1 X  X  X X
Patient Evaluations1 X  X   
AGA In-Service Exam1  X    
Research Presentation X X  X  
Research Proposal  X X X  
Case Presentation X X X   X
Publications  X  X X 
Grand Rounds Presentation X X  X  
Procedure Log  X X   
Procedure Competence Evaluation  X X   
Journal Club Presentations X X X   
Faculty Research Evaluations    X X 
Duty hour Compliance     X 
Medical Records Compliance     X 
Semi-Annual Performance Summary     X 
Program Evaluation     X 
MS 3 Lecture Evaluations1 X     
MS 2 Study Section Participation X     
Complaints/Praise X  X X X X
CQI  X X   X

1 Performed annually

Interim Benchmarks for Competency

Faculty Clinical Evaluations (e-value)
A mean overall score not less than 6.0 on a scale of 9 in the prior 6 months of training
No mean score in any competency area of less than 5.0 on a scale of 9 in the prior 6 months of training

Nursing Evaluations
No mean score in any area of less than 2.0 on a scale of 5 in a year of training

Patient Evaluations
A mean overall score not less than 3.0 on a scale of 5 in a year of training
No mean score in any area of less than 2.0 on a scale of 5 a year of training

AGA In-Service Exam
Score not less than one standard deviation below the mean score of all fellows of the same year of training on the AGA Gastroenterology Training Exam (GTE).

Research Presentation (2nd and 3rd year only)
Submit a research proposal including background, hypothesis, aims, methods, and references.
Present the research proposal and final progress.

Case Presentation
Present at least 4 cases in a year.

Publications (2nd and 3rd year only)
Present at least 1 abstract at a national meeting including American College of Gastroenterology, American Gastroenterology Association, and American Society for Gastrointestinal Endoscopy or American Association for the Study of Liver Disease.

Grand Rounds Presentation
Present at least 1 topic at GI Grand Rounds and attend at least 80% of the meetings

Procedure Log
Maintain a procedure log in the format indicated by the Program Director.
Document performance of the minimum number of procedures required according to AGME and ASGE guidelines (whichever is greater), prior to assessing competency

Procedure Competence Evaluation
(To be completed in 1st or 2nd year) Document competency in colonoscopy and EGD using ASGE competency forms completed during direct observation by faculty
(Optional in 3rd year) Document competency in ERCP using ASGE competency forms completed during direct observation by faculty

Journal Club Presentations
Present one review of an original article and attend at least 80% of meetings.

Faculty Research Evaluations
No less than a mean overall score of 7.0 on a scale of 9 in the prior 6 months of training
No mean score in any area of less than 5.0 on a scale of 9 in the prior 6 months of training

Duty hour Compliance
Complete all surveys for duty hour compliance during the prior 6 months of training
No violations of duty hours in the prior 6 months of training

Medical Records Compliance
No suspension of privileges for medical records violations in the prior 6 months of training.

Semi-Annual Performance Summary
Satisfactorily address any deficiencies identified in the most recent summary.

MS 3 Lecture Evaluations (1st or 2nd year)
Obtain a mean overall score of satisfactory for the MS3 lecture

MS 2 Study Section Participation
Participate in a MS2 Study Section for IMD420 course

Complaints/Praise
Satisfactorily address any complaints or letters from faculty, support staff or patients

CQI
Present all cases involved in to CQI
Attend 80% of CQI meetings


Curriculum Review and Revision


The curriculum should be evaluated by faculty and fellows annually and revised at least every three years. The responsibility for curriculum review and revision will be delegated to the Curriculum Review Committee composed of the Program Director (Bowlus), Associate Program Directors for Gastroenterology (Al-Juburi) and Hepatology (Torok).