Structured Education

The structured education program within the curriculum includes a variety of didactic and other teaching methods. Intramural conferences are held weekly or biweekly from September through June.


Division rounds

Objectives

  • Develop the skill of condensing a clinical topic.
  • Critically reviewing and summarizing relevant literature in a compact 25-minute presentation.
  • Understand principles of gastroenterology through presentations by faculty, fellows, and visiting professors.

Frequency

Every week except during the summer and national holidays.

Description

Fellows prepare and present one topic each year. The fellow chooses the topic with advice from his or her faculty mentor or the program director. Presentations are made with slides and include a literature review. Time is allowed for questions. Fellows receive feedback from members of the faculty regarding content of presentation, clinical relevance of topic and skill at delivery.

Evaluation

  • A feedback letter by the program director is delivered on a one-to-one basis and is appended to the fellow’s permanent file.
  • Formal written evaluation following each rotation.
  • Semi-annual feedback sessions with the program director.
  • Fellow evaluation form.

Clinical correlation conference

Objectives

  • Provide an opportunity for interdepartmental discussions of interesting cases, diagnostic and therapeutic dilemmas, and rare conditions.
  • Learn to interpret data regarding a specific aspect of the presented case and summarize current approach to the diagnostic or therapeutic problem.

Frequency

Once a week except during summer and national holidays.

Description

Three to four cases are presented each week. Expert opinion is available from radiologists, pathologists and surgeons. Fellows are required to keep a list of appropriate cases available for presentation at this conference. Presentations are brief and highlight a clinical point or a diagnostic or therapeutic problem. Fellows are encouraged to review the literature and briefly discuss a key aspect of the case.

Evaluation

  • Direct one-to-one critique of presentation style and content, and review of literature.
  • Formal written evaluation following each rotation.
  • Semi-annual feedback sessions with the program director.
  • Fellow evaluation form.

Clinical journal club

Objectives

Develop an ability to critically analyze research work published in leading gastroenterological journals and determine whether conclusions are reliable.

Frequency

Every week. Each fellow presents three to four articles during an academic year.

Description

Two articles are presented and discussed at each session. Fellows select a clinical article from one of the leading gastroenterology or medical journals with the assistance of his or her faculty or research mentor, who also attends the journal club session. A critical analysis of the methodology and results is encouraged, followed by the fellow’s views regarding the topic, the appropriateness of the study and the conclusions. The topic is opened for discussion and comments by faculty members and fellows.

Evaluation

  • Direct feedback from faculty members at the end of the session.
  • Formal written evaluation following each rotation.
  • Semi-annual feedback sessions with the program director.

Pathology conference

Objectives

  • Familiarize the fellow with histopathologic appearances of common gastroenterological diseases.
  • Develop an ability to interpret histopathology in a clinical context, and to apply this knowledge to the day-to-day management of patients.

Frequency

Two to three sessions each academic year. Additional participation in liver pathology slide evaluation while rotating through the liver service.

Description

This consists of interactive didactic sessions hosted by established GI pathologists from the Department of Pathology. The patient’s clinical history is briefly discussed, and the fellows are asked to interpret the biopsy samples under the supervision of a faculty pathologist specialized in gastroenterologic biopsy interpretation. Additional small group discussions with a faculty pathologist specialized in liver biopsy interpretation while rotating through the liver service.

Evaluation

  • Direct one-on-one feedback by the faculty pathologist.
  • Formal written evaluation following each rotation.
  • Semi-annual feedback sessions with the program director.
  • Fellow evaluation form.

Professor’s rounds

Objectives

Develop an understanding of current opinions regarding etiology, pathogenesis and therapy within gastrointestinal and liver disease by interacting with a senior expert faculty member.

Frequency

Weekly

Description

Fellows choose one or two representative cases to present to senior faculty who were not directly involved in management of these cases. Fellows are encouraged to present complicated cases with difficult diagnostic or management issues. Patients are presented and discussed in a group discussion format with ample question and answer opportunities. The objective is to understand how an expert in the field dissects clinical scenarios that may require structured investigation and management.

Evaluation

  • Direct one-on-one feedback after topic presentation.
  • Faculty critique of presentations.
  • Formal written evaluation following each rotation.
  • Semi-annual feedback sessions with the program director.
  • Fellow evaluation form.

Extramural conferences

Objectives

  • Develop an understanding of surgical, hepatobiliary, colorectal and radiologic issues in gastroenterology and medical problems seen in conjunction with gastroenterological problems.
  • Continue training the gastroenterology fellow as an internist who can deal with investigation and management of common medical problems.

Description

Fellows are encouraged to attend the following conferences:

  • Colorectal Surgery
    • Held weekly in a case-presentation format, after which the cases are opened for discussion by other faculty members.
  • Combined Hepatobiliary
    • Held once a month where difficult hepatobiliary cases are presented.
  • Medicine Grand Rounds
    • Held weekly in a lecture format. Presenters are either faculty members from internal medicine, medicine residents and chief residents, or invited speakers from other departments or other institutions. Question-answer sessions follow each presentation.
  • Medicine Clinico-pathologic
    • Held weekly in a case discussion format. A distinguished clinician is presented a difficult or rare case and is asked to analyze the problem and his approach to further investigation and diagnosis. The clinician delivers a short didactic session on the best investigation of the presenting symptom.

Evaluation

Evaluation is based on appropriate gain in knowledge toward fulfillment of the integrated objectives. The participation of the fellow in these conferences is not directly evaluated.


Medical ethics

Objectives

  • Develop an understanding of the composite issues in medical ethics.
  • Encourage ethical conduct in the fellow’s approach to clinical medicine.

Description

Direct one-on-one discussions occur when situations are encountered in which ethics play a role in the consult service’s recommendations. Fellows are encouraged to attend formal ethics conferences held twice a month by the Department of Medicine. These sessions consist of discussions of situations in which ethics play an integral part in patient care, with didactic lectures on ethics.

Evaluation

  • Direct observation of the trainee’s skills and knowledge of ethical conduct during clinical rotations.
  • Comment on professional conduct on the quarterly faculty evaluations and during semiannual feedback sessions with the division chief.

Risk management

Objectives

  • Encourage practice of safe and appropriate medical care and good documentation in patient charts.
  • Develop ability to identify situations where the assistance of risk management may be required.

Description

Fellows are required to complete a risk management self education tool involving multiple choice questions, descriptions of clinical situations, and issues involved in documentation and interpretation of medical records. The Department of Risk Management is available by phone 24 hours a day for discussion of patient-related issues.

Evaluation

  • Scoring of multiple choice questions in the self-education tool and feedback of deficiencies.
  • Continued re-education until satisfactory scores achieved.
  • Deficiencies are discussed at faculty meetings.
  • Quarterly feedback sessions with the division chief.
  • Fellow evaluation form.

Summer start-up lecture series

Objectives

  • To introduce the new first-year fellow to the basic workings of procedural aspects of gastroenterology and hepatology.
  • Understand the basic indications, complications, logistics and techniques of commonly performed procedures in gastroenterology.
  • Learn an approach to the management of common situations encountered in the consult service. Understand basic principles of being a consultant.

Frequency

One-hour didactic sessions every weekday during the months of July and August.

Description

The new fellow is introduced to procedural logistics and other basic clinical aspects of the gastroenterology division. Scheduling of procedures, indications for urgent procedures, conscious sedation issues, working as a consultant, and indications for specialized procedures are discussed. Approaches to common problems encountered on the consult service are dealt with in a lecture format, with question-answer sessions at the end of each lecture. Introductory techniques for the procedures performed by the first-year fellow are explained. Second and third year fellows are also encouraged to attend the didactic sessions; residents and students rotating through the GI service also attend.

Evaluation

  • Limited evaluation for this part of the structured education curriculum.
  • Comprehension and appropriate progress is subsequently evaluated during the clinical rotations.

Core conference and board review

Objectives

  • Develop a more detailed understanding of GI and liver diseases.
  • Review topics that may not be covered otherwise during the curriculum in clinical rotations and conference settings.
  • Develop comprehensive knowledge base to better prepare the trainee for the GI Boards and for a consultative career.

Frequency

Two one-hour sessions every month, excepting the summer months and national holidays.

Description

This conference begins in the fall and cycles for two years. Core GI topics are discussed under the supervision of a faculty attending. Core topics essential for GI boards are of particular focus.

Evaluation

  • Oral quizzing of the fellow during the review sessions.
  • Faculty review of basic knowledge base during quarterly evaluations.
  • Semiannual summary of knowledge base during feedback sessions with the program director.

Extramural postgraduate courses

Objectives

  • Develop an understanding of GI diseases.
  • Augment knowledge of core topics in preparation for board examination.
  • Learn about newer techniques and approaches by experts in the field.

Description

Fellows are encouraged to attend postgraduate courses hosted by the gastroenterological associations in conjunction with national and international meetings. Travel and registration costs are covered by the division for one course during each year of fellowship. Fellows are also encouraged to attend board review courses in preparation for board examinations.

Evaluation

  • Semi-annual feedback sessions with the program director.
  • Fellow evaluation form.