The curriculum is designed to promote six goals based on the ACGME core competencies:
  • Medical knowledge
  • Patient care
  • Interpersonal and communication skills
  • Professionalism
  • Practice-based learning and improvement
  • Systems-based practice
    ​
The following are the goals and objectives for each competency at each level of training.
FIRST YEAR GI FELLOW​
​Goal: A PGY-4 fellow should be able to assess new patient problems, formulate and execute a treatment plan with guidance and teach basic gastroenterology skills to medical students and other trainees. PGY-4 fellows should begin to develop basic procedural competencies in diagnostic upper endoscopy and colonoscopy.

Patient Care:
  • Perform an accurate physical examination and present information concisely with an initial assessment plan
  • Follow the patient's disease course during the patient's hospital stay
  • With attending consultation, formulate and execute an impression and a list of recommendations for the primary service
  • When indicated, consent patients for procedures and order appropriate diagnostic tests (e.g., endoscopy, radiologic tests, etc.) in conjunction with the primary/referring service
  • Perform (with supervision) the following basic gastroenterology procedures:
    • Diagnostic colonoscopy to the cecum with limited assistance
    • Diagnostic endoscopy to the second portion of the duodenum
    • Esophagogastroduodenoscopy (EGD or upper endoscopy)
  • Develop expertise in the diagnosis and management of acute and chronic inpatient and outpatient gastrointestinal diseases including:
    • GI infections
    • Hepatobiliary diseases
    • Neoplasms of the digestive system
    • Pancreatic diseases
    • Peptic ulcer disease
    • Small and large intestinal diseases
    • Upper and lower GI bleed
    • Vascular disorders of the digestive tract
  • Learn to provide inpatient and outpatient care that is safe and compassionate
  • Develop the ability to thoroughly and clearly educate the inpatient in the relevant areas of disease prevention, detection, progression and therapy to promote gastrointestinal health

Medical knowledge:
  • Attend core conferences and teaching rounds to learn the pathophysiology, epidemiology, disease management, procedural and medical management of common and uncommon inpatient and outpatient gastrointestinal diseases
  • Teach medical students and residents the basics of gastroenterology and hepatology
  • Take the Gastroenterology Training In-service Examination

​Practice-based learning and improvement:
  • Become familiar with the concepts of quality improvement
  • Begin to review, analyze and utilize scientific evidence from the gastrointestinal literature for the management of GI patients
  • Learn the best practice patterns to facilitate gastroenterology care through clinic operating procedures and patient interactions
  • Participate in conferences such as M&M, geared to the programmatic review of adverse events

Interpersonal and communication skills:
  • Communicate effectively with staff, peers, attending gastroenterologists, referring physicians and other consultants
  • Convey bad news compassionately and honestly
  • Interview patients and family members accurately, patiently and compassionately, and present information in an understandable and compassionate manner

Professionalism:
  • Be sensitive to cultural, age, gender and disability issues
  • Cross-cover colleagues' services when needed and conduct this coverage carefully with appropriate feedback to responsible colleagues
  • Demonstrate ethical principles with relation to patient care and confidentiality
  • Interact collegially with peer group and other healthcare professionals
  • Participate in program planning, including Program Director meetings
  • Practice appropriate interactions with pharmaceutical representatives and be unbiased in prescribing habits
  • Understand and demonstrate professional behavior in daily activities

​Systems-based practice:
  • Achieve basic understanding of healthcare systems related to gastroenterology care and overall system activities
  • Attend conferences concerning healthcare system patient management and components of systems of healthcare
  • Attend national gastroenterology conferences (e.g., ACG and endoscopy training courses)
  • Begin involvement to understand the standard operating procedures and quality improvement initiatives within the hospital
  • Learn proper documentation and billing skills to practice cost-effective care
  • Utilize an appropriate range of healthcare professionals to care for patients, working closely with social services to maximize patient care and understanding the role of hospice, referring appropriately when needed
SECOND YEAR GI FELLOW
Goal: A PGY-5 fellow should learn to assess and care for a larger volume of patients and learn and teach basic textbook and evidence-based medicine to medical students and other trainees. PGY-5 fellows will acquire the skill of performing diagnostic upper endoscopy and colonoscopy and begin with therapeutic maneuvers under direct supervision.

Patient Care:
  • Complete a time-efficient history and physical examination
  • Supervise and critique the work and orders of PGY-4 fellows
  • Direct the PGY-4 fellows successfully with the appropriate level of intervention for each trainee's skills
  • Complete competency-level performance of the following basic gastroenterology procedures:
    • Colonoscopy
    • Endoscopic maneuvers, including snare polypectomy
    • Sclerotherapy and thermal coagulopathy to control GI bleeding
    • Upper endoscopy
  • Develop clear expertise in the diagnosis and management of acute and chronic inpatient gastrointestinal diseases including:
    • Digestive system neoplasms
    • GI infections
    • Hepatobiliary diseases
    • Idiopathic abdominal pain
    • Inflammatory bowel disease
    • Intestinal/colonic pseudo-obstruction
    • Ischemic colitis
    • Neuroendocrine diagnosis
    • Pancreatitis
    • Peptic ulcer disease
    • Secretory diarrheal states
    • Upper and lower GI bleeding
    • Vascular diseases of the digestive system
  • Present cases succinctly and in a direct manner
  • Know the GI Hospital Rotation's patients at a management level
  • Handle consult calls respectfully and appropriately
  • Teach good symptom management skills to medical students and other trainees
  • Provide inpatient and outpatient care that is safe and compassionate
  • Develop the ability to thoroughly and clearly educate the inpatient in the relevant areas of disease prevention, detection, progression and therapy to promote gastrointestinal health

Medical Knowledge:
  • Begin to take a leadership role at core conferences and teaching rounds regarding the pathophysiology, epidemiology, disease management and procedures and medicine management skills for common and uncommon inpatient gastrointestinal diseases
  • Organize the team's performance at teaching rounds
  • Read textbook and pertinent literature materials concerning problems encountered
  • Teach medical students and other trainees about GI disease states and patient management

Practice-based learning and improvement:
  • Address or refer patients related to spiritual or existential issues
  • Communicate effectively with staff, peers, attending gastroenterologists, referring physicians and other consultants
  • Counsel patients about transitioning to palliative care, when needed
  • Give usable feedback to medical students and other trainees based on observation of their performance, and assess their improvement

Interpersonal and communication skills:
  • Interview patients and family members accurately, patiently and compassionately and present information in an understandable manner. Convey bad news compassionately and honestly.
  • Know the best practice patterns to facilitate gastroenterology care through clinic operating procedures and patient interactions
  • Learn to become a teacher of gastroenterology to junior trainees, medical students and other healthcare professionals
  • Participate in problem-based quality improvement projects
  • Participate in programmatic reviews and conferences studying adverse events
  • Participate in project groups, committees and hospital groups when requested
  • Plan patient and family conferences
  • Present cases succinctly, in a problem-based, direct manner
  • Review, analyze and utilize scientific evidence from the gastrointestinal literature for the management of GI patients

Professionalism:
  • Cross-cover colleagues' services when needed and conduct this coverage carefully with appropriate feedback to responsible colleagues
  • Interact collegially with his/her peer group and other healthcare professionals, including acting responsibly in the larger context of pursuing programmatic successes
  • Mentor medical students, other trainees and PGY-4 fellows in professional conduct
  • Participate in professionalism-based learning activities through conferences
  • Participate in Program Director meetings
  • Practice ethical principles with relation to patient care and confidentiality
  • Practice interactions with pharmaceutical representatives and be unbiased in prescribing habits
  • Practice sensitivity to cultural, age, gender and disability issues
  • Understand and demonstrate professional behavior in daily activities

Systems-based practice:
  • Assist other trainees in the utilization of appropriate healthcare resources for the best care of the GI Hospital Rotation's patients
  • Attend conferences concerning healthcare system patient management and components of systems of healthcare
  • Attend national gastroenterology or hepatology conferences (e.g., DDW or AASLD)
  • Model appropriate interactions in multidisciplinary planning, including standard operating procedures and quality improvement initiatives
  • Understand and practice proper documentation and billing skills to practice cost-effective care
THIRD YEAR GI FELLOW
Goal: The senior-level, PGY-6 fellow should demonstrate rapid assessment and planning skills and near-attending-level care planning and management, while teaching medical students and other trainees at near to or exceeding attending-level teaching. PGY-6 fellows should be able to perform diagnostic and therapeutic upper endoscopy and colonoscopy procedures with direct supervision.

Patient care:
  • Master the PGY-5 fellow objectives
  • Demonstrate efficient organization of the GI Hospital Consult Rotation and a working knowledge of all patients
  • Demonstrate near-attending-level capacity for program assessment and care planning
  • Attain trainer-level proficiency in the following gastroenterology procedures pertinent to his/her career choices:
    • Colonoscopy:
      • Intubation of the terminal ileum
      • Removal of large or complex polyps by saline-assisted polypectomy or piecemeal resection
      • Control of bleeding using clips or argon plasma laser coagulation
    • Upper endoscopy:
      • Pass a side-viewing scope to identify the papilla or lesions difficult to observe with forward viewing scope
      • Perform advanced maneuvers, such as placing clips on bleeding vessels or argon plasma laser coagulopathy
  • Secure expertise in the diagnosis and management of acute and chronic inpatient and outpatient gastrointestinal diseases at an attending physician level
  • Provide inpatient and outpatient care that is safe and compassionate with the leadership ability to thoroughly and clearly educate the inpatient and all other trainees regarding relevant areas of disease prevention, detection, progression and therapy to promote gastrointestinal health

Medical knowledge:
  • Access and critique the medical literature regarding gastroenterology and hepatology problems encountered
  • Assume the trainee leadership role at core conferences and teaching rounds regarding the pathophysiology, epidemiology, disease management, procedures and medicine management skills for common and uncommon inpatient gastrointestinal diseases
  • Teach medical students, other trainees and PGY 4/5 fellows at near-attending level
  • Organize team activities in a smooth and efficient fashion
  • Assist PGY-5 fellows' development directly at teaching conferences and indirectly at work sites

Practice-based learning and improvement:
  • Demonstrate mastery of PGY-5 fellow skills and encourage participation of colleagues
  • Review, analyze and utilize scientific evidence from the gastrointestinal literature for the management of GI patients, taking a leadership role in guiding PGY-4 and PGY-5 fellows in addition to sharing relevant literature reviews with them
  • Know and be able to succinctly communicate the best practice patterns to facilitate gastroenterology care through clinic operating procedures and patient interactions

Interpersonal and communication skills:
  • Interview patients and family members accurately, patiently and compassionately and present information in an understandable manner. Convey bad news compassionately and honestly.
  • Supervise PGY-4 and PGY-5 fellows' work related to planning patient/family conferences and patient communications/counseling
  • Communicate effectively as a consultant with staff, peers, attending gastroenterologists, referring physicians and other consultants, and lead other trainees related to appropriate fellow-to-medical-professional communications
  • Present cases succinctly, in a problem-based, direct manner
  • Assume the role of a teacher of gastroenterology to junior trainees, medical students and other healthcare professionals

Professionalism:
  • Demonstrate proficiency in PGY-5 and PGY-6 objectives
  • Mentor medical students, other trainees and PGY-4 fellows in professional conduct
  • Assist in formal teaching exercises as requested
  • Assert leadership in program planning, including fellow participation in the annual Faculty/Fellow Meeting, Fellow Curriculum Committee and Conference Planning Committees.
    ​
Systems-based practice:
  • Attend conferences concerning healthcare system patient management and components of systems of healthcare
  • Model appropriate interactions in multidisciplinary planning, including improvements related to standard operating procedures and quality improvement initiatives
  • Participate in hospital and national medical association committees and multidisciplinary planning groups when requested
  • Attend national conferences directed at career goals
  • Demonstrate near-attending-level utilization of overall systems of care