Gastroenterology Consult Rotation

Goals and Objectives

The goal of the consult rotation is to impart the basic skills of a gastroenterology consultant to the fellow. These include: a broad knowledge base, the ability to generate a relevant differential diagnosis based on an accurate history and physical examination, an understanding of the indications and contraindications for diagnostic and therapeutic procedures, skill at performing these procedures, the ability to think critically, and an appreciation of the humanistic and ethical aspects of medicine. The fellow will also have learned how to manage complex multifaceted disease processes in a coordinated way with multiple health care providers from varying disciplines.

Method of Teaching

The consult service assists in the management of patients while they are under the direct care of virtually every other clinical department on campus, including Family Medicine, Obstetrics & Gynecology, Internal Medicine, Neurology & Neurosurgery, Vascular Surgery, General Surgery, Cardiothoracic Surgery, Pediatrics, Psychiatry, and Geriatrics. At the present time there are two consult teams, one for general gastroenterology and one for hepatology. Each consists of one faculty member, one GI fellow and a variable number of medical/family practice residents and students.

Fellows see patients independently, assimilate the core clinical information from a variety of sources (i.e., pathology, surgery, radiology, nutrition service), construct a problem list and a list of the differential diagnoses, and develop a diagnostic and therapeutic plan. This evaluation is then presented to the faculty on the service at the bedside on the same day as the initial evaluation. The faculty reviews the findings and modifies the assessment and plan formulated by the fellow according to any additional data that comes to light during the review of the case, and the faculty’s own experience and knowledge. The faculty attending serves as a role model in developing the skills of a consultant and to foster a broad and scholarly approach to consultative gastroenterology. Risk/benefit and cost/benefit ratios are emphasized in these discussions. The role of the physician as a compassionate caregiver and teacher for the patient and his/her family is also emphasized and encouraged. Pathologic and radiologic findings and other primary data are reviewed by the team of housestaff and the attending GI faculty with experts in those areas. The fellows are expected to follow up on patients throughout the period of hospitalization and, where appropriate, in a longitudinal manner in the outpatient GI clinic after discharge.

In addition to the many conferences and didactic lectures that take place on a weekly basis, fellows on this rotation are also encouraged to study independently and develop a scholarly approach to the clinical problems they encounter on the consult rotation by reading current textbooks and monographs and, especially, current and relevant journal articles. Readings are readily available in the GI Library, which has all of the recent major textbooks and houses an impressive journal article file. During this rotation, the fellow acts as both a student and a teacher of housestaff and students, utilizing his/her experience as well as the core resources available (e.g., the GI library).

Method of Evaluation

Faculty on the consult rotation daily observe the fellows’ skill and competence in history taking, physical exam, clinical judgment, and consulting skills. By rounding on patients and informally meeting with the fellow, the faculty also have the opportunity to evaluate the fellows’ communication skills, attitude/behavior, and commitment to the field of gastroenterology. At the conclusion of the month’s rotation, the faculty complete an ABIM approved numerical ranking form which also allows for candid comments in a narrative section of the form. Fellows will meet individually with the program director every six months. These meetings will allow evaluation summaries and discussions of the fellow’s progress. These meetings also provide an opportunity for the individual fellow to reflect on their progress, and to provide feedback to the program director regarding the fellowship program. Fellows will be asked to evaluate their supervising faculty on a monthly basis. These evaluations are performed online. Faculty will not see the actual evaluation, but will receive a composite evaluation at the end of six months from all evaluation materials.

Elements of Competence to be Evaluated in Consultative Gastroenterology and Hepatology

An understanding and commitment to all elements of professionalism.

A thorough knowledge of history-taking, including family, genetic, psychosocial, and environmental histories, and the ability to perform a comprehensive and accurate physical examination.

The ability to arrive at an appropriate differential diagnosis, to outline a logical plan for specific and targeted investigations pertaining to the patient’s complaints, and to formulate a plan for management and follow-up treatment of the patient.

The ability to present effectively the results of a consultation orally and in writing and to defend the clinical assessment, differential diagnosis, and diagnostic and management plan.

A core fund of knowledge in gastroenterological and hepatic physiology, palhophysiology, and clinical pharmacology as outlined in the goals of each task force report.

Procedural skills appropriate to the level of training.