Goals and Objectives
The goal of the ambulatory care experience are to provide fellows with the opportunity to see a broad spectrum of patients in an ambulatory care setting. Patients from a diverse ethnic, socioeconomic and cultural background present with a wide range of conditions presenting with manifestations ranging from mild to severe, the course of illnesses ranging from early to late. A specific objective of the ambulatory care experience is to provide the opportunity to provide continuing care of patients during the three years of fellowship training. Rotations in specialty clinics allow fellows to develop additional expertise in the management of conditions including complicated GI motility disorders, hepatology cases (pre- and post-liver transplantation patients included), inflammatory bowel disease, nutritional disorders and pediatric gastroenterology.
Method of Teaching
Each GI fellow is responsible for one half-day clinic per week throughout the three years of training. Both new and follow-up patients are scheduled to be seen by the fellow and reviewed with the faculty attending in the clinic who provide advice regarding evaluation and management of these cases. Fellows learn how to manage chronic GI and liver disorders by following patients over the duration of their fellowship training at UTMB. This allows trainees to observe disease progression and response to therapy, establish more long-term doctor-patient relationships, and recognize the role that psychosocial issues play in the management of GI illness, either as contributing factors or as a result of disease. Fellows also learn various management aspects of out-patient care including effective telephone communication with patients, the role of the sub-specialist in a managed care environment, and communication with referring physicians. Fellows are encouraged to communicate their findings and recommendations to the referring physicians in the form of dictated letters. The faculty also assist the fellows in this aspect of their training.
GI fellows assigned to the Hepatology Service and the Elective/Endoscopy and GI lab rotation see outpatients in the TDCJ Hospital on Friday mornings in conjunction with internal medicine housestaff and medical students who are supervised by the hepatology faculty attending. Although this does not provide a longitudinal experience, fellows have the opportunity to see patients in various stages of disease with a wide range of conditions including approximately 50% with liver disease. As in the out-patient fellows' clinic, the attending faculty is responsible for reviewing each case with the GI fellows.
Fellows have the opportunity to participate in seeing patients in specialty clinics of various GI faculty . Fellows see patients referred to the attending faculty for consultation or follow-up of specific gastrointestinal conditions. An intense exposure to these patients provides the fellow with an approach to the evaluation and management of specific gastrointestinal disorders which will augment their experience on other rotations including consultative in-patient and other ambulatory care experiences.
Method of Evaluation
Individual faculty who supervise the fellows during their clinics, in the TDCJ clinic or in specialty clinics, provide on-going verbal feedback to the fellow. In addition, faculty evaluate out-patient clinic performance on a written form on either a three- or six-month basis. This written evaluation forms the basis of formal evaluations of each fellow by the Training Director as well as the Director of the Division as discussed earlier under Gastroenterology Consult Rotation, Method of Evaluation.
The department of internal medicine is developing evidence based clinical protocols which will be available in EPIC (as order sets) for use when admitting patients with these diagnoses. Their AIM is to standardize care and decrease length of stay and readmission rates.Currently available protocols are:
- CAP - Community Acquired Pneumonia Orderset
- Congestive Heart Failure (CHF)
- Chronic Obstructive Pulmonary Disease (COPD)
- Diabetic Ketoacidosis Adult, ICU
- General Medicine Admission
- Immunodeficiency Flow Panel
- MICU/CCU Admission Order Set
- Oral Analgesic Medicaitons
- Parenteral Opioids
- Sepsis, Adult ICU
- 111 - Stroke Alert
- 112 - Stroke Activation
- 300086 - Stroke Floor Admission
- 3000000001 - Stroke Critical care without tPA
- 300088 Stroke - Transfer from Critical care to floor
- 3004002 - Stroke Discharge
All protocols can be found in the EPIC order set section.
The department of Internal Medicine has a large role in the Meaningful Use Initiative. Our participation is key for the success of the initiative. Please visit the meaningful use website for important communication and updates from the Meaningful Use Initiative.