Training Goals and Objectives USF Gastroenterology Fellowship

The training program of the Division of Digestive Diseases and Nutrition is designed to instruct, develop, and instill in advanced subspecialty residents who have completed internal medicine training the following competencies:

Medical Knowledge: 1. A knowledge and understanding of the basic scientific principles including molecular biology, immunology, genetics, pharmacology, pathophysiology, clinical laboratory methods, and cognitive skills necessary to diagnose and treat patients with gastrointestinal and liver diseases. 2. Familiar with a broad range of GI and hepatic pathology and the clinical implications of the pathological findings in biopsies and in surgical specimens. 3. A knowledge of the broad range of gastrointestinal symptoms and their implications. 4. The ability to recognize gender differences in the pathophysiology of health and disease states and different responses to treatment. 5. An appreciation of the unique aspects of pediatric gastroenterology and an awareness of the clinical problems of pediatric gastroenterology. 6. A knowledge of the effect of age on the pathophysiology of gastrointestinal disease and response to treatment. 7. A knowledge and understanding of the methods of nutritional assessment, and the principles of enteral and parenteral nutrition necessary to diagnose and treat patients with nutritional disorders. 8. A basic understanding of liver disease. 9. A knowledge of the indications, contraindications, alternatives to, and potential complications of gastrointestinal endoscopy. 10. An understanding of when to biopsy, how it may aid the diagnosis, and what the limitations of biopsy are; an understanding of when and how biopsies should be submitted to the pathology laboratory for other than routine processing in formalin; and a familiarity with the mechanisms and the usefulness of new techniques, such as flow cytometry, immunohistochemistry, and tests based in molecular biology. 11. A basic understanding of liver disease, in general, including the signs, symptoms, diagnostic methods necessary to evaluate and treat these disorders. 12. A critical approach to the medical literature to facilitate review and assessment of the quality of reported scientific studies. 13. A knowledge of the design and conduct of clinical research projects. 14. Scientific writing skills needed to prepare and publish papers in peer- reviewed journals. 15. The ability to plan and present continuing medical education lectures. Patient Care: 1. The ability to assess the broad range of gastrointestinal symptoms and disorders and to initiate appropriate diagnostic studies and therapy. 2. The ability to recognize, diagnose and treat all commonly seen liver diseases. 3. The ability to diagnose and treat common pediatric disorders and to perform standard endoscopic procedures in pediatric patients. 3. Competence in the evaluation and management of gastrointestinal and liver disorders in older patients. 5. Proficiency with the techniques of gastrointestinal endoscopy necessary to diagnose and treat gastrointestinal disorders. 6. Proficiency at performing nutritional assessment and recognize the circumstances in which a formal nutritional assessment is necessary for diagnosis. 7. The ability to institute enteral nutrition, and parenteral nutrition in order to treat patients with nutritional and feeding disorders. 8. The ability to participate in a limited scope of care of children with gastrointestinal disorders when, in underserved areas, pediatric gastroenterology consultation is not available. 9. An ability to recognize, diagnose and treat all types of routinely seen liver diseases. 10. Proficiency in upper gastrointestinal endoscopy (EGD), colonoscopy, biopsy techniques, polypectomy, variceal hemostasis, non-variceal hemostasis, esophageal dilation, liver biopsy, capsule endoscopy, and diagnostic and therapeutic ERCP. 11. The ability to appropriately select patients who would benefit from endoscopic ultrasound 12. The ability to exercise good judgment in applying diagnostic and therapeutic endoscopy to patient care.

Practice Based Learning and Improvement 1. A critical approach to the medical literature to facilitate review and assessment of the quality of reported scientific studies. 2. An understanding and abillity to apply the methods employed to assess quality of care and initiate improvement projects. 3. A commitment to continuous improvement in the delivery of medical care. 4. The ability to evaluate reported research and use the information obtained from reviewing the literature to improve patient care. 5. The capability to use information technology to manage practice information. 6. The ability to use information technology to enhance professional development and continuing education. 7. A willingness to participate in the education of students, residents and other health care professionals.

Systems Based Practice 1. A working knowledge of the different systems of providing medical care including the governance of these organizations and the roles of physicians in providing care and in managing these systems. 2. Sufficient training about medical economics, including contract negotiations, so that trainees can evaluate different employment. opportunities and make plans for a career that is satisfactory for them. 3. The ability to apply a knowledge of the mechanics of insurance schemes, coding and billing so that reimbursement for professional services can be sought without violating the law. 4. The desire and ability to serve as a patient advocate. 5. A understanding of the function of a transplant committee and the ability to guide patients through the pre-transplant evaluation. 6. The ability to partner with health care managers and other providers. 7. The ability to use the entire health care system to provide the services the patient needs. 8. The ability to utilize support groups, such as the Celiac Sprue Association and Crohn’s and Colitis Foundation, to facilitate patient care and provide community support for patients with chronic gastrointestinal disorders.

Communication 1. The ability to communicate effectively with patients, and their families. 2. The ability to create and sustain a therapeutic and ethically sound relationship with patients. 3. The ability to counsel and educate patients and their families concerning health issues, gastrointestinal and surgical procedures, and expectations. 4. The ability to use effective listening skills. 5. The ability to communicate with other health care professionals both verbally and in writing. 6. The ability to work as both an effective team member and as an effective team leader. 7. The ability to plan and present continuing medical education lectures.

Professionalism: 1. Development of the fundamental qualities of professional and ethical behavior, and humanistic attitudes. 2. Development of respect compassion and integrity in all interpersonal relationships. 3. Development of a sense of accountability to patients, society and the profession. 4. Respect for the confidentiality of patient information. 5. A commitment to excellence. 6. A commitment to lifelong learning. 7. A willingness to participate in a limited scope of care for pediatric patients when, in underserved areas, pediatric gastroenterology consultation is not available. 8. An understanding of the informed consent process and ability to apply this to obtaining informed consent for diagnostic procedures, therapy, and participation in research studies. 9. An appreciation of the moral values necessary to engage in satisfying and ethical professional interactions with colleagues and patients. 10.An understanding of and a commitment to ethical principles pertaining to business practices.