University Of South Florida College Of Medicine

UNIVERSITY OF SOUTH FLORIDA COLLEGE OF MEDICINE

ADVANCED SUBSPECIALTY TRAINING PROGRAM IN GASTROENTEROLOGY

The Division of Digestive Diseases and Nutrition of the Department of Internal Medicine at the University of South Florida College of Medicine offers an accredited comprehensive residency program in clinical gastroenterology which consists of three years of training. There are two positions available this year. Our program no longer participates in the Medical Specialties Matching Program. Upon completion of this training, the individual will have met the training requirements for qualification to take the American Board of Internal Medicine Subspecialty examination in Gastroenterology (see attached: Goals and Objectives, Curriculum). The training program has been fully accredited since its inception by the ACGME. The Subspecialty Board pass rate for the last two cycles of residents has been 100%.

I. Facilities

A. Tampa General Hospital :

The gastroenterology unit at TGH consists of a suite of five examination rooms, offices, conference room, and other support areas. The unit is equipped with fluoroscopy and video endoscopy. The latest equipment for diagnostic and therapeutic endoscopy is available, including a Nd-YAG laser and esophageal, biliary and anal manometry unit. Staffing consists of a full- time member of the faculty, a first, second and third year GI resident; and intermittently medical residents and medical students, as well as six gastrointestinal assistants. A consultant service is provided for this 1000-bed general hospital. An outpatient clinic meets once a week.

B. James A. Haley Veterans Administration Hospital :

The James A. Haley VA Hospital is a 600 bed facility. The new Gastroenterology Unit consists of a laboratory, three endoscopy procedure rooms, a recovery room and offices. A full range of upper, lower and biliary GI endoscopic procedures are performed. The unit is equipped with video endoscopy and fluoroscopy. Esophageal manometry, 24 hour pH monitoring, Nd:YAG laser therapy and EUS equipment are available. Four full-time GI assistants are available. The GI consult service is staffed by a full-time member of the faculty, a first, second and third-year GI resident, a nurse practitioner, and intermittently a medical resident, and medical students. Three outpatient clinics meet each week to care for consultation and follow- up patients.

C. USF College of Medicine Clinics :

The GI Facilities include the Center for Swallowing Disorders and the new Endoscopy and Ambulatory Surgery Center which is fully equipped for outpatient endoscopy. The clinic building is attached to the College of Medicine which is located on the USF campus and across the street from the Tampa VAH.

The Endoscopy and Ambulatory Surgery Center is staffed by four full-time assistants. Faculty members attend to private patients in the clinic on assigned days each week and may be assisted by GI residents. In 1987 the Center for Swallowing Disorders (CSD) was established to provide tertiary level consultation and therapy for patients with both neuromotor and obstructive types of dysphagia. Procedural training for outpatients and inpatients at USF Medical Clinics and Moffitt Cancer Center will include upper endoscopy, complex esophageal stricture dilation for benign and malignant diseases, pneumatic dilation for achalasia, botox injection, esophageal prostheses for malignant obstruction, esophageal manometry and 24 hour pH studies for gastroesophageal reflux. Emphasis will be placed on the cognitive aspects of the diagnosis and management of dysphagia.

D. H. Lee Moffitt Cancer Center and Research Institute :

This 162 bed tertiary care center opened in November 1986 and provides the latest in medical and surgical techniques for the diagnosis, therapy and extended care for patients with malignant diseases. The center recently received comprehensive cancer center status from the NCI, the only facility in Florida with this designation. The gastroenterology services include a daily outpatient consultation clinic; a 7-room, fully equipped diagnostic and therapeutic endoscopy unit and physiology laboratory including Nd-YAG laser, fluoroscopy, manometry, EUS equipment, argon plasma coagulation and endoscopy. Full inpatient consultation services, including nutrition support, are provided by our Division.

E. Libraries :

There are excellent libraries in each hospital with a complete collection of journals and textbooks. The College of Medicine Library provides the service for computerized national and international bibliographic literature search in addition to an extensive collection of textbooks and journals.

II. GI Resident Responsibility:

A. Patient Care :

1. The team (staff physician, resident and students) is responsible for each patient's care. Quality care for the individual patient is the goal of each physician team member.

2. The first year GI resident has primary responsibility for patient care on consult services, is responsible for a comprehensive clinical evaluation and will perform upper GI endoscopy, flexible proctosigmoidoscopy, liver and small bowel biopsy and esophageal dilations under faculty supervision. Rotations are equally divided between VA and TGH consultation services.

3. The second year GI resident has responsibility for consultations and additional specialized procedures: colonoscopy and polypectomy, endoscopic hemostasis, percutaneous endoscopic gastrostomy, esophageal variceal sclerosis, laparoscopy and esophageal manometry. The GI resident is also responsible for the conduct of certain regularly scheduled teaching conferences. During three/four month rotations in the second year he/she will be assigned to the VAH, TGH consultation services, and for some rotations to the Moffitt Cancer Center.

4. The third year resident performs advanced therapeutic endoscopy like ERCP, EUS, laser therapy and clinical research, while remaining an important part of the care team and has significant teaching responsibilities. There is opportunity to participate in rounds of the hepatic transplant team at TGH.

5. Regularly scheduled outpatient hours are assigned for ambulatory care patent management at both VAH and TGH. Clinic patients are seen by appointment one half day each week. Each resident will also be assigned to 2 faculty members in the USF Clinic for 18 months each. This will provide a continuity of care for the outpatient experience covering the entire length of training during this weekly clinic.

B. House Officers and Medical Students :

GI residents will assist the house officers and students in the development of clinical skills, knowledge and maturity in Internal Medicine and Gastroenterology. Primary GI resident responsibilities include:

1. Teaching patient care via basic history and physical examination methods, interpretation of laboratory and procedural data and therapy.

2. Instruction in the development of logical approaches to clinical problems.

3. Encourage in-depth reading on topics concerning patient care.

C. Research :

GI residents are required to initiate and conduct their own project under supervision or assist in clinical investigation being conducted by a member of the faculty. Each GI resident also is required to prepare at least one scholarly manuscript suitable for publication during the three year program. Two months of protected time are provided in each year for pursuit of individual research. Support for attendance of national scientific meetings is dependent on submission of an abstract (second and third year). The division allows participation in one major scientific meeting a year per resident.

D. Pediatric Rotation:

GI residents may rotate one month through the pediatric gastroenterology service at All Children’s Hospital in St. Petersburg on an elective basis.

III. Rotations: An example of a typical rotation follows. Rotations may change according to number of residents/year, service load and educational needs:

Jul Aug Sept Oct Nov Dec Jan FebMar Apr May June 1st Yr VAH TGH TGH RES VAH TGH TGH RES TGH VAH 2nd Yr VAH TGH RES VAH TGH TGH RES VAH TGH MCC 3rd Yr TGH MCC VAH RES TGH VAH VAH RES PEDS MCC

IV. Conferences:

Basic Science Conference - Friday, 7:30 - 8:30 AM, weekly, Veterans Administration Hospital.

Research Conference - Friday, 7:30 - 8:30 AM, monthly, as part of the pathophysiology schedules.

X-Ray Conference - Friday, 7:30 - 8:30 AM, monthly, V.A. Hospital

Medical Grand Rounds are held on Thursday at Noon at the Medical Center.

TGH GI Surgery-Radiology Conference - A multidisciplinary conference held Tuesday, 4:00 - 5:00 PM

TGH Gastroenterology Conference - Tuesday, 5:00 PM - 6:00 PM. The format for the GI conference varies from week to week: faculty lecture, clinical conference, endophotography imaging and hepatology, alternative with GI pathology on consecutive weeks.

GI Journal Club and QA, Risk Management Conference - evenings, monthly.

Postgraduate Courses - are conducted by the Division, and usually involve some participation by the residents from the Division. A guest faculty of internationally known experts join the USF faculty.

V. Administrative Data:

A. Salary :

The salary structure for postgraduate training at USF is based on the level of prior postgraduate training and experience. Residents are paid bi-weekly. Malpractice and disability insurance are provided while working in University affiliated facilities. Group health insurance is available for individuals and families.

B. Communicable Disease Prevention

Prior to beginning training at the University of South Florida and its affiliated institutions, you must complete a Certification of Communicable Disease Prevention form before patient contact will be permitted.

C. Uniforms : White coats are provided for all residents.

D. Pagers : Long-distance pagers are assigned to all residents. E. Parking : There is adequate parking at all facilities.

F. Vacation : Three weeks of vacation is granted each year.

G. Meeting time: Up to 1 week is provided to attend out-of-town G.I. meetings/conferences/courses. The Division provides funds to attend one national meeting per year.

H. Residents must have a valid Florida medical license.