CLINICAL COMPETENCIES
The Accreditation Council of Graduate Medical Education (ACGME) Core Competencies introduced six defined areas of competency, which residents must obtain over the course of their training. The core competencies, established in July 2001, are outlined below.
1. PATIENT CARE
Residents are expected to delivery patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
a. Residents are expected to provide patient care that is compassionate, appropriate and effective for the promotion of health, prevention of illness, treatment of disease and care at the end of life.
b. Gather accurate, essential information from all sources, including medical interviews, physical examination, records, and diagnostic/therapeutic procedures.
c. Make informed recommendations about preventive, diagnostic, and therapeutic options and interventions that are based on clinical judgment, scientific evidence, and patient preferences.
d. Develop, negotiate and implement patient management plans.
e. Perform competently the diagnostic procedures considered essential to the practice of Gastroenterology and Hepatology
2. MEDICAL KNOWLEDGE
Residents are expected to demonstrate knowledge about established and evolving biomedical, clinical and cognate (e.g. epidemiological and social-behavioral) sciences and the application of the knowledge in patient care.
a. Residents are expected to demonstrate knowledge of established and evolving biomedical, clinical and social sciences, and demonstrate the application of their knowledge to patient care and education of others.
b. Apply an open-minded and analytical approach to acquiring new knowledge
c. Develop clinically applicable knowledge of the basic and clinical sciences that underlie the practice of Gastroenterology and Hepatology
d. Apply this knowledge in developing critical thinking, clinical problem solving and clinical decision-making skills.
e. Access and critically evaluate current medical information and scientific evidence and modify knowledge base accordingly.
3. PRACTICE-BASED LEARNING AND IMPROVEMENT
Residents are expected to demonstrate practice-based learning and improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in-patient care.
a. Residents are expected to be able to use scientific methods and evidence to investigate, evaluate, and improve their patient care practices.
b. Identify areas for improvement and implement strategies to improve their knowledge, skills, attitudes and processes of care
c. Analyze and evaluate their practice experiences and implement strategies to continually improve their quality of patient practice
d. Develop and maintain a willingness to learn from errors and use errors to improve the system or processes of care
e. Use information technology or other available methodologies to access and manage information and support patient care decisions and their own education
4. INTERPERSONAL AND COMMUNICATION SKILLS
Residents are expected to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their families and other health professionals.
a. Residents are expected to demonstrate interpersonal and communication skills that enable them to establish and maintain professional relationships with patients, families and other members of health care teams.
b. Residents are expected to demonstrate interpersonal and communication skills that enable them to establish and maintain professional relationships with members of the health care teams.
c. Provide effective and professional consultation to other physicians and health care professionals and sustain therapeutic and ethically sound professional relationships with patients, their families, and colleagues.
d. Use effective listening, nonverbal questioning and narrative skills to communicate with patients and families
e. Interact with consultants in a respectful and appropriate fashion
f. Maintain comprehensive, timely and legible medical records
5. PROFESSIONALISM
Residents are expected to demonstrate professionalism as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.
a. Residents are expected to demonstrate behaviors that reflect a commitment to continuous professional development and ethical practice.
b. Residents are expected to demonstrate an understanding and sensitivity to diversity and responsible attitude toward their patients, their profession and society.
c. Demonstrate respect, compassion, integrity, and altruism in their relationships with patients, families and colleagues.
d. Demonstrate sensitivity and responsiveness to patients and colleagues, including gender, age, culture, religion, sexual preference, socioeconomic status, beliefs, behaviors and disabilities
e. Adhere to principles of confidentiality, scientific/academic integrity, and informed consent
f. Recognize and identify deficiencies in peer performance
6. SYSTEMS-BASED PRACTICE
Residents are expected to demonstrate systems-based practice as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.
a. Residents are expected to demonstrate and understanding of the contexts and systems in which health care is provided and demonstrate the ability to apply this knowledge to improve and optimize health care
b. Understand access, and utilize the resources and providers necessary to provide optimal care
c. Understand the limitations and opportunities inherent in various practice types and delivery systems, and develop strategies to optimize care for the individual patient.
d. Apply evidence-based, cost-conscious strategies to prevention, diagnosis and disease management.
e. Collaborate with other members of the health care team to assist patients in dealing effectively with complex systems and to improve systematic processes of care.
Conference Schedule
Conferences are mandatory for all the fellows and will cover clinical pathophysiology and basic science aspects of Gastroenterology. Other topics will include GI radiology, cellular pathology, Endoscopy and morbidity/mortality.
Journal Club meets on a monthly basis, Presentations will only be made by fellows, attendings, or residents/students currently on the GI service. 4-5 articles will be covered. Any remaining time will be filled with presentation and discussion of interesting cases.
Internal Medicine noon conference covers a GI topic on the 1st and 3rd Monday of each month for a total of approximately 24 topics.
IM Noon Conference 1st & 3rd Monday of each month 12:00 Café E
Journal Club 4th Tuesday monthly (changes may be made for Christmas, ACG etc). 18:00 Outside Restaurant
Core CurriculumClinical /Basic Science 1st and 3rd Thursday monthly 2nd Tuesday monthly 17:30 GI Conference Room
Core Curriculum GI Radiology 1st or 3rd Thursday monthly (or) 2nd Tuesday monthly 17:30 Cardiology Conference Room
Core Curriculum Pathology Once monthly 16:00 GI Conference Room
Core Curriculum GI Tumor Board 3rd Friday of each month 07:00 Radiology Conference Room
Core CurriculumM&M, ERCP, etc. TBA TBA GI Conference Room
Noon
Conference: Each member of the teaching staff will be required to resent at least one assigned Gastroenterology topic to the Internal Medicine Residents. Presenting at noon conference above and beyond the required single presentation may be counted toward Core Curriculum attendance.
Core
Curriculum: Each member of the teaching staff will be required to attend at least 10 Core Curriculum lectures annually.
CME: Efforts are being made to obtain CME for Core Curriculum lectures. (Currently available for Journal Club).
Teaching service structure:
SERVICE 1 SERVICE 2 SERVICE 3 SERVICE 4
SGA DeVore Stawick DHA
Akkay/Sosa E. Gelzayd Grier
Teaching Level:
We will also be introducing the assignment of a "Teaching Level" this upcoming academic year. Teaching levels will be base on each private attendings or group's current and future rounding practices with the fellows. The various Teaching Levels will be defined as follows:
Level 1:
a) GI Fellows on service will make consults and procedures for these attendings their first priority.
b) Attendings will staff verbally each new consult with the fellow completing the consult on the day the consult is completed. Each new consult will be seen with the consulting fellow within 24 hours of consult completion. All patients being covered by the assigned fellow will be seen on daily teaching rounds with that fellow. Level 1 attendings will also provide the fellows with outpatient clinic exposure. Failure to fulfill teaching commitments will result in a downward change in the attendings teaching level regardless of group membership.
Level 2:
a) GI Fellows on service will make consults and procedures for these attendings their second priority. Urgent and emergent consults will be given first priority. Effort will be made to see additional new consults as time and other duties permit. As primary duties permit, the fellow will follow consulted inpatients for as long as the Level 2 attending rounds on sequential days following the initial consult with the consulting fellow.
b) Attendings will staff verbally each new consult with the fellow completing the consult on the day the consult was completed. Each new consult will be seen with the consulting fellow within 24 hours of consult completion. If the attending wishes the consulting fellow to follow a patient, teaching rounds must be made daily with the fellow. Failure to fulfill teaching commitments will result in a downward change in teaching level.
Level 3:
a) GI fellows on an inpatient service will see patients for these attendings on an Emergency basis only. Emergencies will be given first priority. No routine consults will be done. Fellows will be expected to see each emergency in a timely fashion if during regular business hours. Patient safety and stability take precedence. Once the patient is assessed, the fellow will contact the Level 3 attending to agree on a plan. A full consult will then follow by the consulted attending.
b) Level 3 teaching attendings will utilize fellows during regular business hours to see only "urgent and emergent" patients. All patients seen by a fellow will be discussed on the same day the patient is seen. The consulted GI attending the same or following day will complete a full consult. Repeated request to see non-urgent patients will possibly result in the Level 3 attendings withdrawal from teaching service.
