ROTATION: Gastroenterology
Preceptorship
PRECEPTOR(S): Drs. Dreyer (Coordinating
Preceptor), Gerstner, Kengis, Lans, and Rogers
DURATION: One Month
1. GOALS/OBJECTIVES OF ROTATION:
--- Become knowledgeable about the diagnosis
and management of common gastrointestinal disorders
(e.g. peptic ulcer, esophagitis/GERD,
GI bleeding, inflammatory bowel disease, diarrhea, irritable bowel syndrome,
hepatitis, cirrhosis).
--- Become familiar with common procedures
(endoscopy, paracentesis, ERCP) and proficient in the cost-effective use of
common laboratory and radiographic tests.
--- Become proficient in initial
stabilization of gastrointestinal bleeding prior to endoscopy.
--- Become proficient in screening for gastrointestinal
cancer and familiar with treatment options.
--- Develops awareness of proper use and
timing of GI consultants.
2.
EXPECTATIONS OF
ROTATION:
--- Be assertive in contacting Dr. Kengis before the rotation or
on the very first day to discuss your level of interest in endoscopy and how
you will work with the attendings (Dr. Kengis’ pager #: 287-2609).
--- Your
first priority will be seeing inpatient consultations for any of the three
gastroenterologists. Do a complete H&P; write up and discuss your findings,
impressions, and plan with the attending as soon as possible. Whenever possible
participate in relevant procedures. It is not necessary to sit and watch all
endoscopies; ask attendings to call you when relevant findings are identified
so that you can see pathology.
--- Do daily rounds on inpatient consults or
patients followed primarily by the gastroenterologists (those you have worked
up or any other interesting patients that the attendings identify for you). Due
to morning conferences, you may need to start before 7:30 a.m., depending on
volume. Review x-rays with the radiologists.
* --- Try to attend as many physician office half-days as
possible, preferably working at some time with all three attendings. You
may be called away from the office if a new inpatient consult is identified.
Doing some work-ups helps to defray some of the teaching time that they are
investing; if possible write up or dictate cases for them. Try to divide up
your time evenly between Drs. Dreyer and Rogers. Note the schedule below in
planning this important activity.
Physician's
office hours:
--- Dr. Dreyer - Monday: 9:00 a.m. - 12:30 p.m.
--- Dr. Rogers - Wednesday: 9:00 a.m. - 12:30 p.m.
(Go
to Wednesday clinic before Educational Conferences. Try to get there no later
than 4:00 p.m.)
--- Try to follow patients that you've seen
in the office by attending scheduled procedures.
--- In both the hospital and office
settings, utilize the syllabus of articles provided to facilitate discussion of
selected problems based on patients seen. Try to read all syllabus articles
during the month.
--- Do as many endoscopies as time permits
so that you can begin developing skills in flexible sigmoidoscopy. At a
minimum, you should target ten procedures where you either start a colonoscopy
or do a flexible sigmoidoscopy with Dr. Kengis.
--- Read syllabus and be conversant with
contents when seeing patients in office or hospital.
3. SUGGESTED PREPARATION AND REFERENCES:
--- See Syllabus of Articles.
--- See
AAFP Flex Sig Syllabus
--- In Hospital Library, use
Gastroenterology Reference Texts.
4. TYPICAL DAY/WEEK:
* --- You will be
responsible for your usual half-days in the Family Practice Clinic (always try
to schedule Tuesday morning, Thursday afternoon, or Friday morning – avoid any
other afternoons). This will be variable and must be discussed with attendings.
Try to share your schedule with attendings from week to week so that they know
where you will be.
5. WORK-UPS/WRITE-UPS:
--- Complete H&P and write up or dictate
each case for consultations in the hospital. Attendings should sign off on your
write ups, impressions and orders. Write up or dictate office consultations
when attendings indicate it would be appropriate to do so. (Remember by doing
this you can help save them some time that can be spent on teaching.)
6. AVAILABLE EDUCATIONAL
EXPERIENCES/CONFERENCES:
--- Attend all required residency related
conferences.
7. IMPACT ON OFFICE SCHEDULE:
* --- Maintain
involvement in residency-related educational sessions including
your standard Family Practice Clinic responsibility.
8. CALL:
--- Weekdays: When possible, let attendings know that
you’ll be available for interesting consults.
--- Weekends: Schedule 1 Friday and Saturday call as noted
below.
9. WEEKEND REQUIREMENTS:
--- One Friday and Saturday night call -
which will allow attendings to do Saturday rounds with you and focus on
teaching.
10. VACATION/TIME OFF:
--- One week maximum (preferably scheduled
either at the very beginning or end of the rotation to enhance continuity).
11. EVALUATION:
--- Attendings will look for: assertive
interaction in providing care for patients, getting promptly to consults, doing
follow-up notes on your patients daily, reviewing syllabus articles and
discussing your findings with attendings, in addition to those skills expected
of an effective resident.
12. CRITERIA FOR SUCCESSFUL COMPLETION:
--- See consults, do write-ups, follow
patients, and be educationally assertive as noted above.
--- Attend clinic in physician's offices
twice per week minimum.
--- Complete call requirements.
--- Read syllabus articles and set up time
to discuss with attendings.
--- Perform ten endoscopies with Dr. Kengis.
--- Take and pass the AAFP post-test for
Flex Sig.
13. SUPERVISION:
--- All attendings will provide supervision
of all rotation activities and will sign orders as well as consultations after
they have been reviewed. Dr. Dreyer is
the coordinating preceptor and should be contacted for any issues regarding
the rotation (pager # 544-2525, dial 2807).
Revised:
5/05 (DLF)
S:\WFPC\Admin\Curriculum
Coordinator\Rotation Descriptions\GI -
Gastroenterology\DESCRIPT\Gastroenterology - PG2&3.doc