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Attending's Clinic

Overview

Currently, each fellow is assigned to participate in a half-day clinic session per week for one attending preceptor for 4-8 months before changing preceptors.  This provides a longitudinal exposure to most outpatient consultative experiences in which a consultation, procedure, and two or three follow up visits may complete the patient problem episode.  It also allows for a breath of exposure to different attending preceptor styles of interaction, patient populations, patterns of relationships with referring physicians, etc..  Attendance at the attending’s clinic takes precedence over all other clinical activities including Consult Service and Endoscopy, Research, ERCP, Hepatology and other Electives.

Principal Teaching/Learning Activities

Fellows will see from 2-4 new outpatient consults per session, and 4-8 follow up visits.  Fellows will perform complete history and physical examinations, review laboratory data including actual Radiology studies, formulate differential diagnoses, and formulate a plan or set of recommendations, including timing of intervention and/or follow up.  After presentation and review with the Attending physician, the fellow will document the encounter in the medical record.  The Attending physician will supervise every fellow’s patient encounters. 

Problem mix/Patient characteristics/Types of encounters

The Fellow is exposed to a wide variety of consultative questions which fully embrace the complete lists of clinical disorders and clinical problems as contained in the outline of the ACGME Specific Program Content within Program Requirements for Residency Education in Gastroenterology.  All patients are ambulatory outpatients referred by a primary care physician in almost all instances.

In the first year of fellowship, the Attending Clinic assignment will be with a General Gastroenterologist, where patients with a wide variety of General Gastroenterology problems are seen, including inflammatory bowel disease and motility disorders. In the second year of fellowship, the Attending Clinic assignments will be with a Hepatologist, where patient with a wide variety of general hepatology problems will be seen. In the third year of fellowship, 8 months of the year will be spent in an Advanced Endoscopy outpatient clinic, where patients with a wide variety of complex pancreatico-biliary and oncologic problems are seen. The other 4 months are spent in a clinic with an Inflammatory Bowel Disease specialist.

Purpose and Principal Educational Goals by Competency

Patient Care

Principal Educational Goals

  • Demonstrate that the fellow has acquired the capacity to extract critical elements of pertinent history and physical exam findings pertinent to the accurate construction of a differential diagnosis, for clinical scenarios in consultative Gastroenterology and Hepatology.
  • Demonstrate that the fellow has acquired the capacity to formulate an appropriate, focused, rationale differential diagnosis supported by the elements of history and exam, and other clinical data.
  • Demonstrate the fellow can develop rational clinical evaluation and management plans.
  • Demonstrate that the fellow recognizes and responds to the indications, contraindications, special needs, alternatives, and risk/benefits of any recommended diagnostic or therapeutic Gastrointestinal procedures.
  • In addition, the ambulatory setting requires the fellow to maintain focus and timeliness in completing and presenting patient evaluations.
  • Become familiar with areas of counseling more germane to the ambulatory Gastroenterology and Hepatology setting, such as counseling on diet, lifestyle, sexual practices/risks, family planning in certain diseases and with certain medications and   risks of inherited disorders, end-of-life issues and palliative care counseling for the terminally ill.

Medical Knowledge

Principal Educational Goals

  • Demonstrate the medical knowledge base applicable to the clinical scenarios encountered in Gastroenterology and Hepatology subspecialty consultation, which would be sufficient to function as an independent consultant.

Practice-Based Learning and Improvement

Principal Educational Goals

  • Identify gaps in personal knowledge and clinical skills in the consultative assessment of clinical disorders and problems in Gastroenterology and Hepatology.
  • Implement strategies for correcting these deficits.

Interpersonal Skills and Communication

Principal Educational Goals

  • Learn to communicate effectively with office/clinic staff to optimize patient satisfaction with health care interaction.
  • Learn to communicate effectively with patients and families across a broad range of socioeconomic backgrounds. 
  • Communicate in comprehensive yet clear and concise letters of consultation to referring physicians.

Professionalism

Principal Educational Goals

  • Demonstrate respect, compassion, and honesty in relationships with patients, families and colleagues.
  • Demonstrate sensitivity to patients and colleagues on issues of gender, age, culture, religion, sexual preference, socioeconomic status, beliefs, behaviors and disabilities.
  • Adhere to principles of patient confidentiality.
  • Practice informed consent and informed refusal.

Systems-Based Practice

Principal Educational Goals

  • Demonstrate the ability to cooperate and collaborate with colleagues in other disciplines for complex patient problems that require multidisciplinary management.
  • Use evidence-based, cost-conscious strategies in management of patient problems.
  • In addition, begin to understand the business aspects of practice management.

Evaluation

Fellow’s performance is evaluated by faculty as discussed in detail later.   In addition, the Program Director evaluates the dictations for communication skills, evidence of clinical problem management comprehension, thoroughness of history and pertinent exam documentation, and evidence of competency in medical knowledge, systems-based practice, and patient care.

Recommended Reading

A general Gastroenterology and Hepatology text and computerized data-base service is recommended as per the recommended reading under the Inpatient Consult Service.  Various titles are available in the fellow’s library.