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Fellow’s Continuity Clinic

Overview

In addition to participating in an attending’s clinic, the fellows will have their own patients to follow throughout the length of the training program.  The Fellow’s Continuity Clinic will be one half-day session per week, and will be fully supervised by an Attending.  Any procedures that require scheduling will be performed under the schedule of that Attending.  Long-term continuity clinic will give the fellows experience as the primary (consultant) caregiver, and place a greater emphasis on development of skills in Communication and Professionalism competencies, as well as the Practice-Based Learning and Improvement and Systems-based Practice competency.  Long-term Continuity clinic also provides the fellow with a greater length of follow up for those patients with chronic and/or remitting illnesses, such as cirrhosis or inflammatory bowel disease.

Principal Teaching/Learning Activities

Fellows will see from 2-3 new outpatient consults per session, and 4-6 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 supervises every encounter, and is ultimately responsible for the patient care.  Nonetheless, the role of the Attending physician in the Fellow’s Longitudinal Clinic is more one of oversight and guidance.

In 2017, an educational series of lectures in the form of modules, designed specifically for gastroenterology fellows, was introduced as part of the weekly clinic teaching content.

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. 

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, family planning in certain diseases and with certain medications, risks of inherited disorders, end-of-life issues and palliative care 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, weekly direct feedback is given by the longitudinal clinic preceptor.

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.