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Motility

Overview

In the third year of fellowship, Fellows will participate in a 2-week Motility rotation.  During this rotation, Fellows will participate in esophageal pH, esophageal manometry, anorectal manometry, balloon expulsion testing and pelvic floor biofeedback procedures.  The GI Motility Lab is currently under the co-supervision of Dr. Sonia S. Yoon and Dr. Asad Ullah, clinical faculty members in the Division of Gastroenterology.  The GI motility lab team is comprised of a technician as well as dedicated nurse specialists and Advanced Practice Providers who handle patient preparation, scheduling, probe placement, performance of procedures and initial analysis of procedures.  Fellows will participate in performance of motility procedures (including placement of catheters) and interpretation of studies.

Principal Teaching/Learning Activities

Fellows will learn the indications/contra-indications, patient preparations and protocols involved in each GI Motility procedure performed in the laboratory.  This includes pH impedance, wireless pH testing, esophageal manometry, anorectal manometry with balloon expulsion and pelvic floor biofeedback.  Fellows will observe and participate in all aspects of patient preparation and placement of catheters.  Dedicated time will be devoted to interpretation and analysis of the various motility tests as described above.  Online learning modules pertaining to pH impedance and esophageal manometry are expected to be completed prior to the end of the rotation.

Problem mix/Patient characteristics/Types of encounters

The experience is an outpatient experience with patients referred for a variety of general gastroenterology complaints related to acid-peptic issues, dysphagia, non-cardiac chest pain, constipation and fecal incontinence. 

Purpose and Principal Educational Goals by Competency

Patient Care

Principal Educational Goals

  • Identify appropriate indications and contraindications for each of the motility procedures (pH impedance, wireless pH testing, esophageal manometry, anorectal manometry, pelvic floor biofeedback)
  • Describe patient preparation protocols for each of the procedures performed in the GI Motility Lab
  • Perform the placement of an esophageal manometry probe, pH catheter, wireless pH and manometry probe.
  • Analyze and interpret each of the procedures performed in the GI Motility Lab.

Medical Knowledge

Principal Educational Goals

  • Expand the fellow’s medical knowledge of various diagnostic motility techniques utilized in the evaluation and management of common GI disorders including refractory acid reflux, dysphagia, atypical chest pain, constipation and fecal incontinence

Practice-Based Learning and Improvement

Principal Educational Goals

  • Identify knowledge gaps in common diagnostic tools used for the evaluation and management of various GI motility related disorders.
  • Implement strategies to correct these deficits.

Interpersonal Skills and Communication

Principal Educational Goals

  • Communicate effectively with patients and families
  • Communicate effectively with the team members of the GI Motility Lab.
  • Collaborate with physicians in other disciplines and with other health care team members to optimize the delivery of subspecialized medical testing.

Professionalism

Principal Educational Goals

  • Demonstrate respect, compassion, and honesty in relationships with patients, families and colleagues.
  • Demonstrate a willingness and enthusiasm for work.
  • Practice informed consent and informed refusal.

Systems-Based Practice

Principal Educational Goals

  • To learn the practical aspects of the equipment, personnel, and facilities required to perform highly specialized diagnostic testing in GI Motility.

Evaluation

Fellow’s performance is evaluated by faculty as discussed in detail later.  Evaluations are also sought from GI Motility Lab team members.

Recommended Reading

General Gastroenterology text chapters on acid reflux disease, esophageal motility disorders, non-cardiac chest pain, constipation, and fecal incontinence.  Selected articles/online modules dedicated to specific procedures are available.