Overview Gastroenterology Elective for Medical Housestaff
The objective of the gastroenterology elective is to provide medical housestaff with a well-rounded learning experience in gastroenterology and hepatology that is integral to the specialty of internal medicine. This elective is geared towards medical housestaff and covers topics in general gastroenterology, hepatology, transplant hepatology, and advanced endoscopy. Inpatient and outpatient experiences are available to housestaff who choose to undertake the elective.
Housestaff who select an inpatient elective will be exposed to a variety of educational opportunities. Inpatient gastroenterology and hepatology consultative teams are composed of attending physicians, gastroenterology fellows, medical housestaff, and medical students. House officers who select an outpatient elective will also have a variety of learning experiences. Housestaff who opt for the outpatient experience will work closely with a gastroenterology or hepatology attending physician.
Inpatient Gastroenterology and Hepatology Rotations
Medical housestaff may rotate on the inpatient gastroenterology (gut) service for general gastroenterology training. Patients admitted to the gastroenterology attending on the gut service are co-managed by the inpatient medical housestaff. Medical residents rotating on the gut service will assess and co-manage patients with a variety of gastrointestinal disorders admitted to the inpatient medical housestaff in conjunction with the gut attending. Medical housestaff will also participate in the evaluation and management of patients who are called in as consults by other services within the health system. All consults are divided among housestaff, students, and gastroenterology fellows rotating on the gut service. Work rounds are performed daily on the gut service, usually in the morning. Medical housestaff who are assigned consults are expected to follow these patients during their hospital stay. Housestaff will be expected to complete a consult form and may write daily progress notes in conjunction with the gut attending. Housestaff are also invited to watch all procedures on inpatients, especially those cases where they have served as a consultant.
Medical housestaff rotating on the inpatient hepatology service will be expected to follow patients admitted to the inpatient liver service in conjunction with the hepatology attending, gastroenterology fellow, and inpatient medical housestaff. As with the gut service, hepatology consults will be divided among members of the liver team. The house officer will be exposed to pre and post transplant patients with a variety of liver diseases and their complications. Medical housestaff will be expected to see assigned consults, write a consult note on the consult form, and present new consults to the liver team. Additionally, housestaff will be expected to follow their patients during the hospital course. Work rounds are performed on a daily basis from 9:00 AM until 10:30 AM. During this time, all inpatients are presented by the inpatient medical housestaff. This is an ideal opportunity to discuss relevant physiology and pathophysiology of a variety of liver diseases. If time permits, the inpatient hepatology attending will also discuss a topic of his or her choosing. It is expected that medical housestaff rotating on the inpatient hepatology service will participate actively in daily work rounds. As with the gut service, house officers are invited to watch procedures on hepatology inpatients, especially those patients whom the house officer is following.
Outpatient Gastroenterology and Hepatology Rotations
House officers may also choose to do an elective on the outpatient gastroenterology and hepatology services. Services are provided in the 3 Dulles GI Clinic until the fall of 2008, where after services will be rendered at The Center for Advanced Medicine. If house officers choose to participate in the evaluation of patients for liver transplantation or to follow patients after liver transplantation, these clinics will be held in Ground Rhoads. Housestaff will be exposed to patients with a variety of gastrointestinal and hepatic disorders both in the pre and post transplant settings. Housestaff will be expected to see selected new patients in the clinic and to present these patients to the attending physician. They will also follow attending physicians in the evaluation and assessment of patients who are returning to the clinic. House officers will be expected to participate actively in clinic and work closely with the attending physician.
Didactic Methods
A variety of educational experiences are available to house officers who rotate on the inpatient and outpatient gastroenterology and hepatology services. There are many gastroenterology and hepatology conferences that are available to housestaff participating in elective rotations. GI Journal Club meets on Mondays, pathology conference meets on Tuesdays, clinical case conference meets on Wednesdays, GI grand rounds meets on Wednesdays, and GI outpatient lectures meet on Fridays. In addition to these conferences, house officers should take advantage of the “Residency Scholars program” that offers lectures in gastroenterology and hepatology at least 6 times per year from 8-8:45 AM on Thursdays in the 100 Centrex Conference room. Weekly conferences are also given every Wednesday (gut attending) and Thursday (hepatology attending) from 8:30-9:00 AM in the 14 Founders Conference Room. Handouts are usually provided for conferences in 100 Centrex and 14 Founders. House officers are also invited to attend the weekly Friday morning hepatobiliary tumor conference from 7-8:00 AM in the 2 Dulles Transplant Conference Room and the liver transplant selection committee meeting from 2-4:00 PM every Friday in the 2 Dulles Transplant Conference Room.
Areas of Learning
During inpatient and outpatient gastroenterology and hepatology rotations, house officers will be exposed to a variety of gastrointestinal and hepatic disorders. Housestaff will see patients with abdominal distension, abdominal pain, abnormal liver-associated enzymes, ascites, constipation, diarrhea, gastrointestinal bleeding, dyspepsia, liver failure, nausea and vomiting, and dysphagia. House officers may also see patients with peptic ulcer disease, malignancies (gastrointestinal, hepatobiliary, and pancreatic), acute and chronic pancreatitis, diseases of the gallbladder and bile ducts, viral hepatitis, autoimmune liver diseases, metabolic liver diseases, complications of portal hypertension, end-stage liver disease necessitating transplantation, maldigestion and malabsorption, inflammatory bowel disease, irritable bowel syndrome, diverticular disease, and intestinal obstruction and ischemia.
House officers rotating through inpatient and outpatient electives will understand the indications and contraindications of upper and lower endoscopy, ERCP, liver biopsy, and paracentesis. Housestaff will also acquire knowledge in the interpretation of tests relevant to gastroenterology and hepatology. Housestaff may be exposed to esophageal pH monitoring, interpretation of liver-associated enzymes and serologic tests, medical imaging relevant to gastroenterology and hepatology, and gastric acid analysis.
Evaluation
All house officers rotating through inpatient and outpatient gastroenterology and hepatology electives will be evaluated by their preceptors. The gastroenterology and hepatology programs will also expect feedback from housestaff at the conclusion of the rotation.
Reading Material
All housestaff rotating through inpatient and outpatient gastroenterology electives are free to use The Residency Scholar Program Reference list of timely articles relevant to gastroenterology and hepatology. A comprehensive set of PDFs is also provided covering an extensive array of gastrointestinal and hepatic diseases. The syllabus for the gastroenterology curriculum for the MOD2 pathophysiology course given to 1st year Penn medical students is also provided. House officers may also choose to further their education through access to Virtual Curriculum 2000 which offers a variety of topics in gastroenterology and hepatology.
For more information contact:
Anil K. Rustgi, MD
T. Grier Miller Professor of Medicine and Genetics
Chief, Division of Gastroenterology
University of Pennsylvania
Division of Gastroenterology
415 Curie Boulevard, 600 Clinical Research Building
Philadelphia, PA 19104
Phone: 215-898-0154 Fax: 215-573-2024
Email: anil2@mail.med.upenn.edu