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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 be exposed to 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. The service is consultative, and the medical residents rotating on the gut service will assess and co-manage patients with a variety of gastrointestinal disorders in conjunction with the GI fellow and attending.  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 encouraged to observe endoscopic procedures on inpatients, especially those cases where they have served as a consultant.  The housestaff is also encourage to attend the GI educational conferences.

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 patients with a variety of liver diseases and their complications, including pre- and post-liver transplant patients. 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 observe 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. Outpatietn services are provided at Perelman Center for Advanced Medicine. House officers can also elect to participate in the care of pre- and post-transplant patients, in specialized transplantation clinic on Ground Rhoads.  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. These include GI Journal Club on Mondays, Pathology Conference on Tuesdays, Clinical Case Conference and GI Grand Rounds on Wednesdays, and GI core curriculum lectures on Thursdays and 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.  House officers are also invited to attend the hepatology conferences which include Hepatology Transplant Conference Monday morning 8-9AM, Liver Transplant Selection Meeting from 3-5PM, also on Monday and Hepatobiliary Tumor Conference on Friday from 7-8AM; all 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.

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.

Course Reading List

For more information contact:

Nuzhat A. Ahmad, MD
Associate Professor of Medicine
Medical Residency Director for Gastroenterology
Hospital of the University of Pennsylvania
3 Ravdin
3400 Spruce Street
Philadelphia, PA 19104
Phone: 215-615-4678 Fax: 215-349-5915

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