Curriculum Template - Partners HealthCare
Curriculum Template
| |
|Continuity Clinic - Brigham & Women’s Hospital |
|The mission of the Brigham and Women's Hospital Gastroenterology Fellowship Program is to train physician-investigators and future |
|academic leaders in Gastroenterology. |
| |
|Mastery of the principles of clinical gastroenterology and the role of consultant requires that a fellow observe and manage a |
|patient’s illness in the office setting over an extended period of time. Each fellow follows a panel of his/her own patients for |
|three years in a weekly longitudinal clinic at BWH mentored full – time by a faculty mentor. The fellow is responsible for all |
|aspects of the patient’s care including proper documentation of all written and verbal communications. The fellow works with a team|
|which includes a physician’s assistant or nurse practitioner, medical assistant, support staff and practice administrator. The |
|fellow will be evaluated regularly by the mentor and other members of the healthcare team based on the six core competencies. |
| |
|Year One of Training: |
|Fellows will perform a thorough history and physical that incorporates all data required to synthesize a differential diagnosis, |
|scholarly discussion, and safe and effective treatment plan, based on published guidelines, that is appropriate for the individual |
|patient that is clearly communicated to the entire healthcare team. They are able to monitor test results and discuss them with |
|faculty and act on them. The fellows can function well in a team and recognize clinical trends in their patient panels. |
| |
|Year Two of Training: |
|Fellows will be aware of the more subtle manifestations of the common digestive diseases and be able to discuss alternative |
|treatment methods as they apply to individual patients. They are able to teach their peers, residents and students proper clinical |
|management. They analyze trends and formulate improvements in best-practice for the benefit of their patients. They will use these |
|observations to design and perform scientific studies as well as give didactic presentations. |
| |
|Year Three of Training: |
|The fellow will have a high level of understanding of the clinical subtleties of digestive disease and be able to apply it a |
|therapeutic plan that can be used to influence the quality of care beyond their own clinic.. The fellows will seek ways to improve |
|patient care and complete evidence –based studies based on their clinical observations of patients. |
|Patient Care |
|Goal |
|Fellows must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems|
|and the promotion of health. Fellows are expected to: |
| |
| |
|Competencies: |
|1. Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health |
|problems and the promotion of health. Residents are expected to: |
|communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families |
|gather essential and accurate information about their patients |
|make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date |
|scientific evidence, and clinical judgment |
|develop and carry out patient management plans |
|counsel and educate patients and their families |
|use information technology to support patient care decisions and patient education |
|perform competently all medical and invasive procedures considered essential for the area of practice |
|provide health care services aimed at preventing health problems or maintaining health |
|work with health care professionals, including those from other disciplines, to provide patient-focused care. |
| |
|Objectives: |
|1. The fellow will obtain a complete medical history and a thorough physical examination in a respectful and courteous manner. |
|2. The fellow will communicate the findings and recommendations to the patient and family with compassion and respect and will |
|incorporate this information in a polished, lucid scholarly report in a timely fashion to the referring physician. |
|3. The fellow will make well – informed decisions about any recommendations for evaluation and treatment based on a combination of |
|the patient’s condition, personal preferences, up-to-date evidence – based scientific evidence and expert clinical judgment. |
|4. The fellow will educate the patient and family about their illness and its prevention and the maintenance of future health. |
|5. The fellow will take advantage of all members of the healthcare team including consultants to provide patient – focused |
|excellent care. |
|6. The fellow will maintain in standard fashion an up-to-date log of all new patient clinic consultation diagnoses and procedures |
|performed on these patients and make this log readily available to their clinic mentor and the Program Office to assure proper |
|clinical experience. |
| |
| |
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|Medical Knowledge |
|Goal |
|Fellows must demonstrate competence in the knowledge of established and evolving biomedical, clinical, epidemiological, and |
|social-behavioral sciences, as well as the application of this knowledge to the diagnosis and longitudinal care of gastrointestinal|
|disease as it is manifested in the office practice of a tertiary medical center and discussed in the Program weekly didactic |
|conferences designed in compliance with the Gastroenterology Core Curriculum, 3rd Edition, May 2007. Fellows are expected to: |
| |
|Competencies: |
|Fellow must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and |
|social-behavioral) sciences and the application of this knowledge to patient care. Fellows are expected to: |
|demonstrate an investigatory and analytic thinking approach to clinical situations |
|know and apply the basic and clinically supportive sciences which are appropriate to their discipline. |
|Objectives |
|1. Fellows will manage proficiently the following diseases by the end of their three years of fellowship: |
| |
|XIV. Specific Program Content (ACGME) |
|1. diseases of the esophagus; |
|2. acid peptic disorders of the gastrointestinal tract; |
|3. motor disorders of the gastrointestinal tract; |
|4. irritable bowel syndrome; |
|5. disorders of nutrient assimilation; |
|6. inflammatory bowel diseases; |
|7. vascular disorders of the gastrointestinal tract; |
|8. gastrointestinal infections, including retroviral, mycotic, and parasitic diseases; |
|9. gastrointestinal diseases with an immune basis; |
|10. gallstones and cholecystitis; |
|11. alcoholic liver diseases; |
|12. cholestatic syndromes; |
|13. drug-induced hepatic injury; |
|14. hepatobiliary neoplasms; |
|15. chronic liver disease; |
|16. gastrointestinal manifestations of HIV infections; |
|17. gastrointestinal neoplastic disease; |
|18. acute and chronic hepatitis; |
|19. biliary and pancreatic diseases; |
|20. women’s health issues in digestive diseases; |
|21. geriatric gastroenterology; |
|22. gastrointestinal bleeding; |
|23. cirrhosis and portal hypertension; |
|24. genetic/inherited disorders; |
|25. medical management of patients under surgical care for gastrointestinal disorders |
|26. management of GI emergencies in the acutely ill patient. |
| |
|2. Fellows will apply the clinical and scientific principles acquired from the following Program conferences. |
| |
|Monday: |
|Endoscopy Conference: Complications, Standards and QA (BWH) |
|Research Conference: Intra-Divisional (BWH) |
|Tuesday: |
|Liver Histopathology Conference (BWH) |
|IBD Conference (BWH) |
|GI Medical/Surgical Conference (BWH) |
|Boston Swallowing & Motility Conference (VAH) |
|Intercity Evening Rounds (monthly-rotating) |
|Wednesday: |
|Academic Enrichment Conference (AEC) |
|Clinicopathology Conference |
|Journal Club |
|Liver Conference |
|Research Conference |
|Thursday: |
|Didactic Conference |
|GI Combined Clinical Conference (Longwood – BWH, CH, BIDMC) |
|Friday: |
|Pancreas Study Group |
|Medical Grand Rounds |
| |
|3. Fellows will use an evidence – based (EBM) approach to medical decision - making using published treatment guidelines from |
|experts eg., the ACG and AGA . |
|4. Each fellow will be evaluated for competence commensurate with their training year based on objective evaluations including |
|OSCE, Mini CEX, the Program In – House exam, the AGA GI Training Exam and six-month evaluations by their clinic mentor. |
| |
|Practice- Based Learning and Improvement |
|Goal |
|Fellows must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific |
|evidence, and to continuously improve patient care based on constant self-evaluation and life long learning. Fellows are expected |
|to develop skills and habits to be able to: |
| |
|Competencies: |
|Identify strengths, deficiencies and limits in one’s knowledge and expertise; |
|Set learning and improvement goals |
|Identify and perform appropriate learning activities |
|Systematically analyze practice, using quality improvement methods, and implement changes with the goal of practice improvement |
|Incorporate formative evaluation feedback into daily practice |
|Participate in the education of patients, families, students, residents and other health professionals, as documented by |
|evaluations of a resident’s teaching abilities by faculty and/or learners. |
| |
|Objectives |
|1. Each fellow will analyze periodically their clinic practice to confirm compliance with published treatment guidelines and will |
|present these results to the Division at Quality Assurance Conference. |
|2. Each Fellow will present to clinic colleagues and staff a case example of EMB database analysis of a challenging case from their|
|practice once a week. |
| |
|Systems Based Practice |
|Goal |
|Fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability|
|to call effectively on other resources in the system to provide optimal health care. Fellows are expected to: |
| |
|Competencies |
|Coordinate patient care within the health care system relevant to gastroenterology. |
|Incorporate cost awareness and risk-benefit analysis in patient care |
|Advocate for and enhance patient safety and improve patient care quality |
|Participate in identifying systems errors and implementing systems solutions |
| |
|Objectives |
|1. Each fellow will analyze and discuss twice a year a common practice system problem impacting on the access to, cost of, and |
|quality of care received by patients in their practice and present it for discussion and resolution with clinic colleagues and |
|staff. |
|2. Each fellow will recognize, and understand the role of each member of their clinic health care team. |
| |
|Professionalism |
|Goal |
|Fellows must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. |
|Fellows are expected to demonstrate: |
| |
|Compassion, integrity, and respect for the diversity in others |
|Responsiveness to patient needs and autonomy that supersedes self-interest |
|Accountability to patients, society, and the profession |
| |
|Objectives: |
|1. Each fellow will demonstrate respect and compassion for others, manage conflict, and behave in a manner consistent with the |
|principles of Brigham and Womens’ Hospital and the Partners Healthcare System. |
|2. Each fellow will act in an ethical fashion with sensitivity toward to difference between themselves and their colleagues and |
|patients. |
| |
|Interpersonal and Communication Skills |
|Goal |
|Fellows must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming |
|with patients, their families, and professional associates. Fellows are expected to: |
| |
|Competencies |
|Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds |
|Communicate effectively with physicians, other health professionals or related agencies |
|Work effectively as a member or leader of a health care or professional group |
|Act in a consultative role to other physicians and health professionals |
|Maintain comprehensive, well – organized, grammatical, timely, and legible medical records |
| |
|Objectives |
|1. Each fellow will demonstrate strong leadership skills through respectful consideration of the opinion of all members of the |
|healthcare team, including the patient. |
|2. Each fellow will communicate frankly, clearly and empathically with colleagues, staff and patients. |
|3. Each fellow will maintain a medical record that will serve as an ideal template for patient care. |
|4. Each fellow will learn the components of teacher excellence including introspection, patience, humility, compassion, candor, |
|and effective use of bedside observation, the advice of colleagues, and the medical literature. |
| |
|Teaching Methods |
|1. Faculty review of every case seen by the fellow. |
|2. Faculty – fellow (s) end-of-session case summary discussion weekly. |
|3. “Two-Minute Preceptor” |
|4. Selected review of EBM Literature by fellow |
|5. Bedside Teaching with the Patient |
|Assessment Method (Fellows) |
|1. OSCE bi-annually |
|2. Mini – CEX |
|3. 360 degree Observation bi-annually |
|4. Six – Month Evaluation by Clinic mentor |
|5. In-House Exam and GI Training Exam annually |
|6. GI Board Exam |
|7. Standardized evaluation by faculty monthly: |
|Core-competency based 9 point evaluation to be completed before by the end of rotation and reviewed by the In-Service |
|faculty member and fellow. |
|Evaluations must be signed by the faculty and fellow during this meeting. |
| |
|The evaluation will be made based on the following levels of training: |
|Guide To Level-Based Evaluation |
| |
|Fellowship Year 1 |
| |
|A. 1st Segment (July – October) |
|Makes clinical decisions based on well-established rules and communicates them clearly and succinctly to all members of the |
|healthcare team and referring physicians. |
| |
|B. 2nd Segment (November – February) |
|Grasps situational aspects of knowledge, particularly the major GI illnesses. Understands program mission and future role as |
|consultant, educator and investigator. |
| |
|C. 3rd Segment (March – June) |
|Recommendations are based on a firm understanding of pathophysiology. Discriminates between data. Pathway to |
|physician-investigator/academic leader is better defined. |
| |
|Fellowship Year 2 |
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|Reasons more intuitively in decision – making. Increasing mastery of core curriculum and relevant literature. Thinks more |
|independently and creatively as teacher and role model. |
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|Fellowship Year 3 |
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|Provides subtle discriminations in clinical observations and immediate intuitive analysis. Relishes challenge clinical challenges. |
|Mastery of an area as teacher and investigator. Next career step firmly established. |
|after Dreyfuss, H. 2007 |
|Assessment Method (Program Evaluation) |
|Fellows’ Retreat annually |
|Faculty Retreat annually |
|Zoomerang Anonymous Education Survey - annual |
|Level of Supervision |
|1. Faculty member assigned to each fellow for each clinic session reviews all communications, laboratory and diagnostic studies, |
|and management decisions with the fellow. |
|2. Nurse practitioner and/or physician’s assistant at each clinic |
|3. Practice administrator |
| |
|Educational Resources |
|1. PC with software for access to Pubmed, Medline, UptoDate, Medical Library. |
|2. Medical Library staffed full-time. |
Created 07/01/07
Revised 07/20/07
Revised 10/30/2008
FLM/cb
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