Curriculum Template - Partners HealthCare



Curriculum Template

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|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. |

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|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. |

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|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. |

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|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. |

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|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: |

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|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. |

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|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: |

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|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: |

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|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. |

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|2. Fellows will apply the clinical and scientific principles acquired from the following Program conferences. |

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|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 |

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|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. |

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|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: |

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|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. |

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|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. |

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|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: |

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|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 |

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|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. |

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|Professionalism |

|Goal |

|Fellows must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. |

|Fellows are expected to demonstrate: |

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|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 |

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|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. |

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|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: |

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|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 |

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|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. |

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|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. |

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|The evaluation will be made based on the following levels of training: |

|Guide To Level-Based Evaluation |

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|Fellowship Year 1 |

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|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. |

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|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. |

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|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. |

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|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 |

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|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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