HO III - Endoscopy

Specific Educational Goals and Education

Level: PGY-3

Service: Endoscopy

Supervision: PGY-3 → Attending

All management decisions will be discussed with the supervisory staff and faculty.

Duty Hours:

Hours are to be logged into GMEOne on a weekly basis and will be reviewed weekly by the Program Director for ACGME violations and reviewed weekly for delinquencies by the Program Coordinator. Over a four week period; you will not average more than 80 hours a work week, you will have one day in seven free of clinical duty, in-house call will be no more frequent than one in three nights, you should receive 10 hours free between all duty periods and after in-house call and you will not be on duty for more than 30 consecutive hours. If you are assigned more hours than mentioned heretofore or have patient care duties that are extending you beyond these limits, it is your responsibility to notify your supervising resident or faculty so arrangements can be made to relieve you.

Educational Activities:

  1. Recommended Reading
    1. Schwartz's Principles of Surgery
    2. SCORE curriculum modules
  2. Conferences
    1. Wednesday Resident Educational Curriculum

Competency Based Performance Objectives:

Patient Care:

Goal: The resident will be able to use acquired skills and knowledge to demonstrate the ability to use a variety of endoscopic instruments in the screening, diagnosis, and treatment of various diseases.

Objective: The resident will be able to:

  1. Observe and monitor appropriate anesthetic techniques used to sedate the patient.
  2. Prepare patients for various routine and elective endoscopic procedures.
  3. Under supervision, demonstrate proper cleansing and sterilization of endoscopic instruments.
  4. Distinguish between the indications for use and the preparation methods of biopsy, smears (cytologic), culture, and cytology.
  5. Performance (under supervision) of diagnostic:
    1. Esophagogastroduodenoscopy (EGD)
    2. Colonoscopy
    3. Sigmoidoscopy
  6. Observe, recognize, and interpret normal and abnormal findings by the use of the endoscopic procedures listed abov
  7. Be familiar with uncomplicated therapeutic endoscopic maneuvers such as:
    1. Excision of pedunculated colonic polyps
    2. Performance of percutaneous endoscopic gastrostomy (PEG)
    3. Sclerotherapy and banding of esophageal varices
    4. Electrocoagulation of upper and lower bleeding lesions
    5. Removal of foreign bodies
    6. Endoscopic polypectomy
    7. Percutaneous gastrostomy

Competency Based Knowledge Objectives:

Medical Knowledge:

Goal: Demonstrate knowledge of anatomy, physiology and pathophysiology of diseases identified by endoscopy

Objectives: The resident will be able to:

  1. Review normal anatomy and physiology of the gastrointestinal tract, airway, mediastinum, and thorax.
  2. Demonstrate a working knowledge of the anatomical landmarks in the following organs. Describe and contrast the normal and pathological appearance of the:
    1. Esophagus
    2. Stomach and duodenum
    3. Small bowel
    4. Colon
    5. Airways
  3. Identify the indications for endoscopy and common pathological conditions outlined below:
    1. Esophagus
      1. Classes of esophagitis
      2. Esophageal varices
      3. Barrett's Esophagus
      4. Neoplasms (benign/malignant)
      5. Ulcers
      6. Strictures
      7. Infections
    2. Stomach
      1. Ulcers: benign/malignant
      2. Gastric varices
      3. Gastric polyps: benign/malignant
      4. Erosive gastritis
      5. Gastric outlet obstruction
      6. Gastric Bezoar
      7. Marginal ulcer
      8. The post-operative stomach
    3. Duodenum
      1. Ulcers
      2. Polyps: benign/malignant
      3. Inflammatory conditions (Duodenal Crohns)
      4. Tumors of the duodenum and ampulla of Vater
    4. Small bowel
      1. Ileal Crohns
      2. Angiodysplasia
      3. Leiomyoma
    5. Large bowel
      1. Polyps: benign and malignant; sessile and polypoid
      2. Diverticulosis/Diverticulitis
      3. Inflammatory conditions
        1. Ulcerative colitis
        2. Crohns Colitis
        3. Pseudomembranous colitis
      4. Intestinal ischemia
      5. Tumors: benign and malignant
      6. Melanosis Coli
  4. Identify the various anatomical landmarks during endoscopy:
    1. Esophagus
      1. GE jnc/Z-line
    2. Stomach
      1. Cardia
      2. Fundus
      3. Body
      4. Incisura angularis
      5. Antrum
      6. Pylorus
    3. Duodenum
      1. Duodenal bulb
      2. Duodenal mucosa
      3. Papilla of Vater
    4. Colon
      1. Rectum
      2. Sigmoid
      3. Descending
      4. Splenic flexure
      5. Transverse
      6. Hepatic flexure
      7. Ascending colon
      8. Ileocecal valve
      9. Cecum, confluence of tinea coli, and appendiceal orifice
  5. Describe the fundamental mechanics and physics of endoscopic equipment and accessories (e., rigid and flexible scopes, multichannel scopes, types of snares, and biopsy forceps).
  6. Be familiar with the routine operation of endoscopes and their support systems, including:
    1. Ability to troubleshoot minor malfunctions
    2. Knowledge of established procedures for cleaning, sterilization, and routine handling
  7. Summarize methodological issues in endoscopy to include:
    1. Patient preparation
    2. Intubation
    3. Biopsy techniques
    4. Cytology techniques
    5. Specimen handling
    6. Polypectomies
  8. Summarize the use of sedatives (conscious sedation) and analgesics during endoscopic procedures, including:
    1. Mode of onset
    2. Principles of monitoring
    3. Side effects
    4. Reversing agents
  9. Differentiate between the following therapeutic maneuvers utilizing the endoscope:
    1. Dilatation
    2. Laser ablation
    3. Endomucosal resection
    4. Sclerotherapy
    5. Electrocautery (bipolar, monopolar, heater probe)
    6. Polyp excision
  10. Analyze the use of endoscopes in the diagnosis and treatment of upper and lower gastrointestinal hemorrhag
  11. Assess the complications that may result from flexible endoscopic procedures, including:
    1. Hemorrhage
    2. Perforation and the various causes
  12. Determine and categorize the essential features of a wide variety of diseases as seen through the endoscopes listed in #8 abov

Interpersonal and Communication Skills:

Goal: Counsel patients and obtain informed consent for endoscopic procedures

Objectives: The resident will demonstrate the ability to obtain informed consent, outlining the risks and benefits

Goal: Communicate effectively to discharge patients after endoscopic procedures.

Objectives: The resident will demonstrate the ability to instruct patients regarding monitoring for endoscopic complications:

Goal: Communicate effectively as a member of the healthcare team.

Objectives: The resident will demonstrate the ability to communicate effectively by:

  1. Providing appropriate check out when handing patients to another team member
  2. Requesting consults from other services with appropriate information
  3. Dictating operative reports in a timely fashion

Professionalism:

Goal: Maintain patient confidentiality

Objectives: The resident will demonstrate

  1. The ability to protect health-related patient information per HIPAA compliance
  2. List and be aware of sites in the hospital and clinic where loss of privacy for the patient may occur

Goal: Maintain appropriate professional relationships

Objectives: The resident will demonstrate professional interactions with:

  1. Medical students
  2. Nursing and support staff
  3. Supervising faculty
  4. Consulting residents
  5. Physician peers
  6. Patients and their families

Practice-Based Learning and Improvement

Goal: Identify personal and practice improvement strategies

Objective: The resident will demonstrate:

  1. Receptiveness to faculty instruction and feedback
  2. Ability to use medical information with the ability to access information through traditional and online sources to support their educational experience

Goal: Use medical evidence to evaluate endoscopic practices

Objective: The resident will demonstrate the ability to discuss studies regarding endoscopic procedures

Systems-Based Practice

Goal: Provide safe patient care

Objective: The resident will:

  1. Attend Crew Resource Management courses as required by the hospital
  2. Follow recommended protocols in the Endoscopy Suite for patient safety
  3. Demonstrate compliance with Medical Center policy for patient identification

Duties/Responsibilities:

  1. Serve as PGY-3 on the endoscopic service
  2. Manage endoscopy patients with supervision
  3. Attend educational conferences
  4. Complete endoscopy case logs
  5. Dictate in a timely fashion

Evaluation:

  1. Performance feedback will be given to the resident as appropriate for educational events and mid-term progress will be discussed.
  2. Global evaluation will be performed by the endoscopic attending physicians at the completion of each rotation. Surgical case logs will be evaluated for the appropriate number and breadth of procedures and will be present in the resident's portfolio to be reviewed at the Program Evaluation meeting held twice yearly.
  3. At the completion of this rotation, the resident is required to complete a rotation evaluation form assessing the quality of the rotation. The resident should also address the teaching undertaken by the attending physicians on the rotation at the conclusion of this rotation.