Ascension Providence Hospital Curriculum

This curriculum is developed for the use of Gastroenterology fellows at Ascension Providence Hospital . It is designed to outline the curricular goals and expectations for the Gastroenterology fellows. This curriculum is structured around the six Accreditation Council of Graduate Medical Education (ACGME) core competencies.


The content of the Gastroenterology curriculum is based upon an assessment of the knowledge and skills desired at the completion of fellowship training, review of the ACGME requirements and the Tasks Force recommendations from the American Gastroenterological Association and American Society of Gastrointestinal Endoscopy. The Task Force recommendations are the results of the efforts of major Gastroenterology / Hepatology societies. This curriculum is written in effort to set the highest standard for excellence in training.

The Gastroenterology training at Ascension Providence Hospital  consists of 3 years of training. The core clinical curriculum requires a minimum of 18 months of clinical activity and consists of traditional inpatient and outpatient consultation experience supplemented by conferences and didactic sessions.  A longitudinal outpatient experience is required during their 3 years of training.  Training in the basic endoscopic skills is supported by the curriculum. Training in advanced procedures is reserved for selected trainees who have demonstrated endoscopic skill and desire procedural experience for advanced interventional Endoscopy.

Program Requirements

Gastroenterology fellows have formal instruction, clinical experience and opportunities to acquire expertise in the evaluation and management of the following disorders

1. Motility, Diverticular Disease, and Functional Illness
a. Level 1 training - Hands on experience in motility studies, including 24 hour pH monitoring.
b. Level 2 training - Specific studies;
            i. Esophageal motility                   50
            ii. PH recording                           25 
            iii. Gastric / small bowel motility   25
            iv. Gastric emptying                     25
            v. Colonic motility studies            20
            vi. Anorectal motility studies        30
            vii. Anal sphincter biofeedback    10
            viii. Colonic transit study              20
2. Acid Peptic Disease
    a. All the fellows have information given, exposure and experience in the following areas;
            i.  Upper GI Endoscopy-bleeding, biopsy, and polypectomy
            ii. Dilation of esophageal strictures - benign/malignant
           iii. Motility, 24pH probe, gastric secretory studies
           iv. Radiology of the upper GI tract, including US, CT, MRI
           v. A working knowledge of upper GI pathology
3. Biliary Tract Disease and Pancreatic Disorders
           a. Level 1 training - trainees should understand ERCP
           b. Level 2 training - At least 12 months of training (after the first 18 months)  Also inolved in clinical or basic research
4. GI inflammation, Enteric and Infectious Diseases
           a. Involves training in infectious GI disease, HIV, and Inflammatory Bowl   Disease (IBD) - it includes immunology, microbiology, and molecular biology of these diseases.  Also, trainees should be able to assume long term care of these patients, especially IBD patients.
5. Gastrointestinal malignancy
           a. Involves a variety of topics including;
                     i. Endoscopic management of Barrett's
                     ii. Familiarity with, and at least limited experience with, laser and  stenting for esophageal cancer
                     iii. Indications for ERCP for pancreatic/biliary cancers
                     iv. Polypectomy
                      v. Surveillance for IBD
                      vi. Anal cancer lesions diagnosed via Endoscopy
                      vii. Radiology
                     viii. Pathology
6. Hepatology
     a. Level 1 training - Approximately 30% of 18 months will be in liver disease
     b. Level 2 training - Increased training in transplantation, length, and intensity of training in liver disease
7. Gastrointestinal Endoscopy
     a. Level 1 training - Routine procedures
                  i. EGD-130
                 ii. Colonoscopy - 140
     b. Level 2 training - Advance procedure
                 i. ERCP - 200
                 ii. EUS - 150
     c. Objective performance criteria after above numbers achieved
                 i. Intubations of different areas
                 ii. Cannulation of ducts
                 iii. Recognition of normal / abnormal
                 iv. Appropriate knowledge and treatment of findings
8. Nutrition
     a. Level 1 training
                 i. Assessment of nutritional status
                ii. Under nutrition
               iii. Stress states
               iv. Nutritional support - oral, eternal, and parenteral
               v. Obesity
9. Pediatric Gastroenterology
    a. Achieve a level of competency in general concepts
    b. Appreciate the unique aspects of pediatric GI
10. Pathology
    a. Recognize normal historology
    b. Recognize abnormal GI and liver pathology
    c. Recognize aspiration cytology
11. Radiology

                    12. Surgery
                          a. Learn the way that surgical procedures are conducted
                          b. Post-op care of patients after major and minor procedures
                          c. Indications and contraindications for surgery
                          d. Knowledge of surgical anatomy, especially relationships of ductile vascular and luminal structures
                          e. Endoscopic vs. interventional radiology vs. surgical procedure and when to pursue which one
                     13. Research
                           a. Have protected time during fellowship for research
                           b. Have opportunities for basic-lab based and clinical patient oriented
                           c. Have opportunity for research mentor
                    14. Gastrointestinal Cellular and Molecular Physiology
                           a. General concepts
                                      i. Molecular biology
                                     ii. Genetics
                                    iii. Cell biology
                                    iv. Pharmacology and cellular signaling
                                    v. Host environment interactions
                                   vi. Immunology
                         b. Understanding of technologies/technical advances and incorporated into clinical training, not separate from it
                  15. Geriatric Gastroenterology
                        a. Level 1 training
                                  i. General issues
                                  ii. Specific to Gastroenterology (Normal function, drug metabolism, nutrition, specific GI conditions in the elderly)
                        b. Level 2 training - One year in geriatric medicine
                 16. Women's Health Issues in Digestive Diseases
                        c. Level 1 training
                                 i. General women's health issues
                                 ii. Specific issues in digestive diseases
                                iii. Pregnancy and childbearing issues