Ascension Providence Hospital Curriculum

Introduction

The Gastroenterology Training Program at Ascension Providence Hospital consists of 36 months of training. The core clinical curriculum requires a minimum of 21 months of direct clinical patient care. Both inpatient and outpatient experiences are represented with longitudinal outpatient experience required during the 3 years of training. Throughout the training there is strong emphasis on academic pursuit with regularly scheduled fellow lectures, pathology conferences, radiology conferences, journal clubs, and morbidity/mortality conference. Additional training is supplemented with online instruction and modules through ACG Universe. Basic and advanced endoscopic skills are supported by the curriculum and present throughout fellow training. Substantive research experience is supported by direct faculty involvement and dedicated research rotations. Goals and objectives of each rotation are included in the curriculum and are specific for each level of training. The goals and objectives are structured around the six ACGME core competencies with evaluation of fellow performance based on evaluation with ACGME subcompetency and specific mastery of subjects outlined in the 13 Entrustable Professional Activities (EPAs) outlined by the following major gastroenterological societies:

- American Association for the Study of Liver Diseases (AASLD)
- American College of Gastroenterology (ACG)
- American Gastroenterology Association (AGA)
- American Neurogastroenterology and Motility Society (ANMS)
- American Society for Gastrointestinal Endoscopy (ASGE)

 

Clinical Rotations

  • Advanced Endoscopy: Providence (Southfield and Novi campuses), and Ascension Macomb.
  • Colorectal Surgery
  • Gastroenterology Ambulatory Continuity Clinic
  • Gastroenterology Inpatient Consult Service: Ascension Providence (Southfield) 1, Ascension Providence (Southfield) 2, Ascension Providence (Novi) 1, Ascension Providence (Novi) 2, Ascension Macomb (Warren)
  • Gastrointestinal Radiology
  • Transplant Hepatology – Henry Ford Hospital
  • Hyperalimentation
  • Irritable Bowel Disease – Henry Ford Hospital
  • Providence GI Continuity Clinic
  • Research

 

Year 1
Fellows have 9 months of inpatient clinical care during which they will perform inpatient consults and procedures. They have 1 month outpatient ambulatory rotation during which they will round with a small group of attendings in the clinic setting. The first year also has 2 months of dedicated research time. During the first year and throughout their fellowship, fellows also experience longitudinal outpatient care in two settings - GI fellow continuity clinic and attending continuity clinic.

Year 2
Fellows have 5 months of inpatient clinical care where they will continue to perform inpatient consultation and procedures with increased independence. An additional 1 month outpatient ambulatory rotation during which they will round with a different group of attendings in the clinic setting. Fellows will have a 1 month Hepatology/Transplant rotation at Henry Ford Hospital as well as a diverse multidisciplinary experience with a 1 month Nutrition rotation, 1 month Gastroenterology Radiology rotation, and 1 month Colorectal Surgery rotation. Fellows will have an additional 2 months of dedicated research time during their second year.

Year 3
In addition to continued mastery of core endoscopic procedures, third year fellows will have 6 months of advanced procedures rotations where they will perform advanced endoscopy procedures including endoscopic retrograde cholangiopancreatography (ERCP) and deep enteroscopy (DE) with exposure to endoscopic ultrasound (EUS) if desired. Fellows will also have 1 month of Irritable Bowel Disease rotation at Henry Ford Hospital, 1 month of inpatient clinical care, 1 month of outpatient ambulatory rotation, and 2 months of dedicated research time.

Conferences

  • Core Curriculum Conference Weekly
  • GI Radiology Conference Monthly
  • GI Pathology Conference Monthly
  • Research Meeting Quarterly
  • GI Journal Club Monthly
  • GI Morbidity and Mortality Conference Quarterly
  • Internal Medicine Resident Conference Monthly

 

Curriculum Topics Overview

Gastroenterology fellows have formal instruction, clinical experience and opportunities to acquire expertise in the prevention, evaluation, and management of the areas listed below. Specific subjects required are listed for each rotation:

  • Acid peptic disorders of the GI tract
  • Functional disorders of the GI tract
  • Motility disorders of the GI tract
  • Acute and chronic liver diseases
  • Complications of Cirrhosis
  • Biliary Disorders
  • Acute and chronic pancreatic diseases
  • Gastrointestinal infections
  • Non-infectious luminal GI diseases
  • Gastrointestinal and hepatic neoplastic disease
  • Diseases of nutrient assimilation

 

Procedural Curriculum

Gastroenterology fellows are provided opportunities to gain competency in a variety of gastrointestinal procedures. A skilled preceptor is present to teach and supervise each procedure. The fellow documents the procedure in a procedure log. The fellow's log includes the procedure performed, the indication and outcomes of the procedure, the patient's diagnosis and the supervising physician(s). The fellow must demonstrate competency of the following procedures, including, but not limited to:

  • Biopsy of the mucosa of the esophagus, stomach, small bowel, and colon
  • Capsule endoscopy
  • Colonoscopy with polypectomy
  • Conscious sedation
  • Esophageal dilation
  • Esophagogastroduodenoscopy
  • Nonvariceal hemostasis including actively bleeding
  • Other diagnostic and therapeutic procedures utilizing enteral intubation
  • Percutaneous endoscopic gastrostomy tube placement
  • Retrieval of foreign bodies from the esophagus
  • Variceal hemostasis including actively bleeding patients

 

The 2017 ASGE guidelines recommending the minimum number of procedures to begin to assess competency are followed and are listed below:

Procedure
 

Minimum number to be performed
before assessment of competency

Quality of evidence
(out of total of 4)
 Moderate sedation  20  1
 Upper endoscopy  130  2
 Colonoscopy  275  3
 Flexible sigmoidoscopy  30  2
 ERCP  200  3
 Capsule endoscopy  20  1
 DE, lower  20  1
 DE, upper  10  1
 EMR (upper GI)  20  2
 Endoscopic submucosal
 dissection, stomach
 30  1
 Ablation, Barrett's esophagus  30  2
 Enteral stent placement  10  1
 Enteral feeding tube placement  20  1
 EUS  225  3

 

We follow the 2017 ASGE guidelines which outline the following objective performance components to be evaluated during assessment of endoscopy competence:

  • Reviews patient records/x-ray films
  • Identifies potential risk factors
  • Understands indications/contraindications
  • Believes findings will influence management
  • Obtains proper informed consent
  • Uses appropriate sedation
  • Intubates GI tract with good technique
  • Correctly identifies landmarks
  • Conducts through examination
  • Detects and identifies all pathologic conditions
  • Completes the examination within a reasonable period
  • Obtains tissue sample properly
  • Performs therapeutic maneuvers successfully/effectively
  • Recognizes and manages procedure-related adverse events
  • Prepares an accurate report
  • Plans correct management and disposition
  • Discusses findings with patient\family and other healthcare providers
  • Arranges proper follow-up, review of pathologic findings, and case outcome