Gastroenterology Liver Service

Educational Purpose:

To provide instruction in the diagnosis and treatment of patients with a variety of gastrointestinal illnesses, specific to diseases of the liver and subsequent organ dysfunction due to primary liver disease, and the multi-system dysfunction seen by general internists in patients with liver disease, as well as evaluation, pre-op, and post-op management of liver transplant  patients. 

Goal:  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:

PGY 1

1. Learn presentation and management of common liver disease conditions including viral hepatitis, alcoholic liver disease, hemachromatosis, cirrhosis, and hepatocellular carcinoma.
2. Learn and manage patients in the post transplantation state as well as monitoring of immunosuppressants.

PGY 2 and 3

1. Learn presentation and management of common liver disease conditions including viral hepatitis, alcoholic liver disease, hemachromatosis, cirrhosis, and hepatocellular carcinoma.
2. Learn and manage patients in the post transplantation state as well as monitoring of immunosuppressants.

Medical Knowledge Goals and Objectives:

Goal: Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. 

Residents are expected to:

PGY 1

1. Learn presentation and management of acute liver failure, encephalopathy, and evaluation and selection for liver transplantation.

PGY 2 and 3

1. Learn presentation and management of acute liver failure, encephalopathy, and evaluation and selection for liver transplantation.

Practice-Based Learning and Improvement Goals and Objectives:

Goal: Residents 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.

Residents are expected to develop skills and habits to be able to:

PGY 1

PGY 2 and 3

1. Develop short-term treatment goals, as well as long-term follow up and coordination of care.

Systems Based Practice Goals and Objectives:

Goal: Residents 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.

Residents are expected to:

PGY 1

PGY 2 and 3

1. Supervise and manage team members, including interns and medical students.

Professionalism Goals and Objectives:

Goal:  Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.

Residents are expected to demonstrate:

PGY 1

PGY 2 and 3

Interpersonal and Communication Skills Goals and Objectives:

Goal: Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. 

Residents are expected to:

PGY 1

PGY 2 and 3

Teaching Methods:

Participation in the care of inpatients with a variety of gastrointestinal ailments. Bedside or “sit down” teaching rounds for in-hospital patients. Formal, regularly scheduled clinical conferences (many of which are multidisciplinary in nature). Teaching rounds include didactic lectures provided by attendings and fellows assigned to the inpatient liver service.

Mix of Diseases and Pathological Material:

The program incorporates three teaching hospitals: The Medical University Hospital (MUH), Ashley River Tower (ART), and the Charleston VA Medical Center (VAMC). Faculty expertise draws patients with a myriad of disease processes including liver transplantation, cirrhosis, non-alcoholic liver disease, familial hemachromatosis, and Wilson’s diseases. In particular, MUH is a tertiary facility providing a high level of care in all aspects of Internal Medicine where renal, bone marrow, cardiac, lung, pancreas, and liver transplantation programs are ongoing.  In addition, the interests of the Gastroenterology faculty attracts patients with biliary tract and liver disease, nutritional problems, gastrointestinal motility disorders, and malignancies.

Patient Characteristics:

Residents care for a diverse patient population with respect to age, ethnicity, and gender. The majority of the patients are older adults, but there are significant numbers of adolescent and young adult patients in some sites.  All have acute or chronic gastrointestinal diseases as well as chronic general medical conditions.

Types of Clinical Encounters:

Chronic gastrointestinal bleeding, alcohol and viral-related liver diseases, pancreatitis, and gastrointestinal malignancy. To provide patient coverage:  MUH Luminal in-patient service, MUH Luminal consults service, MUH Liver in-patient consult service,

Procedures and Services:

The MUH and VAMC provide a full spectrum of flexible endoscopic procedures. Over 6000 procedures are performed each year. At MUH there are both in-patient and out-patient endoscopy suites. Each endoscopy facility is equipped and staffed for upper endoscopy (EGD), colonoscopy, percutaneous endoscopic gastrostomy (PEG), esophageal dilation, esophageal banding, and the like. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) are performed in the inpatient endoscopy facility at MUH.  Residents have the opportunity to perform and supervise interns on simple bedside procedures including diagnostic and therapeutic paracentesis. 

Supervision:

The attending physician of record supervises the GI fellow, the resident, the intern and the students. The fellow assists in this supervision. The resident helps supervise the intern and the students.

Educational Resources to be Used and Reading Lists:

The residents and medical students assigned to the various services are required to attend the weekly GI fellows’ conference. The Division maintains an up-to-date audiovisual library for self-directed learning containing textbooks, journals, teaching slides, and DVDs located adjacent to the Video Conference Room. Weekly or bi-weekly conferences include: GI Fellows’ Conference, Pancreaticobiliary Conference, Clinical Research Conference, various multidisciplinary tumor boards, Liver Biopsy Review as well as  teaching rounds by gastroenterology faculty members.

Method of Evaluation of Resident Competence:

The attending physician provides formative feedback at the halfway mark of the rotation. Residents are evaluated summatively using the global evaluation form. The Mini-CEX is often administered on this service as well. Patient Care is assessed based on direct observation and complete review of all records. Medical Knowledge is assessed through direct questioning and observation. Interpersonal Skills and Communication is assessed by observation of interactions with consulting physicians, patients, and families. The attending physician evaluates Professionalism through direct interaction and observation of the resident. Systems-Based Practice is evaluated based on interactions with the primary team and the ability to provide medical care in collaboration with consultants, and other specialists in the cares of the patients with emphasis placed on optimization of patient care. Practice-Based Learning is evaluated based on the ability to consult the literature and to improve their performance throughout the rotation. The residents evaluate the rotation and the attending physician through the E*Value system. The consult attendings review the rotation evaluations and each attending anonymously receives his or her evaluations.