Description of Rotation or Educational Experience

This is a one month elective rotation for the acute care surgical resident. Exposure to colorectal patients and their diseases will occur at University Medical Center and participating outpatient surgery centers. While on this rotation, residents will acquire a broad understanding of the evaluation and management of patients with diseases of the colon, rectum, anus and pelvic floor. Residents will also become familiar with frequently performed endoscopic procedures.

Patient Care

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:

Competencies

• Understand the goals for performing diagnostic and therapeutic colonoscopy, flexible sigmoidoscopy, anoscopy
• Ability to recognize the indications for endoscopy and when to appropriately request its performance.
• Explain the physiologic rationale for the following gastrointestinal operations:

a. Ostomy formation

b. Resection of lower GI tract segments with nodes for tumors

c. Bypass of GI tract segments for resectable tumors

d. Drainage of abdominal and retroperitoneal abscesses (percutaneous vs. operative)

• Detail the standard intraoperative techniques and alternatives associated with each of the above operations.
• Assess alternatives to surgical intervention in the management of complex diseases of the alimentary tract such as:

a. Intestinal polyposis

b. Inflammatory bowel disease

c. Colon cancer

d. Rectal cancer

e. Squamous cell cancer of the anus

Objectives

• Assist in surgeries involving colorectal pathology
• Perform assisted and supervised colonoscopy

Medical Knowledge

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:

Competencies

• Describe the pathophysiology of diseases that require endoscopy
• Explain the role of surgical intervention when management fails in the following:

a. Inflammatory bowel disease

b. Lower GI bleeding

c. Diverticulitis

• Summarize the preoperative, intraoperative, and postoperative management of complex diseases of the alimentary tract and digestive system.

a. Re-operative abdomen

b. High output GI fistulas

c. Inflammatory bowel disease with strictures, pouches, ostomies, and perineal fistulas

d. Recurrent colon malignancy

e. Carcinomatosis

• Explain the indications for endoscopic examination of the gastrointestinal tract

Objectives

• Attend >= 75% of conferences, M&M, grand rounds and other educational activities in the Division of Gastroenterology during the rotation
• Take a post-rotation self-assessment test with at least 75% accuracy

Practice- Based Learning and Improvement

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 :

Competencies

• Identify strengths, deficiencies and limits in one’s knowledge and expertise
• Incorporate formative evaluation feedback into daily practice
• Locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems

Objectives

• Write an evidence-based literature review discussing a topic in the realm of gastroenterologic endoscopy
• Formulate a means of applying mid-rotation constructive criticism provided by an online e-value method of evaluation.

Systems Based Practice

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:

Competencies

• Work in interprofessional teams to enhance patient safety and improve patient care quality
• Participate in identifying systems errors and in implementing potential systems solutions

Objectives

• Attend interdisciplinary rounds with nutrition, social services, rehabilitation on a semi-weekly basis.

Professionalism

Goal

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

Competencies

• Compassion, integrity, and respect for others
• Respect for patient privacy and autonomy
• Accountability to patients, society, and the profession

Objectives

• Obtain a satisfactory score on an online e-value post rotation assessment on a measure compassion
• Complete the HIPAA examination for the medical center.

Interpersonal and Communication Skills

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:

Competencies

• Communicate effectively with physicians, other health professionals, and health related agencies
• Maintain comprehensive, timely, and legible medical records

Objectives

• Obtain a satisfactory score on an online e-value post rotation assessment on a measure communication skills
• Complete all outstanding medical records upon completion of the rotation and complete all eSignatures of procedures performed during the rotation

Teaching Methods

• Attendance of all lectures, conferences and quality improvement meetings
• Review of assigned reading materials
• Attending preceptorship

Assessment Method (residents)

• Focused observation by faculty staff
• 360 degree evaluation by faculty at end of rotation through e-value system.
• Case log review with program director

Assessment Method (Program Evaluation)

• Using e-value system, rotation is assessed on several qualities including but not limited to value, accessibility, and relevance to practice
• Outcome on national standardized exams

Level of Supervision

• Residents are under direct or indirect supervision by faculty staff at all times.

Educational Resources

• American College of Gastroenterology Guidelines as published in the American Journal of Gastroenterology