GI Consult Teaching Rotation

The GI Consult Teaching Rotation is the cornerstone of our teaching programs.  On this rotation, trainees will get broad exposure to the spectrum of GI and liver diseases in an underserved setting. Trainees are functioning members of the team and are called upon to evaluate, present, and assist in the management of patients on the inpatient service, the endoscopy unit, and GI/Liver Clinics. This rotation is active all year round.

If you have been APPROVED and SCHEDULED to rotate on the GI Consult Teaching Rotation, please fill out the "GI Trainee Intake Form" using this link: https://goo.gl/forms/qLFqVfTz27npPVux1

• Attending Faculty: Our five full-time faculty rotate on the teaching service on a weekly basis (i.e. they switch every week). Their general role is to provide daily teaching, clinical oversight, and mentorship to the trainees on the GI Consult Rotation. 

• CPMC GI Fellow Inpatient: There are a few months in the year where a GI Fellow will be rotating through the GI Consult Team. They will act as the junior attending. Their general role is to provide daily teaching, clinical oversight, and mentorship to the trainees on the GI Consult Rotation. 

• R2 or R3 Internal Medicine Resident: There is typically one R2/R3 on the GI Consult Team and this resident typically rotates on a 1-2 week cycle. Their general role is to teach, lead, and manage the more junior trainees on the GI Consult team under the direction of the Attending Faculty. 

• R1 Internal Medicine Intern: There is typically one R1 on the GI Consult Team. The interns rotate on a 1-2 week cycle, depending on their individual schedule. Their general role is to learn clinical medicine, teach medical students, and to actively support the functioning of the GI Consult Team. 

• Medical Students: There is usually 1 medical student on the GI Consult Team. The students come from a variety of medical schools from around the country, but are typically from either UCSF or St. George's University School of Medicine. Their general role is to learn clinical medicine and to actively support the functioning of the GI Consult Team. 

• UCSF East Bay Surgery Resident or CPMC GI Fellow Outpatient: UCSF East Bay Surgery Residents and/or CPMC GI Fellows are present throughout the year but are on separate rotations. Their rotations can have clinical overlap with the GI Consult Team but they are not regular members of the GI Consult Team. Please see "Expectations" on the Medical Education homepage for further specifics about these positions.

CLINICAL EDUCATION COMPONENTS OF THE ROTATION:

There are 3 clinical education components to the GI Consult Team.

• Inpatient Gastroenterology/Liver Consultation Service

• Endoscopy

• Independent Study 

INPATIENT GASTROENTEROLOGY/LIVER CONSULTATION SERVICE (MON-FRI)

As consultants, we are called upon by other services throughout the hospital to advise upon, address, and facilitate the evaluation of specific issues relating to GI/Liver diseases. All consults will be divided among the housestaff and medical students rotating on the service.  The consult pager (see Pearls: How To Take A Consult) will be carried by the senior-most medicine housestaff on the team who will appropriately triage and distribute consults to the team. For each new consult, you will be expected to present the case and dictate a consult note (Note: Medical Students are not allowed to dictate) that concisely summarizes the pertinent clinical data, offers a differential diagnosis, and proposes a suitable management plan.  Further, you will write daily notes on patients while they are on the service. All of these activities will, of course, be guided and overseen by the GI staff attending.

Work rounds are performed daily, usually in the morning but sometimes with an additional afternoon session as needed.  New consults and existing patients will be presented and discussed during this time, both at the bedside and in the GI Endoscopy Teaching Room.  You are expected to know your patients well and to be able to concisely present each case to the attending.

Communication to our referring teams is critical to the success of this service and is an essential skill to refine as a physician.  As such, we expect you to effectively and efficiently communicate our assessments/plans to our referring teams on a daily basis.

INDEPENDENT STUDY

It is our expectation that our trainees aggressively pursue a program of independent study. Most of the resources that you will need are available on the Education Resources page. The independent study program for this rotation includes:

• Medical Knowledge Self-Assessment Program (MKSAP) GI Section. If we were to recommend one single source of GI/Liver learning for all our trainees, this would be it. We strongly encourage those trainees who will be pursuing a career in Internal Medicine to purchase this set. It is an excellent resource.  A copy may be available in our education room and most of our internal medicine residents have access to it.

• Core Articles. These are arranged in a progression of four (4) one-week units. It is the minimal expectation that those on their first week of the rotation should read the first week grouping, those on the second week of their rotation should read the second week grouping, etc., Please note that articles in the latter weeks may be applicable to your patients and these articles can be a tremendous primary resource for your learning.

• Video Library. It is our minimum expectation that our trainees watch at least one video from our Video Library per day. 

GI/LIVER TEACHING CLINIC (MONDAY, TUESDAY, WEDNESDAY, FRIDAY)

• Outpatient management of GI/Liver disorders is an integral component to the specialty.  Housestaff will be expected to see new and returning patients, present these patients to the GI Fellow or the GI Attending, and co-document these visits with the GI Attending.  

• Please email the GI Attending you will be working with 1-2 days prior to the clinic visit. 

• Understand the approach to evaluation of abnormal liver enzymes and functions tests

• Develop a general approach to the differential diagnosis and management of acute upper GI bleeding

• Develop a general approach to the differential diagnosis and management of acute lower GI bleeding

• Develop a systematic approach to the evaluation and management of patients with cirrhosis and cirrhosis-related complications

• Understand the epidemiology and clinical evaluation of patients with common chronic liver diseases, including alcoholic liver disease, chronic hepatitis B virus infection, and chronic hepatitis C virus infection

• Develop a general approach to evaluation and management of patients with ulcerative colitis or Crohn's disease

• Understand the current updated guidelines for colorectal cancer screening and surveillance

• Understand the epidemiology and clinical evaluation of patients with liver lesions, including hepatocellular carcinoma

• Develop a systematic approach to the evaluation and management of esophageal disorders, including GERD

• Develop a systematic approach to evaluation and management of dyspepsia and H. pylori

• Develop a systematic approach to evaluation and management of chronic diarrhea

• Develop a systematic approach to evaluation and management of irritable bowel syndrome and other functional disorders of the gastrointestinal tract

• Develop a general approach to the evaluation and management of acute and chronic pancreatitis

• Know and regularly review the "Core Expectations of All Trainees". These are outlined on the Medical Education landing page. Read the "Expectations" outlines for all members of the team, so you will have a better understanding of everyone's role.

• Learn and practice the principles of effective medical consultation. Strive to be a great consultant. Read this as a start.

• Attend Department of Medicine Conferences. This includes morning report and noon conferences. 

• See GI/Liver consults assigned by the supervising GI resident. Know your consult patients! You should know your patient and their clinical data better than anyone else in the hospital.

• Medical students can start consult and progress notes in our EMR, but are not allowed to sign the notes. Have the supervising resident and/or attending co-sign ALL your notes that will go into the medical record.

• Medical students can explain GI procedures to the patients they are seeing, but they are not allowed to consent patients for procedures. This is the responsibility of the housestaff and the attendings. 

• Pre-round with your team before attending rounds. Know what you are going to say to the attending before you say it.

• You may have the opportunity to perform therapeutic paracenteses under the supervision of the resident. GI housestaff have priority for procedures.

• Additional daily expectations:

  • Observe at least one (1) outpatient endoscopy per day. 

  • Read at least one (1) article from the "Core Articles" section of the Education Resources page.

  • Watch at least one (1) video from the Education Resources page.

  • Pass the GI Test of the Week every week they are on service.

• By the end of your rotation with us, you should have completed the GI MKSAP section, read the appropriate "Core Articles" based on your time with us, and seen most of the videos on the Education Resources page.

• Know and regularly review the "Core Expectations of All Trainees". These are outlined on the Medical Education landing page. Read the "Expectations" outlines for all members of the team, so you will have a better understanding of everyone's role.

• Learn and practice the principles of effective medical consultation. Strive to be a great consultant. Read this as a start.

• Attend Department of Medicine Conferences. This includes morning report and noon conferences. 

• See GI/Liver consults assigned by the supervising GI resident. Know your consult patients! You should know your patient and their clinical data better than anyone else in the hospital.

• Initial inpatient consultations and paracentesis notes are signed on the day the patient is seen. Write daily progress notes on patients that are being actively followed by our service.

• Appropriately consent endoscopy patients as directed by the supervising GI resident and attending. 

• Pre-round with your team before attending rounds. Know what you are going to say to the attending before you say it.

• Make a deliberate effort to develop teaching and mentoring skills for the medical students on our team. Help to develop your medical students into future housestaff.

• Perform therapeutic paracenteses under the supervision of the resident and faculty.

• Additional daily expectations:

  • Observe at least one (1) outpatient endoscopy per day. 

  • Read at least one (1) article from the "Core Articles" section of the Education Resources page.

  • Watch at least one (1) video from the Education Resources page.

  • Pass the GI Test of the Week every week they are on service.

• By the end of your rotation with us, you should have completed the GI MKSAP section, read the appropriate "Core Articles" based on your time with us, and seen most of the videos on the Education Resources page.

• There will be verbal and written feedback given at the end of each week. Please fill out this form prior to your feedback session. 

• Know and regularly review the "Core Expectations of All Trainees". These are outlined on the Medical Education landing page. Read the "Expectations" outlines for all members of the team, so you will have a better understanding of everyone's role.

• Learn and practice the principles of effective medical consultation. Strive to be a great consultant. Read this as a start.

• Know the consult patients you are overseeing! Actively maintain and review the consult list with the team throughout the day. As we say, "Start the day thinking about the list, spend the day thinking about the list, and end the day thinking about the list."

• Ensure that initial inpatient consultations notes are written on the day the patient is seen. Ensure that daily progress notes are written on patients that are being actively followed by our service.

• Ensure that procedure consent is obtained appropriately before procedures. Medical students are not allowed to consent patients.

• Pre-round with your team before attending rounds. This is the best time to identify potential pitfalls before the attending arrives. Know what you and your team are going to say to the attending before they (you ) say it.

• Make a deliberate effort to develop teaching and mentoring skills for the residents and medical students on our team. Help to develop your resident and medical students.

• Be a good leader. Use this rotation to refine the skills of appropriate oversight, delegation, constructive feedback, and developing your team (i.e. residents/students). Remember: When the team looks good, you look good!

• Perform therapeutic paracenteses under appropriate supervision. 

• Additional daily expectations:

  • Read at least one (1) article from PubMed, that answers your clinical question of the day.

  • Watch at least one (1) video from the Education Resources page.

• There will be verbal and written feedback given at the end of each week. Please fill out this form prior to your last feedback session.

• Know and regularly review the "Core Expectations of All Trainees". These are outlined on the Medical Education landing page. Read the "Expectations" outlines for all members of the team, so you will have a better understanding of everyone's role.

• Learn and practice the principles of effective medical consultation. Strive to be a great consultant. Read this as a start.

• Know the consult patients you are overseeing! Actively maintain and review the consult list with the team throughout the day. As we say, "Start the day thinking about the list, spend the day thinking about the list, and end the day thinking about the list."

• Ensure that initial inpatient consultations notes are written on the day the patient is seen. Ensure that daily progress notes are written on patients that are being actively followed by our service.

• Ensure that procedure consent is obtained appropriately before procedures. Medical students are not allowed to consent patients.

• Pre-round with your team before attending rounds. This is the best time to identify potential pitfalls before the attending arrives. Know what you and your team are going to say to the attending before they (you ) say it.

• Make a deliberate effort to develop teaching and mentoring skills for the residents and medical students on our team. Help to develop your resident and medical students.

• Be a good leader. Use this rotation to refine the skills of appropriate oversight, delegation, constructive feedback, and developing your team (i.e. residents/students). Remember: When the team looks good, you look good!

• Perform therapeutic paracenteses under appropriate supervision. 

• Additional daily expectations:

  • Read at least one (1) article from PubMed, that answers your clinical question of the day.

  • Watch at least one (1) video from the Education Resources page.

• There will be verbal and written feedback given at the end of each week. Please fill out this form prior to your last feedback session.