Welcome to the Adult Gastroenterology Training Program. Our program has an exceptional track record of training leaders in academic and community gastroenterology. McMaster University is recognized worldwide as a leader in both gastrointestinal research and clinical practice. We take pride in our outstanding faculty and the positive training environment we provide.
The Adult Gastroenterology Training Program is a two-year program accredited by the Royal College of Physicians and Surgeons of Canada (RCPSC). The program is based at the McMaster Campus of Hamilton Health Sciences (HHS), but also involves St. Joseph’s Hospital and the Juravinski and General Campuses of HHS. At all sites, trainees benefit from clinical and educational collaboration with the Departments of Surgery, Radiology, and Pathology. Trainees benefit from the rich training environment of the Michael DeGroote School of Medicine with world-renowned expertise in Clinical Epidemiology and Biostatistics.
Through a series of inpatient and outpatient rotations and generous elective time, trainees gain broad exposure to clinical gastroenterology and training in all CANMEDS competencies endorsed by the RCPSC. Trainees gain a solid grounding in the pathophysiology, diagnosis, and management of gastrointestinal disorders with dedicated training in nutrition, motility, and endoscopy. Trainees have access to state-of-the-art equipment, including a dedicated endoscopy simulator. An endoscopy course for new gastroenterology residents from across Canada is hosted in Hamilton each year by the Division of Gastroenterology.
The Farncombe Family Digestive Health Research Institute leads an internationally acclaimed program of bench to bedside research with highly respected faculty. Trainees in the Adult Gastroenterology Training Program are given protected time to engage in research and are encouraged to present their work at institutional, national, and international meetings. The Upper Gastrointestinal and Pancreatic Disease Cochrane Review Group also has a base at McMaster to facilitate the synthesis and knowledge translation of primary GI research to patients and clinicians. The Adult Gastroenterology Training Program takes pride in providing an experience that is individualized to the trainee’s career goals and interests while fulfilling RCPSC goals and objectives. Each trainee receives strong mentorship and career counseling from members of the faculty. Trainees are encouraged to undertake a third year of clinical or research training, which may include postgraduate training in Health Research Methodology through the Department of Clinical Epidemiology and Biostatistics.
In summary, the Adult Gastroenterology Training Program at McMaster University provides the structure and flexibility to accommodate both the individual needs of our trainees and the demands of our ever-changing patient populations.
Residents can be considered for training in Adult Gastroenterology at McMaster University if they have completed at least three years of training in an approved Internal Medicine Residency Training Program. Residents who are unsure of their eligibility for our program should contact the Postgraduate Medical Education Program prior to contacting the Adult Gastroenterology Training Program.
Residents who are eligible for Ontario Ministry of Health-funded training positions should apply through the Canadian Residency Matching Service (CaRMS). All other potential trainees, including those who graduated from non-Canadian medical schools, should contact the Postgraduate Medical Education Program for specific advice about their eligibility for training at McMaster University. Further information is available from The College of Physicians and Surgeons of Ontario website.
Applications must include:
Proof of citizenship MUST be submitted with each application since only Canadian Citizens, Permanent residents, or Landed Immigrants can apply to CaRMS positions in Ontario. One of the following documents must be submitted:
Applicants who will not be funded by the Ontario Ministry of Health (e.g. international medical graduates, those requiring a work authorization permit) will also need to provide details about their sponsorship and demonstrate successful completion of the Medical Council of Canada Evaluating Examination. Residents currently training outside of Canada or are uncertain of their eligibility to train at McMaster, should review the requirements for training found at the Postgraduate Medical Education Program website. Applicants for non-Ontario Ministry of Health-funded positions should send their application package directly to the Postgraduate Medical Education Program office before September 1st to confirm training eligibility.
September 1st.
The Residency Program Committee (RPC) assists the Program Director in the planning, organization, and supervision of the Adult Gastroenterology Training Program.
The RPC meets regularly, at least quarterly, and keep minutes. Agenda and any relevant documentation are pre-circulated to RPC members prior to each meeting. Minutes are sent to all staff and residents, as well as the Assistant Dean of Postgraduate Education and the General Internal Medicine Program Director.
The RPC is responsible for the overall operations of this two-year residency program. This includes the global objective of providing the environment, mentorship and uniform experience whereby each resident will have access to the educational experience sufficient to successfully complete the program objectives. The RPC committee is responsible for assisting and contributing to the program functions for the Adult Gastroenterology Training Program at McMaster University, including the following important domains:
Site coordinators are primarily responsible for coordinating the resident rotations at their site and ensuring the educational value of those rotations.
At the beginning of each block, the residents are expected to meet with the Site Coordinators for orientation to review both the clinical setting, and objectives and expectations specific to the individual.
Specific issues relating to scheduling clinics, endoscopy lists and teaching sessions will be reviewed. Over the course of each rotation, the Site Coordinators are available as resources for conflicts that arise and for help in coordinating the evaluation process.
Site coordinators distribute and collate resident evaluations for rotations at their site and review those evaluations with residents.
Hepatology curriculum coordinator is primarily responsible for coordinating the mandatory Hepatology rotation during the First Year and elective in Hepatology during the Second Year, and ensuring the educational value of the rotation / elective.
At the beginning of each Hepatology rotation / elective, the residents are expected to meet with the Hepatology curriculum coordinator for orientation to review both the clinical setting, and objectives and expectations specific to the rotation.
Specific issues relating to scheduling clinics, endoscopy lists, paracentesis / liver biopsy, and teaching sessions will be reviewed. Over the course of the rotation / elective, the Hepatology curriculum coordinator is available as a resource for conflicts that arise and for help in coordinating the evaluation process.
Hepatology curriculum coordinator distributes and collates resident evaluations for the Hepatology rotation / elective and reviews those evaluations with residents.
In addition, the Hepatology curriculum coordinator is responsible for organizing academic half day sessions and journal club series on Hepatology topics.
Motility Curriculum Coordinator is primarily responsible for coordinating the Motility rotation during the Second Year and Motility elective during the Second Year, and ensuring the educational value of the rotation / elective.
At the beginning of each Motility rotation / elective, the residents are expected to meet with the Motility Curriculum Coordinator for orientation to review both the clinical setting, and objectives and expectations specific to the rotation.
Specific issues relating to scheduling clinics, endoscopy lists, motility and pH-metry sessions (observation and interpretation of test results), and teaching sessions will be reviewed. Over the course of the rotation / elective, the Motility Curriculum Coordinator is available as a resource for conflicts that arise and for help in coordinating the evaluation process. Motility Curriculum Coordinator distributes and collates resident evaluations for the Motility rotation / elective and reviews those evaluations with residents.
In addition, the Motility Curriculum Coordinator is responsible for organizing Academic Half-Day sessions on Motility topics.
Nutrition Curriculum Coordinator is primarily responsible for coordinating the Clinical Nutrition rotation during the Second Year and Clinical Nutrition elective during the Second Year, and ensuring the educational value of the rotation / elective.
At the beginning of each Clinical Nutrition rotation / elective, the residents are expected to meet with the Nutrition Curriculum Coordinator for orientation to review both the clinical setting, and objectives and expectations specific to the rotation.
Specific issues relating to scheduling clinics, endoscopy lists, ward rounds and teaching sessions will be reviewed. Over the course of the rotation / elective, the Nutrition Curriculum Coordinator is available as a resource for conflicts that arise and for help in coordinating the evaluation process. Nutrition Curriculum Coordinator distributes and collates resident evaluations for the Nutrition rotation / elective and reviews those evaluations with residents.
In addition, the Nutrition Curriculum Coordinator is responsible for organizing Academic Half-Day sessions on Clinical Nutrition topics.
The Endoscopy Coordinator is responsible for developing, monitoring and evaluation of the endoscopy training of residents in the Adult Gastroenterology Training Program.
The coordinator assists the Program Director in updating the goals and objectives of training in endoscopy, the integration of endoscopy simulator exposure and maintaining electronic procedure logs.
The Endoscopy Coordinator also helps the Program Director to coordinate resident participation in external opportunities such as the annual McMaster Resident Endoscopy Training Course.
Each trainee is assigned a mentor who will be available to discuss problems ranging from personal (e.g. stress) to professional (e.g. career choices).
The mentor is expected to develop a special relationship with the trainee over the duration of his or her stay in the program. The mentor should assist the trainee in meeting his or her goals within the context of the program, and specifically with respect to general objectives #4 and #6 of the second year.
The role of the mentor does not conflict with the roles of the Program Director or the Site Coordinators; all will contribute to resolving a trainee's particular problems and all will be directly involved in achieving general objective #5 of the second year.
The Research Coordinator is responsible for guiding and monitoring the research activity of GI residents.
Specifically, the coordinator ensures that each resident identifies a research project and supervisor for their first year block, reviews their progress over that block, and assesses their eligibility for more research time in the second year.
The Research Coordinator also ensures that residents meet the core productivity requirements of the research block.
The Academic Half Day Coordinator is responsible for assisting the Program Director in developing, monitoring and evaluation of the academic half day curriculum in the Adult Gastroenterology Training program. A syllabus is outlined for each year by the Chief Resident, Academic Half Day Coordinator and the Program Director.
Specific issues relating to the structure, content, and scheduling of the half-day sessions are reviewed by the Academic Half Day Coordinator and the Program Director. The Academic Half Day Coordinator is also available as a resource for issues arising during the half-day sessions.
The Academic Half Day Coordinator collates resident evaluations for all half-day sessions and reviews these evaluations with the Chief Resident and the Program Director at the end of the year. The data is then analyzed annually for program review and faculty feedback.
All residents participate in mock OSCE and written examinations twice a year. The experience is invaluable preparation for the Royal College of Physicians and Surgeons of Canada licensing examinations, and also facilitates organized thinking around problems and dilemmas in Gastroenterology. The results of these tests are reviewed and used as formative assessment tools to guide future learning objectives.
OSCE stations are generated by the OSCE Coordinating Committee and reviewed by the OSCE Coordinator and the Program Director before being implemented. Written exams are prepared by 2 faculty members (1 luminal and 1 hepatology) and submitted to the OSCE coordinator for review and approval prior to implementation.
The Chief Gastroenterology Resident is selected from the second year gastroenterology residents by a faculty vote. The position provides an opportunity for the resident to be involved with the administrative organisation and day-to-day running of the training program. The Chief Resident attends meetings of regional gastroenterologists and provides residency input. He/she is a member of the interview committee to admit candidates into the Training Program. Additional responsibilities of the Chief Resident include:
The Chief Resident receives a small stipend for these duties. In some years, the position is shared by two residents (each serves a 6-month term). On an ad hoc basis, the Chief Resident may delegate specific responsibilities to other residents. A second Resident Representative to the Gastroenterology Training Program Education Committee is elected following a ballot of all residents.
A resident representative (separate from the Chief Resident) is elected by the Gastroenterology residents following a ballot of all residents. This resident provides input and representation to the Residency Program Committee.
We expect each resident to develop into a consultant sub-specialist over 2 years of training. This requires a transition from the role of trainee to one of greater responsibility. It is expected that residents assume the role of consultant quickly, as their knowledge of the subspecialty increases. This has implications for punctuality, reliability, oral and written communication abilities, teaching and supervision of junior house-staff, and interactions with allied health staff. Performance in these areas is monitored and assessed at regular intervals, with feedback provided. Moonlighting is not encouraged when it compromises a trainee's ability to function punctually and efficiently, thereby compromising his or her ability to meet the Program's objectives.
The primary aim of the Adult Gastroenterology Training Program is to produce a gastroenterologist capable of providing comprehensive care to patients with gastrointestinal problems. These include disorders of the gastrointestinal tract, pancreas, biliary tree and liver. Implicit in this prime objective is the expectation that the candidate meets the requirements of the Examination for Certification in Gastroenterology of the Royal College of Physicians of Canada
The requirements of the Royal College of Physicians and Surgeons of Canada for training in adult gastroenterology are a minimum of 18 months in clinical activities and up to 6 months in research. A trainee’s acceptance into the program implies a 2-year commitment. A third-year is optional, individualized, and dependent on available external funding. Because of the recognized strength in basic and clinical gastrointestinal research at McMaster University, the Adult Gastroenterology Training Program has often attracted candidates who seek careers combining clinical practice with research. Thus, three months of research are offered in the first year of training. Up to 3 additional months of research are also available in the second year to trainees who demonstrate sufficient interest and productivity in their first-year experience. For other trainees, clinical electives are undertaken in lieu of a second research block.
Clinical rotations are located primarily at the McMaster, Juravinski and General Sites of Hamilton Health Sciences, and at St. Joseph’s Hospital. There is a Site Coordinator at each location to assist residents in optimising their experience. Each location offers a unique experience.
The McMaster Site offers considerable experience in ambulatory care. The McMaster Site also houses the GI Clinical Investigation Unit and a Motility Laboratory, offering diagnostic breath testing, motility assessments of the upper and lower tracts, 24-hour pH-metry, and capsule endoscopy. Trainees gain exposure to gastrointestinal complications of pregnancy, given on-site specialized services in Maternal Medicine. With the Children’s Hospital on-site, trainees can also interact with faculty and trainees in pediatric gastroenterology. The McMaster Site also has a large state-of the-art endoscopy unit, including interventional endoscopy, ERCP, and argon plasma coagulation. Endoscopic ultrasound is provided at the McMaster Site.
The Juravinski Site offers a busy inpatient service, with complex cases focused on inflammatory bowel diseases, motility disorders, liver diseases, and acid-peptic diseases. The Juravinski Site also houses the Cancer Centre, and offers exposure to gastrointestinal complications of malignancy. The gastroenterology service works closely with an active group of surgeons interested in colorectal disorders and pancreaticobiliary disorders. The clinical service also interacts extensively with advanced interventional gastrointestinal radiologists.
The General Site offers a busy gastroenterology consultation service. Patients requiring admission under a gastroenterologist as the most responsible physicians are transferred to the Juravinski Site. With state-of-the-art facilities, the General Site is recognized as a regional centre of excellence in cardiovascular care, neurosciences, trauma, and burn treatment. Trainees on consultation service gain exposure to gastrointestinal and nutritional complications of these complex medical conditions.
The St. Joseph’s Site offers a busy clinical gastroenterology service with specialized interests in gastrointestinal motility and functional disorders. It also has a large endoscopy unit, including interventional endoscopy, ERCP, and argon plasma coagulation. As the hospital also provides regional and tertiary specialty services in respirology, rheumatology, nephrology, and psychiatry, trainees gain exposure to gastrointestinal and nutritional aspects of behavioral, psychiatric, and complex medical disorders. A large outpatient clinic allows the residents to experience not only in-patient consultation but also ambulatory care. With the regional thoracic and esophageal surgery program being based at St Joseph’s, and the availability of a comprehensive motility laboratory, the residents gain exposure to all aspects of esophageal disease. With the presence of the Brain-Body Institute, with its unique imaging facilities (including PET and fMRI) and interest in gut-brain interactions, the academic research mission of the Institute complements the educational opportunities offered by the clinical service.
A major part of the Adult Gastroenterology Training Program at McMaster University involves active participation of the trainees in a series of regularly scheduled educational activities.
Academic Half-Day sessions occur on Wednesday mornings throughout the year. Sessions repeat on a 2-year cycle, allowing residents the opportunities to attend each session during the 2-year program. The Academic Half-Day is protected time when trainees meet as a group to address a wide variety of topics in GI and Hepatology. In addition to core GI topics included under the Medical Expert CanMEDS competency, several sessions designed to satisfy the requirement for teaching of the Collaborator, Communicator, Health Advocate, Manager, Scholar, and Professional domains are also included. This learning experience is partly self-directed and partly didactic. Its structure and content are monitored by the Residency Program Committee, the Academic Half-Day Coordinator and the Program Director. A syllabus is outlined each year by the Chief Resident(s), the Academic Half-Day Coordinator and the Program Director based on feedback from the residents.
This is followed by a semi-didactic teaching session (0900 h to 1000 h) on a predefined subject, led by an invited speaker from the clinical division, the Farncombe Institute or another division. This session is used twice each year for a practice OSCE and written examination. This is followed by the weekly Journal Club (1000 h to 1100 h). The rest of the morning (1100h-1200h) is allocated to group discussion of a complicated, interesting and difficult case. Once every three months, the case discussion takes the form of morbidity and mortality (M & M) rounds, wherein adverse outcomes or complications of therapy are reviewed with the aim of improving patient safety and quality of care. The M & M rounds are preceded by lecture sessions on various topics related to medical ethics. All staff, including those on service at each training site, are encouraged to attend this session to facilitate discussion. Once every three months, the case discussion takes the form of combined Gastroenterology and Surgery Inflammatory Bowel Disease (IBD) case rounds, wherein challenging IBD cases are reviewed with guided discussion by Gastroenterology and Surgery Staff. These rounds aim to promote communication and collaboration between the two services. All trainees attend regardless of the particular site of the current rotation. The Academic Half- Day ends with the Farncombe Institute GI Rounds at 1300 h (see below). An evaluation form for the Half-Day lecture is distributed by the Chief Resident (or designate) at each session.
Attendance at Academic Half-Day is MANDATORY for all residents, except for those residents who are on vacation, post-call or on electives (distance > 50 km from McMaster University). The minimum required attendance at Academic Half-Day is 80%. This policy will be reinforced by the Program Director and the Chief Residents who regularly take attendance at Academic Half-Day and expect an explanation for any residents missing any Half-Day sessions. A summary of resident attendance at the Academic Half-Day is provided to the Program Director every 6 months. Should any given resident’s attendance fall below the acceptable standards (< 80%), a letter will be sent to the resident by the Program Director. Should there be no adequate justification for these absences and the overall attendance during the two years of residency training falls below 80%, the FITER will reflect this in the “Scholar” and the “Professional” sections of the CanMEDS competencies.
Trainees meet each week to critically appraise newly published research papers using an evidence-based approach. A faculty member is assigned to each session to guide the discussion, review the topic in detail, and teach research methodology as relevant. All trainees attend regardless of the particular site of the current rotation.
Trainees on inpatient and outpatient services present the clinical history of patients with radiographic findings of interest. Basic approaches to the interpretation of GI radiology are reviewed. These rounds are chaired by GI radiologists (Drs. Parag Vora and Nina Singh). Through participation in these rounds, trainees will appreciate the importance of close collaboration between radiologists and gastroenterologists to optimize patient care. All trainees attend regardless of the particular site of the current rotation.
These are combined clinical pathology rounds at which interesting cases are discussed in the context of histopathology and clinical findings. These rounds are chaired by GI pathologists (Dr. Jennifer Ramsay) at McMaster Site once per month. Trainees identify interesting cases from the inpatient and outpatient services, and GI pathologists present interesting specimens from other sources. These rounds are attended by residents and faculty. Through participation in these rounds, trainees can learn about the close collaboration between pathologists and gastroenterologists to optimize patient care. All trainees attend regardless of the particular site of the current rotation.
Every three months, a topic-oriented IBD Case Rounds takes place and the GI residents (alternating with General Surgery residents) are responsible for presenting challenging IBD cases and conducting a literature review on the topic with guided discussion by GI and Surgery Staff. Cases are chosen to highlight important issues in the medical and surgical management of IBD. Through participation in these rounds, trainees can learn about the close collaboration between surgeons and gastroenterologists to optimize patient care. All trainees attend regardless of the particular site of the current rotation.
These rounds are the main weekly avenue at which clinicians and basic scientists meet. There is a formal seminar (45 minutes) given followed by discussion (15 minutes). Speakers include visiting faculty, in-house faculty, clinical trainees, and research trainees in the Farncombe Institute. The topics vary considerably but, overall, they cover the spectrum of GI physiology, pathophysiology, mucosal immunity, inflammation, drug therapy, and the clinical management of all gastroenterological or hepatological diseases. GI trainees are expected to organize and present at least 1 formal presentation every year on their research protocol/results. All trainees attend regardless of the particular site of the current rotation.
These rounds are a forum for the informal presentation of research in progress. Since GI residents are expected to undertake a research project, this event affords trainees the opportunity to present their own work. The rounds are organized by the Farncombe Institute. Attendance by trainees is encouraged.
The goals of M & M Rounds are to: identify medical errors, improve patient care by implementing preventative strategies for further errors, review medical literature related to medical errors and medico-legal issues, and encourage residents to consider research in Quality Improvement. These rounds are not intended to be punitive and are moderated by an attending physician supervisor and the Chief Residents to ensure this is followed. All faculty members and health care providers involved in the case are invited to participate to facilitate the discussion. Residents prepare and present M & M Rounds at least once during their residency.
In preparation for the Royal College of Physicians and Surgeons Examination in Gastroenterology, two mock OSCE and written examinations are held annually. The results of these tests are reviewed with the resident and should be used as a tool to guide the setting of future learning objectives. They are NOT used by the Residency Program for evaluative purposes. These mock examinations are MANDATORY for all residents.
This national initiative of CAG is an interactive satellite broadcast to all GI training programs in Canada. Prominent speakers present on a variety of topics with trainees from each site able to ask questions “live”. These interactive lecture series are intended to integrate clinical Gastroenterology with basic science and pathophysiology. All trainees attend regardless of the particular site of the current rotation.
The Postgraduate Medical Education Office organizes multi-disciplinary sessions for all residents on Wednesday afternoons at McMaster University. The MAD days provide a forum for residents to meet, discuss and learn about issues that cross all disciplines of medicine. They are intended to focus on the Non-Medical Expert CanMEDS roles. The topics are derived from the interests and leadership of the resident planners who are the steering committee of the Postgraduate Medical Education Office. Topics may include financial planning, career planning, professionalism, and social contract, international health, and physician involvement in the inner city, the power of overcoming barriers, resident stress, and harassment. Attendance at MAD days is MANDATORY for all residents, except for those residents who are on vacation, post-call, or on electives (distance > 50 km from McMaster University).
These are interactive lecture series organized by the Internal Medicine Sub-Specialty Programs Committee. They are intended to focus on the Non-Medical Expert CanMEDS roles. Topics may include hospital administration, patient complaints, the power of habit, billing, and office management. Attendance at the CanMEDS rounds is highly encouraged.
These are rounds attended by faculty and house staff from all divisions of the Department of Medicine. Topics focus on clinical issues, with an emphasis on critical appraisal and evidence-based learning. The rounds are organized by the Department of Medicine and are broadcast to all three Hamilton Health Sciences Sites. Attendance by trainees is strongly encouraged.
This is an intensive 2-day training course hosted by McMaster University but attended by First Year GI residents from across Canada. This course incorporates didactic lectures, small group discussions, hands-on training on simulation, and dinner event with debate by course faculty. Topics covered include endoscopic techniques, endoscopy reporting, preparing for endoscopy, bioethics, endoscopy unit management, endoscope construction and care, and endoscopic equipment and accessories. Attendance is MANDATORY for all first-year trainees.
This is an annual workshop organized by ConMed Canada. The workshop is intended to provide trainees with the principles, practice, and safety of electrosurgery and the various electrosurgical technologies available. Trainees also have the opportunity to gain hands-on exposure to endoscopic electrocautery and accessories.
This is an annual workshop designed to help residents develop their presentation skills. This workshop is filled with practical information on improving delivery skills, and also includes interactive coaching sessions for participants to immediately apply the learning. This seminar emphasizes personal delivery styles and the mechanics of presenting. Trainees will learn the power of body language, eye contact, and gestures for enhancing their personal effectiveness and style. Also included are techniques for maintaining control of the audience through planned movements, key body angles, balanced actions and proper phrasing. Other discussion points will include optimizing visual design elements, especially when presenting research data and other information that may appear challenging. For optimal skills coaching session, trainees are required to deliver about 5 to 7 slides, containing materials that they are familiar presenting.
These are professional / social evening events at which gastroenterologists and GI trainees discuss clinical issues of common interest (e.g. practice guidelines or regional deployment of service). Attendance by trainees is encouraged.
These are professional / social evening events at which difficult cases from the region are presented and discussed. The rounds are held at a restaurant in the Hamilton area and are organized by Dr. Bruno Salena. The rounds are attended by many community gastroenterologists, surgeons, and radiologists. Attendance by trainees is encouraged.
The Department of Medicine Resident Research Day is a high profile educational and social event where residents can share their work with core internal medicine residents, subspecialty residents, and faculty. GI residents are encouraged to submit at least one abstract to the Department of Medicine Research Day for presentation each year.
The Farncombe Trainee Research Day is an educational and social event where clinical and basic trainees can share their work with each other. GI residents are encouraged to submit at least one abstract to the Farncombe Research Day for presentation each year.
Resident well-being is becoming increasingly recognized as an area that medicine has not devoted enough time to. The PAIRO Resident Well-Being Days are held at McMaster University every year featuring topics related to residents’ lives and other fun filled participating events.
Residents are encouraged to attend at least one national or international meeting every year (e.g. Canadian Digestive Disease Week, Digestive Disease Week). In case of limited attendance allowance, the selection will be made by the Program Director based on career goals, equity, and fairness. A random draw will be used in case of stalemate.
CAG GRIT Course (contingent on acceptance of abstract to GRIT)
CDDW / CASL Meeting (contingent on acceptance of abstract to main meeting)
International conferences (e.g. DDW, ACG annual meeting, AASLD), subject to Program Director’s approval.
National / Regional conferences of sound academic value, subject to Program Director’s approval (Canadian IBD Conference, North American IBD Conference, ACG Second Year Fellows’ Course).
Funding per resident per academic year is currently set at $1,500 per year. The amount is subject to annual review by the Program Director based on available funding resources.
The annual allowance must be used by the end of the academic year, any unused amount cannot be carried forward.
Approval for all meetings and funding requests must be submitted prior to booking of airline tickets or hotel accommodation. An official request must be submitted via medportal at least 2 months before the conference date. Funding will not be approved retroactively.
Residents are encouraged to approach the research supervisor first for partial or complete funding support.
Additional funding may be available for any resident who is presenting a poster or talk at a conference.
Meetings funded by industry (with no prior approval by the Residency Program Committee or the Program Director) are not permitted.
Guidelines for travel reimbursement
Residents are to refer to the McMaster University Travel Guidelines for policy on reimbursement.
To claim a travel allowance, an expense form can be obtained from the GI Residency Program Assistant. The resident is responsible for completing the sections pertaining to contact information and meeting details (dates, location, purpose), as well as for signing and dating the form. The Program Assistant will complete the remainder of the form detailing the expenses, based upon the ORIGINAL receipts and credit card statements submitted by the resident. The resident should also keep a photocopy of these receipts for their files.
For airfare to be reimbursed, three items are required: itinerary/invoice/bill/receipt which the travel company provides at the time of booking the flight + credit card statement + boarding passes are required.
For meals to be reimbursed, original, itemized receipts and credit card statements are required.
The resident is encouraged to submit their expenses within 15 days. The time to reimbursement is dependent upon the Finance Department.
Gastroenterology is the medical subspecialty that deals with the investigation, diagnosis, and management of conditions affecting the digestive system, including the liver and pancreas. The subspecialty can be further defined by and separated into pediatric and adult streams based on differences in clinical diagnoses, knowledge, and procedural skills. There is overlap in some aspects of the two streams in the care of adolescent patients transitioning to adult gastroenterology care.
Gastroenterologists provide care for patients with a wide range of conditions affecting the digestive system. Common patient presentations include abdominal pain, constipation, diarrhea, difficulty swallowing, gastrointestinal bleeding, indigestion, liver dysfunction, and suspected cancer of the digestive system.
Gastroenterologists provide consultation for emergent, urgent, and non-urgent patient presentations, perform diagnostic and therapeutic gastrointestinal endoscopic procedures, and provide acute and long-term medical management and/or surveillance of the patient’s condition.
The rapid evolution in gastroenterology care has led to specialization within the discipline, with some physicians undergoing advanced training and/or focusing their practice in areas such as hepatology, liver transplantation, inflammatory bowel disease, gastrointestinal motility, intestinal failure, pancreaticobiliary conditions, and advanced endoscopic interventions.
Royal College certification in Internal Medicine or Pediatrics
OR
Eligibility for the Royal College certification examination in Internal Medicine or Pediatrics
OR
Registration in a Royal College-accredited residency program in Internal Medicine or Pediatrics (see requirements for these qualifications)
A maximum of one year of training in Gastroenterology may be undertaken at the fourth year residency level during training for certification in Internal Medicine or Pediatrics.
All candidates must be Royal College certified in Internal Medicine or Pediatrics in order to be eligible to write the Royal College examination in Gastroenterology.
Definition
Gastroenterology is the medical specialty that deals specifically with the investigation, diagnosis and management of disorders of the digestive system including the pancreas and liver. The specialty is further defined by pediatric and adult disciplines based on differences in knowledge and technical skills. There is overlap in some aspects of the two disciplines at the adolescent transition.
General Objectives
Only candidates certificated by the Royal College of Physicians and Surgeons of Canada in Internal Medicine or Pediatrics may be eligible for the Certificate of Special Competence in Gastroenterology.
Specialists in Gastroenterology are expected to be competent consultants with well-founded knowledge of all aspects of Gastroenterology including relevant basic sciences, research and teaching and appropriate technical capabilities who are able to establish effective professional relationships with patients and their families and care givers. They must have sound knowledge of either general internal medicine or pediatrics and an appreciation and understanding of the close relationship that commonly exists between diseases of the digestive organs and of other organ systems. They are competent self-directed learners who can adapt practice patterns according to the general principles of evidence-based medicine.
Residents must demonstrate the knowledge, skills and attitudes relating to gender, culture and ethnicity pertinent to Gastroenterology. In addition, all residents must demonstrate an ability to incorporate gender, cultural and ethnic perspectives in research methodology, data presentation and analysis.
Goals
Upon completion of training, a resident is expected to be a competent subspecialist in Gastroenterology, capable of assuming a consultant’s role in the subspecialty. The resident must acquire a working knowledge of the theoretical basis of the subspecialty, including its foundations in the basic medical sciences and research.
Only candidates certified by the Royal College of Physicians and Surgeons of Canada in Internal Medicine or Pediatrics may be eligible for certification in Gastroenterology.
Residents must demonstrate the requisite knowledge, skills, and attitudes for effective patient-centered care and service to a diverse population. In all aspects of subspecialist practice, the graduate must be able to address issues of gender, sexual orientation, age, culture, ethnicity and ethics in a professional manner.
Medical Expert
Definition:
As Medical Experts, Gastroenterologists integrate all of the CanMEDS Roles, applying medical knowledge, clinical skills, and professional attitudes in their provision of patient-centered care. Medical Expert is the central physician Role in the CanMEDS framework.
Key and Enabling Competencies: Gastroenterologists are able to…
1. Function effectively as consultants, integrating all of the CanMEDS Roles to provide optimal, ethical and patient-centered medical care
1.1. Perform a consultation, including the presentation of well-documented assessments and recommendations in written and/or verbal form in response to a request from another health care professional
1.2. Demonstrate effective use of all CanMEDS competencies relevant to Gastroenterology
1.3. Identify and appropriately respond to relevant ethical issues arising in patient care
1.4. Demonstrate the ability to prioritize professional duties when faced with multiple patients and problems
1.5. Demonstrate compassionate and patient-centered care
1.6. Recognize and respond to the ethical dimensions in medical decision-making
1.7. Demonstrate medical expertise in situations other than patient care, such as providing expert legal testimony or advising governments, as needed
2. Establish and maintain clinical knowledge, skills and attitudes appropriate to Gastroenterology
2.1. Apply knowledge of the clinical, socio-behavioural, and fundamental biomedical sciences relevant to Gastroenterology, including:
2.1.1. Anatomy, embryology, physiology and pathology of the digestive system including the pancreas and liver
2.1.2. Principles of biochemistry, molecular biology and genetics as they apply to the digestive system
2.1.3. Principles of metabolism, pharmacokinetics, pharmacodynamics and toxicity of drugs commonly used in Gastroenterology
2.1.4. Principles of endocrinology, intermediary metabolism and nutrition, oncology, microbiology and psychiatry as they apply to the digestive system
2.1.5. Principles of gastrointestinal surgery including the indications for and the complications of operations on the gastrointestinal tract
2.1.6. Diseases affecting the digestive system, pancreas and liver including the epidemiology, pathophysiology, methods of diagnosis, management and prognosis of such diseases
2.1.7. Indications, interpretations, limitations, and complications of diagnostic procedures performed on the digestive tract
2.1.8. Hazards of endoscopic procedures for the operator, assistants and patient, and the measures appropriate to minimize such hazards
2.1.9. Principles of fluoroscopy used during endoscopic procedures including the safe use of X-rays for both patient and operator
2.1.10. Advances in the management of gastrointestinal disorders, including organ transplantation, therapeutic endoscopy
2.2. Describe the CanMEDS framework of competencies relevant to Gastroenterology
2.3. Apply lifelong learning skills of the Scholar Role to implement a personal program to keep up-to-date, and enhance areas of professional competence
2.4. Contribute to the enhancement of quality care and patient safety in Gastroenterology, integrating the available best evidence and best practices
3. Perform a complete and appropriate assessment of a patient
3.1. Identify and explore issues to be addressed in a patient encounter effectively, including the patient’s context and preferences
3.2. Elicit a history that is relevant, concise and accurate to context and preferences for the purposes of prevention and health promotion, diagnosis and/or management
3.3. Perform a focused physical examination that is relevant and accurate for the purposes of prevention and health promotion, diagnosis and/or management, with particular emphasis on areas specific to the digestive system and its disorders including nutritional deficiencies
3.4. Select and interpret medically appropriate investigative methods in a resource-effective and ethical manner, including:
3.4.1. Imaging modalities (barium studies, ultrasound, computerized tomography (CT) scan, magnetic resonance imaging (MRI), radioisotope scan, endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound, capsule endoscopy) for the digestive system, pancreas and liver
3.4.2. Tests commonly employed in gastrointestinal function laboratories including breath tests and motility studies
3.4.3. Tissue biopsies of the gastrointestinal tract and liver
3.4.4. Endoscopic procedures including biopsies of the upper and lower gastrointestinal tract including, but not limited to, colonoscopy, upper endoscopy and sigmoidoscopy
3.4.4.1. Appropriate use and care of equipment used in endoscopic procedures
3.4.5. Appropriate use of clinical data to formulate problems and to correctly develop investigation and management plans to deal with the patient’s problem(s)
3.5. Demonstrate effective clinical problem solving and judgment to address patient problems, including interpreting available data and integrating information to generate differential diagnoses and management plans for gastrointestinal diseases
3.5.1. Demonstrate the ability to recognize, evaluate and manage gastrointestinal emergencies, including, but not limited to:
3.5.1.1. Acute gastrointestinal hemorrhage
3.5.1.2. Acute abdominal pain
3.5.1.3. Fulminant colitis
3.5.1.4. Biliary obstruction, including ascending cholangitis
3.5.1.5. Liver failure
3.5.1.6. Ingested foreign bodies
4. Use preventive and therapeutic interventions effectively
4.1. Implement an effective management plan in collaboration with a patient and their family
4.2. Demonstrate effective, appropriate, and timely application of preventive and therapeutic interventions relevant to Gastroenterology, including, but not limited to:
4.2.1. Screening colonoscopy
4.2.2. Upper endoscopy for Barrett’s esophagus
4.2.3. Upper endoscopy for portal hypertension
4.2.4. Surveillance for hepatobiliary malignancy
4.3. Ensure appropriate informed consent is obtained for therapies and transfusion of blood products
4.4. Ensure patients receive appropriate end-of-life care
5. Demonstrate proficient and appropriate use of procedural skills, both diagnostic and therapeutic
5.1. Demonstrate effective, appropriate, and timely performance of diagnostic procedures relevant to Gastroenterology including:
5.1.1. Upper gastrointestinal (GI) endoscopy and biopsy
5.1.2. Colonoscopy and biopsy
5.1.3. Esophageal manometry
5.1.4. Paracentesis (adult patients only)
5.2. Demonstrate effective, appropriate, and timely performance of therapeutic procedures relevant to Gastroenterology including:
5.2.1. Luminal dilation
5.2.2. Polypectomy
5.2.3. Endoscopic hemostasis
5.2.4. Foreign body removal
5.3. Ensure appropriate informed consent is obtained for procedures
5.4. Document and disseminate information related to procedures performed and their outcomes
5.5. Ensure adequate follow-up is arranged for procedures performed
6. Seek appropriate consultation from other health professionals, recognizing the limits of their expertise
6.1. Demonstrate insight into their own limits of expertise
6.2. Demonstrate effective, appropriate, and timely consultation of another health professional as needed for optimal patient care
6.3. Arrange appropriate follow-up care services for a patient and their family
Definition:
As Communicators, Gastroenterologists effectively facilitate the doctor-patient relationship and the dynamic exchanges that occur before, during, and after the medical encounter.
Key and Enabling Competencies: Gastroenterologists are able to…
1. Develop rapport, trust, and ethical therapeutic relationships with patients and families
1.1. Recognize that being a good communicator is a core clinical skill for Gastroenterologists, and that effective physician-patient communication can foster patient satisfaction, physician satisfaction, adherence and improved clinical outcomes
1.2. Establish positive therapeutic relationships with patients and their families that are characterized by understanding, trust, respect, honesty and empathy
1.3. Respect patient confidentiality, privacy and autonomy
1.4. Listen effectively
1.5. Communicate effectively in order to obtain a thorough and relevant patient history
1.6. Be aware of and responsive to nonverbal cues
1.7. Demonstrate sensitivity to patient concerns when presenting in the presence of a patient and/or family
1.8. Facilitate a structured clinical encounter effectively
2. Accurately elicit and synthesize relevant information and perspectives of patients and families, colleagues, and other professionals
2.1. Gather information about a disease and about a patient’s beliefs, concerns, expectations and illness experience
2.2. Seek out and synthesize relevant information from other sources, such as a patient’s family, caregivers and other professionals
3. Convey relevant information and explanations accurately to patients and families, colleagues and other professionals
3.1. Deliver information to a patient and family, colleagues and other professionals in a humane manner and in such a way that it is understandable, encourages discussion and participation in decision-making
4. Develop a common understanding on issues, problems and plans with patients, families, and other professionals to develop a shared plan of care
4.1. Identify and explore problems to be addressed from a patient encounter effectively, including the patient’s context, responses, concerns, and preferences
4.2. Respect diversity and difference, including but not limited to the impact of gender, religion and cultural beliefs on decision-making
4.3. Encourage discussion, questions, and interaction in the encounter
4.4. Engage patients, families, and relevant health professionals in shared decision-making to develop a plan of care
4.5. Address challenging communication issues effectively such as delivering bad news, and addressing anger, confusion, misunderstanding and language barriers
5. Convey effective oral and written information about a medical encounter
5.1. Maintain clear, concise, accurate and appropriate records of clinical encounters and plans
5.2. Demonstrate effective consultation skills in presenting well documented assessments and recommendations in written and/or verbal form including:
5.2.1. Procedural and specialty test reports
5.2.2. Responses to requests by other health professionals and third parties
5.3. Present medical information effectively to the public or media about a medical issue
Definition:
As Collaborators, Gastroenterologists effectively work within a health care team to achieve optimal patient care.
Key and Enabling Competencies: Gastroenterologists are able to…
1. Participate effectively and appropriately in an interprofessional health care team
1.1. Describe the Gastroenterologist’s roles and responsibilities to other professionals
1.2. Describe the roles and responsibilities of other professionals within the health care team, especially general surgeons, radiologists, pathologists, nurse practitioners, dieticians, social workers and speech language pathologists
1.3. Recognize and respect the diversity of roles, responsibilities and competences of other professionals in relation to their own
1.4. Work with others to assess, plan, provide and integrate care for individual patients (or groups of patients)
1.5. Work with others to assess, plan, provide and review other tasks, such as research problems, educational work, program review or administrative responsibilities
1.6. Participate effectively in interprofessional team meetings
1.7. Enter into interdependent relationships with other professions for the provision of quality care
1.8. Describe the principles of team dynamics
1.9. Respect team ethics, including confidentiality, resource allocation and professionalism
1.10. Demonstrate leadership in a health care team, as appropriate
2. Work with other health professionals effectively to prevent, negotiate, and resolve interprofessional conflict
2.1. Demonstrate a respectful attitude towards other colleagues and members of an interprofessional team
2.2. Work with other professionals to prevent conflicts
2.3. Employ collaborative negotiation to resolve conflicts
2.4. Respect differences and address misunderstandings and limitations in other professionals
2.5. Recognize one’s own differences, misunderstanding and limitations that may contribute to interprofessional tension
2.6. Reflect on interprofessional team function
Definition:
As Managers, Gastroenterologists are integral participants in health care organizations, organizing sustainable practices, making decisions about allocating resources, and contributing to the effectiveness of the health care system.
Key and Enabling Competencies: Gastroenterologists are able to…
1. Participate in activities that contribute to the effectiveness of their health care organizations and systems
1.1. Work collaboratively with others in their organizations
1.1.1. Organize junior trainees to maximize clinical care and educational opportunities
1.2. Participate in systemic quality process evaluation and improvement, such as patient safety initiatives
1.2.1. Describe the principles behind the operation of a safe and effective endoscopy unit including infection control and sedation
1.3. Describe the structure and function of the health care system as it relates to Gastroenterology, including the roles of physicians
1.4. Describe principles of health care financing, including physician remuneration, budgeting and organizational funding
2. Manage their practice and career effectively
2.1. Set priorities and manage time to balance patient care, practice requirements, outside activities and personal life
2.2. Manage a practice including finances and human resources
2.3. Implement processes to ensure personal practice improvement
2.4. Employ information technology appropriately for patient care
3. Allocate finite health care resources appropriately
3.1. Recognize the importance of just allocation of health care resources, balancing effectiveness, efficiency and access with optimal patient care
3.2. Apply evidence and management processes for cost-appropriate care
4. Serve in administration and leadership roles
4.1. Chair or participate effectively in committees and meetings including but not limited to endoscopy administration
4.2. Lead or implement change in health care
4.3. Plan relevant elements of health care delivery
Definition:
As Health Advocates, Gastroenterologists responsibly use their expertise and influence to advance the health and well-being of individual patients, communities, and populations.
Key and Enabling Competencies: Gastroenterologists are able to…
1. Respond to individual patient health needs and issues as part of patient care
1.1. Identify the health needs of an individual patient
1.2. Identify opportunities for advocacy, health promotion and disease prevention with individuals to whom they provide care
1.3. Demonstrate an understanding of the role of screening tests in reducing mortality from colorectal cancer and hepatocellular carcinoma
2. Respond to the health needs of the communities that they serve
2.1. Describe the practice communities that they serve
2.2. Identify opportunities for advocacy, health promotion and disease prevention in the communities that they serve, and respond appropriately
2.2.1. Describe, in broad terms, the key issues currently under debate regarding changes in the Canadian health care system, indicating how these changes might affect societal health outcomes and how Gastroenterologists can advocate to decrease the burden of illness at a community or societal level of conditions or problems relevant to Gastroenterology
2.2.2. Describe population-based approaches to health care services including screening and immunization programs and their implications for medical practice
2.3. Appreciate the possibility of competing interests between the communities served and other populations
3. Identify the determinants of health for the populations that they serve
3.1. Identify the determinants of health of the populations, including barriers to access to care and resources, and apply this understanding to common problems and conditions in Gastroenterology
3.2. Identify vulnerable or marginalized populations within those served, including but not limited to candidates for hepatitis B virus (HBV) vaccine, hepatitis C virus (HCV) screening amongst high risk populations and respond appropriately, applying the available knowledge about prevention to "at risk" groups within the practice
4. Promote the health of individual patients, communities, and populations
4.1. Describe an approach to implementing a change in a determinant of health of the populations they serve
4.2. Describe how public policy impacts on the health of the populations served
4.2.1. Identify current policies that affect gastrointestinal health, either positively or negatively including but not limited to immunization for viral hepatitis, anti-tobacco legislation, alcohol and substance abuse programs and health care for high risk populations
4.3. Identify points of influence in the health care system and its structure
4.4. Describe the ethical and professional issues inherent in health advocacy, including altruism, social justice, autonomy, integrity and idealism
4.5. Appreciate the possibility of conflict inherent in their role as a health advocate for a patient or community with that of manager or gatekeeper
4.6 Describe the role of the medical profession in advocating collectively for health and patient safety
Definition:
As Scholars, Gastroenterologists demonstrate a lifelong commitment to reflective learning, as well as the creation, dissemination, application and translation of medical knowledge.
Key and Enabling Competencies: Gastroenterologists are able to…
1. Maintain and enhance professional activities through ongoing learning
1.1. Describe the principles of maintenance of competence
1.2. Describe the principles and strategies for implementing a personal knowledge management system
1.3. Recognize and reflect on learning issues in practice
1.4. Conduct a personal practice audit
1.5. Pose an appropriate learning question
1.6. Access and interpret the relevant evidence
1.7. Integrate new learning into practice
1.7.1. Demonstrate knowledge of new advances in the management of gastrointestinal disorders including but not limited to organ transplantation, therapeutic endoscopy, endoscopic ultrasound and capsule endoscopy
1.8. Evaluate the impact of any change in practice
1.9. Document the learning process
2. Critically evaluate medical information and its sources, and apply this appropriately to practice decisions
2.1. Describe the principles of critical appraisal
2.2. Critically appraise retrieved evidence in order to address a clinical question
2.3. Integrate critical appraisal conclusions into clinical care
2.3.1. Describe and critically appraise recent landmark articles that impact current Gastroenterology practice
3. Facilitate the learning of patients, families, students, residents, other health professionals, the public and others
3.1. Describe principles of learning relevant to medical education
3.2. Identify collaboratively the learning needs and desired learning outcomes of others
3.3. Select effective teaching strategies and content to facilitate others’ learning
3.4. Demonstrate an effective lecture or presentation
3.5. Assess and reflect on a teaching encounter
3.6. Provide effective feedback
3.7. Describe the principles of ethics with respect to teaching
4. Contribute to the development, dissemination, and translation of new knowledge and practices
4.1. Describe the principles of research and scholarly inquiry
4.2. Describe the principles of research ethics
4.3. Pose a scholarly question
4.4. Conduct a systematic search for evidence
4.5. Select and apply appropriate methods to address the question
4.6. Disseminate the findings of a study
Definition:
As Professionals, Gastroenterologists are committed to the health and well-being of individuals and society through ethical practice, profession-led regulation, and high personal standards of behaviour.
Key and Enabling Competencies: Gastroenterologists are able to…
1. Demonstrate a commitment to their patients, profession, and society through ethical practice
1.1. Exhibit appropriate professional behaviors in practice, including honesty, integrity, disclosure, commitment, compassion, respect and altruism
1.2. Demonstrate a commitment to delivering the highest quality care and maintenance of competence
1.3. Recognize and appropriately respond to ethical issues encountered in practice
1.4. Manage conflicts of interest
1.5. Recognize the principles and limits of patient confidentiality as defined by professional practice standards and the law
1.6. Maintain appropriate relations with patients
2. Demonstrate a commitment to their patients, profession and society through participation in profession-led regulation
2.1. Demonstrate knowledge and an understanding of the professional, legal and ethical codes of practice, including physician-industry interaction
2.2. Fulfill the regulatory and legal obligations required of current practice
2.3. Demonstrate accountability to professional regulatory bodies
2.4. Recognize and respond to others’ unprofessional behaviours in practice
2.5. Participate in peer review
3. Demonstrate a commitment to physician health and sustainable practice
3.1. Balance personal and professional priorities to ensure personal health and a sustainable practice
3.2. Strive to heighten personal and professional awareness and insight
3.3. Recognize other professionals in need and respond appropriately
The primary objective of the Gastroenterology Training Program is to produce a competent gastroenterologist with the requisite knowledge, skills and attitudes for providing ethical and effective patient-centred care for a wide variety of gastrointestinal conditions. These include disorders of the gastrointestinal tract, pancreas, biliary tree and liver.
The resident will acquire in-depth knowledge of aspects of biochemistry, genetics, immunology, pathology, pathophysiology, diagnosis and treatment of gastrointestinal diseases and will learn the conditions unique to pediatric and obstetric patients. He/she will learn about the psychosocial care of patients with gastrointestinal diseases, with an understanding of and sensitivity to issues involving disabilities, gender, sexual orientation, race and culture. The resident will develop skills required for the performance of diagnostic and therapeutic procedures and interpretation of laboratory tests relevant to the practice of Gastroenterology.
The graduating resident is expected to be able to accurately convey relevant information and explanations to patients and their families, colleagues, and other professionals; to effectively collaborate within the healthcare team; to exhibit managerial skills pertinent to the operation of outpatient Gastroenterology clinic and endoscopy unit; to demonstrate a commitment to self-directed learning; to critically evaluate scientific information and facilitate the education of colleagues, students, residents, and other healthcare workers; and to practice in an ethical and professional manner.
It is expected that trainees will meet the requirements for Subspecialty Certification in Gastroenterology by the Royal College of Physicians and Surgeons of Canada. The Gastroenterology Training Program endorses the CanMEDS competency framework of the Royal College of Physicians and Surgeons of Canada. This framework identifies seven physician roles that must be addressed by all Canadian postgraduate training programs. Throughout their training and upon its completion, residents are expected to fulfil all of these roles. Goals and objectives specific to the McMaster University training program are listed below to supplement but not replace those of the Royal College. Trainees are encouraged to review details of the CanMEDS objectives on the Royal College website (www.rcpsc.medical.org).
Specific Objectives
Medical Expert
In his/her role as Medical Expert, the resident is expected to demonstrate:
Communicator
In his/her role as Communicator, the resident is expected to:
Collaborator
In his/her role as Collaborator, the resident is expected to:
Manager
In his/her role as Manager, the resident is expected to:
Health Advocate
In his/her role as Health Advocate, the resident is expected to:
Scholar
In his/her role as Scholar, the resident is expected to:
Professional
In his/her role as Professional, the resident is expected to:
General Objective
The first year of training emphasizes knowledge and experience in clinical Gastroenterology. The trainee is expected to fulfil all of the CanMEDS roles described above. Additional goals and objectives specific to the first year of training in Adult Gastroenterology include:
Specific Objectives
Medical Expert
The residents must be able to:
Communicator
The residents must be able to:
Collaborator
The residents must be able to:
Manager
The residents must be able to:
Health Advocate
The residents must be able to:
Scholar
The residents must be able to:
Professional
The residents must be able to:
General Objective
The second year of training consolidates and extends experience gained in the first year, and allows the trainee to gain confidence as a consultant in Gastroenterology. The trainee is expected to fulfil all of the CanMEDS roles described above. In addition, the second-year trainee is also expected to assimilate knowledge gained in the first year to function as a consultant gastroenterologist. Goals and objectives specific to the second year of training in Adult Gastroenterology include:
Specific Objectives
Medical Expert
The residents must be able to:
Communicator
The residents must be able to:
Collaborator
The residents must be able to:
Manager
The residents must be able to:
Health Advocate
The residents must be able to:
Scholar
The residents must be able to:
Professional
The residents must be able to:
The goals of an optional third year of training are tailored to individual needs, as identified during the second year. They may include acquiring skills in advanced therapeutic endoscopy, motility, medical education, research methodology, or any combination thereof. The availability of a third year is subject to salary support from peer-reviewed granting agencies (e.g. Canadian Institutes for Health Research, Canadian Association of Gastroenterology, Canadian Digestive Health Foundation, American Society for Gastrointestinal Endoscopy, American College of Gastroenterology, Crohn’s and Colitis Foundation of Canada), the private sector, or the Department of Medicine (e.g. Clinical Scholar model). Trainees interested in a third year of training are asked to discuss their plans early in the second year to permit sufficient time for applications to external or mobilization of internal resources.
These objectives are met under the direct supervision of consulting gastroenterologists at each training location. These locations differ in the emphasis of their clinical services and supporting resources.
For example, the McMaster Site offers extensive outpatient services focused on inflammatory bowel disease, functional bowel disease, acid-peptic disease and liver disease, with on-site exposure to pediatrics and obstetrics/gynecology.
The Juravinski Site offers a busy inpatient service, with complex cases focused on inflammatory bowel diseases, motility disorders, liver diseases, and acid-peptic diseases. The Juravinski Site also houses the Cancer Centre, and offers exposure to gastrointestinal complications of malignancy. It receives inpatient gastroenterology admissions from the Hamilton General Hospital.
The Hamilton General Site offers a busy consultation service with on-site exposure to interventional cardiology, cardiovascular surgery, burns, trauma and neurosurgery.
The St. Joseph´s Site offers outpatient and inpatient general gastroenterology services with on-site exposure to hepatobiliary endoscopy/surgery, rheumatology, respirology, nephrology and psychiatry.
All locations (except the McMaster Site) offer active emergency rooms and busy general medical and surgical wards. All sites have full spectrums of endoscopy facilities.
Thus, the rotation-specific objectives serve to identify the particular opportunities afforded by each institution and should be read in conjunction with the General Objectives of a given year.
McMaster University Medical Centre is a tertiary care facility and a regional referral centre for patients with a wide variety of gastrointestinal and hepatological conditions. It supports a comprehensive outpatient facility that hosts 30 clinics per week, including a specialty Barrett’s clinic and the Multi-disciplinary Inflammatory Bowel Disease (IBD) clinic. A unique Gastrointestinal Investigational Unit offers special testing that is often not found at other medical centres including hydrogen breath testing (for fructose malabsorption, small bowel bacterial overgrowth and delayed orocecal transit) and 24 hour pH-metry. The associated GI Motility Laboratory performs numerous diagnostic studies including esophageal and anorectal manometry, and small bowel capsule endoscopy studies.
Extensive exposure to outpatient practice is a key component of training in Adult Gastroenterology. In addition to longitudinal participation in outpatient clinics and elective endoscopy lists through all rotations, residents are specifically assigned to a dedicated outpatient clinic block in Year 1 and four blocks in Year 2. Residents on this 4-week rotation will be exposed to ambulatory aspects of gastrointestinal and liver diseases through the following venues: Gastroenterology clinic, Hepatology clinic, IBD clinic, and out-patient endoscopy. This will be performed under the supervision of staff gastroenterologists and hepatologists. This rotation serves to complement in-patient rotations by providing comprehensive experience in the assessment and management of patients in the ambulatory care environment. With exposure to dedicated IBD clinics, residents develop an appreciation of the multi-disciplinary team approach to management of inflammatory bowel disease. The overall structure of the rotation is designed to provide trainees with graded responsibility as they progress from the First to the Second year.
Residents on this rotation are expected to attend four outpatient clinics each week. First year residents are expected to perform the initial assessment of at least 2 to 4 new referrals and 2 to 4 follow-up visits each week. Second Year residents are expected to assess a greater proportion of follow-up patient visits than new referrals. At this level, the resident is expected to provide an expert opinion on gastrointestinal problems, with a management plan that is analogous to that of the supervising consultant. Second Year residents also have the invaluable opportunities to participate in the Urgent Clinic and Rapid Assessment Clinic as junior consultants where they will learn how to run an outpatient clinic independently and effectively from screening and triaging referrals to providing a management plan for patients. Throughout the Second Year, residents have a weekly longitudinal clinic geared towards their specific subspecialty interests where they assess and follow outpatients under the supervision of the assigned staff. Residents are also expected to attend four ambulatory endoscopy sessions each week under the supervision of a staff physician. At the end of their second-year experience, residents should be able to complete diagnostic and therapeutic upper and lower endoscopic procedures independently and competently with minimal help from the supervising consultant.
Over the course of these ambulatory experiences, the resident is given increasing responsibility and by the end of the Second Year should be ready for independent practice. Residents will learn to function as consultants in the ambulatory setting through the integration of all of the CanMEDS roles.
Ambulatory block rotation can be combined with Motility, Clinical Nutrition, or Hepatology curricula. Those curricula are described separately.
Responsibilities of the Resident
Rotation schedule is prepared by the Chief Residents on a monthly basis. Residents are expected to attend each assigned clinic and endoscopy list, to be punctual, and to complete procedure notes and consultation notes on all patients seen in the clinic in a timely fashion. Clinical supervisors must be informed of vacation / professional leave at least 4 weeks prior to the start date of the rotation. In addition, clinical supervisors must be informed when residents are unable to attend clinic or endoscopy lists post-call. Residents are expected to develop, implement and monitor a personal continuing education strategy. To facilitate this objective, at least one half day is set aside per week for self-directed, integrated learning related to topics and diseases encountered in the clinics.
Prior to the beginning the Second Year, residents are provided with a list of available ambulatory clinics and are responsible for arranging to participate in a longitudinal clinic with the Chief Residents. The resident is given freedom in choosing a clinic supervisor from amongst the faculty members of the GI Division. Second Year residents are responsible for triaging of referrals for the Urgent GI and Rapid Assessment Clinics. Residents assigned to Dr. Collins’ Clinic are responsible to follow-up on any laboratory or imaging tests ordered during the clinic. The McMaster Site Coordinator is available to provide mentorship for triaging of referrals and clinic management.
Urgent GI clinic, Rapid Assessment Clinic, and Dr. Collin’s Clinic are mandatory clinics. Alternative coverage for these clinics will need to be arranged with another resident in the event of vacation / professional leave. The default resident(s) will be the resident(s) attending other clinics in the same time slot. However, it is the resident’s responsibility to confirm and arrange alternative coverage when necessary.
Evaluation of the Resident
Residents are encouraged to seek regular informal verbal feedback about their proficiency at managing clinical problems and performing endoscopic procedures over the course of their outpatient clinic experience. A formal evaluation session with the resident will take place at the end of the rotation. Input is sought from other members of the clinic team who have worked with the resident (e.g. nurses, nurse practitioners, other allied health professionals). Based on all feedback received, a formal web-based CanMEDS compliant ITER is compiled by the supervisor. Final evaluations are discussed with the resident.
To directly assess and improve the ability of residents to communicate effectively with referring physicians, written documentation will be evaluated during every outpatient clinic rotation by means of a Written Consultation Dictation Evaluation Form. It is the expectation that the resident will review one consultation letter with an attending staff and have the evaluation form completed for each outpatient clinic rotation.
Evaluation of the Rotation
Residents are encouraged to provide feedback on how the rotation and teaching are structured. As with all rotations, an anonymous rotation evaluation is handled by the One 45 WebEval System. Each teaching faculty is evaluated separately in a similar manner. The Residency Program Committee meets semi-annually to compile a collective rotation and faculty evaluation, respecting resident anonymity. This has been important for the purposes of constructive feedback.
In addition to the general objectives outlined above, rotation-specific goals and objectives for the First Year of Training in Adult Gastroenterology at McMaster University are listed below.
Medical Expert
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Communicator
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Collaborator
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Manager
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Health Advocate
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Scholar
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Professional
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
The second-year McMaster Site Outpatient Clinic Rotation consolidates and extends experience gained in the first year, and allows the resident to gain confidence as a consultant in Gastroenterology. The resident is expected to fulfil all of the CanMEDS roles described in the first year. In addition, the second-year resident is expected to assimilate knowledge gained in the first year to function as a consultant gastroenterologist in an outpatient setting.
In addition to the general objectives outlined above, rotation-specific goals and objectives for the Second Year of Training in Adult Gastroenterology at McMaster University are listed below.Medical Expert
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Communicator
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Collaborator
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Manager
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Health Advocate
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Scholar
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Professional
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
OVERVIEW
The Juravinski Site is a regional referral centre for patients with a wide variety of gastrointestinal and hepatological conditions. The large population of patients with inflammatory bowel disease and liver diseases followed at the McMaster site constitutes the majority of in-patients under the GI service. These cases are often complicated, and provide a challenging learning experience for the trainees. The Juravinski Site also houses the Cancer Centre, and offers exposure to gastrointestinal complications of malignancy. The clinical service comprises an endoscopy unit, a joint Gastroenterology-oncology ward on 3C, and an outpatient facility. The Juravinski Site admits patients from outpatient practice of attending gastroenterologists and also from the Emergency Departments at two acute-care sites of Hamilton Health Sciences (Juravinski and General Sites). In addition, many patients are transferred from community hospitals that do not have the resources or expertise to manage complex GI conditions. Our clinical faculty encompasses expertise in all areas of GI including inflammatory bowel disease, irritable bowel syndrome, motility, acid-related disorders, nutrition, hepatology, and interventional endoscopy (ERCP and endoscopic ultrasound).
A multi-disciplinary team (gastroenterologists, Gastroenterology residents, rotating medical residents, medical students, nursing unit manager, nurses, pharmacists, occupation therapists, physiotherapists, nutritionists, social workers and discharge coordinators) manages patients in the inpatient unit. The inpatient rotation consists of inpatient consultations, inpatient and ambulatory endoscopy and one ½ day GI clinic per week. The primary goal of this rotation is to provide in-depth exposure to complex GI problems in an adult tertiary care, referral population.
Responsibilities of the Resident
The inpatient rotation is 4 weeks in duration and includes patient care activities in both an inpatient and outpatient setting, as well as educational and scholarly activities.
Inpatient Experience
The inpatient service at the Juravinski Site is usually responsible for 7-10 inpatients on the joint Gastroenterology-oncology ward (3C). Patients on this ward have serious medical illnesses such as exacerbation of inflammatory bowel disease, gastrointestinal hemorrhage, liver failure and GI infection.
The resident will function under the supervision of the attending physicians who assume responsibility for the inpatient unit on a rotational basis (every 2 weeks). A team consists of two GI residents, rotating medical residents, medical students and the attending physician. Residents gain clinical experience by functioning as consultants in Gastroenterology. Inpatient consultations are first done by residents. Their assessments and recommendations are then reviewed with the attending staff. The GI resident will be expected to be an active member of the team providing primary care to the inpatients, taking responsibility for the day-to-day care of a proportion of the in-patients commensurate with their level of training, and provide supervision and facilitate teaching of junior housestaff. It is expected that the GI resident will be familiar with all patients on the ward and act as a resource for other members of the team providing primary care to these patients. This care will include the development of skills in diagnosis, primary therapy, and supportive care including dealing with the psychosocial aspects of these diseases that affect both the patients and their families. The GI resident also performs endoscopic procedures under the supervision of the attending staff on patients seen in consultation. Booking of procedures should be coordinated with the charge nurse in the endoscopy unit. The GI resident will attend short daily morning ward rounds (09:00 AM) with the nursing staff on C3 to coordinate discharge planning. There is also a multi-disciplinary meeting held on a weekly basis, and residents are expected to attend and contribute effectively to patient are. Attending rounds with the residents are generally held daily, depending on the volume of consultations, their complexity, and acuity. At the end of each working day or prior to weekend, the resident will update the signover list of patients in Citrix, and sign out critically ill patients to the resident on call to ensure continuity of care.
On discharge, the resident will review the diagnosis, prognosis, implications and medications with the patients and families. He/She will dictate a discharge summary promptly on discharge and communicate with the referring physician and/or patient’s own gastroenterologist regarding hospital course and follow-up plans.
The resident will also provide a consultation service to other inpatient areas. These consultations will be completed under the supervision of the attending physician responsible for inpatient consultations. If the care of such a patient requires the ongoing input from the Gastroenterology service, the resident will provide follow-up assessment and recommendations to the referring service.
Through these activities, trainees gain an in-depth experience in both common and uncommon GI problems.
Outpatient Experience
Ambulatory clinic experience is considered to be an important component of the inpatient rotation. While on the inpatient rotation, trainees attend at least one outpatient clinic each week, where they have the opportunity to assess new and return patients with a wide variety of gastrointestinal, hepatic and pancreatic conditions under the supervision of a faculty attending physician. Residents also attend one elective endoscopy session each week.
Educational and Scholarly activities
Educational activities, which are a priority for the GI resident, include both scheduled rounds and other academic sessions. The resident is expected to attend the Gastroenterology Residents’ academic half-day, including the Farncombe noon rounds, on a weekly basis. In addition, the resident is expected to attend weekly structured teaching sessions with the Juravinski Site Coordinator (Monday 0800 h to 0900 h). These are structured teaching sessions with an overview of major topics in GI and Hepatology. In addition, an informal teaching session led by the attending staff on service at the Juravinski site occurs on a weekly basis (Thursday or Friday). There is also bedside teaching session with a focus on physical examination skills in GI and Hepatology every two weeks conducted by the McMaster Site Coordinator (Tuesday 0800 h to 0900 h). The resident’s educational activities will also include the regular ward rounds with the attending staff. The resident will be expected to do one formal presentation on a topic of their choice during CTU noon rounds or team rounds.
Evaluation of the Resident
An orientation session will take place during the first week of the rotation to discuss the goals and description of this rotation with the resident. The specific objectives of the resident will be discussed and an attempt made to integrate these objectives into the overall objectives of the rotation.
Residents are encouraged to seek informal verbal feedback throughout the rotation concerning their proficiency at managing clinical problems and performing endoscopic procedures. A formal evaluation session with the resident will take place at the end of the rotation with the supervisors and the Juravinski Site Coordinator. Input is sought from other members of the clinic team who have worked with the resident (e.g. nurses, nurse practitioners, other allied health professionals). A Multi-source evaluation tool is used to assess the resident’s skill in the collaborator role. Based on all feedback received, at the end of the rotation, a formal web-based CanMEDS compliant ITER is compiled by the supervisors. Final evaluations are discussed with the resident. The resident’s teaching skills will also be evaluated by junior residents formally through the GI Residents Teaching Evaluation Tool. It is the responsibility of the residents to distribute these forms to the junior residents during rounds, and forward them to the Juravinski Site Coordinator after completion.
Evaluation of the Rotation
Residents are encouraged to provide feedback on how the rotation and teaching are structured. At the time of the weekly structured teaching session with the Juravinski Site Coordinator and final evaluation of the resident, feedback regarding the rotation, including its strengths and shortcomings, is requested from the resident. If issues arise during the rotation, the resident is encouraged to bring these to the attention of the rotation supervisor and the Site Coordinator(s). A mechanism for dealing with any shortcomings will then be discussed with the resident and subsequently at the Residency Program Committee meeting. As with all rotations, an anonymous rotation evaluation is handled by the One 45 WebEval System. Each teaching faculty is evaluated separately in a similar manner. The Residency Program Committee meets semi-annually to compile a collective rotation and faculty evaluation, respecting anonymity. This has been important to maintaining feedback.
GI/GIM Collaborative Agreement
The GIM/CTU (including the GIM physician covering the MD-Based team) and GI services at the Juravinski Site have agreed to adopt the following guidelines to assist the ED physicians with the most appropriate service for referral of patients presenting to the ED with GIM/GI problems.
The following is a guideline and does not pre-empt the ED physician from referring to either service based on their assessment of the clinical problem and the most appropriate service to consult. Both services will consult on any patients referred and will retain the option of transferring care between the two services as agreed upon by the two consultants (GIM/CTU and GI) after both services/staff have had an opportunity to review the case. The MRP service will also retain the option of asking the other service to continue to follow the patient as a consulting service.
The ED physician will use the guidelines for any patient whom they feel is likely to require admission to hospital. The ED physician can refer any patient to the General Internal Medicine Rapid Assessment Outpatient Clinic (GIMRAOC) or the urgent GI clinic, if in their opinion the patient does not need admission or an ED consult, but can be safely discharged with urgent follow-up using the existing protocol for referral to either of these clinics.
Patients with the following acute problems who are likely to need admission to hospital can be referred to the GIM/CTU service on call:
The first-year rotation at the Juravinski site centers on the inpatient GI service, but with weekly exposure to ambulatory clinic and endoscopy service. In addition to the general objectives outlined above, rotation-specific goals and objectives for the First Year of Training in Adult Gastroenterology at McMaster University are listed below.
Medical Expert
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Communicator
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Collaborator
Key Competencies:Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Manager
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Health Advocate
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Scholar
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Professional
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
The second year Juravinski Site Inpatient Rotation centres on consolidating and extending clinical skills acquired during the first year, and allows the resident to gain confidence as a consultant in Gastroenterology. Second-year residents serve as senior GI residents and function as junior consultants to provide teaching and supervision of the day-to-day patient management for first-year GI residents, medical residents, and medical students rotating through the GI inpatient service, and allied health professionals. The resident is expected to fulfil all of the CanMEDS roles described in the first year. In addition, the second year resident is expected to assimilate knowledge gained in the first year to function as a consultant gastroenterologist in an inpatient setting.
In addition to the general objectives outlined above, rotation-specific goals and objectives for the Second Year of Training in Adult Gastroenterology at McMaster University are listed below.
Medical Expert
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Communicator
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Collaborator
Key Competencies:Physicians are able to
Specific Requirements:Gastroenterology residents are able to
Manager
Key Competencies:Physicians are able to
Specific Requirements:Gastroenterology residents are able to
Health Advocate:
Key Competencies:Physicians are able to
Specific Requirements:Gastroenterology residents are able to
Scholar
Key Competencies:Physicians are able to
Specific Requirements:Gastroenterology residents are able to
Professional
Key Competencies:Physicians are able to
Specific Requirements: Gastroenterology residents are able to
OVERVIEW
The St. Joseph’s Site offers a busy clinical Gastroenterology service with specialized interests in gastrointestinal motility and functional disorders. It also has a large endoscopy unit, including interventional endoscopy, ERCP, argon plasma coagulation and YAG-laser. As the hospital also provides regional and tertiary specialty services in respirology, rheumatology, nephrology and psychiatry, trainees gain exposure to gastrointestinal and nutritional aspects of behavioral, psychiatric and complex multisystem diseases, such as the cardiovascular and gastrointestinal complications of end-stage renal disease (and dialysis). Psychiatric patients also present complex biopsychosocial issues often requiring a thoughtful approach from consulting services. The presence of inpatient geriatric and rehabilitation services also present specific patient populations with particular needs. A large outpatient clinic allows the residents to experience not only inpatient consultation but also ambulatory care. Unique aspects of the outpatient experience reflect the expertise of the gastroenterologists at this site and include gastrointestinal neoplasia and laser therapy (Dr. Morgan), functional and motility disorders (Dr. Ganguli), and hepatology (Dr. Tsoi).
A multi-disciplinary team (gastroenterologists, Gastroenterology residents, rotating medical residents, medical students, nursing unit manager, nurses, pharmacists, occupation therapists, physiotherapists, nutritionists, social workers and discharge coordinators) manages patients in the inpatient unit. The inpatient rotation consists of inpatient consultations, inpatient and ambulatory endoscopy and one ½ day GI clinic per week. The primary goal of this rotation is to provide in-depth exposure to common GI problems in an adult tertiary care centre.
Responsibilities of the Resident
The inpatient rotation is 4 weeks in duration and includes patient care activities in both an inpatient and outpatient setting, as well as educational and scholarly activities.
Inpatient Experience
The inpatient service at St. Joseph’s Site is usually responsible for 7-10 inpatients on the joint Gastroenterology-surgery ward (6th Floor, May Grace Wing). Patients on this ward have serious medical illnesses such as exacerbation of inflammatory bowel disease, gastrointestinal hemorrhage, liver failure and GI infection.
The resident will function under the supervision of the attending physicians who assume responsibility for the inpatient unit on a rotational basis (every week). A team consists of two GI residents, rotating medical residents, medical students and the attending physician. Residents gain clinical experience by functioning as consultants in Gastroenterology. Inpatient consultations are first done by residents. Their assessments and recommendations are then reviewed with the attending staff. The GI resident will be expected to be an active member of the team providing primary care to the inpatients, taking responsibility for the day-to-day care of a proportion of the in-patients commensurate with their level of training, and provide supervision and facilitate teaching of junior housestaff. It is expected that the GI resident will be familiar with all patients on the ward and act as a resource for other members of the team providing primary care to these patients. This care will include the development of skills in diagnosis, primary therapy, and supportive care including dealing with the psychosocial aspects of these diseases that affect both the patients and their families. The GI resident also performs endoscopic procedures under the supervision of the attending staff on patients seen in consultation. Booking of procedures should be coordinated with the charge nurse in the endoscopy unit. The GI resident will attend a multi-disciplinary meeting held on every Friday morning, and residents are expected to attend and contribute effectively to patient are. Attending rounds with the residents are generally held daily, depending on the volume of consultations, their complexity, and acuity. At the end of each working day or prior to weekend, the resident will update the signover list of inpatients in Citrix, and sign out critically ill patients to the resident on call to ensure continuity of care.
On discharge, the resident will review the diagnosis, prognosis, implications and medications with the patients and families. He/She will dictate a discharge summary promptly on discharge and communicate with the referring physician and/or patient’s own gastroenterologist regarding hospital course and follow-up plans.
The resident will provide a consultation service to the emergency room and other inpatient areas. These consultations will be completed under the supervision of the attending physician responsible for inpatient consultations. If the care of such a patient requires the ongoing input from the Gastroenterology Service, the resident will provide follow-up assessment and recommendations to the referring service.
Through these activities, trainees gain in-depth experience in common GI problems.
Outpatient Experience
Ambulatory clinic experience is considered to be an important component of the inpatient rotation. While on the inpatient rotation, trainees attend at least one outpatient clinic each week, where they have the opportunity to assess new and return patients with a wide variety of gastrointestinal, hepatic and pancreatic conditions under the supervision of a faculty attending physician. Residents also attend one elective endoscopy session each week.
Educational and Scholarly activities
Educational activities, which are a priority for the GI resident, include both scheduled rounds and other academic sessions. The resident is expected to attend the Gastroenterology Residents’ academic half-day, including the Farncombe noon rounds, on a weekly basis. In addition, the resident is expected to attend weekly structured teaching sessions with Dr. S. Ganguli (Thursday 8:00 – 9:00 AM) and D. Morgan (Tuesday 8:00 – 9:00 AM), St. Joseph’s Gastroenterology Rounds (Friday 7:30 – 8:30 AM), St. Joseph’s Medical Grand Rounds (Wednesday 8:00 – 9:00 AM) and St. Joseph’s Combined GI Surgery/GI Medicine Rounds (Wednesday 4:30 – 5:30 PM). The resident’s educational activities will also include the regular ward rounds with the attending staff.
Evaluation of the Resident
An orientation session will take place during the first week of the rotation to discuss the goals and description of this rotation with the resident. The specific objectives of the resident will be discussed and an attempt made to integrate these objectives into the overall objectives of the rotation.
Residents are encouraged to seek informal verbal feedback throughout the rotation concerning their proficiency at managing clinical problems and performing endoscopic procedures. A formal evaluation session with the resident will take place at the end of the rotation with the supervisors and the St. Joseph’s Site Coordinator. Input is sought from other members of the clinic team who have worked with the resident (e.g. nurses, nurse practitioners, other allied health professionals). A Multi-source evaluation tool is used to assess the resident’s skill in the collaborator role. Based on all feedback received, at the end of the rotation, a formal web-based CanMEDS compliant ITER is compiled by the supervisors. Final evaluations are discussed with the resident. The resident’s teaching skills will also be evaluated by junior residents formally through the GI Residents Teaching Evaluation Tool. It is the responsibility of the residents to distribute these forms to the junior residents during rounds, and forward them to the St. Joseph’s Site Coordinator after completion.
Evaluation of the Rotation
Residents are encouraged to provide feedback on how the rotation and teaching are structured. At the time of the weekly structured teaching session with the St. Joseph’s Site Coordinator and final evaluation of the resident, feedback regarding the rotation, including its strengths and shortcomings, is requested from the resident. If issues arise during the rotation, the resident is encouraged to bring these to the attention of the rotation supervisor and the Site Coordinator. A mechanism for dealing with any shortcomings will then be discussed with the resident and subsequently at the Residency Program Committee meeting. As with all rotations, an anonymous rotation evaluation is handled by the One 45 WebEval System. Each teaching faculty is evaluated separately in a similar manner. The Residency Program Committee meets semi-annually to compile a collective rotation and faculty evaluation, respecting anonymity. This has been important to maintaining feedback.
The first-year rotation at the St. Joseph’s site centers on the inpatient GI service, but with weekly exposure to ambulatory clinic and endoscopy service. In addition to the general objectives outlined above, rotation-specific goals and objectives for the First Year of Training in Adult Gastroenterology at McMaster University are listed below.
Medical Expert
Key Competencies:Physicians are able to
Specific Requirements:Gastroenterology residents are able to
Communicator
Key Competencies:Physicians are able to
Specific Requirements:Gastroenterology residents are able to
Collaborator
Key Competencies:Physicians are able to
Specific Requirements:Gastroenterology residents are able to
Manager
Key Competencies:Physicians are able to
Specific Requirements:Gastroenterology residents are able to
Health Advocate
Key Competencies:Physicians are able to
Specific Requirements:Gastroenterology residents are able to
Scholar
Key Competencies:Physicians are able to
Specific Requirements:Gastroenterology residents are able to
Professional
Key Competencies:Physicians are able to
Specific Requirements:Gastroenterology residents are able to
The second year St. Joseph’s Site Inpatient Rotation centres on consolidating and extending clinical skills acquired during the first year, and allows the resident to gain confidence as a consultant in Gastroenterology. Second-year residents serve as senior GI residents and function as junior consultants to provide teaching and supervision of the day-to-day patient management for first-year GI residents, medical residents, and medical students rotating through the GI inpatient service, and allied health professionals. The resident is expected to fulfil all of the CanMEDS roles described in the first year. In addition, the second year resident is expected to assimilate knowledge gained in the first year to function as a consultant gastroenterologist in an inpatient setting.
In addition to the general objectives outlined above, rotation-specific goals and objectives for the Second Year of Training in Adult Gastroenterology at McMaster University are listed below.
Medical Expert
Key Competencies: Physicians are able to
Specific Requirements:Gastroenterology residents are able to
Communicator
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Collaborator
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Manager
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Health Advocate
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Scholar
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Professional
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
OVERVIEW
The General Site offers a busy Gastroenterology consultation service. With state-of-the-art facilities, the General Site is recognized as a regional center of excellence in cardiovascular care, neurosciences, trauma and burn treatment. Residents on consultation service gain exposure to gastrointestinal and nutritional complications of these complex medical conditions. In addition, residents have the opportunity to gain experience in the outpatient Hepatology clinic run by Dr. Witt-Sullivan. A busy endoscopy unit with on-site ERCP service is led by Drs. Lumb and Seaton.
There are no in-patient beds at the General site. Emergency patients are not admitted to the General site but rather, referred to the consultant on call at the Juravinski site and arrangements will be made for their transfer to this site. In extraordinary circumstances, a very unstable GI bleed may be determined to be unsafe for transfer at which point the GI resident may be asked to take part in the resuscitation and investigation of this patient. In-patients with life threatening gastrointestinal bleeding will be managed at the General site unless it is determined that their management needs to be referred on to the Juravinski site. However, these individuals will remain under the primary service rather than being transferred to the Gastroenterologist on-call in terms of most responsible physician.
The busy rotation at the consultation service provides excellent exposure to consultative practice in a tertiary care setting. Widely diverse gastrointestinal problems, both acute and chronic, will be encountered. Consultations will arise from inpatient services and the intensive care units (Cardiac and Neurotrauma). Many of the patients referred to the consultation service, such as those with active upper and lower GI tract bleeding and biliary tract disease, require urgent endoscopic evaluation. The consultation rotation will expose residents to a variety of practice styles and clinical approaches by the members of the GI Division and will in turn increase the resident’s competence and confidence in managing a wide variety of common GI problems.
The inpatient rotation consists of inpatient consultations, inpatient and ambulatory endoscopy and one ½ day Hepatology clinic per week. The primary goal of this rotation is to provide in-depth exposure to common GI problems in an adult tertiary care centre.
Responsibilities of the Resident
The consult rotation is 4 weeks in duration and includes patient care activities in both an inpatient and outpatient setting, as well as educational and scholarly activities. This rotation is only for Second Year GI residents. The duties and responsibilities of the GI resident are advanced, as per the principle of graduated responsibility.
The overall goals of this rotation are:
Inpatient Experience
The inpatient experience at the General Site is a consultation based service. The consultation service is structured such that one consultant is on call on a rotational basis for referrals (every 2 weeks). The resident will be expected to function as a junior attending. He/She will triage consults, assess patients, and perform any necessary endoscopic procedures under supervision. The junior attending resident will also liaise with consulting services and allied health professionals to optimize the care of the patients under their care. He/She will provide teaching to junior residents and medical students on the Medicine team.
The attending physician will serve as a supervisor / observer in the background to the junior attending resident, observing all aspects of patient care behavior, medical expert and the other CanMEDS competencies expected of a Junior Faculty. During this time, the junior attending resident assumes all the day to day attending responsibilities. The attending physician will only intervene if he/she believes that significant change in the medical plan is necessary for patient safety.
Through these activities, the junior attending resident gains confidence as an independent consultant.
The following are general guidelines that may assist the junior attending resident on this rotation:
Outpatient Experience
This rotation offers the opportunity for the junior attending resident to gain experience in the outpatient Hepatology clinic under the supervision of Dr. H. Witt-Sullivan in the OPD area (Tuesday 08:30 AM). The junior attending resident is expected to attend one Hepatology clinic each Tuesday morning at the General Site, where they have the opportunity to assess new and return patients with hepatic conditions. If the resident is not able to attend this clinic due to vacation / leave, alternative coverage for this clinic will need to be arranged as extra patients are booked ahead of time for teaching purpose. If the resident is scheduled to be on call on any Monday night during this rotation, the chief residents will need to be informed ahead of time to arrange a switch in call dates to avoid being post call for this clinic. Residents also attend elective endoscopy sessions on a daily basis.
Educational and Scholarly activities
Educational activities, which are a priority for the GI resident, include both scheduled rounds and other academic sessions. The resident is expected to attend the Gastroenterology Residents’ academic half-day, including the Farncombe noon rounds, on a weekly basis. In addition, the resident is expected to identify a topic of interest to review with the attending physician on a weekly basis.
The resident will be expected to do one formal presentation on a topic of their choice during CTU noon rounds. It is the responsibility of the junior attending resident to contact the GIM chief resident at the beginning of the rotation to arrange a suitable date for the presentation.
Evaluation of the Resident
An orientation session will take place during the first week of the rotation to discuss the goals and description of this rotation with the resident. The specific objectives of the resident will be discussed and an attempt made to integrate these objectives into the overall objectives of the rotation.
Residents are encouraged to seek informal verbal feedback throughout the rotation concerning their proficiency at managing clinical problems and performing endoscopic procedures. A formal evaluation session with the resident will take place at the end of the rotation with the supervisors (every 2 weeks) and the General Site Coordinator (at the end of the 4-week rotation). Input is sought from other members of the clinic team who have worked with the resident (e.g. nurses, nurse practitioners, other allied health professionals). The Site Coordinator should be informed a few days prior to the end of the rotation to collate comments from all supervisors and health professionals. A Multi-source evaluation tool is used to assess the resident’s skill in the collaborator role. Based on all feedback received, at the end of the rotation, a formal web-based CanMEDS compliant ITER is compiled by the supervisors. Final evaluations are discussed with the resident. The resident’s teaching skills will also be evaluated by junior residents formally through the GI Residents Teaching Evaluation Tool. It is the responsibility of the residents to distribute these forms to the junior residents during rounds, and forward them to the Program Administrator (Cindy Potter) after completion.
Evaluation of the Rotation
Residents are encouraged to provide feedback on how the rotation and teaching are structured. If issues arise during the rotation, the resident is encouraged to bring these to the attention of the rotation supervisor and the Site Coordinator. A mechanism for dealing with any shortcomings will then be discussed with the resident and subsequently at the Residency Program Committee meeting. As with all rotations, an anonymous rotation evaluation is handled by the One 45 WebEval System. Each teaching faculty is evaluated separately in a similar manner. The Residency Program Committee meets semi-annually to compile a collective rotation and faculty evaluation, respecting anonymity. This has been important to maintaining feedback.The junior attending consult rotation centres on consolidating and extending clinical skills acquired during the first year, and allows the resident to gain confidence as a consultant in Gastroenterology. The overall goals of this experience are to develop consultancy and time management skills required to practice Gastroenterology, as well as to allow the resident experience in education of junior residents and medical students. The resident is expected to fulfil all of the CanMEDS roles described in the first year. In addition, the second year resident is expected to assimilate knowledge gained in the first year to function as a consultant gastroenterologist in an inpatient consultation based setting.
In addition to the general objectives outlined above, rotation-specific goals and objectives for the Second Year of Training in Adult Gastroenterology at McMaster University are listed below.
Medical Expert
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Communicator
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Collaborator
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
ManagerKey Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Health Advocate
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Scholar
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Professional
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
OVERVIEW
The overall goal of the Hepatology curriculum is to train gastroenterologists who are competent to manage the broad spectrum of liver-related problems encountered in a typical Gastroenterology practice. To obtain the core knowledge required for the Hepatology curriculum, residents will be required to attend lectures during academic half day on Hepatology topics, as well as complete selected readings. The clinical experience will be provided by a rotation in outpatient clinic dedicated to Hepatology patients and problems, and through interaction with Hepatology physicians.
Residents will acquire a broad knowledge of the physiology of the liver and a thorough knowledge of the management of patients with hepatobiliary diseases obtained through teaching rounds, outpatient clinic experience, lectures and personal reading / research. The curriculum will ensure exposure to the following aspects of Hepatology:
It is anticipated that all Gastroenterology fellows in the McMaster University Gastroenterology Training Program will be a participant. To allow early exposure to Hepatology and to help with career choice, a one-month rotation is mandatory for First Year residents. In addition, Second Year residents are encouraged to obtain additional training in Hepatology during their elective months and during the outpatient rotation.
Dr. Marco Puglia is the Hepatology Curriculum Coordinator.
Responsibilities of the Resident
Outpatient Experience
Rotation schedule is prepared by the Hepatology Curriculum Coordinator on a monthly basis. Residents are expected to attend each assigned clinic and endoscopy list, to be punctual, and to complete procedure notes and consultation notes on all patients seen in the clinic in a timely fashion. Clinical supervisors must be informed of vacation / professional leave 4 weeks prior to the start date of the rotation. In addition, clinical supervisors must be informed when residents are unable to attend clinic or endoscopy lists due to post-call reasons. Residents are expected to develop, implement and monitor a personal continuing education strategy. To facilitate this objective, at least one half day is set aside per week for self-directed learning of topics and diseases encountered in the clinics.
Rotation Schedule |
||
|
AM |
PM |
Monday |
Clinic (Puglia) |
Endoscopy (Puglia) |
Tuesday |
Clinic (Witt-Sullivan) |
Reading day |
Wednesday |
Academic Half Day |
Endoscopy (Tsoi) |
Thursday |
Clinic (Witt-Sullivan) |
Endoscopy |
Friday |
Paracentesis / Liver biopsy |
Clinic (Tsoi) |
* Multi-disciplinary hepatobiliary rounds (optional) on Friday 7-9 am
Educational and Scholarly activities
Educational activities, which are a priority for the GI resident, include both scheduled rounds and other academic sessions. The resident is expected to attend the Gastroenterology Residents’ academic half-day, including the Farncombe noon rounds, on a weekly basis. In addition, the resident is expected to identify a topic of interest to review with the attending physician on a weekly basis.
Residents are encouraged to gain exposure through participation in activities at the Hamilton Hepatology Clinical Research Unit. They are invited to collaborate with staff hepatology supervisors in available research opportunities, and in successful cases present in local, national and international conferences.
Evaluation of the Resident
Residents are encouraged to seek informal verbal feedback throughout the Hepatology outpatient experience concerning their proficiency at managing clinical problems and performing endoscopic procedures / paracentesis. A formal evaluation session with the resident will take place at the end of the rotation. Input is sought from other members of the clinic team who have worked with the resident (e.g. nurses, nurse practitioners, other allied health professionals). Based on all feedback received, at the end of the rotation, a formal web-based CanMEDS compliant ITER is compiled by the supervisor. Final evaluations are discussed with the resident.
Evaluation of the Rotation
Residents are encouraged to provide feedback on how the rotation and teaching are structured. As with all rotations, an anonymous rotation evaluation is handled by the One 45 WebEval System. Each teaching faculty is evaluated separately in a similar manner. The Residency Program Committee meets semi-annually to compile a collective rotation and faculty evaluation, respecting anonymity. This has been important to maintaining feedback.
In addition to the general objectives outlined above, rotation-specific goals and objectives for the First Year of Training in Adult Gastroenterology at McMaster University are listed below.
Medical Expert
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Communicator
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Collaborator
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Manager
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Health Advocate
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Scholar
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Professional
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
OVERVIEW
The Functional GI Laboratory is located at the McMaster University Medical Center under the Directorship of Dr. Bercik. Motility, 24-hour pH-metry and combined pH-metry/impedance studies are conducted by specially trained nurses daily from Monday to Thursday, under the supervision of Drs. Bercik and Collins. Motility studies are performed using state of the art high-resolution manometry system, for both upper and lower GI tract examinations.
The overall goal of the Motility Curriculum is to acquire practical knowledge and skills in the diagnosis and management of GI motor disorders. The specific objectives include:
Dr. Premysl Bercik is the Coordinator for the Motility Curriculum.
Motility Curriculum
The Motility Curriculum includes the following components:
The Motility Rotation can be incorporated into an Outpatient Rotation or an Elective Block in the Second Year.
Second Year residents can obtain additional experience in GI motility by participating in on-going clinical trials using novel techniques of videofluoroscopy image analysis and magnet tracking to assess gastroduodenal and small intestinal motility.
Responsibilities of the Resident
Rotation schedule is prepared by the Chief Residents on a monthly basis. However, the rotation schedule should be confirmed with the Motility Curriculum Coordinator 4 weeks prior to the start date of the rotation. Residents are expected to attend each assigned Motility Lab session, clinic and endoscopy list, to be punctual, and to complete procedure notes and consultation notes on all patients in a timely fashion. Clinical supervisors must be informed of vacation / professional leave 4 weeks prior to the start date of the rotation. In addition, clinical supervisors must be informed when residents are unable to attend clinic or endoscopy lists due to post-call reasons. Residents are expected to develop, implement and monitor a personal continuing education strategy. To facilitate this objective, at least one half day is set aside per week for self-directed learning of topics and diseases encountered in the clinics.
Residents are expected to attend Motility Lab sessions on Monday morning, Wed afternoon and Thursday morning. Tuesday afternoon is devoted to analysis of motility and pH recordings under the supervision of Dr. Bercik or Dr. Collins. Residents are also expected to assess patients in Dr. Bercik’s and Dr. Collins’ clinic which have a focus on motility and functional disorders on Tuesday morning. Residents will also have the opportunity to assess patients with complex motility disorders (second opinion referrals) on Friday morning.
Rotation Schedule |
||
|
AM |
PM |
Monday |
Motility Lab |
Endoscopy |
Tuesday |
Clinic (Bercik / Collins) |
Analysis of motility and pH recordings |
Wednesday |
Academic Half Day |
Motility Lab |
Thursday |
Motility Lab |
Endoscopy (Bercik) |
Friday |
Complex Motility Clinic |
Reading day |
Evaluation of the Resident
Residents are encouraged to seek informal verbal feedback throughout the Motility Rotation concerning their proficiency at interpreting functional GI investigations and managing clinical problems related to functional bowel / motility disorders. A formal evaluation session with the resident will take place at the end of the rotation. Input is sought from other members of the clinic team who have worked with the resident (e.g. motility nurse, other allied health professionals). Based on all feedback received, at the end of the rotation, a formal web-based CanMEDS compliant ITER is compiled by the supervisor. Final evaluations are discussed with the resident.
Evaluation of the Rotation
Residents are encouraged to provide feedback on how the rotation and teaching are structured. As with all rotations, an anonymous rotation evaluation is handled by the One 45 WebEval System. Each teaching faculty is evaluated separately in a similar manner. The Residency Program Committee meets semi-annually to compile a collective rotation and faculty evaluation, respecting anonymity. This has been important to maintaining feedback.
Specific goals and objectives of the Motility Curriculum in CanMEDs format are as follows:
Medical Expert
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Communicator
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Collaborator
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Manager
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Health Advocate
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Scholar
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Professional
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
OVERVIEW
The recognition and management of malnutrition, including nutritional deficiencies associated with gastrointestinal and hepatopancreaticobiliary dysfunction as well as the gastrointestinal luminal, hepatic and pancreatic consequences of overweight and obesity are key elements of Gastroenterology practice. There is a general expectation, on the part of health care professionals and patients, that gastroenterologists are, or should be expert in the area of nutrition and nutrition is one of the topics highlighted in the Royal College curriculum for subspecialty Gastroenterology training programs. Despite this, there is evidence that practising gastroenterologists do not consider that they have had adequate training in the field of nutrition, either to provide comprehensive nutritional care for their patients with gastrointestinal diseases or to advise other health care professionals with respect to nutritional care (Singh H, Duerksen DR. Can J Gastroenterol 2006;20:527-30).
In Canada, the Royal College of Physicians and Surgeons of Canada (RCPSC) requires training in nutrition in GI residency programs and, in the U.S., a consortium of Gastroenterology associations has designated nutrition training of GI fellows as a mandatory component of their training programs (Heimburger DC. J Clin Gastroenterol 2002;34:505-8)
The overall goal of the Clinical Nutrition Curriculum is to acquire practical knowledge and skills in the major clinical nutrition domains relevant to gastroenterologists. These include:
Dr. David Armstrong is the Coordinator for the Clinical Nutrition Curriculum.
Clinical Nutrition Curriculum
The Clinical Nutrition Curriculum includes the following components:
The Clinical Nutrition Rotation can be incorporated into an Outpatient Rotation or an Elective Block in the Second Year.
At completion of the Nutrition Curriculum, the Gastroenterology resident will:
Responsibilities of the Resident
Rotation schedule is prepared by the Chief Residents on a monthly basis. However, the rotation schedule should be confirmed with the Nutrition Curriculum Coordinator 4 weeks prior to the start date of the rotation. Residents are expected to attend each assigned clinic and endoscopy list, to be punctual, and to complete procedure notes and consultation notes on all patients seen in the clinic in a timely fashion. Clinical supervisors must be informed of vacation / professional leave 4 weeks prior to the start date of the rotation. In addition, clinical supervisors must be informed when residents are unable to attend clinic or endoscopy lists due to post-call reasons. Residents are expected to develop, implement and monitor a personal continuing education strategy. To facilitate this objective, at least one half day is set aside per week for self-directed learning of topics and diseases encountered in the clinics.
Rotation Schedule |
||
|
AM |
PM |
Monday |
Endoscopy |
Nutrition Ward Rounds (JH) |
Tuesday |
Endoscopy |
Dr. Armstrong Clinic (2F) |
Wednesday |
Academic Half Day |
Cystic Fibrosis Clinic |
Thursday |
Nutrition Clinic (2F) |
Dr. Armstrong Clinic (2F) |
Friday |
Reading day |
Evaluation of the Resident
Residents are encouraged to seek informal verbal feedback throughout the Clinical Nutrition Rotation concerning their proficiency at diagnosing and managing clinical problems related to nutritional disorders. A formal evaluation session with the resident will take place at the end of the rotation. Input is sought from other members of the clinic team who have worked with the resident (e.g. motility nurse, other allied health professionals). Based on all feedback received, at the end of the rotation, a formal web-based CanMEDS compliant ITER is compiled by the supervisor. Final evaluations are discussed with the resident.
Evaluation of the Rotation
Residents are encouraged to provide feedback on how the rotation and teaching are structured. As with all rotations, an anonymous rotation evaluation is handled by the One 45 WebEval System. Each teaching faculty is evaluated separately in a similar manner. The Residency Program Committee meets semi-annually to compile a collective rotation and faculty evaluation, respecting anonymity. This has been important to maintaining feedback.
Specific goals and objectives of the Clinical Nutrition Curriculum in CanMEDs format are as follows:
Medical Expert
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Communicator
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Collaborator
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Manager
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Health Advocate
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Scholar
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Professional
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
OVERVIEW
Health care reforms have significantly changed the practice of medicine, resulting in a continuing expansion of medical care delivery through community-based programs. The classical teaching hospital may deal with a filtered patient population that may not reflect the ultimate practice pattern of the graduate. The introduction of community experiences to our training program curriculum serves to address these needs within the current teaching system. In Canada, the Royal College of Physicians and Surgeons of Canada (RCPSC) mandates community-based learning experiences as either stand along rotations (equivalent to one block or four weeks) or mandatory half day clinics outside of the academic health sciences centre that would constitute an equivalent experience.
The community Gastroenterology experience will encompass and expand upon the core training elements employed by the Gastroenterology residency training program at McMaster University. The main focus of this rotation will be to address the CanMEDS directed role in the context of community based Gastroenterology. The primary purposes of this rotation are to:
The rotation is carried out in Oakville, ON, supervised by the GI practice group (Drs. N. Arya, D. Bair and J. Pham), where GI consultation care is given to residents in the local and surrounding communities of Oakville. Oakville has a catchment population over 150,000 people. The Gastroenterology practice is very diverse and consists of inpatient hospital service, outpatient clinics and as well as outpatient endoscopy. Residents will have the opportunity to be exposed to a wide range of therapeutic endoscopy procedures that include endoscopy, colonoscopy, ERCP, ampullectomies, Zenker's diverticulectomies, endoscopic mucosal resections, a full metal stenting program and diagnostic and therapeutic endoscopic ultrasound.
During this four week rotation, second year Gastroenterology trainee will be working directly with established community-based GI physicians in ambulatory clinics and inpatient hospital settings, and the performance of endoscopic procedures in relation to these consultations. This rotation will consist of 2 or 3 weeks of ambulatory GI clinics and 1 or 2 weeks of inpatient hospital service. During the ambulatory blocks, there will be three and a half days of clinics and one and a half day of endoscopy. While on inpatient service, residents will perform endoscopy on their patients and outpatient endoscopy lists when possible.
Alternatives to Rotation in Oakville
It is highly encouraged that residents undertake their community GI rotation in Oakville as the rotation goals and objectives are structured and tailored to the Second Year GI residents. However, residents are free to identify and choose other community based settings for this rotation in keeping with their individual training objectives, subject to approval by the Program Director and Residency Program Committee. Residents must identify a supervisor responsible for monitoring and evaluating his / her performance. If an alternative community site is chosen for this rotation, an elective form with CanMEDS based goals and objectives of this experience will need to be formalized and submitted to the Program Director and the rotation supervisor for review 4 weeks prior to the start of this rotation.
Residents on this rotation are not exempted from on-call duties.
Responsibilities of the Resident
Inpatient and Outpatient Experience
The community rotation is 4 weeks in duration and includes patient care activities in both an inpatient and outpatient setting, as well as educational and scholarly activities outside a teaching hospital. This rotation is only for Second Year GI residents. Residents should contact Dr. J. Pham (Community GI Rotation Coordinator, 905 849 7426) 4 weeks prior to the start of the rotation to obtain hospital privileges and to confirm schedule of activities.
Educational and Scholarly activities
Educational activities, which are a priority for the GI resident, include both scheduled rounds and other academic sessions. The resident is expected to attend the Gastroenterology Residents’ academic half-day, including the Farncombe noon rounds, on a weekly basis. In addition, the resident is expected to identify a practice management topic of interest to review with the attending physician on a weekly basis.
Trainees are welcome to attend the local monthly journal club in Oakville that includes the surgical and radiology teams.
Evaluation of the Resident
An orientation session (with Dr. J. Pham) will take place during the first week of the rotation to discuss the goals and description of this rotation with the resident. The specific objectives of the resident will be discussed and an attempt made to integrate these objectives into the overall objectives of the rotation.
Residents are encouraged to seek informal verbal feedback throughout the rotation concerning their proficiency at managing clinical problems and performing endoscopic procedures. A formal evaluation session with the resident will take place at the end of the rotation with the Rotation Coordinator (Dr. J. Pham) at the end of the 4-week rotation. Input is sought from other members of the clinic team who have worked with the resident (e.g. gastroenterologists, nurses, nurse practitioners, other allied health professionals). The Rotation Coordinator should be informed a few days prior to the end of the rotation to collate comments from all supervisors and health professionals. Based on all feedback received, at the end of the rotation, a formal web-based CanMEDS compliant ITER is compiled by the supervisors. Final evaluations are discussed with the resident.
Evaluation of the Rotation
Residents are encouraged to provide feedback on how the rotation and teaching are structured. If issues arise during the rotation, the resident is encouraged to bring these to the attention of the rotation supervisor and the Site Coordinator. A mechanism for dealing with any shortcomings will then be discussed with the resident and subsequently at the Residency Program Committee meeting. As with all rotations, an anonymous rotation evaluation is handled by the One 45 WebEval System. Each teaching faculty is evaluated separately in a similar manner. The Residency Program Committee meets semi-annually to compile a collective rotation and faculty evaluation, respecting anonymity. This has been important to maintaining feedback.
The Community GI Rotation centres on consolidating and extending clinical skills acquired during the first year, and allows the resident to gain confidence as a consultant in Gastroenterology in a community-based setting. The overall goals of this experience are to develop consultancy and time management skills required to practice Gastroenterology, as well as to allow the resident experience in community-based medicine. The resident is expected to fulfil all of the CanMEDS roles described in the first year. In addition, the second year resident is expected to assimilate knowledge gained in the first year to function as a consultant gastroenterologist in a community-based setting.
In addition to the general objectives outlined above, rotation-specific goals and objectives for the Second Year of Training in Adult Gastroenterology at McMaster University are listed below.
Medical Expert
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Communicator
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Collaborator
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Manager
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Health Advocate
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Scholar
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Professional
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
OVERVIEW
The Pediatric Gastroenterology Rotation at McMaster University Medical Centre is intended for Second Year Gastroenterology Residents. It is designed to meet the objectives of the Royal College of Physicians and Surgeons and to provide an experience that will facilitate the resident’s education in becoming a competent consultant in Gastroenterology. Increasingly, adult Gastroenterologists are expected to participate in a limited scope of care for pediatric patients when, in underserved areas, Pediatric Gastroenterology consultation is not available, or to assist pediatric colleagues with complex endoscopic procedures more common in adult patients.
This 2-week rotation will include outpatient consultative Pediatric Gastroenterology exposure, as well as ongoing outpatient clinical care. There are also opportunities to participate in inpatient Pediatric Gastroenterology activities relevant to the learning goals and objectives of the Adult Gastroenterology residents. In addition, Second Year residents are encouraged to obtain additional exposure to Pediatric Gastroenterology during their elective months and during the outpatient rotation. During this 2-week rotation, the Adult Gastroenterology resident will be expected to participate primarily in the care of Pediatric GI ambulatory consultation with the availability of daily clinics. The consultation service is broad-based with GI, nutritional and Hepatology consults, with focused clinics for IBD, Hepatology, Celiac disease, constipation, and Cyclic Vomiting Syndrome. The objectives outlined below represent topics that should be covered and discussed in the context of pathophysiology, clinical presentation and management. Many of the conditions are similar to Adult Gastroenterology (inflammatory bowel disease, celiac disease, cystic fibrosis, functional abdominal pain, gastroesophageal reflux disease, functional GI disorders, chronic liver disease), but the presentation, management and natural history may vary in patients under 18 years of age. There is also an opportunity to observe pediatric endoscopy, and participate if pediatric GI residents are not assigned to the list.
The goal of this limited rotation is NOT proficiency in Pediatric Gastroenterology but to understand the conditions unique to pediatrics, pediatric diseases which will impact adult life, and the similarities and differences in disorders found in both Adult and Pediatric Gastroenterology. The use of medications, radiological, and endoscopic investigations in children will be discussed. Through these activities, the resident will gain a pediatric perspective and an increased awareness of the important distinctions between Adult and Pediatric Gastroenterology including the overall approach to the evaluation of pediatric patients of varying ages and their families; the spectrum of disease in children; the need to adapt diagnostic tests and interventions to the age-specific needs of the pediatric patient; and the attention to therapeutics in the pediatric age groups, especially with regard to the mode of delivery, side effect profiles and long-term implications. In addition, this experience will increase understanding of the differences in practice, enhance collaboration and improve transition of care.
Responsibilities of the Resident
Outpatient Experience
Rotation schedule is prepared by the Pediatric Program Director on a monthly basis. The schedule will need to be confirmed prior to the start of the rotation. Residents meet with the Pediatric GI Division’s Educational Resource Person on the first day. Residents are expected to attend each assigned clinic, to be punctual, and to complete consultation notes on all patients seen in the clinic in a timely fashion. Clinical supervisors must be informed of vacation / professional leave 4 weeks prior to the start date of the rotation. In addition, clinical supervisors must be informed when residents are unable to attend clinic due to post-call reasons. Residents are expected to develop, implement and monitor a personal continuing education strategy. To facilitate this objective, at least one half day is set aside per week for self-directed learning of topics and diseases encountered in the clinics.
Rotation Schedule |
||
|
AM |
PM |
Monday |
Zachos (Constipation Clinic) |
Brill (GI/Hepatology) |
Tuesday |
Sherlock |
Issenman (IBD Clinic) |
Wednesday |
Academic Half Day |
Adult / Pediatric Endoscopy / Celiac / CVS |
Thursday |
Brill (GI/IBD) |
Issenman (GI Clinic) |
Friday |
Reading day / observe inpatient service |
* Please contact Andrea Brydges (brydgea@mcmaster.ca), Administrative Assistant, Paediatric Gastroenterology & Nutrition, prior to the start of this rotation to confirm meeting time with the Educational Resource Person.
Educational and Scholarly activities
Educational activities, which are a priority for the GI resident, include both scheduled rounds and other academic sessions. The resident is expected to attend the Gastroenterology Residents’ academic half-day, including the Farncombe noon rounds, on a weekly basis. In addition, the resident is expected to actively participate in the Pediatric Teaching rounds / seminars on Monday from 1200 to 1300. During these educational sessions, essential topics in Pediatric Gastroenterology will be discussed. The resident is expected to present a topic of interest or a journal article during this session. Pathology rounds are held every Tuesday from 1200 to 1300 at McMaster Site.
Evaluation of the Resident
Residents are encouraged to seek informal verbal feedback throughout the Pediatric Gastroenterology outpatient experience concerning their proficiency at managing clinical problems. A formal evaluation session with the resident will take place at the end of the rotation. Input is sought from other members of the clinic team who have worked with the resident (e.g. nurses, nurse practitioners, other allied health professionals). Based on all feedback received, at the end of the rotation, a formal web-based CanMEDS compliant ITER is compiled by the supervisor. Final evaluations are discussed with the resident.
Evaluation of the Rotation
Residents are encouraged to provide feedback on how the rotation and teaching are structured. As with all rotations, an anonymous rotation evaluation is handled by the One 45 WebEval System. Each teaching faculty is evaluated separately in a similar manner. The Residency Program Committee meets semi-annually to compile a collective rotation and faculty evaluation, respecting anonymity. This has been important to maintaining feedback.
In addition to the general objectives outlined above, rotation-specific goals and objectives for the Second Year of Training in Adult Gastroenterology at McMaster University are listed below.
Medical Expert
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Communicator
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Collaborator
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Manager
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Health Advocate
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Scholar
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
Professional
Key Competencies: Physicians are able to
Specific Requirements: Gastroenterology residents are able to
OVERVIEW
Endoscopy training in the Adult Gastroenterology Training Program takes place at four sites: the McMaster, the Juravinski and the General Sites of Hamilton Health Sciences, and St. Joseph’s Hospital. Experience on-call is acquired at all three acute care sites in Hamilton. Training in endoscopy occurs continuously throughout the two years of the fellowship, at whatever site the trainee is based for his/her rotation. All residents receive orientation to the Endoscopy Unit in the first month of residency. This includes instruction on patient preparation, safety, antibiotic prophylaxis, equipment maintenance, and disinfection of instruments. In addition to the endoscopic procedure, appropriate patient care is expected to include thorough explanation of the procedure, review of appropriateness of the indication, assessment of contraindications, explanation of risks, informed consent, appropriate conscious sedation, recovery, discharge planning and communication of findings and management plans to patients, families and referring health professionals. Endoscopy is provided as part of a comprehensive Gastroenterology service in cooperation with physicians, surgeons, radiologists, pathologists and allied health personnel.
FACILITIES
Endoscopy units at the four teaching hospitals in Hamilton perform approximately 20,000 gastrointestinal endoscopic procedures each year. A full range of endoscopic procedures is provided to assess and manage a broad spectrum of medical and surgical disorders. Each endoscopy unit is furnished with modern PentaxTM endoscopy equipment and access to fluoroscopy for ERCP (all sites), argon plasma coagulation (Juravinski, McMaster and St. Joseph’s Sites), laser (St. Joseph’s Site) and endoscopic ultrasound (McMaster Site).
The endoscopy suite at the McMaster Site offers four video-equipped endoscopy rooms with state-of-the art Pentax equipment for both adult and pediatric endoscopy. A fluoroscopy suite with radiologist supervision is available. The unit is staffed by endoscopy nurses well-trained in adult and pediatric endoscopy. Endoscopic ultrasound is provided at this site. Additionally, the unit is equipped for enteroscopy. Endoscopy reports are generated immediately post-procedure using EndoPro software with digital image capture. Capsule endoscopy is available on-site. In addition, the site offers computerized video simulations with the SymbionixTM endoscopy simulator.
The endoscopy suite at the Juravinski Site offers two video equipped rooms with full access to fluoroscopy suites and EndoPro software.
The endoscopy suite at the St. Joseph’s site has 5 fully equipped rooms with Pentax video endoscopic instruments. It also boasts interventional laser facilities. In addition, the site offers full endoscopic training facilities using computerized video simulations in collaboration with the Centre for Minimal Access Surgery.
Trainees’ initial exposure to endoscopy after joining the training program is with the SymbionixTM endoscopy simulator, housed at the McMaster Site. Trainees are expected complete a defined curriculum of simulator scenarios successfully before beginning to perform endoscopy under supervision on patients.
TRAINING EXPECTATIONS
Trainees attend a minimum of one endoscopy session each week over their two years of training. Generally, at least 500 procedures are completed under direct supervision. Because therapeutic endoscopy is considered more hazardous, it is taught only after satisfactory basic training in diagnostic endoscopy is complete. During all endoscopic training, the complementary roles of histology, radiology and surgery are emphasized.
Competence at diagnostic upper gastrointestinal endoscopy is achieved well before the end of the first year. During the first year, residents also become competent at flexible sigmoidoscopy and are introduced to colonoscopy. During the second year of training, the resident focuses on therapeutic aspects of upper endoscopy and becomes competent at colonoscopy, including polypectomy. Training in urgent endoscopy, including interventions for acute gastrointestinal bleeding, is acquired largely through participation in regional call rota. All emergency endoscopies are performed under direct supervision of the on-call consultant.
Competence at upper gastrointestinal endoscopy is expected to include diagnostic assessment, biopsy, brushing, injection therapies, thermal coaptive therapies (e.g. heater probe, BiCAP), mechanical hemostatic techniques (eg. hemo-clip), injection sclerotherapy, variceal band ligation, argon plasma coagulation, foreign body removal, polypectomy, bougie and balloon dilatation, and percutaneous endoscopic gastrostomy. Competence at lower gastrointestinal endoscopy is expected to include diagnostic assessment including terminal ileal intubation, biopsy, polypectomy, injection therapy, thermal coaptive therapies, mechanical hemostatic techniques, and balloon dilation. Endoscopy unit personnel provide training in equipment set-up, maintenance, cleaning and disinfection. This is also reviewed in detail at the introductory endoscopy course.
Trainees in the core two-year program are offered exposure to ERCP and EUS, but competence in diagnostic / therapeutic ERCP and EUS is not an objective of the program. Core trainees are expected to gain a thorough understanding of the technique, indications, contraindications, complications and interpretation of related radiography, and to gain early experience with intubation of a side-viewing endoscope.
Trainees interested in therapeutic biliary endoscopy (including endoscopic sphincterotomy and biliary stent placement) or endoscopic ultrasound are encouraged to consider a third year of advanced endoscopic training. Trainees in the core program may undertake electives in biliary endoscopy upon identifying an appropriate supervisor. However, priority to assist at ERCP is given to fellows in their third year. Third-year training in advanced endoscopy could also include experience in laser endoscopy, pediatric endoscopy, enteroscopy, endoscopic mucosal resection and intra-operative endoscopy.
Summary of Endoscopy Objectives
Competence at Upper Endoscopy
Diagnostic (including biopsy and brushing)
Injection (including sclerotherapy)
Coaptive therapy (including heater probe, BiCAP)
Hemoclip application
Dilation (bougie and balloon)
Argon plasma coagulation
Variceal ligation
Foreign body removal
Polypectomy
Percutaneous endoscopic gastrostomy
Competence in Colonoscopy
Diagnostic (including terminal ileal intubation, biopsy)
Polypectomy
Argon plasma coagulation
Balloon dilation
Injection
Coaptive therapy (including heater probe, BiCAP)
Hemoclip application
Training in GI endoscopy has largely been based on hands-on acquisition of experience in patients rather than on a structured training program. Unlike most diagnostic modalities, endoscopies evolved amidst a number of specialties, being performed by gastroenterologists, surgeons, and radiologists and as a result, clear training requirements and provision differed. There are currently no guidelines regarding how endoscopists should be trained. Many national endoscopy societies have produced guidelines that include aspects of endoscopy that should be learned and have recommended minimal competency procedural thresholds. Yet none have addressed the issue of how to teach endoscopic skills in a structured way. The traditional model of “see one, do one, teach one” is probably not an adequate method of conveying the necessary information for successful, safe endoscopy. A well-organized, structured training is essential if we are to ensure that procedures are performed in a safe and effective manner. In addition, such a program would serve to improve and standardize the training and practice of endoscopy, and ultimately improve the quality and safety of endoscopic procedures.
A structured pre-endoscopy training curriculum should ideally include introductory lectures and courses on the cognitive aspects of competency of endoscopy including informed consent, safety and sedation, indications and complications of endoscopy, unit management, endoscopy and accessory design, and their operation. Once the cognitive aspects of competency has been taught and assessed, teaching of psychomotor skills necessary for endoscopy can be addressed. These skills can be taught by the use of simulation which has been shown to decrease the time needed to improve the performance of trainees significantly especially in the early training period. Once the psychomotor skills are mastered, the trainees can then achieve proficiency by practice on real patients under supervision. Underpinning the acquisition of cognitive and psychomotor skills is the ability to identify and correctly interpret pathologies. This component of endoscopy training can be taught by reviewing video clips or endoscopic pictures of pathologies.
With the goal of formalizing a structured pre-endoscopy training curriculum, the First Year GI Residents Endoscopy Training Course was first introduced in 2005 at McMaster University. It is an intensive 2-day course which incorporates didactic lectures, small group discussions, hands-on training on simulation and dinner event with debate by course faculty at McMaster University. This annual course has been endorsed by many GI training programs across the country and has been very well received by trainees. This is now, attended by 35 to 40 first year Adult and Pediatric GI residents and surgical residents, and the course has included faculty from across the country. It is important to highlight that all faculty trainers for the simulation sessions have received formal training as endoscopic trainers through Train-the-Trainers (TTT) programs.
The steering committee of this course includes: David Armstrong, Frances Tse, Lawrence Hookey, Don MacIntosh, Mark Borgaonkar, David Morgan, John Marshall and John Anderson (UK National Endoscopy Training Lead).
Specific goals and objectives
Medical Expert
Understand the importance of integration of all CanMEDS roles to provide optimal, ethical and patient-centered medical care in endoscopy:
Communicator
Collaborator
Manager
Health Advocate
Scholar
Professional
Competence in performing endoscopy is an essential component of a Gastroenterology trainee’s professional development, and yet the standards that both facilitate and confirm the achievement of competency are poorly defined. Increasingly, objective assessment of performance is recognized as a critical assessment parameter in determining endoscopic competence accurately. Furthermore, the ASGE training guidelines mandated that each trainee’s acquisition of technical and cognitive skills be monitored on a regular basis. Most training programs do so by the use of procedure logs or subjective evaluation by proctors. Unfortunately, performance of a minimum number of procedures, while a prerequisite for skill acquisition, does not guarantee competence. Furthermore, subjective observation is neither valid nor reliable. Tracking quality indicators for trainees may provide more reliable outcome data to improve educational programs and establish training requirements. As such, the objective of the RPAGE program is to measure specific endoscopic quality indicators for trainees to determine if outcome can be used to assess the quality of procedure training and contribute to more objective means of establishing uniform training requirements among programs.
The Resident Practice Audit Program Gastro-Enterology (RPAGE) is an innovative program that was developed by the Division of Gastroenterology at McMaster University (Dr. Ted Xenodemetropoulos, Dr. Frances Tse, Dr. David Armstrong) in collaboration with the Canadian Association of Gastroenterology (CAG). The RPAGE is a natural and logical extension of the Practice Audit in Gastroenterology (PAGE) program for practicing Canadian endoscopists. Over the last 6 – 7 years, the PAGE program has developed into a powerful, real time instrument for practice audit, continuing professional development and quality improvement, recognized by the Royal College of Physicians and Surgeons of Canada with their 2011 Innovations in Accreditation Award.
The RPAGE program is designed to provide trainees with a point-of-care, peer-comparator practice audit tool. With the help of the endoscopic trainers, all trainees enter details of each procedure they complete in real-time. Anonymized trainee, patient and practice data are collected using touchscreen smartphones or desktop computer with automated data upload for data analysis and review by participants. The program allows trainees to objectively record key endoscopic quality indicators (e.g. gastroscope and colonoscope insertion and withdrawal times, segments of procedure performed independently or with assistance, bowel preparation quality, sedation, immediate complications and polypectomy, biopsy rates). There is also an evaluation tool built in the program that allows trainees to have their endoscopic performance objectively evaluated by their trainers on a regular basis. The RPAGE program will allow trainees to review their own performance and compare this with their peers, promoting the identification of learning needs and objectives, as well as the basis for the development of targeted education programs. The Program Director can review procedure volumes, endoscopic quality indicators and evaluation results on a regular basis.
To assess the usability of the RPAGE program, pilot testing is currently undertaken at McMaster University. The project was presented to the Program Directors at the Canadian Digestive Disease Week in 2012 and was met with great enthusiasm. The plan is to gradually roll out the fully functioning RPAGE program to other GI training programs (adult and pediatric) across the country by the end of 2012. It is anticipated that this program will foster the ability for trainees and programs to benchmark themselves and provide impetus for quality improvement in endoscopy training.
MEDICAL ETHICS
Each rotation incorporates informal teaching in ethics around clinical cases and scenarios. Formal teaching in ethics also occurs during Multidisciplinary Academic Half-Days organized by the Postgraduate Medical Education Office. These are scheduled five times per year, and are attended by all core and subspecialty trainees in internal medicine, including residents in the GI Training Program. Ethics Grand Rounds are co-organized by the Hamilton Health Sciences Clinical Ethics Committee and McMaster University Faculty of Health Sciences on a monthly basis. In addition, several sessions of the GI Academic Half Day are devoted to topics relevant to medical ethics. Every three months, one case discussion at the GI Academic Half-Day is devoted to a Morbidity and Mortality format. Here, an adverse treatment outcome or procedure complication is discussed, with review of ethical issues related to consent and disclosure. The ethical issues surrounding the use of diagnostic and therapeutic endoscopy are reviewed in the annual First Year GI Residents’ Endoscopy Training Course. All trainees are encouraged to access the Royal College of Physicians and Surgeons of Canada Bioethics Education Project online.
For research ethics, trainees are encouraged to access the McMaster University’s web-based tutorial that reviews the implications of Ontario’s Health Information Protection Act legislation and the National Institutes of Health web-based tutorial on Protecting Human Research Participants (PHRP) course.
QUALITY ASSURANCE
Gastroenterology residents acquire experience and skills in quality assurance through various aspects of their training. Orientation to the regional endoscopy units addresses the appropriate use and maintenance of endoscopy equipment and the proper function of an endoscopy unit. Trainees are introduced to the principles underlying quality assurance in endoscopy including the Global Rating Scale (an endoscopy quality assurance program) and key performance indicators (e.g. cecal intubation rate, adenoma detection rate) during the First Year Residents’ Endoscopy Training Course. The Resident Practice Audit Gastro-Enterology (RPAGE) program provides our trainees with a powerful, real time peer-comparator practice audit tool for continuing professional development and quality improvement in endoscopy training. The concepts of quality assurance in endoscopy are reinforced during residency by the RPAGE program and through review of performance of local endoscopy units with the Global Rating Scale during the Hamilton Association of Gastroenterology meetings. Many clinical research projects undertaken by trainees include detailed review of local practices and outcomes relative to national standards and/or published guidelines. At pathology rounds, biopsy and autopsy results are discussed in the context of clinical diagnoses and overall case management. At M & M rounds, adverse outcomes are discussed and possible improvements in the delivery of care are reviewed. Quality assurance is also a component of the weekly Journal Club, where new evidence is assessed and evaluated, and current practices are reconsidered. Finally, quality assurance is a common component of discussions on clinical ward rounds at all sites.
OVERVIEW
Gastrointestinal research at McMaster University has enjoyed considerable success for over 25 years due to the close collaboration between clinicians and basic scientists. Indeed, McMaster has often ranked within the top 5 institutions in the world in the number of abstracts submitted to international meetings such as Digestive Diseases Week. Many of our successful papers have been authored by Gastroenterology trainees. Many of the Faculty of the GI division are internationally renowned researchers and have published groundbreaking research in wide range of subjects. GI faculty have published approximately 400 peer reviewed papers and obtained over $78 million in funding from industry and grant agencies in the last 5 years. Research published by GI faculty has received over 24,000 citations with 47 papers each receiving over 100 citations.
The GI Training Program is particularly strong in its ability to offer training in research. Three blocks in the first year (and up to 3 more blocks in the second year) are designated to research activities. It is intended that the resident work on a viable project with an experienced supervisor, optimizing the chance that an abstract and paper will result. Residents are encouraged to submit their work to national (e.g. Canadian Digestive Diseases Week), international (e.g. American Gastroenterological Association) or local (e.g. McMaster Resident Research Day, Farncombe Family Digestive Health Research Institute Research Day) meetings.
The Training Program believes that exposure to research is an integral and important part of clinical training. Faculty members perform research in a wide variety of basic and clinical areas, and both clinical and basic research projects are feasible. Basic research is performed within the Farncombe Family Digestive Health Research Institute, and several members of the GI Division are Full Members of the Farncombe Institute. Clinical research may include retrospective clinical studies, case reviews, prospective clinical studies or even intervention trials. Furthermore, the Upper Gastrointestinal and Pancreatic Diseases Cochrane Review Group is based at McMaster University under the leadership of Dr. Paul Moayyedi and Dr. Grigorios Leontiadis. Residents are encouraged to take advantage of the expertise in systematic reviews and meta-analyses of the Cochrane Collaboration in conducting their research projects.
Research Curriculum
The research curriculum comprises three aspects:
Residents entering the GI Training Program are required to identify a Research Mentor and a research project within the first few months of training. A list of basic science and clinical research projects prepared by our faculty are available to trainees in the beginning of the academic year. Research projects and mentors are reviewed and approved by the Research Coordinator (Dr. Premysl Bercik). Residents are then asked to present their research question and/or research protocol at Farncombe Noon Rounds early in the academic year. The research proposal will state the question, hypothesis, objectives, design and proposed outcome measures of the study. The nature and scope of the project should allow the resident to generate an abstract for national or international meetings. Throughout their training, residents are also encouraged to identify unique and rare clinical cases that can yield case reports and/or literature reviews for publication. Residents are encouraged to submit their work to national (e.g. Canadian Digestive Diseases Week), international (e.g. American Gastroenterological Association) or local (e.g. McMaster Resident Research Day, IDRP Research Day) meetings.
Responsibilities of the Resident
The overall goals of the Research Rotation are:
Evaluation of the Resident
At the end of the first year, each resident must review his/her project with the Research Coordinator. Residents who demonstrate sufficient interest and productivity will be offered up to three blocks of research time in their second year to continue their work and/or begin new projects. Successful completion of the research training component requires each of the following:
Completion of each of these requirements will result in a “PASS” of the Research Component of the Final in-Training Evaluation Report (FITER).
Evaluation of the Rotation
Residents are encouraged to provide feedback on how the rotation and teaching are structured. If issues arise during the rotation, the resident is encouraged to bring these to the attention of the Research Coordinator. A mechanism for dealing with any shortcomings will then be discussed with the resident and the Research Mentor, and subsequently at the Residency Program Committee meeting. As with all rotations, an anonymous rotation evaluation is handled by the One 45 WebEval System. Each teaching faculty is evaluated separately in a similar manner. The Residency Program Committee meets semi-annually to compile a collective rotation and faculty evaluation, respecting anonymity. This has been important to maintaining feedback.
GOALS AND OBJECTIVES
The Adult GI Training Program at McMaster University incorporates research training as part of the requirement of the Royal College of Physician and Surgeons of Canada. Specific goals and objectives of the research rotation in CanMEDS format are as follows:
Medical Expert
Specific Requirements: Gastroenterology residents are able to
Communicator
Specific Requirements: Gastroenterology residents are able to
Collaborator
Specific Requirements: Gastroenterology residents are able to
Manager
Specific Requirements: Gastroenterology residents are able to
Health Advocate
Specific Requirements: Gastroenterology residents are able to
Scholar
Specific Requirements: Gastroenterology residents are able to
Professional
Specific Requirements: Gastroenterology residents are able to
BASIC RESEARCH ACTIVITY (FARNCOMBE FAMILY DIGESTIVE HEALTH RESEARCH INSTITUTE)
The Farncombe Family Digestive Health Research Institute is an integrated group of clinical and basic scientists dedicated to understanding the impact of digestive health and nutrition on disease across the life span. The institute is focused on developing new strategies for the diagnosis, treatment and prevention of intestinal diseases such as Crohn’s disease and ulcerative colitis. However, the focus of research in the institute is not limited to digestive disease; rather, it includes diseases of many other organ systems that may be caused and/or profoundly influenced by digestive health.
Facilitated by an extraordinary $15 million donation from the Farncombe family, the institute was established as an outgrowth of McMaster University’s Intestinal Diseases Research Program (IDRP), originally founded in 1983. The Farncombe Family’s generous contribution has allowed by the establishment of endowed chairs and infrastructure capital, which will ensure the long-term success of the institute and enhance its role as an innovative training environment.
For more than 20 years, McMaster’s Intestinal Diseases Research Program has garnered an international reputation as one of the top 10 gastrointestinal research groups in the world. The growth in research funding, faculty awards and the expansion into a Research Institute is a testament to the critical role McMaster researchers are playing in the study of digestive disorders.
Mission
The mandate of Farncombe Family Digestive Health Research Institute encompasses its leadership role in research, innovation and training as it relates to intestinal diseases. The mission of the Farncombe Family Digestive Health Research Institute:
There are 14 full members of the Farncombe Family Digestive Health Research Institute. These members conduct their primary research within the Institute’s facilities. There are 13 associate members who conduct collaborative research with the institute’s members. The Farncombe Institute includes Canada’s only gnotobiotic laboratory and houses a metagenomics platform that includes a Roche 454 rapid DNA sequencer. There is a clinical research center within the institute that conducts clinical trials, meta-analyses, epidemiological studies in affiliated hospitals as well as on a national and international basis. The institute has a large complement of technical staff, graduate students and research fellows as well as administrative staff.
Research Themes
The Farncombe Family Digestive Health Research Institute conducts research under the following themes:
The above-described themes represent overlapping areas of research interests, with most institute researchers working in more than one area. This forms the basis of the institute’s integrated research program on gut function in health and disease.
Specific Areas of Research
OVERVIEW
The objectives of the elective experience are to provide flexibility and opportunities to explore career possibilities, to gain experience in aspects of medicine beyond the core curriculum, and to study certain areas in greater depth. Knowledge, skills and attitudes are further developed in a self-directed choice of area across the curriculum.
Trainees are provided between one and four months for elective experience. Trainees are free to identify and choose specific electives in keeping with their individual training objectives, subject to approval by the Program Director and Residency Program Committee. It is expected that electives will be undertaken in Hamilton, barring exceptional circumstance where the trainee demonstrates that the regional facilities are insufficient to meet his/her training objectives. For each elective, trainees must identify a supervisor responsible for monitoring his/her experience and evaluating his/her performance. Both the resident and the supervisor are responsible for ensuring a clear, mutual understanding of the learning activities designed to meet the objectives of the elective.
A completed and signed Elective Request Form must be submitted to the Program Director at least four weeks prior to beginning an elective. Using this form, the trainee is expected to provide: (1) a summary of the elective experience; (2) a statement of goals and objectives for the elective experience; and (3) a schedule of activities and responsibilities to be undertaken during the elective. This document must be signed by the Program Director, the elective supervisor and the trainee. The goals and objectives of elective rotations must address the CanMEDS physician roles identified by the Royal College. Elective evaluations will address both the CanMEDS roles and the elective-specific objectives identified by the trainee. The trainee may choose to undertake two electives in parallel, if neither provides full-time activity.
The following list suggests some appropriate electives and potential supervisors:
Hepatology (Drs. Puglia, Witt-Sullivan, Tsoi)
Gastrointestinal motility (Drs. Bercik, Collins)
Clinical nutrition (Dr. Armstrong)
Inflammatory bowel disease (Drs. Marshall, Halder)
Colorectal Surgery (Drs. Kelly, Stephens, Forbes)
Gastrointestinal oncology (Drs. Zbuk, Wong)
Gastrointestinal radiology (Drs. Vora, Midia)
Gastrointestinal anatomical pathology (Dr. Ramsay)
Psychiatry (Dr. Anglin)
Pain management (Drs. Buckley)
Pediatric Gastroenterology (Drs. Issenman, Brill, Ratcliffe, Zachos)
Laser endoscopy (Dr. Morgan)
Biliary endoscopy (Drs. Lumb, Seaton, Tse)
Endoscopic ultrasound (Dr. Tse)
Swallowing disorders (Dr. Mazzadi)
Responsibilities of the Resident
Rotation schedule is prepared by the resident and the clinical supervisor for the elective. The schedule will need to be approved by the Program Director prior to the start of the rotation. Residents are expected to attend each assigned activity, to be punctual, and to complete written documentations on all patients seen in a timely fashion. Clinical supervisors must be informed of vacation / professional leave 4 weeks prior to the start date of the rotation. In addition, clinical supervisors must be informed when residents are unable to attend assigned activities due to post-call reasons. Residents are expected to develop, implement and monitor a personal continuing education strategy. To facilitate this objective, at least one half day is set aside per week for self-directed learning of topics and diseases encountered during the elective. Residents on elective experience are not exempted from on-call duties.
Evaluation of the Resident
Residents are encouraged to seek informal verbal feedback throughout the elective concerning their performance. A formal evaluation session with the resident will take place at the end of the rotation. Input is sought from other members of the health care team who have worked with the resident (e.g. nurses, other allied health professionals). Based on all feedback received, at the end of the rotation, a formal web-based CanMEDS compliant ITER is compiled by the supervisor. Final evaluations are discussed with the resident.
Evaluation of the Rotation
Residents are encouraged to provide feedback on how the rotation and teaching are structured. As with all rotations, an anonymous rotation evaluation is handled by the One 45 WebEval System. Each teaching faculty is evaluated separately in a similar manner. The Residency Program Committee meets semi-annually to compile a collective rotation and faculty evaluation, respecting anonymity. This has been important to maintaining feedback.
GOALS AND OBJECTIVES
The broad goals of the elective rotation are noted below. The following CanMEDS competencies apply to all clinical elective experiences and are listed on the evaluation form for the elective:
Medical Expert
Key Competencies: Physicians are able to
Communicator
Key Competencies: Physicians are able to
Collaborator
Key Competencies: Physicians are able to
Manager
Key Competencies: Physicians are able to
Health Advocate
Key Competencies: Physicians are able to
Scholar
Key Competencies: Physicians are able to
Professional
Key Competencies: Physicians are able to
Criteria Specific to Elective
In addition, specific objectives are to be agreed BEFORE the beginning of the elective by the resident and the supervisor: at least two major specific objectives are to be listed in the space provided on the Evaluation Form.OVERVIEW
The goal of the Adult Gastroenterology Training Program is to produce subspecialists in Gastroenterology who can work independently in any clinical setting. Trainees are also expected to sit the subspecialty exams of The Royal College of Physicians of Canada, and to fulfil all CANMEDS role competencies. Their progress through the program is monitored in order to meet these objectives.
The McMaster University Gastroenterology Residency Training Program maintains a collegial atmosphere in which feedback is frequently exchanged between residents and faculty in order to promote excellence in resident education and resident performance. We want to ensure that every resident successfully achieves or exceeds rotation objectives and that every rotation meets or exceeds resident learning objectives. The evaluation process is instrumental in meeting these goals.
EVALUATION PROCESS
Faculty are expected to follow the official policy and procedures of the Postgraduate Medical Education (PGME) Office for the evaluation of residents’ performance. Appeal processes are defined by the PGME Office. The Evaluation Policy in its entirety is available on the PGME website: //fhs.mcmaster.ca/postgrad/documents/ResidentEvaluation1.pdf.
All evaluations are site-, year-, and rotation-specific based on the CanMEDS competencies. Within each domain and for each goal and objective on the ITER, there may be several levels of competence identified. However, the overall (summative) evaluation on the ITER should indicate one of the following designations:
Satisfactory |
Resident has successfully met the goals and objectives of the rotation |
Provisional Satisfactory |
Resident has demonstrated significant deficiencies in one or more of the RCSC competenciesidentified in the rotation objectives, or any other requirement of the rotation, and that while such deficiencies require remediation,they are not so severe to necessitate the Resident repeating the entire rotation. The Clinical Supervisor believes that the Resident can satisfy the deficient rotation objective(s) or requirement(s) during other rotations. These deficiencies often relate to non-Medical Expert CanMEDS domains. |
Unsatisfactory |
Resident has demonstrated significant deficiencies in one or more of the RCPSC competenciesidentified in the rotation objectives, or any other requirement, and the Clinical Supervisor believes that the rotation objective(s) or requirement(s)can only be reasonably met by remediation and having the Resident repeat the entire rotation. These deficiencies often relate to Medical Expert CanMEDS domains. |
Incomplete |
“Incomplete” indicates that the Clinical Supervisor has beenunable to properly and fully evaluate the Resident because the Resident’s time spent on the rotation was insufficient, for whatever reason, e.g. illness, extenuating circumstances etc.As the rotation is incomplete, time will have to be made up to fulfil the requirements of the rotation.A designation of “incomplete” may be appropriate where the Resident has not spent at least 50% of the required time on the rotation. Even where a designation of “incomplete” is indicated, the Clinical Supervisor should complete the ITER in order to document the Resident’s time spent in the rotation and the Resident’s performance during that limited time. |
Rotation In-Training Evaluation Reports (ITERS)
The ITER is the main modality of assessing resident knowledge and observed performance according to CanMEDS competencies. Residents are evaluated at the end of each rotation with a rotation-specific and year-specific ITER that encompasses all of the CanMEDS domains and follows each rotation description in this syllabus. Our program uses the one-45 computer-based evaluation system. Once completed, residents can review their ITERs electronically, provided they have no outstanding rotation evaluations to complete.
Mock Examinations
In preparation for the Royal College of Physicians and Surgeons Examination in Gastroenterology, trainees undergo a mock OSCE and written exam twice per year (November and May). This exam is intended to follow the format of the Royal College Examination in Adult Gastroenterology. The OSCE consists of several stations that test history taking, physical examination, endoscopic / histopathologic / radiologic interpretation, and clinical management of a wide variety of gastroenterologic problems. The stations are designed to assess all CanMEDS roles. Individualized instruction and feedback are provided after each station as part of formative feedback that helps learners become aware of any gaps that exist between their goals and their current knowledge, understanding, or skill and guides them through actions necessary to obtain the goals. OSCE stations are generated by the OSCE Coordinating Committee and reviewed by the OSCE Coordinator and the Program Director before being implemented. Written exams are prepared by 2 faculty members (1 luminal and 1 hepatology) and submitted to the Written Exam Coordinator for review and approval prior to implementation. This experience is invaluable preparation for the Royal College of Physicians and Surgeons of Canada licensing examinations, and also facilitates organized thinking around problems and ethical dilemmas in Gastroenterology. The results of these tests are reviewed and used as formative assessment tools to guide future learning objectives.
Resident Practice Audit Gastro-Enterology
Residents are responsible for maintaining a Procedural Skill Competency Log via the Resident Practice Audit Gastro-Enterology (RPAGE) Program. The RPAGE is designed to provide trainees with a point-of-care, peer-comparator practice audit tool. The purpose of the RPAGE program is to monitor and document the trainee’s progress and development in endoscopic skills. With the help of the endoscopic trainers, all trainees enter details of each procedure they complete in real-time. Anonymized trainee, patient and practice data are collected using touchscreen smartphones or desktop computer with automated data upload for data analysis and review by participants. The program allows trainees to objectively record key endoscopic quality indicators. There is also an evaluation tool built in the program that allows trainees to have their endoscopic performance objectively evaluated by their trainers on a regular basis. The RPAGE program allows trainees to review their own performance and compare this with their peers, promoting the identification of learning needs and objectives, as well as the basis for the development of targeted education programs. The Program Director can review procedure volumes, endoscopic quality indicators and evaluation results on a regular basis.
Progress Review
Each resident meets with the Program Director semi-annually to review progress, career goals, fellowship plans and other issues. Evaluations of all rotations are reviewed with residents at the semi-annual meetings. Particular areas of weaknesses and strengths are brought to the attention of the Site Coordinator and Mentor, to generate discussion among faculty and the resident involved. In this plan, plans for remedial help and supervision can be initiated promptly.
The clinical faculty also meet as a group once each year to discuss trainees’ performance on the wards, in the emergency department, in clinics, in endoscopy, and on the mock OSCE/written examinations. For each resident, completed online evaluations are reviewed and summarized by the Program Director. A broad and open discussion is initiated for each resident to counterbalance discrepant evaluations by individual faculty members. The discussion complements the online evaluations from each rotation, and generates a formal appraisal of each trainee’s strengths and weaknesses that is used to inform the FITER. These are then submitted to the Postgraduate Medical Education Office and then forwarded to the Royal College. Feedback from this meeting is also reviewed with the individual resident during the semi-annual meeting with the Program Director.
Final In-Training Evaluation Report
At the end of training, a final evaluation form (FITER) is prepared by the Program Director, with assistance from all faculty members and the Residency Training Program Committee. The FITER is forwarded to the Royal College and is used specifically in cases of borderline Royal College Examination results.
Allied Health Profession Evaluation of Resident
Evaluations from the health care team can provide feedback useful in guiding residents’ professional growth. Feedback from allied health professionals on residents’ competencies of interpersonal and communication skills and professionalism are obtained by means of a multi-source evaluation twice each year. These evaluations are very useful for formative feedback in residents’ professional development.
Peer Evaluation and Self-Assessment
360-degree assessment is a way of providing feedback about progress by placing the persons to be evaluated at the “hub of the wheel”. To provide a full-circle view of resident skills and abilities of interpersonal and communication skills, a self-assessment and a peer 360-degree evaluation form will be obtained twice per year. These evaluations encourage reflection and promote development of a self-improvement plan.
Evaluation of Written Consultation Dictation
To assess and improve the ability of residents to communicate effectively with referring physicians, written evaluation is formally evaluated during every ambulatory rotation by means of a Written Consultation Dictation Evaluation Form. It is the expectation that the resident on clinic block will review one consultation letter with an attending staff and have the evaluation form completed for each clinic rotation.
Rotation Evaluati on
Residents are encouraged to complete confidential Rotation Evaluations at the end of each rotation using the web-based evaluation system. The Residency Program Committee (RPC) reviews individual rotations and the rotation evaluations formally twice per year, but also on an ad hoc basis at its regular meetings in order to make adjustments as necessary. To maintain anonymity, only cumulative evaluation summaries are prepared for review by the Program Director and the RPC. Residents are free to bring concerns about rotations to the Program Director directly, and to table concerns for formal discussion by the RPC.
Faculty Evaluation
Residents are encouraged to complete a confidential faculty evaluation in respect of each member of the clinical teaching faculty with responsibility for the resident via the web-based evaluation system. Evaluation and feedback is expected to reflect the four broad domains of influence which the clinical faculty have with the residents: supervision; teaching; evaluation; and professional behaviour. At 6 month intervals, the Program Director receives and reviews cumulative summary evaluations for every individual faculty member, and each faculty member receives his/her summary evaluation as feedback. The average score obtained by their colleagues is also given. The summaries of all evaluations are forwarded to the Division Chief and to the Site Coordinators and Service Chiefs. These summaries are brought to the RPC for discussion at least once per year. Any concerns are reviewed by the Program Director and the Division Chief. These are then discussed with the individual faculty and the Service Chief at the hospital site. Depending on the nature of the concern, various measures are taken. This may simply require a discussion with the individual faculty concerned with on-going monitoring. If the concerns are more serious, changes would be made to the resident rotations to remove the residents from being taught by the individual faculty member. This would involve discussions with the Postgraduate Medical Education (PGME) Office, the Division Chief and the Department Chair according to the PGME policy.
PROMOTION PROCESS
Evaluations are reviewed with the Resident at his / her semi-annual meetings with the Program Director. Particular areas of weakness are brought to the attention of the Site Coordinator and the respective Mentor, to generate discussion among faculty and the Resident involved. In this way, plans for remedial help and supervision can be initiated promptly. Career counselling is also discussed. Resident progress is reported to the Residency Program Committee.
In the second half of each academic year, a special meeting of the Residency Program Committee is convened to discuss resident performance. Resident representatives do not attend this meeting, but all faculty members (including those who are not members of the Residency Program Committee) are invited to attend. For each resident, completed online evaluations are reviewed and summarized by the Program Director. A broad and open discussion is initiated for each resident to counterbalance discrepant evaluations by individual faculty members. Promotion of a Resident to the next academic level occurs if all rotation periods during the academic year have been completed with satisfactory evaluations. The Committee discussion forms the basis for the Program Director’s completion of FITER reports. These are then submitted to the Postgraduate medical Education Office and then forwarded to the College. Feedback from this special meeting is also reviewed with the individual resident by the Program Director.
APPEAL PROCESS
Only ITERs rated as “Unsatisfactory” or “Provisional Satisfactory” can be appealed. An appeal of an ITER can be made only on the basis that the Clinical Supervisor failed to follow the process set out in the Evaluation Policy by the PGME office, or on the basis that there are extraordinary mitigating personal circumstances that ought to be considered. All appeals must be made within 15 days after the Resident being sent the ITER.
The first level of appeal is made to the Program (Level 1). At the Program level, there is an emphasis on informal resolution.
If the issue is not resolved at the Program Level (Level 1), it can be directed to the PGME Office, which is Level 2. The PGME office will convene a meeting of the Appeal Review Board. Level 3 is the final level of appeal and at this point the Dean, Faculty of Health Sciences will strike a Tribunal, whose decision is final. The PGME Appeal Policy in its entirety is available on the PGME website.
The mission of our Residency Program is to help each individual Resident achieve their personal career goals and to develop a foundation for a rewarding career in Gastroenterology.
Career planning is performed throughout the residency training. Broad career goals are first identified when applicants are interviewed for admission, and are reviewed upon entry to the Gastroenterology Training Program by the Program Director. Where feasible, career expectations are incorporated into the individual’s objectives for residency and considered when choosing elective rotations. Career expectations are reviewed formally at semi-annual meetings between each Resident and the Program Director, and especially at the end of the first year. This allows the Program Director time to council individual Residents based on their interests (including discussion of various fellowships) and allows the Program Director to adjust the annual rotation schedules as necessary. In addition, career counselling is performed on an informal basis during each rotation. The program maintains flexibility in scheduling rotations, and provides elective experience in the Second Year to meet all career planning choices. Each Resident’s career plans are also discussed when the Residency Program Committee and regional faculty meet to review resident performance.
A formal mentorship program is in place. Each Resident is assigned a Mentor upon entry to the Program. The Mentor is expected to know the resident well, and to be in a position to offer personal insight into his / her aspirations and concerns. One responsibility of the Mentor is to provide career counselling. Where possible, Mentors are selected to match the resident’s career interests. However, the Mentor is also expected to direct the resident to others for advice in areas outside his / her expertise. If a Resident has expressed an interest in an academic career, the Research Supervisor becomes another important source of counselling.
A Resident Career Night is held every 2 years to develop Second Year Residents’ understanding of how their education can be put into practice. First Year Residents are also invited to attend. Practicing gastroenterologists from the community and also from academic centres are invited to offer advice, guidance and support, and answer residents’ questions based on real-life experience. The seminar is designed to expose the Residents to career options and information. Topics covered include: hospital medicine, how to set up private outpatient clinics and endoscopy units, life after residency and fellowship, job search, networking, and what to look for in an employment contract.
In addition, the following centralized resources are available to all residents:
In summary, career planning and counselling is provided on an ongoing basis throughout the residency through the sources identified above.
The Gastroenterology Training Program makes every effort to provide a friendly and supportive environment for its residents. However, there are a variety of support systems available to residents to provide assistance with stress and / or personal problems.
Support is available through the Postgraduate Medical Education Office and information about resident support systems is distributed at registration (Housestaff Support Systems) and is available on the Postgraduate Medical Education Office website.
Support services are available through:
Harassment and intimidation includes but is not limited to unfair work demands or workload abuse, discrimination, verbal abuse, physical abuse, sexual abuse, and reprisal for having lodged or being a witness in a harassment or intimidation complaint. The Gastroenterology Residency Program and McMaster University have zero tolerance for harassment. Both the Postgraduate Medical Education Office and the Internal Medicine Residency Program Office at McMaster University have policies and procedures to deal with intimidation, harassment, and abuse. Residents should deal with these issues in that way that makes them most comfortable – complaints may be informal (unwritten) or formal (written). No one shall be compelled to proceed with a complaint. Reprisal of the complainant for involvement in this process will not be tolerated. Confidentiality of the identity of the complainant and the respondent will be protected.
Residents have the option of discussing their concerns with the individual involved in the incident, a friend or colleague (including the Chief Resident), the family physician, the Clinical Supervisor, the Site Coordinator, the Program Director, the Mentor, the External Program Ombudsperson, and/or the Assistant Dean, Postgraduate Education. If the incident involves human rights (e.g. based on sex, sexual orientation, race, religion, age, skin color, etc), the resident can also directly discuss the issue with the University Office of Human Rights and Equity Services.
If a formal complaint is submitted to the Residency Program Director, Division Director, or Postgraduate Education, University counsel will be sought in consultation with the Program Director, Division Director, and Assistant Dean, as appropriate. If the incident falls within the University definition of human rights related harassment, the University Office of Human Rights and Equity Services will be consulted. The complaint should be made in a timely fashion (no later than 12 months from the date of the harassment. The complaint should include dates, names of individuals involved, and a full description of the event. The respondent will be notified that a complaint has been filed and, with the permission of the complainant and respondent, a meeting will be scheduled with the Assistant Dean, Postgraduate Education and/or Program Director and/or Clinical Supervisor and appropriate University counsel. The group will attempt to arrive at a negotiated process. However, if the group reaches the conclusion that no resolution is possible, both the complainant and respondent will be informed in writing within 5 working days of that determination. If the complainant and/or respondent are not satisfied with the decision of the group, a request may be made in writing for a formal hearing. This request will be forwarded to the Board of Governors.
If the reported incident is patient related, it must be reported to the College of Physicians and Surgeons of Ontario.
Resident education must occur in a physically safe environment (Royal College of Physicians and Surgeons of Canada, standard A.2.5; College of Family Physicians of Canada). The university also recognizes that safe working environment for trainees is beneficial to resident education and patient care, and that there are ethical and moral reasons for maintaining such a working environment.
The purpose of this document is to provide a policy regarding workplace safety for postgraduate trainees in Gastroenterology at McMaster University and to demonstrate the commitment of the residency training program in providing and maintaining healthy and safe working and learning environment for all postgraduate trainees. This is achieved by observing best practices which meet or exceed the standards to comply with legislative requirements as contained in the Ontario Occupational Health and Safety Act, Environmental Protection Act, Nuclear Safety and Control Act and other statutes, their regulations, and the policy and procedures established by the University.
It is expected that the postgraduate trainee, the residency training program, the Postgraduate Medical Education (PGME) Office will work together with the affiliated teaching hospitals and community training sites to ensure the personal safety of all postgraduate trainees.
This policy complies with the Royal College accreditation standards A2.5 and B1.3.9 and does not supersede any University wide or PGME Policy that is already established. In this policy, “Safety” relates to the residents’ physical, emotional and professional wellbeing.
This policy covers resident safety in the areas of travel, patient encounters, including house calls, after-hours consultations in isolated departments and patient transfers (Royal College Standard B1.3.9). This policy should allow resident discretion and judgment regarding their personal safety and ensure residents are appropriately supervised during all clinical encounters.
These policies apply only during residents’ activities that are related to the execution of residency duties.
3.1 The Resident Safety Policy needs input and acceptance from the residents through the residency education committee.
3.2 Residents need to provide rotation and faculty evaluations to help direct or establish concerns of resident safety.
3.3 The residency program administration and the Program Director need to act promptly to verify safety issues and take due action to rectify the problem.
3.4 Critical incidents involving residents must be recorded, and appropriate debriefing should occur in a timely fashion.
4.1 Residents traveling for clinical or other academic duties by private vehicle should maintain their vehicle adequately and travel with appropriate supplies and contact information. Cell phone use or text messaging while driving is not recommended.
4.2 If the resident has determined that it is unsafe to travel (i.e. due to extreme weather concerns), the resident may elect not to attend clinic / endoscopy lists, inpatient service, or academic half day. However, they must inform their clinical supervisors as soon as possible in a professional manner.
4.3 Residents are encouraged to discuss safety procedures at rural or remote locations with their supervisors as soon as possible after arriving. Emergency contact information should be recorded and carried.
4.4 Residents should ensure adequate rest after call duties before traveling home from the site of clinical duties. Call rooms are available at each training site to accommodate residents for rest before travel. Residents should discuss such arrangements with the site coordinator or attending physician.
4.5 Residents who are called in for clinical duties after 6 pm and before 6 am, and feel unsafe to drive post call should opt to take a taxi for transportation. Reimbursement for taxi charges will be provided upon presentation of appropriate receipts.
4.6 Residents are not required to attend academic half day if they are greater than 50 km away from the academic half day location nor are they required to attend on post call days. Should residents feel well rested despite being post call, they are encouraged and welcome to attend academic sessions. If not attending due to post call, residents must inform the Program Assistant (Cindy Potter) of this reason for absence.
4.7 Residents must participate in required safety sessions including Workplace Hazardous Materials Information and Safety (WHMIS), Fire safety, and abide by the Safety codes of the designated area where s/he is training.
4.8 Residents must observe universal precautions and isolation procedures. If necessary, a refresher or literature will be provided on universal precaution procedures.
4.9 Residents should familiarize themselves with the occupational and safety office. This includes familiarity with policies and procedures in reporting contact with contaminated fluids, needles, TB exposure or risk, etc.
4.10 Residents should keep their immunizations and TB skin testing up to date. Overseas travel immunizations and advice should be organized well in advance when traveling abroad for electives or meetings. Since the residency training program does not mandate overseas electives, the resident is expected to coordinate and finance these services.
4.11 Residents should not assess violent or psychotic patients without the backup of security or a supervisor and also an awareness of accessible exits.
4.12 Residents should not work alone at after-hours clinics, make unaccompanied home visits, perform air transport, or arrange to meet patients after hours without on-site support. This does not apply if a patient is being seen in the emergency room or on a hospital ward. A supervisor must always be present if the resident is assessing a patient in an ambulatory setting after hours.
4.13 If the resident feels that his/her own personal safety is threatened, s/he should seek immediate assistance and remove themselves from the situation in a professional manner. The resident should be aware of the contact for security at participating training sites. The resident should ensure that their immediate supervisor and/or Program Director, has been notified, as appropriate. The resident can also bring their safety concerns to the attention of the PGME office (905 525 9140 Ext. 22118) during regular work hours, particularly if the Program Director is not available. If an issue arises after regular office hours, where the clinical supervisor and/or Program Director may not be available, contact Security of the institution where the trainee is based.
4.14 Residents doing home call and arriving after hours should be aware of their environment before leaving their car and have a cellphone available to contact security if it is deemed an escort is required. If residents feel potential threat to their safety, residents should not exit their cars and leave accordingly. In the rare event this occurs, residents should notify the clinical supervisors on call.
4.15 Residents must complete the Field Trips and Electives Planning and Approval process when planning to do an elective outside of North America to ensure compliance with standards and best practices for the safety of all trainees. International electives must occur in a stable political environment with a qualified preceptor to provide appropriate supervision. Additionally, there must be a Canadian Consulate in that country.
4.16 Residents must use caution with respect to confidential personal and patient information, and exercise good judgment and professional behavior when using social media.
4.17 If an injury occurs while working, the injury must be reported as follows:
- During daytime hours, while working at one of the Hamilton teaching hospitals, the trainee should go to the Employee Health Office at any of the teaching hospitals. An incident form will be provided by the Employee Health Office to the trainee. Trainees are encouraged to submit a copy of the incident form to the Program Director and the PGME Office for records.
- During after hours, while working at one of the Hamilton teaching hospitals or if working at a training site outside of the Hamilton area, the trainee should go to the nearest emergency room and identify themselves as a resident and request to be seen on an urgent basis. The trainee must complete, within 24 hours, an Injury / Incident Report available in the local emergency room. The form should be submitted to the hospital where the injury took place, the Program Director and the PGME office for record
4.18 Residents are encouraged to report incidents of intimidation, harassment and discrimination to the Program Director. Any incidents or issues brought forth to the Program Director will remain confidential and residents have the right to confidential psychological and counseling services.
4.19 Residents are encouraged to comment on the rotation evaluations professional issues encountered by staff and residents.
4.20 Residents must not be expected to participate in any situation that would go against their professional responsibilities, ethics, or moral beliefs.
4.21 Residents must have adequate contact with their clinical supervisors for help during critical incidents.
4.22 CMPA provides legal advice and insurance for residents who have acquired coverage.
5.1 It is the responsibility of the residency training program and the PGME to ensure that appropriate safety sessions are available to all trainees. In addition to WHMIS, the residency training program must ensure that there is an initial, specialty, site-specific orientation available to the trainee.
5.2 It is the responsibility of the residency training program to ensure that individual clinics or practice settings develop a site specific protocol in the event that personal safety is breached. The protocol should include the following:
- Identify potential risks to the trainee
- Include how the trainee would alert the supervisor if they felt at risk during an encounter, identification of potentially problematic patients at the beginning of the encounter, so they could be monitored.
- A supervisor or co-worker must be present:
- While the trainee is seeing a patient after hours in clinic. This would not apply if the patient is being seen in an emergency room.
- At the end of office hours if the trainee is still with patients.
5.3 It is the responsibility of the residency training program to ensure (via the site coordinators for each site) that each training site remains compliant with the program policy.
5.4 It is the responsibility of the residency training program to ensure a safe learning environment that is free from intimidation, harassment and discrimination. The residency training program will not tolerate such behaviors.
ON-CALL
The objective of resident involvement in the call process is to develop skills in the efficient assessment and triage of patients in the Emergency Room while under supervision by GI attending staff. As part of this training, GI residents participate in home call and assessment will sometimes occur over the phone by communicating with a junior resident rotating through the GI service. In situations of diagnostic or therapeutic uncertainty, patients may require direct assessment by the GI resident in person. The frequency of call is designed to provide optimal and adequate exposure to urgent clinical problems and endoscopic procedures. In both years of the program, the resident is on-call approximately one night per week and one in four weekends.
Attending staff on-call remains available for advice either by phone or in person. Attending staff needs to be informed of all patients who have been seen or assessed by the GI resident. The timing of this notification depends on the resident’s stage of training, and subject to the judgment of the resident. Graduated responsibility applies as the resident’s knowledge and skills mature. Routine and uncomplicated consultations can usually be discussed with staff early on the next working day. Attending staff should be informed in a timely fashion in the following circumstances:
Several things to note:
The travel allowance will be provided upon presentation of appropriate receipts and credit card statements
LEAVE
Vacation
The Postgraduate Medical Education Committee has drawn up guidelines relating to vacations in keeping with the terms of the PAIRO-CAHO Agreements:
New Year’s Day |
Thanksgiving Day |
Family Day |
Christmas Day |
Victoria Day |
Boxing Day |
Canada Day |
New Year’s Day |
August Civic Holiday |
Floating Holiday |
Labour Day |
Please refer to Medportal for the dates of each holiday |
If a resident works on a recognized holiday, s/he is entitled to a paid day off in lieu at a mutually convenient time within 90 days.
Professional Leave
Leave of Absence
Interruptions in training which require a leave of absence may be granted by the Postgraduate Dean on recommendation of the Program Director. In order to request a leave of absence from the program, the Resident should complete a Request for Leave of Absence Form that can be obtained from the PGME website. This form is then submitted to the Program Director for approval and then forwarded to the Postgraduate Medical Education Office. Additional information regarding maternity leave, parental leave, and sick leave entitlements are available through the Postgraduate Medical Education Office website.
It is understood that residents will return to a residency program following the leave of absence and that residents are expected to maintain a standard of conduct in keeping with the standards of the residency program, the university and the medical profession at large. It is anticipated that the required time lost or rotations missed must be made up with equivalent extra time in residency upon the residents return to the program. Normally all residents will be required to complete all mandatory / elective components of the program.
All leaves are reported to the College of Physicians and Surgeons of Ontario by the Postgraduate Medical Education office.
Medical Leave
Compassionate/Personal Leave
Maternity/Paternity Leave
OVERVIEW
Moonlighting is defined as residents registered in postgraduate medical education programs leading to certification with the Royal College of Physicians and Surgeons of Canada or the College of Family Physicians of Canada who provide clinical services for remuneration outside of the residency program. Moonlighting has been more recently called “restricted registration for residents”.
POLICES ON MOONLIGHTING
The Ontario Faculties of Medicine does not support resident moonlighting. Moonlighting compromises postgraduate programs and undermines the educational environment. McMaster Postgraduate Medical Education (PGME) supports this policy. It is recognized that McMaster PGME cannot restrict, from a practical point of view, those residents with an independent practice certificate from participating in this practice, but this activity must not interfere with the training program and the Program Director should be informed by the resident of this activity so that s/he can monitor its effect on the resident as well as the program.
It is recognized that there is a manpower problem within health care in Ontario but it is not under the mandate of McMaster PGME to solve this problem. The McMaster Postgraduate Medical Education Program wishes to maintain an environment in which there is:
The Royal College of Physicians and Surgeons of Canada neither condemns nor condones the practice of moonlighting during residency training. However, it does suggest that the following principles be considered if this practice does occur:
Restricted Registration
There is a process whereby residents are able to practice medicine with a certificate of Restricted Registration. “Restricted Registration” is a certificate offered by the College of Physicians and Surgeons of Ontario (CPSO) to Residents who meet agreed on criteria.
The Council of Ontario Faculties of Medicine have defined “Restricted Registration”, another term for Limited Licensure, as “Residents registered in postgraduate medical education programs leading to certification with the Royal College of Physicians and Surgeons of Canada or the College of Family Physicians of Canada who provide clinical services for remuneration outside of the residency program.”
Responsibilities of the Resident
The following criteria must be met before approval for participation in the Restricted Registration Program will be granted:
Restricted Registration activities cannot interfere with the educational requirements of the Program.Therefore, for each rotation in the preceding 12 months, there can be no provisional or unsatisfactory evaluations. Residents must at least “meet expectations” in all criteria and have at least 50% “exceeds expectations” in all criteria in all CanMEDS domains. Residents must also be in good standing overall in the Program. This includes satisfactory attendance at mandatory educational events and satisfactory progress with respect to their research projects. If the Resident does not maintain good academic standing or if the Restricted Registration activities negatively impact on his/her academic and/or clinical obligations in his/her residency program, the Program Director and Postgraduate Dean reserves the right to withdraw their approval for the Restricted Registration, and/or inform the College requesting that the Restricted Registration be terminated.
Failure to comply with the terms of the agreement (abiding by the Collective Agreement, obtaining necessary CMPA coverage, and working within the scope of the Restricted Registration) may constitute unprofessional conduct and may warrant further action by the CPSO under the Act or Rules.
For details, please refer to Restricted Registration Program for Ontario Medical Residents website.HSC-2F59
McMaster University Medical Centre
1200 Main St W
Hamilton, ON
L8N 3Z5
Monday to Friday
8:30am to 4:30pm
Phone: 905-521-2100 ext. 76782
Email: monizs4@mcmaster.ca
The Faculty of Health Sciences is committed to providing a website that is accessible to the widest possible audience. If there is an accessibility issue with this website, please contact us at fhsweb@mcmaster.ca.