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UNIVERSITY OF MANITOBA

OBJECTIVES OF THE GASTROENTEROLOGY SUBSPECIALTY RESIDENCY TRAINING PROGRAM

OVERALL GOALS AND OBJECTIVES OF THE PROGRAM

DEFINITON 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 includes pediatric and adult disciplines, each demonstrating differences in both cognitive and technical skills. There is overlap in some aspects of the two disciplines at the adolescent transition. GENERAL OBJECTIVES 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 general internal medicine 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. Research experience is regarded as an essential part of the program; preparation to be able to pursue an academic career is provided. If a fellow chooses not to pursue an academic career, the research experience is still considered essential for successful continuing self-education in academia or clinical practice. Please note that only candidates certificated by the Royal College of Physicians and Surgeons of Canada in Internal Medicine may be eligible for the Certificate of Special Competence in Gastroenterology.

GASTROENTEROLOGY COMPENTENCIES At the completion of training, the resident will have acquired the following competencies and will function effectively as a: 1. Medical Expert Definition: As Medical Experts, physicians integrate all of the CanMEDS Roles, applying medical knowledge, clinical skills, and professional attitudes in their provision of patient-centred care. Medical Expert is the central physician role in the CanMEDS framework. Description: Gastroenterologists possess a defined body of knowledge and procedural skills which are used to collect and interpret data, make appropriate clinical decisions, and carry out diagnostic and therapeutic procedures within the boundaries of their discipline and expertise. Their care is characterized by up-to-date, ethical, and cost-effective clinical practice and effective communication in partnership with patients, other health care providers, and the community. The role of medical expert is central to the function of specialist physicians, and draws on the competencies included in the roles of scholar, communicator, health advocate, manager, collaborator, and professional. Key Competencies (Medical Expert): Gastroenterologists are able to…

1.1 Function effectively as consultants, integrating all of the CanMEDS roles to provide optimal, ethical and patient-centered medical care

1.2 Establish and maintain clinical knowledge, skills and attitudes appropriate to

Gastroenterology 1.3 Perform a complete and appropriate assessment of patients with gastrointestinal,

hepatobiliary or pancreatic disorders 1.4 Use preventive and therapeutic interventions effectively in patients with

gastrointestinal disease 1.5 Demonstrate proficient and appropriate use of procedural skills, both diagnostic and

therapeutic for patients with gastrointestinal, hepatobiliary or pancreatic disorders 1.6 Seek appropriate consultation from other health professionals, recognizing the limits

of their expertise Enabling Competencies: Gastroenterologists are able to... 1.1 Function effectively as consultants, integrating all of the CanMEDS Roles to provide

optimal, ethical and patient-centered medical care

1.1.1 Effectively 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

C:\Documents and Settings\Administrator\Local Settings\Temporary Internet Files\OLK68\GI Fellowship Core Program Objectives Canmeds (ed by CB SD).doc CanMEDS 2005 Compliant as of January 2008 of 20

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1.1.2 Demonstrate effective use of all CanMEDS competencies relevant to their practice

1.1.3 Identify and appropriately respond to relevant ethical issues arising in patient care

1.1.4 Effectively and appropriately prioritize professional duties when faced with multiple

patients and problems

1.1.5 Demonstrate compassionate and patient-centered care

1.1.6 Recognize and respond to the ethical dimensions in medical decision-making

1.1.7 Demonstrate medical expertise in situations other than patient care, such as providing expert legal testimony or advising governments, as needed

1.2. Establish and maintain clinical knowledge, skills and attitudes appropriate to

Gastroenterology

1.2.1. Apply knowledge of the clinical, socio-behavioral, and fundamental biomedical sciences relevant to Gastroenterology Gastroenterology residents will demonstrate specific knowledge in the following relevant areas:

The anatomy, embryology, physiology and pathology of the digestive system including the pancreas and liver

The principles of biochemistry, molecular biology and genetics as they apply to the

digestive system The concepts of pharmacology including the principles of metabolism,

pharmacokinetics, pharmacodynamics and toxicity of drugs commonly used in Gastroenterology

The principles of endocrinology, intermediary metabolism and nutrition, oncology,

microbiology and psychiatry as they apply to the digestive system and its disorders The principles of gastrointestinal surgery including the indications for and the

complications of operations on the gastrointestinal tract The diseases affecting the digestive system, pancreas and liver including the

epidemiology, pathophysiology, methods of diagnosis, management and prognosis of such diseases


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The indications, interpretations, limitations, and complications of diagnostic procedures performed on the digestive tract

New advances in the management of gastrointestinal disorders (e.g. organ transplantation, therapeutic endoscopy)

The ability to select medically appropriate investigative tools in a cost-effective,

ethical and useful manner including: i. the selection and interpretation of imaging modalities (barium studies,

ultrasound, CT scan, MRI, radioisotope scan) for the digestive system, pancreas and liver

ii. the selection, performance, and interpretation of tests commonly

employed in gastrointestinal function laboratories (including breath tests and motility studies)

iii. the selection, performance and interpretation of tissue biopsies of the

gastrointestinal tract and liver iv. the selection, performance and interpretation of endoscopic procedures,

diagnostic and therapeutic, of the upper and lower gastrointestinal tract (including colonoscopy, upper endoscopy and sigmoidoscopy)

v. the appropriate use and care of equipment used in endoscopic

procedures vi. the appropriate use of the clinical database to formulate problems and

to correctly develop investigation and management plans to deal with the patient’s problem(s)

The ability to recognize, evaluate and manage gastrointestinal emergencies including

acute gastrointestinal hemorrhage, acute abdominal pain, fulminant colitis, ascending cholangitis and liver failure and to remove ingested foreign bodies from the gastrointestinal tract

The ability to demonstrate effective consultation skills in presenting well documented assessments and recommendations in written and/or verbal form including:

i. procedural reports and specialty test (motility) reports ii. allied health providers and third party request responses

The ability to demonstrate the attitudes and the skills necessary to retrieve and implement the information necessary to provide health care services to patients in meeting the needs and expectations of the community


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The ability to access, retrieve, assist and apply relevant information of all kinds to problem-solving and introduce new therapeutic options to clinical practice

The ability to demonstrate medical expertise in situations other than those involving

direct patient care (e.g. presentations, and medico-legal cases) The ability to demonstrate insight into his/her own limitations of expertise by self-

assessment

The ability to recognize both common pediatric problems and the common disorders affecting adolescents in transition (e.g. inflammatory bowel disease, celiac sprue, cystic fibrosis, functional abdominal pain, neonatal jaundice, viral hepatitis) and knowledge of the special technical aspects of pediatric endoscopy including special needs for sedation. Adult gastroenterology residents are not expected to possess the cognitive database of a resident in a pediatric program. Adult gastroenterology residents are not expected to be expert in pediatric endoscopy.

1.2.2 Describe the RCPSC framework of competencies relevant to Gastroenterology 1.2.3 Apply lifelong learning skills of the Scholar Role to implement a personal program to

keep up-to date, and enhance areas of professional competence in Gastroenterology 1.2.4 Contribute to the enhancement of quality care and patient safety in their practice,

integrating the available best evidence and best practices The Gastroenterology Resident must have in depth knowledge of current practice

guidelines as set out by the major GI societies (CAG, AGA, ASGE and ACG) Up to date knowledge through on-going literature reviews and personal learning

projects is expected 1.3. Perform a complete and appropriate assessment of a patient with gastrointestinal

disease

1.3.1 Effectively identify and explore issues to be addressed in a patient encounter, including the patient’s context and preferences 1.3.2 For the purposes of prevention and health promotion, diagnosis and or management, elicit a history that is relevant, concise and accurate to the patient’s context and preferences 1.3.3 For the purposes of prevention and health promotion, diagnosis and/or management, perform a focused physical examination that is relevant, accurate, sufficiently elaborate and appropriate with particular emphasis on areas specific to the digestive system and its disorders


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1.3.4 Select medically appropriate investigative methods in a resource-effective and ethical manner 1.3.5 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

1.4. Use preventive and therapeutic interventions effectively

1.4.1 Implement an effective management plan in collaboration with a patient and their family

1.4.2 Demonstrate effective, appropriate, and timely application of preventive and

therapeutic interventions relevant to the practice of Gastroenterology 1.4.3 Ensure appropriate informed consent is obtained for therapies 1.4.4 Ensure patients receive appropriate end-of-life care

1.5 Demonstrate proficient and appropriate use of procedural skills, both diagnostic and

therapeutic. All residents will demonstrate the following clinical and technical skills: 1.5.1 The selection, performance and interpretation of diagnostic endoscopic procedures, of the upper and lower gastrointestinal tract (including colonoscopy, flexible sigmoidoscopy

and upper endoscopy [i.e. gastroscopy, push enteroscopy]) 1.5.2 The selection and performance of therapeutic endoscopy including: cautery, injection,

argon plasma coagulation, polypectomy and balloon dilation 1.5.3 The selection, performance and interpretation of tissue biopsies of the

gastrointestinal tract through endoscopy and the liver through percutaneous liver biopsy

1.5.4 The selection and performance of percutaneous endoscopic gastrostomy 1.5.5 The selection and performance of capsule endoscopy 1.5.6 The selection and general interpretation of Endoscopic ultrasound (including fine

needle aspiration) and Endoscopic retrograde cholangiopancreatography (including sphincterotomy)

1.5.7 The indications, interpretations, limitations, and complications of diagnostic and

therapeutic procedures performed on the digestive tract 1.5.8 The hazards of endoscopic procedures for the operator and assistants and the

measures appropriate to minimize such hazards


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1.5.9 The principles of fluoroscopy used during endoscopic procedures including the safe

use of X-rays for both patient and operator 1.5.10 The appropriate use and care of equipment used in endoscopic procedures 1.5.11 Ensure appropriate informed consent is obtained for all endoscopic procedures 1.5.12 Appropriately document and disseminate information related to procedures

performed and their outcomes o the ability to demonstrate effective consultation skills in presenting well

documented assessments and recommendations in written and/or verbal form including:

i. procedural reports and specialty test (motility) reports ii. allied health providers and third party request responses

1.5.13 Ensure adequate follow-up is arranged for procedures performed

1.6. Seek appropriate consultation from other health professionals, recognizing the limits of their expertise 1.6.1 Demonstrate insight into their own limitations of expertise via self-assessment

Demonstrate effective, appropriate, and timely consultation of another health professional as needed for optimal patient care pertinent to the care of patients with gastrointestinal disease. Common examples include: Surgery, Oncology, Physical medicine, Clinical Psychology/Psychiatry, Dietician

Arrange appropriate follow-up care services for a patients and their family 2. COMMUNICATOR Definition: As Communicators, Gastroenterologists effectively facilitate the doctor-patient relationship and the dynamic exchanges that occur before, during, and after the medical encounter. Description: Patients with gastroenterological disorders commonly benefit from collaborative care by general surgeons, social workers, dietitians, psychologists, and addiction specialists. To provide humane, high-quality care, specialists in gastroenterology establish effective relationships with patients, other physicians, and other health professionals. Communication skills are essential for the functioning of a specialist, and are necessary for obtaining information from, and conveying information to


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patients, their families and other health care personnel. Furthermore, these abilities are critical in eliciting patients’ beliefs, concerns, and expectations about their illnesses, and for assessing key factors impacting on patients’ health. Key Competencies: Gastroenterologists are able to… 2.1 Develop rapport, trust and ethical therapeutic relationships with patients and families 2.2 Accurately elicit and synthesize relevant information and perspectives of patients and families, colleagues and other professionals 2.3 Accurately convey relevant information and explanations to patients and families, colleagues and other professionals 2.4 Develop a common understanding on issues, problems and plans with patients and families, colleagues and other professionals to develop a shared plan of care 2.5 Convey effective oral and written information about a medical encounter. Enabling Competencies: Gastroenterologists are able to... 2.1 Develop rapport, trust, and ethical therapeutic relationships with patients and families 2.1.1 Recognize that being a good communicator is a core clinical skill for physicians, and that effective physician-patient communication can foster patient satisfaction, physician satisfaction, adherence and improved clinical outcomes 2.1.2 Establish positive therapeutic relationships with patients and their families that are characterized by understanding, trust, respect, honesty, empathy and confidentiality 2.1.3 Respect patient confidentiality, privacy and autonomy 2.1.4 Listen effectively 2.1.5 Be aware and responsive to nonverbal cues 2.1.6 Effectively facilitate a structured clinical encounter 2.2 Accurately elicit and synthesize relevant information and perspectives of patients and

families, colleagues, and other professionals 2.2.1 Gather information not only about the disease but also about the patient's beliefs, concerns and expectations about the illness, while considering the influence of factors such as the patient's age, gender, ethnic, cultural and socioeconomic background, and spiritual values on


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that illness. 2.2.2 Seek out and synthesize relevant information from other sources, such as a patient’s family, caregivers and other professionals 2.3 Accurately convey relevant information and explanations to patients and families,

colleagues and other professionals 2.3.1 Deliver information to the patient, family and other interested caregivers in a humane manner and in such a way that it is understandable, encourages discussion and promotes the patient’s participation in decision-making to the degree that they wish. 2.4 Develop a common understanding on issues, problems and plans with patients,

families, and other professionals to develop a shared plan of care 2.4.1 Effectively identify and explore problems to be addressed from a patient encounter, including the patient’s context, responses, concerns, and preferences 2.4.2 Respect diversity and difference, including but not limited to the impact of gender, religion and cultural beliefs on decision-making 2.4.3 Encourage discussion, questions, and interaction in the encounter 2.4.4 Engage patients, families, and relevant health professionals in shared decision-making to develop a plan of care

Gastroenterologists will understand and demonstrate the importance of cooperation and communication among health professionals involved in the care of individual patients (in particular, general surgeons, radiologists, pathologists and clinical dietitians) such that the roles of these professionals are delineated and consistent messages are delivered to patients and their families.

2.4.5 Demonstrate skills in working with others who present significant communication challenges such as anger or confusion, obtaining an informed consent, delivering bad news or an ethno-cultural background different from the physician's own. 2.5 Convey effective oral and written information about a medical encounter 2.5.1. Produce concise and informative referral letters to referring physicians in regards to patient encounters. 2.5.2 Maintain clear, accurate, and appropriate records (e.g., written or electronic) of clinical encounters and plans


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2.5.3 Effectively present verbal reports of clinical encounters and plans 2.5.4 Effectively provide information to the general public and media about areas of local concern in the discipline 3. COLLABORATOR Definition: As Collaborators, Gastroenterologists effectively work within a healthcare team to achieve optimal patient care. Description: Gastroenterologists work in partnership with others who are appropriately involved in the care of individuals or specific groups of patients. It is therefore essential for specialists to be able to collaborate effectively with patients and a multidisciplinary team of expert health professionals for provision of optimal patient care, education, and research. Members of the healthcare team that commonly collaborate with Gastroenterologists include general surgeons, radiologists, pathologists, dietitians, social workers and addiction experts. Key Competencies: Gastroenterologists are able to… 3.1 Participate effectively and appropriately in an inter-professional healthcare team 3.2 Effectively work with other health professionals to prevent, negotiate, and resolve inter-professional conflict. Enabling Competencies: Gastroenterologists are able to... 3.1 Participate effectively and appropriately in an inter-professional healthcare team 3.1.1 Clearly describe their roles and responsibilities to other professionals 3.1.2 Describe the roles and responsibilities of other professionals within the health care team 3.1.3 Recognize and respect the diversity of roles, responsibilities and competences of other professionals while contributing expertise in the field of Gastroenterology 3.1.4 Develop a care plan for a patient (or groups of patients), including investigation, treatment and continuing care, in collaboration with the members of the interdisciplinary team. 3.1.5 Where appropriate, work with others to assess, plan, provide and review other tasks, such as research problems, educational work, program review or administrative responsibilities 3.1.6 Participate effectively in inter-professional team meetings 3.1.7 Enter into interdependent relationships with other professions for the provision of quality care 3.1.8 Describe the principles of team dynamics


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3.1.9 Respect team ethics, including confidentiality, resource allocation and professionalism 3.1.10 Where appropriate, demonstrate leadership in a healthcare team 3.2 Effectively work with other health professionals to prevent, negotiate, and resolve

Inter-professional conflict 3.2.1 Demonstrate a respectful attitude towards other colleagues and members of an inter-professional team 3.2.2 Work with other professionals to prevent conflicts 3.2.3 Employ collaborative negotiation to resolve conflicts 3.2.4 Respect differences, misunderstandings and limitations in other professionals 3.2.5 Recognize one’s own differences, misunderstanding and limitations that may contribute to Inter-professional tension 3.2.6 Reflect on inter-professional team function 4. MANAGER Definition: As Managers, Gastroenterologists are integral participants in healthcare organizations, organizing sustainable practices, making decisions about allocating resources, and contributing to the effectiveness of the healthcare system. Description: Gastroenterologists function as managers when they make everyday practice decisions involving resources, co-workers, tasks, policies, and their personal lives. They do this in the settings of individual patient care, practice organizations, and in the broader context of the health care system. Thus, specialists require the abilities to prioritize and effectively execute tasks through teamwork with colleagues, and make systematic decisions when allocating finite health care resources. As managers, specialists take on positions of leadership within the context of professional organizations and the dynamic Canadian health care system. Key Competencies: Gastroenterologists are able to… 4.1 Participate in activities that contribute to the effectiveness of their healthcare organizations and systems 4.2 Manage their practice and career effectively 4.3 Allocate finite healthcare resources appropriately 4.4 Serve in administration and leadership roles, as appropriate


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Enabling Competencies: Gastroenterologists are able to... 4.1 Participate in activities that contribute to the effectiveness of their healthcare

organizations and systems 4.1.1 Work collaboratively with others in their health care organizations, ranging from an individual clinical practice to organizations at the local, regional and national level. 4.1.2 Participate in systemic quality process evaluation and improvement, such as patient safety initiatives 4.1.3 Describe the structure and function of the healthcare system as it relates to Gastroenterology, including the roles of physicians 4.1.4 Describe principles of healthcare financing, including physician remuneration, budgeting and organizational funding 4.2 Manage their practice and career effectively 4.2.1 Set priorities and manage time to balance patient care, practice requirements, outside activities and personal life 4.2.2 Manage a practice including finances and human resources.

Gastroenterologists should be able to manage the operational aspects of an endoscopy facility and be able to participate in the planning, budgeting and evaluation of efficient endoscopy services for communities.

4.2.3 Implement processes to ensure personal practice improvement 4.2.4 Employ information technology appropriately to the care of patients in ambulatory care, hospitals and other health care settings. 4.3 Allocate finite healthcare resources appropriately 4.3.1 Recognize the importance of just allocation of healthcare resources, balancing effectiveness, efficiency and access with optimal patient care

Gastroenterologists should make clinical decisions and judgments based on sound evidence for the benefit of individual patients and the population served. This allows for an advocacy role primarily for the individual but in the context of societal needs when monitoring and allocating needed resources.

4.3.2 Apply evidence and management processes for cost-appropriate care 4.4 Serve in administration and leadership roles, as appropriate


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4.4.1 Chair or participate effectively in committees and meetings 4.4.2 Understand the general nature of the Canadian health system and its facilities, function effectively within it and be capable of playing an active role in its change. 4.4.3 Plan relevant elements of health care delivery (e.g., work schedules) 5. HEALTH ADVOCATE Definition: As Health Advocates, Gastroenterologists responsibly use their expertise and influence to advance the health and well-being of individual patients, communities, and populations. Description: Gastroenterologists recognize the importance of advocacy activities in responding to the challenges represented by those social, environmental, and biological factors that determine the health of patients and society. They recognize advocacy as an essential and fundamental component of health promotion that occurs at the level of the individual patient, the practice population, and the broader community. Health advocacy is appropriately expressed both by the individual and collective responses of specialist physicians in influencing public health and policy. Key Competencies: Gastroenterologists are able to… 5.1 Respond to individual patient health needs and issues as part of patient care 5.2 Respond to the health needs of the communities that they serve 5.3 Identify the determinants of health of the populations that they serve 5.4 Promote the health of individual patients, communities and populations Enabling Competencies: Gastroenterologists are able to... 5.1 Respond to individual patient health needs and issues as part of patient care 5.1.1 Identify the health needs of an individual patient 5.1.2 Identify opportunities for advocacy, health promotion and disease prevention with individuals to whom they provide care 5.2 Respond to the health needs of the communities that they serve 5.2.1 Describe the practice communities that they serve


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5.2.2 Identify opportunities for advocacy, health promotion and disease prevention in the communities that they serve, and respond appropriately 5.2.3 Appreciate the possibility of competing interests between the communities served and other populations 5.3 Identify the determinants of health for the populations that they serve 5.3.1 Identify the determinants of health of the populations, including barriers to access to care and Resources

Gastroenterologists should be able to identify important determinants of health (i.e., poverty, unemployment, early childhood education, social support systems), being familiar with the underlying research evidence, and applying this understanding to common problems and conditions in the specialty (e.g. alcoholism and alcohol mediated organ pathology)

5.3.2 Identify vulnerable or marginalized populations within those served and respond appropriately 5.4 Promote the health of individual patients, communities, and populations 5.4.1 Describe an approach to implementing a change in a determinant of health of the populations they serve 5.4.2. Describe how public policy impacts on the health of the populations served

Gastroenterologists should be able to describe how public policy is developed and modified, identifying current policies that affect health, either positively or negatively (i.e., immunization for viral hepatitis, anti-tobacco legislation, alcohol, substance abuse programs, inmate health care).

5.4.3 Identify points of influence in the healthcare system and its structure 5.4.4 Describe the ethical and professional issues inherent in health advocacy, including altruism, social justice, autonomy, integrity and idealism 5.4.5 Appreciate the possibility of conflict inherent in their role as a health advocate for a patient or community with that of manager or gatekeeper 5.4.6 Describe the role of the Gastroenterologist in advocating collectively for health and patient safety as illustrated below in 3 different levels of patient populations

In the management of individual patients by identifying the patient's status with respect to one or more of the determinants of health (i.e., unemployment); adapting the assessment and management accordingly (i.e., the medical history to the


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patient's social circumstances); and assessing the patient's ability to access various services in the health and social system.

In the analysis of a specialist's practice population work with specialty societies and

other associations in identifying current "at risk" groups within a given specialty practice (e.g. candidates for HBV vaccine, HCV screening in inmates) and applying the available knowledge about prevention to "at risk" groups within the practice; and contributing "group data" for better understanding of health problems within the population.

In relation to the general population by describing, in broad terms, the key issues

currently under debate regarding changes in the Canadian health care system (e.g. colon cancer, hemochromatosis screening programs) and immunization programs (viral hepatitis) indicating how these changes might affect societal health outcomes and advocating to decrease the burden of illness (at a community or societal level) of a condition or problem relevant to his/her specialty through a relevant specialty society, community-based advocacy group, other public education bodies, or private organizations.

6. SCHOLAR Definition: As Scholars, Gastroenterologists demonstrate a lifelong commitment to reflective learning, as well as the creation, dissemination, application and translation of medical knowledge. Description: Gastroenterologists engage in a lifelong pursuit of mastery of their domain of professional expertise. They recognize the need to be continually learning and model this for others. Through their scholarly activities, they contribute to the appraisal, collection, and understanding of health care knowledge, and facilitate the education of their students, patients, and others. Key Competencies: Gastroenterologists are able to… 6.1 Maintain and enhance professional activities through ongoing learning 6.2 Critically evaluate information and its sources, and apply this appropriately to practice decisions 6.3 Facilitate the learning by patients, families, students, residents, other health professionals, the public, and others, as appropriate 6.4 Contribute to the creation, dissemination, application, and translation of new medical knowledge and practices Enabling Competencies: Gastroenterologists are able to... 6.1 Maintain and enhance professional activities through ongoing learning


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Gastroenterologists need to recognize the importance of self-assessment and of continuing medical education in gastroenterology and demonstrate a willingness to teach others including students, trainees from other disciplines and allied health care personnel

6.1.1 Describe the principles of maintenance of competence 6.1.2 Demonstrate an understanding of, and the ability to apply, the principles of adult learning, with respect to oneself and others 6.1.3 Demonstrate an understanding of preferred learning methods in dealing with students, residents, and colleagues 6.1.4 Demonstrate an understanding and appreciation of the role and significance of research in the advancement of knowledge 6.1.5 Recognize and reflect on learning issues in practice 6.1.6 Conduct a personal practice audit 6.1.7 Pose an appropriate learning question 6.1.8 Access and interpret the relevant evidence 6.1.9 Demonstrate knowledge of new advances in the management of gastrointestinal disorders (e.g. organ transplantation, therapeutic endoscopy). 6.1.10 Integrate new learning into practice 6.1.11 Evaluate the impact of any change in practice 6.1.12 Document the learning process 6.2 Critically evaluate medical information and its sources, and apply this appropriately

to practice decisions 6.2.1 Describe the principles of critical appraisal 6.2.2 Critically appraise retrieved evidence in order to address a clinical question 6.2.3 Integrate critical appraisal conclusions into clinical care Gastroenterologists should be able to appraise and evaluate scientific and clinical publications in the field of Gastroenterology. Pertaining to clinical practice, one should be able to:

Pose a clinical question Recognize and identify gaps in knowledge and expertise around the clinical question


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Formulate a plan to fill the gap: o conduct an appropriate literature search based on the clinical question o assimilate and appraise the literature o develop a system to store and retrieve relevant literature o consult others (physicians and other health professionals) in a collegial

manner Propose a solution to the clinical question Implement the solution in practice Evaluate the outcome and reassess the solution Identify practice areas for research.

Interpretation of the medical literature:

Gastroenterologists should be able to: 6.2.4 Be able to perform a review of the medical literature to assist with management of a clinical

scenario, and to synthesize the knowledge obtained into a cogent and balanced presentation

6.2.5 Be aware of the benefits and drawbacks of various clinical research methodologies, including:

- randomized controlled trials - evaluation of diagnostic tools - cohort analyses - case-control studies - nested case-control studies - systematic reviews and meta-analyses - decision analysis

6.2.6 In presentation of Clinical Rounds, the fellow is expected to present a review of a clinical question in a presentation of approximately one hour’s duration at Rounds approximately 8 to 12 times over the course of the fellowship. These rounds take place on the 2nd and 4th Thursday of each month between September and June, exclusive of holidays. At these rounds, the fellow will be responsible for choosing a topic of clinical interest, often based on questions arising from a case seen in clinical practice. The fellow will be responsible for performing a review of the medical literature surrounding the specific clinical question, and synthesizing the collected information into a one-hour presentation. The fellow will review the presentation with a faculty member prior to its presentation. During the presentation, the fellow will also be responsible for answering questions presented by the viewing audience in a cogent manner 6.2.7 In the presentation of Research Methodology Journal Club, fellows are expected to attend and participate in research methodology rounds, which take place on the 2nd Tuesday of each month.


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At each session, two fellows will be assigned a recently published article. The fellow will be responsible for summarizing the article, presenting its strengths and weaknesses, identifying areas of faulty methodology leading to confounding, determining the validity of the stated results, and deciding on its applicability to clinical practice. The fellow’s presentation is expected to be informal, without the use of presentation aids such as Powerpoint. FACULTY MEMBERS’ ROLE a) Faculty are expected to attend both Clinical Rounds and Research Methodology Rounds, when

feasible b) Faculty are expected to be available to fellows to assist with the fellow presentations for Clinical

rounds, particularly in their areas of expertise. c) Faculty are expected to provide feedback on the style and content of fellows’ presentations at

these rounds. 6.3 Facilitate the learning by patients, families, students, residents, other health

professionals, the public and others, as appropriate 6.3.1 Describe principles of learning relevant to medical education 6.3.2 Collaboratively identify the learning needs and desired learning outcomes of others 6.3.3 Select effective teaching strategies and content to facilitate others’ learning 6.3.4. Demonstrate an effective lecture or presentation 6.3.5 Assess and reflect on a teaching encounter 6.3.6 Provide effective feedback 6.3.7 Describe the principles of ethics with respect to teaching 6.4 Contribute to the development, dissemination, and translation of new knowledge and

practices 6.4.1 Describe the principles of research and scholarly inquiry 6.4.2 Describe the principles of research ethics 6.4.3 Pose a scholarly/ research question (clinical, basic or population health) 6.4.4 Conduct a systematic search for evidence

Including the ability to consult and collaborate with appropriate content experts to conduct the research


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6.4.5 Select and apply appropriate methods to address the question 6.4.6 Appropriately defend and disseminate the findings of a study 6.4.7 Identify areas for further research that flow from the result


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7. PROFESSIONAL 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 behavior. Gastroenterologists have a unique societal role as professionals with a distinct body of knowledge, skills, and attitudes dedicated to improving the health and well being of others. They are committed to the highest standards of excellence in clinical care and ethical conduct, and to continually perfecting mastery of their discipline. Key Competencies: Gastroenterologists are able to… 7.1 Demonstrate a commitment to their patients, profession, and society through ethical practice 7.2 Demonstrate a commitment to their patients, profession, and society through participation in profession led regulation 7.3 Demonstrate a commitment to physician health and sustainable practice Enabling Competencies: Gastroenterologists are able to... 7.1 Demonstrate a commitment to their patients, profession, and society through ethical practice 7.1.1 Exhibit appropriate professional behaviors in practice, including: honesty, integrity, commitment, compassion, respect and altruism 7.1.2 Demonstrate a commitment to delivering the highest quality care and maintenance of competence 7.1.3 Continually evaluate one’s abilities, knowledge and skills and the personal limitations of professional competence 7.1.4 Adopt specific strategies to heighten personal and professional awareness and explore and resolve interpersonal difficulties in professional relationships 7.1.5.Recognize the roles, in clinical practice, of ethical issues such as truth-telling, consent, advanced directives, confidentiality, end-of-life care, conflict of interest, resource allocation, and research ethics. 7.1.6 Appropriately manage conflicts of interest 7.1.7 Recognize the principles and limits of patient confidentiality as defined by professional practice standards and the law 7.1.8 Maintain appropriate relations with patients.


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7.2 Demonstrate a commitment to their patients, profession and society through

participation in profession-led regulation 7.2.1 Appreciate the professional, legal and ethical codes of practice 7.2.2 Fulfill the regulatory and legal obligations required of current practice 7.2.3 Demonstrate accountability to professional regulatory bodies 7.2.4 Recognize and adopt a practical approach to deal with others’ unprofessional behaviors in clinical practice, taking into account local and provincial regulations practice 7.2.5 Be able to apply relevant legislation that relates to the health care system in order to guide personal clinical practice 7.2.6 Participate in peer review 7.3 Demonstrate a commitment to physician health and sustainable practice 7.3.1 Demonstrate equipoise in balancing personal and professional roles and responsibilities and effective conflict/stress resolution capabilities to ensure personal health and a sustainable practice 7.3.2 Strive to heighten personal and professional awareness and insight 7.3.3 Recognize other professionals in need and respond appropriately