Curriculum

LINES OF RESPONSIBLITIES


RESPONSIBILITY OF FACULTY
  • The faculty preceptor will be available to the fellow for mentoring during assigned laboratory and clinic times, and will assist the fellow in the treatment plan, selection of diagnostic test and prescribed treatment of patients seen by the fellow.
  • The faculty will supervise the fellow’s exposure to, and interpretation of tests.
  • After the fellow sees a patient, the clinic faculty preceptor will listen to the fellow’s presentation, giving feedback as appropriate, and will also discuss the case with the fellow, providing timely teaching as a treatment plan formulated.
  • The faculty will review the medical record for completion and dictations for new patients.
  • The faculty preceptors will focus on role-modeling appropriate patient interaction skills for the fellow during each laboratory and clinic session.
  • The faculty preceptors will role model professionalism.
RESPONSIBILITY OF FELLOW

Fellows are expected to be in attendance from 7:00 am until 6:00 pm daily, except for conferences and outpatient ambulatory clinic. All activities and notes will be reviewed and supervised by attending. Didactic lectures will be delivered weekly. Fellows are expected to attend weekly journal club and other scheduled conferences.

Fellows must complete duty hours log weekly and complete case logs in a timely manner.

CURRICULUM

FIRST YEAR FELLOW:


Inpatient service

As described in the NASPGHAN guidelines, the fellow should become competent in rendering age-appropriate inpatient care from evaluation to discharge of a broad range of gastrointestinal diseases, including intestinal mucosal diseases, motility disorders, Hepatobiliary diseases, pancreatic disorders and functional problems from mouth to anus. Furthermore, the fellow should become competent in the performance of diagnostic and therapeutic invasive procedures. The fellow should learn to evaluate and ameliorate the psychosocial impact of the disease, utilize available ancillary services and deliver cost efficient care.

The fellow will participate, with supervision of attending physicians, in all aspects of the care of patients of all ages hospitalized under the GI service at Children's Hospital. This care includes initial evaluation, formulation of differential diagnosis and evaluation, participation in diagnostic procedures, interpretation of laboratory, radiologic, pathologies and other testing, treatment and discharge planning. The fellow will perform daily duties as described in the Fellows Handbook. The fellow will also participate in teaching residents and students on rounds and at the bedside. The fellow will attend all teaching conferences.


Outpatient service

As described in the NASPGHAN guidelines, the fellow should become competent in rendering age-appropriate outpatient care from evaluation through long-term follow up or discharge from clinic as indicated for each disease process. The fellow should provide care to patients with a broad range of gastrointestinal diseases including intestinal mucosal diseases, motility disorders, Hepatobiliary diseases, pancreatic disorders and functional problems from mouth to anus. Additionally, the fellow should learn to evaluate and ameliorate the psychosocial impact of the disease, utilize available ancillary services and deliver cost efficient care.

The fellow will, with supervision of attending physicians, organize outpatient evaluation, diagnostic procedures and treatment, including hospital admissions as necessary. The fellow will perform history and examination, review of outside data and present cases to the attending physician as per the Fellows Handbook. The fellow will generate a clinic note and dictate a letter to the referring physician.


Consult service

The fellow should become proficient in the evaluation of primary and secondary gastrointestinal signs and symptoms in infants and children with non-GI disease. This includes primary GI diseases in those patients with extraintestinal presentations and secondary GI diseases in patients with known non-GI diseases. The fellow should be able to perform a complete history and examination and review any prior medical evaluation and testing. Formulations and recommendations must be reviewed by the supervising attending physician and then communicated to the referring team and placed in the patient record in a timely and respectful fashion. Objectives: The fellow will evaluate all patients as requested by any primary service at the Hospital. The fellow will present cases, write notes and communicate with the primary service as per the Fellows Handbook. The fellow will attend and make presentations in rotation at all teaching conferences.


Procedure service

The fellow should become increasingly proficient in the performance of various GI invasive procedures including patient assessment, sedation, procedural techniques and post procedure monitoring and management. The fellow will ultimately develop skills to become independent proficient in diagnostic procedures such as upper and lower endoscopy, rectal suction biopsy, liver biopsy and manometry. The fellow will gain experience in therapeutic procedures including esophageal dilation, Sclerotherapy, banding and polypectomy. Objectives: The fellow will review charts of scheduled outpatient procedures daily; will participate in the consent process, conscious sedation, the procedure, and post-procedure management, communication with patients and families and generation of reports.


SECOND YEAR FELLOW:


Research experience

Each fellow will undertake a specific project or projects under specific mentors in order to achieve the goal of significant participation in research. This is per the requirements of the American Board of Pediatrics for certification in Pediatric Gastroenterology, the NASPGHAN guidelines and our program goal to produce graduates who will become academic gastroenterologists. The division chief and program director will assist each fellow in the selection of an appropriate project and mentor.

The specific objectives of each project will vary greatly depending on the project selected and the mentor chosen. The long-term goal is for each fellow to submit at least one manuscript describing their research experience to a peer-reviewed journal for publication. The fellow will attend project specific conferences and the standard clinical GI conferences.


Outpatient / Inpatient service

As described in the NASPGHAN guidelines, the fellow should become competent in rendering age-appropriate outpatient care from evaluation through long-term follow up or discharge from clinic as indicated for each disease process. The fellow should provide care to patients with a broad range of gastrointestinal diseases including intestinal mucosal diseases, motility disorders, Hepatobiliary diseases, pancreatic disorders and functional problems from mouth to anus. Additionally, the fellow should learn to evaluate and ameliorate the psychosocial impact of the disease, utilize available ancillary services and deliver cost efficient care.

The fellow will, with supervision of attending physicians, organize outpatient evaluation, diagnostic procedures and treatment, including hospital admissions as necessary. The fellow will perform history and examination, review of outside data and present cases to the attending physician as per the Fellows Handbook. The fellow will generate a clinic note and dictate a letter to the referring physician.


Nutrition Elective
The nutrition elective is available to second and third year pediatric Gastroenterology fellows. It is a four week program divided between Children’s at Egleston and Emory Children’s Center.
  • Goals and objectives
  • Know how to assess nutritional status by anthropometrics, balance studies, body composition analysis and measurement of energy expenditure
  • Recognize the clinical and biochemical manifestations of nutrient deficiencies and nutrient excess
  • Understand that special nutritional needs of patients with inflammatory bowel disease (IBD), short bowel syndrome, cholestatic liver disease, end-stage liver disease, and renal disease, neoplasia and immunodeficiency states.
  • Become competent in nutritionally rehabilitating patients who are undernourished and competent in recognizing metabolic syndrome as well as other obesity related manifestations as well as implementing better-health programs.