Milestones & Evaluations
The Gastroenterology Fellowship firmly believes in transparency throughout their entire program – this includes the expectations for milestone achievements and evaluations performed during the Fellowship.
Milestones by Year
- Esophagogastroduodenoscopy - Minimum of 25 supervised studies
- Esophageal dilations - Minimum 5 supervised studies
- Colonoscopy with polypectomy - Minimum of 25 supervised colonoscopies and 5 supervised polypectomies
- Percutaneous endoscopic gastrostomy - Minimum of 3 supervised studies and completion of didactic training in complications and anatomy and physiology of replacement relative to time of placement
- Biopsy of the mucosa of the esophagus, stomach, small bowel and colon - Minimum 5 supervised studies any site
- Moderate sedation – Completion to competence
- Summary of evaluations showing adequate performance in each of the six core competencies
- Esophagogastroduodenoscopy - Minimum of 50 supervised studies
- Esophageal dilations - Minimum 10 supervised studies
- Colonoscopy with polypectomy - Minimum of 50 supervised colonoscopies and 10 supervised polypectomies
- Percutaneous endoscopic gastrostomy - Minimum of 5 supervised studies
- Biopsy of the mucosa of the esophagus, stomach, small bowel and colon - Minimum 5 supervised studies each site
- Other diagnostic and therapeutic procedures utilizing enteral intubation and bouginage - Minimum 5 supervised studies
- Non-variceal hemostasis - Minimum 5 supervised studies
- Variceal hemostasis - Minimum 5 supervised studies
- Summary of evaluations showing adequate performance in each of the six core competencies
- Esophagogastroduodenoscopy - Minimum number to be performed - 130 supervised studies and demonstrate competence
- Esophageal dilations - Minimum 50 supervised studies and demonstrate competence
- Colonoscopy with polypectomy - Minimum of 140 supervised colonoscopies and 30 supervised polypectomies studies and demonstrate competence
- Percutaneous endoscopic gastrostomy - Minimum of 10 supervised studies and demonstrate competence
- Biopsy of the mucosa of the esophagus, stomach, small bowel and colon - demonstrates competence
- Other diagnostic and therapeutic procedures utilizing enteral intubation and bouginage - demonstrate competence
- Gastrointestinal motility studies - minimum of 20 each of pH and esophageal motility studies and demonstrate competence
- Non-variceal hemostasis - Fellows will perform 25 supervised cases, including 10 active bleeders studies, and demonstrate competence
- Variceal hemostasis - 10 supervised cases, including 5 active bleeders studies and demonstrated competence
- Moderate sedation studies and demonstrate competence
- Small bowel capsule endoscopy studies and demonstrate competence
- Complete original research report in publishable form
- Summary of evaluations showing adequate performance in each of the six core competencies
Major Advancement Milestones
The major advancement milestones in the area of gastroenterology for the general internist in training are divided into three general areas: Inpatient Urgent, Routine Inpatient, and Outpatient. It is essential that all members of the team (including our fellows) be aware of these and that they also recognize they are a major part of the process.
By the end of the first year, the fellow will be able to rapidly assess and triage the inpatient presenting with symptom and sign complexes typical of common urgent diagnoses including but not limited to GI bleeding, cholangitis, appendicitis, perforation, bowel obstruction, SBP, etc. The learner will have the ability to perform a full abdominal exam to facilitate the evaluation of the patient. The needs for routine stabilization will be easily identified.
By the end of the second year, the fellow will be able to identify and prioritize the appropriate testing to guide initial therapy decisions for common urgent diagnoses, including but not limited to GI bleeding, cholangitis, appendicitis, perforation, bowel obstruction, SBP, etc. The learner will be able to initiation measures for routine stabilization and resuscitation.
By the end of the third year, the fellow will be able to initiate therapy for common and more unusual urgent diagnoses including but not limited to GI bleeding, cholangitis, appendicitis, perforation, bowel obstruction, SBP, IBD, ischemia, etc. After assessing and understanding the likelihood of response to standard medical therapy the fellow will be able to determine when subspecialty consultation is appropriate, thereby being able to fully practice independently.
By the end of the first year the fellow will be able to assess and triage the inpatient presenting with typical routine internal medicine symptoms and conditions related to the gastrointestinal tract, including but not limited to loose stools, nausea, vomiting, pain and, abnormal labs / x-rays etc. The learner will have the ability to perform a full abdominal exam to facilitate the evaluation of the patient. The learner will be facile in routine initiation of assessment, and directed therapy will be easily identified.
By the end of the second year the fellow will be able to synthesize and work through the differential diagnosis selecting appropriate testing and initial therapy for typical routine internal medicine symptoms and conditions related to the gastrointestinal tract including but not limited to loose stools, nausea, vomiting, pain and abnormal labs / x-rays etc. The learner will demonstrate the ability to integrate patient information from multiple internal and external sources. The learner will be able to work with the available systems to initiate disposition plans and will begin to apply these skills at all sites.
By the end of the third year the fellow will be able to independently chose therapy and testing for typical routine internal medicine symptoms and conditions related to the gastrointestinal tract including but not limited to loose stools, nausea, vomiting, pain, and abnormal labs / x-rays etc. in an academic, VA or community setting. After assessing and integrating all available data and understanding the likelihood of response to standard medical therapy the fellow will be able to determine when subspecialty consultation is appropriate based upon available skill sets at any level, thereby being able to fully practice independently.
By the end of the first year the fellow will be able to assess and triage the clinic patient presenting with typical routine internal medicine symptoms and conditions including such conditions as reflux, abnormal liver functions while understanding the standard preventative measures such as colorectal cancer screening and vaccinations. The learner will have the ability to perform a full abdominal exam to facilitate the evaluation of their patient. The learner will be facile in routine initiation of symptom-directed assessment and understand the pharmacology of typical gastrointestinal medications.
By the end of the second year the fellow will be able to synthesize and work through the differential diagnosis selecting appropriate testing and initial therapy for the clinic patient presenting with typical routine internal medicine symptoms and conditions including such conditions as reflux, abnormal liver functions while understanding the standard preventative measures such as colorectal cancer screening and vaccinations, enacting and making future follow up plans including subspecialty consultation The learner will demonstrate the ability to integrate patient information from multiple internal and external sources and determining the pharmacologic interactions of existing medications with planned gastroenterological therapeutics. The learner will also be able to work with the available systems to initiated disposition plans.
By the end of the third year the fellow will be able to independently choose therapy and testing for typical routine and more esoteric condition more complicated than conditions such as reflux, abnormal liver functions while understanding the standard preventative measures such as colorectal cancer screening and vaccinations. The learner will be able to integrate and coordinate the care of these conditions themselves as well as in interaction with other medical problems and therapeutics. After assessing and integrating all available data and understanding the likelihood of response to standard medical therapy using multiple sources (including when appropriate outside information) the graduating R3 will be able to follow through on and coordinate subspecialty consultation recommendations, thereby being able to fully practice independently, guiding and orchestrating their care so as to avoid polypharmacy, drug / drug interactions etc.
