Pediatric Gastroenterology Fellowship Pediatric Nutrition Rotation Goals and Objectives - 1 st Year

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1 Pediatric Nutrition Rotation Goals and Objectives - 1 st Year Goal 1: Gain experience and competency in managing common and rare gastrointestinal, liver and nutritional problems. (Competencies: patient care, medical knowledge, practice-based learning improvement, professionalism) Objectives: At the end of the clinical rotation, the fellow should be able to a. Recognize the general aspects of nutrition and nutritional status assessments b. Recognize the clinical manifestations of vitamin and mineral disorders in the infant/child c. Recognize and manage disease specific nutrition in the infant/child with short bowel syndrome, allergic bowel disorders (eg. milk and soy enterocolitis, eosinophilic esophagitis), celiac disease, pancreatic disorders, hyperlipidemia, Crohn s disease, and cystic fibrosis. d. Recognize and manage nutritional disorders including failure to thrive, obesity, short bowel syndrome. e. Recognize and manage hepatobiliary, metabolic and catheter complications of parenteral nutritional therapy f. Recognize the basic concepts of enteral and parenteral nutrition Goal 2: Gain experience and competency in diagnostic and therapeutic procedures (Competencies: patient care, medical knowledge, practice-based learning, professionalism) Objectives: At the end of the clinical rotation, the fellow should be able to: a. Assess the role for laboratory, radiographic and endoscopic tests in the diagnosis and monitoring of growth, nutritional disorders and bone mineral density. b. Assess the indications and management and care of enteral feeding tubes (nasogastric, gastrostomy, jejunostomy) Goal 3: Interact effectively with primary care physicians and other health care providers (Competencies: patient care, medical knowledge, interpersonal and communication skills practice-based learning) Objectives: At the end of the clinical rotation, the fellow should be able to: a. Recognize the appropriate time and urgency to see patients referred for consultation. b. Communicate management plan to Nutrition support team and have a multidisciplinary approach for complicated patients. 1

2 Goal 4: Recognize resources available for the care of patients with GI, liver and nutritional disorders. (Competencies: practice-based learning, systems-based practice, interpersonal and communication skills) Objectives: At the end of the elective the fellow should be able to: a. Look up literature and practice evidence-based medicine. b. Coordinate care with homecare companies. c. Demonstrate knowledge of the cost-effectiveness of diagnostic and management approaches for children with gastrointestinal disorders. d. Demonstrate knowledge of health care structure including health insurance systems. e. Feel comfortable with triaging patients over the phone on call Competency-Based Rotation Specific Goals and Objectives Inpatient rotation a) Patient Care: Provide patient care that is appropriate and effective for the treatment of hospitalized children with gastrointestinal and liver disorders. Obtain complete and accurate physical exam and history Accurately assess nature, acuity and severity of the clinical problem Devise detailed plan of care for each patient Follow up and interpret all laboratory data Ensure that plan of care is followed through b) Medical Knowledge: Demonstrate knowledge of established and evolving biomedical, clinical and epidemiological sciences of gastrointestinal disorders, as well as the application of this knowledge to patient care Demonstrate knowledge of the pathophysiology of gastrointestinal and nutritional disorders, including common disease processes seen in inpatients such as inflammatory bowel disease, pancreatitis, liver dysfunction, malnutrition. c) Practice- based learning and improvement: Demonstrate the ability to investigate and evaluate the care of patients, to appraise and assimilate scientific evidence and to continuously improve patient care based on constant self-evaluation and life-long learning. Explain clinical decisions in the context of evidence-based medicine Demonstrate knowledge of research that has been performed into patient care, diagnosis and pathophysiology Develop proficiency in the use of on-line information resources, courses, national and regional organization websites pertaining to Pediatric Gastroenterology Interact with faculty and colleagues to discuss regular evaluations and incorporate feedback into promoting professional growth and practice improvement 2

3 d) Interpersonal and communication skills: Demonstrate interpersonal and communication skills that result in the effective exchange of information with patients, their families and other health professionals. Assess resident s understanding of patient plan of care and ensure that they follow through on care Write legible, comprehensive consult and progress notes on all consults and inpatients Outline plan of care on daily rounds Teach residents about the pathophysiology of patient s diseases during rounds Communicate daily with patients and their families in a way that they understand about their sickness and treatment e) Professionalism: Demonstrate competence to carry out professional responsibilities and develop an adherence to ethical principles. Demonstrate compassion integrity and respect for both patients and other health professionals Complete all consults, medical records and patient care activities before leaving the hospital Demonstrate respect for patient privacy and autonomy Demonstrate sensitivity and responsiveness to patients and their families from diverse backgrounds f) System-based practice: Demonstrate an awareness of and responsiveness to the larger system of health care. Demonstrate efficient use of ancillary personnel such as social workers, nurses, nutritionists, and home health care agencies to provide optimal health care Participate actively and lead multidisciplinary rounds Devise discharge plans with care coordinator Work with home health care company to provide complex care such as tube feeding or intravenous antibiotics at home for the patients Advocate for patients with insurance companies to cover the cost of healthcare Outpatient clinics a) Patient Care: Provide patient care that is appropriate and effective for the outpatient treatment of children with gastrointestinal disorders Obtain an accurate history and physical exam Interpret accurately lab data such as blood testing, stool testing, hydrogen breath tests Provide a comprehensive assessment of the medical issues that must be addressed for each patient Devise a comprehensive treatment plan for each patient Follow up on all laboratory data Contact patients to inform them of new laboratory data or changes in treatment plan 3

4 b) Medical Knowledge: Demonstrate knowledge of established and evolving biomedical, clinical and epidemiological sciences of gastrointestinal disorders, as well as the application of this knowledge to patient care Demonstrate knowledge of the pathophysiology and treatment of gastrointestinal and nutritional disorders, including common disease processes such as gastroesophageal reflux, constipation, abdominal pain, inflammatory bowel disease, failure to thrive, short gut syndrome, and liver dysfunction. c) Practice- based learning and improvement: Demonstrate the ability to investigate and evaluate the care of patients, to appraise and assimilate scientific evidence and to continuously improve patient care based on constant self-evaluation and life-long learning. Explain clinical decisions in the context of evidence-based medicine Demonstrate that research has been performed on an ongoing basis into patient care, diagnosis and pathophysiology Develop proficiency in the use of on-line information resources, courses, national and regional organization websites pertaining to Pediatric Gastroenterology Interact with faculty and colleagues to discuss regular evaluations and incorporate feedback into promoting professional growth and practice improvement d) Interpersonal and communication skills: Demonstrate interpersonal and communication skills that result in the effective exchange of information with patients, their families and other health professionals. Write legible, comprehensive, timely clinic notes and letters to the referring physician Explain plan of care to patients and their families in a concise, understandable manner using appropriate lay language Present each patient to the attending in an clear, concise, and organized manner Obtain informed consent for endoscopy procedures after explanation of risks and benefits e) Professionalism: Demonstrate competence to carry out professional responsibilities and develop an adherence to ethical principles. Demonstrate compassion integrity and respect for both patients and other health professionals Complete all clinic letter consults, medical records and patient care activities before leaving the hospital Demonstrate respect for patient privacy and autonomy Demonstrate sensitivity and responsiveness to patients and their families from diverse backgrounds f) System-based practice: Demonstrate an awareness of and responsiveness to the larger system of health care Demonstrate the efficient use of ancillary personnel such as social workers, nurses, nutritionists, and home health care agencies to provide optimal health care Work with home health care company to provide complex care such as tube feeding or intravenous antibiotics at home for the patients Devise plans of care in conjunction with the dietician and nurses to ensure that patient s health care needs are met 4

5 Assess policies of different health insurance companies and be a patient advocate 5

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