Curriculum

INTRODUCTION:
Gastroenterology requires increasingly complex decision making; mastery of a growing number of endoscopic techniques, both diagnostic and therapeutic; an understanding of the sensitivity, specificity, risk-benefit, and cost-benefit of a broad array of diagnostic techniques and therapeutic options; and knowledge of the increasingly complex science that underlies gastroenterological practice. 

The Albany Medical College Gastroenterology Subspecialty Training Program seeks to provide the highest standard of training which will allow the SSR to acquire the knowledge and skills at the completion of the fellowship training to demonstrate and execute expertise as a consultant in the subspecialty of Gastroenterology. The program and the specific training process to achieve this goal is defined and organized as outlined in the following curriculum. The curriculum requires a minimum of 3 years of training. The core curriculum requires a minimum of 18 months of clinical training in traditional inpatient and outpatient consultation as well as conference and didactic sessions. Central to training in gastroenterology the guidelines for endoscopic competency are structured on the accepted ASGE recommendations. An additional substantial period of time is allotted to acquire specialized training (electives) in focused areas such as nutrition, inflammatory bowel disease, motility and therapeutic endoscopy. 

Approximately 30% of this training experience consists of clinical training in hepatic diseases. An outpatient  continuity experience is required for the full 3 years of training. The curriculum strongly encourages independent scholarly activity and research with a designated protected period of 6 months dedicated to clinically based research projects. The program recognizes the need for flexibility within the curriculum to allow trainees to tailor their training to a individual plan of study which attends to the SSR’s interests and the programs strengths leading to career paths in academic or clinical practice. Lastly the curriculum and program reinforce the importance of clinical practice and research based on the highest principles of ethics, humanism, and professionalism.    

PROGRAM GOALS:

• To provide advanced training to allow the resident to acquire clinical competency and expertise as a consultant in Gastroenterology and Hepatology.
• 
  To provide instruction and clinical experience in the traditional curricular content of Gastroenterology and Hepatology as well as the associated disciplines of clinical nutrition, pathology, clinical oncology, radiology, surgery, endoscopy, and research.
  
• To provide instruction to ensure competency in performing the required endoscopic procedures and in addition introduce the SSR to the advanced skills of ERCP and EUS.
  
• To recognize the need for sufficient flexibility within the curriculum commensurate with the SSR’s skills, interests, and career goals.
  
• To emphasize the importance of lifelong learning based on independent self-instruction, development of critical analysis of clinical problems, the desire for self-improvement, and an enduring pursuit of knowledge.
  
• To instruct and guide the trainee to learn to work effectively with members of other specialties and to collaborate with referring primary care providers.
  
• To ensure that all trainees achieve the breadth and depth of knowledge and training to feel confident in their abilities to manage independently the most complicated patients and to pursue careers in academic medicine or clinical practice.

TRAINING THROUGH CONFERENCES:
The training program emphasizes self-instruction and teaching to prepare the SSR for lifelong  learning based on independent and critical thinking and a will for self-improvement. The ability to synthesize current clinical knowledge and to apply this cognitive knowledge appropriately in clinical situations is central to the current practice of gastroenterology. In addition, it is essential to be able to critically interpret relevant literature and present it to a target audience in a succinct manner. The trainees have extensive involvement in researching, organizing, and conducting conferences.

Conference Goals:
The trainee through independent study will be able to research relevant gastrointestinal topics using available resources (medical college library, online computer-assisted research tools, electronic information networks, textbooks and journals). 

• The trainee will be skilled in succinctly researching, organizing and conducting conferences pertaining to relevant core curriculum topics and patient management. 
  Trainees will attend seminars, postgraduate courses, and scientific meetings of the major digestive disease societies.
• Trainees will be able to actively participate in conferences and discussions with visiting professors and investigators to stimulate new ideas, review current research and basic science.
• Trainees will have acquired the skill, through the tool of journal club, of critical reading, detection of bias, assessment of validity of controls, interpretation and application of statistics.
  
• Trainees will be able to participate actively in the teaching of physician assistant students, medical students, residents and less advanced trainees in the form of inpatient teaching rounds and conferences.

Teaching Process:
The didactic training relies on the SSR coordinating and conducting conferences, which are assigned from the core curriculum topics and conference schedule.  In addition the SSRs are provided ample opportunity to attend and participate in seminars and conferences presented by attending faculty and visiting professors. Conferences are scheduled biweekly during the academic calendar. Conferences are mandatory for SSRs and program faculty (attendance is recorded) but in addition are open to internal medicine residents, medical students and other faculty. The conferences are generally multidisciplinary with overlap of disciplines. Specific conferences scheduled within a month may include:

• Clinical case discussions: challenging clinical or endoscopic cases are presented and discussed. This format can be used to resolve difficult management issues and to review relevant morbidity/mortality.
• Journal club: review and critical analysis of recent relevant articles selected from the major scientific journals (Gastroenterology, Hepatology, Am. Journal of Gastroenterology, Gastrointestinal Endoscopy, NEJM, GUT).
• Interdisciplinary conferences: Pathology-designated GI pathologist reviews
  and instructs on pathology of selected clinical cases(AMC/VAMC). Radiology-instruction on specific radiographic topic presented by attending radiologist.  GI/surgical case conferences (VAMC).
• Basic science and research conferences:  reviews of disease pathophysiology and physiology given by program faculty, visiting professors and medical college basic science professors.
• Topic reviews: SSR independently researches and prepares a formal power point presentation of a general gastrointestinal or hepatological topic.
• Visiting professor lectures and case reviews:  Notable nationally recognized experts “visiting professors” present formal lectures/seminars in their area of expertise. These presentations include basic science, pathophysiology and clinical pharmacology.
• Weekly GI/Hepatology tumor board:  case presentation and discussion relevant to management of current patients with GI/hepatic/pancreatic malignancies.  Attended by attendings in oncology, surgery, pathology, radiation oncology and gastroenterology as well as SSRs.
• Medical Grand Rounds: attendance by SSRs is expected to maintain their internal medicine skills and knowledge.
• GME core curriculum lectures: series of lectures covering topics such as statistics, professionalism, clinical ethics, end-of life care, office management and practice.

Lastly SSRs are allotted protected leave and supported financially to attend at least one national meeting or postgraduate review course per year. The first year SSRs are advised to attend a general review course (i.e. Harvard review course, or Hopkins sponsored GI/surgical review), the second year SSRs attend DDW or ASLD and the third year SSRs may attend an advanced endoscopy conference.