Internal Medicine
TITLE:
CLIN GASTRO/HEPATO VAMC -IM -ICE
The elective provides both inpatient and outpatient experience with common gastrointestinal and hepatic disorders. Students are exposed to flexible sigmoidoscopy and paracentesis. Students must complete full VA onboarding prior to starting course.
PREREQUISITES:
26931373 (INTERNAL MEDICINE CORE CLKSP), 26931373 (INTERNAL MEDICINE CORE CLKSP)
Completion of the Internal Medicine Clerkship and up-to-date onboarding at the VAMC
expand all
GENERAL INFORMATION
INTERNATIONAL VISITING:
NO
GRADED:
Honors/High Pass/Pass/Fail
COURSE QUALIFICATIONS:
ICE
STATUS:
Full-Time
OFFERED AS FULL-TIME AND PART-TIME:
NO
ALLOWS OVERLAP:
NO
COURSE LENGTH:
2 or 4 weeks
DIRECTOR:
Marshall Weesner
Marshall.Weesner@va.gov
ADMINISTRATIVE SUPPORT PERSON:
Gabriela Ionascu
ionascgi@ucmail.uc.edu
513-558-2592
MSB, 6055A
ROTATIONS:
Rotation |
Dates |
Max |
1 |
05/06/2024 - 05/17/2024 |
1 |
1 |
05/06/2024 - 05/31/2024 |
1 |
1 |
05/20/2024 - 05/31/2024 |
1 |
2 |
06/03/2024 - 06/14/2024 |
1 |
2 |
06/03/2024 - 06/28/2024 |
1 |
2 |
06/17/2024 - 06/28/2024 |
1 |
3 |
07/01/2024 - 07/12/2024 |
1 |
3 |
07/01/2024 - 07/26/2024 |
1 |
3 |
07/15/2024 - 07/26/2024 |
1 |
4 |
07/29/2024 - 08/09/2024 |
1 |
4 |
07/29/2024 - 08/23/2024 |
1 |
4 |
08/12/2024 - 08/23/2024 |
1 |
5 |
08/26/2024 - 09/06/2024 |
1 |
5 |
08/26/2024 - 09/20/2024 |
1 |
5 |
09/09/2024 - 09/20/2024 |
1 |
6 |
09/23/2024 - 10/04/2024 |
1 |
6 |
09/23/2024 - 10/18/2024 |
1 |
6 |
10/07/2024 - 10/18/2024 |
1 |
7 |
10/21/2024 - 11/01/2024 |
1 |
7 |
10/21/2024 - 11/15/2024 |
1 |
7 |
11/04/2024 - 11/15/2024 |
1 |
8 |
11/18/2024 - 12/13/2024 |
1 |
8 |
12/02/2024 - 12/13/2024 |
1 |
9 |
12/16/2024 - 01/10/2025 |
0 |
10 |
01/13/2025 - 01/24/2025 |
1 |
10 |
01/13/2025 - 02/07/2025 |
1 |
10 |
01/27/2025 - 02/07/2025 |
1 |
11 |
02/10/2025 - 02/21/2025 |
1 |
11 |
02/10/2025 - 03/07/2025 |
1 |
11 |
02/24/2025 - 03/07/2025 |
1 |
12 |
03/10/2025 - 03/21/2025 |
1 |
12 |
03/10/2025 - 04/04/2025 |
1 |
12 |
03/24/2025 - 04/04/2025 |
1 |
13 |
04/07/2025 - 04/18/2025 |
1 |
13 |
04/07/2025 - 05/02/2025 |
1 |
13 |
04/21/2025 - 05/02/2025 |
1 |
NOTE: If a rotation is offered in both 2 and 4 week slots, the max capacity is limited to the actual spots offered for the 4 weeks. (ie: the 2 week rotations listed share the max of the 4 week rotation)
WORKING HOURS:
7:30 am - 4:30 pm, Monday-Wednesday, Friday; 7:30 am - 5:30 pm, Thursday
REPORT 1ST DAY:
VAMC GI LAB on 3rd Floor at 8:00 a.m. Take Primary Care elevator.
INSTRUCTION
LEARNING ACTIVITIES:
- Clinical Experience - Ambulatory
- Clinical Experience - Inpatient
- Discussion-Small Group (Small Group (=12)
- Independent Learning (Instructor-guided learning activities to be performed by the learner outside of formal educational settings.)
- Patient Presentation--Learner
- Self-Directed Learning (Learners take initiative for their own learning; diagnosing needs; formulating goals; identifying resources; implementing appropriate activities; and evaluating outcomes.)
- Ward Rounds
LEARNING ENVIRONMENT POLICIES:
UCCOM strives to provide medical students with a learning environment that is conducive to their professional growth. All UCCOM and visiting medical students are encouraged to review the Student Handbook.
The Office of Student Affairs and Admissions is available to all UCCOM and visiting medical students to discuss any concerns/questions related to the learning environment. Please call 558-6796 to access faculty/staff that can assist you.
TEACHING:
60% |
Attending Physician |
40% |
Fellow Physician |
ASSESSMENT:
Evaluation
ASSESSMENT METHODS:
Clinical Performance Rating/Checklist
Narrative Assessment
FINAL GRADE:
GRADE ASSIGNED BY:
Course director
OBJECTIVES
Curricular Resources :
- Sleisenger & Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management, 11th ed. 2020.
-
Francis DL, Katzka DA: Achalasia: Update on the Disease and Its Treatment. Gastroenterology. 139: 369-374, 2010. Journal Article.
-
Spechler SJ: Barrett's Esophagus. NEJM. 346: 136-142, 2002. Journal Article.
-
Kahrilas PJ: Gastroesophageal Reflux Disease. NEJM. 359:1700-1707, 2008. Journal Article.
-
Enzinger PC, Mayer RJ: Esophageal Cancer. NEJM. 349: 2241-2252, 2003. Journal Article
-
Bankun AN, et al.: International Consensus Recommendations on the Management of Patients with Nonvariceal Upper Gastrointestinal Bleeding. Ann Intern Med. 152: 101-113, 2010. Journal Article.
-
Vakil N, Megraud F: Eradiacion Therapy for Helicobacter Pylori. Gastroenterology. 133:985-1001, 2007. Journal Article.
-
Screening and the Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps. Cancer J Clinical. 58: 130-160, 2008. Journal Article.
-
Nikolaus S, Schreiber S: Diagnostics of Inflammatory Bowel Disease. Gastroenterology. 133:1670-1689, 2007. Journal Article.
-
Pandol SJ, et al.: Acute Pancreatitis: Bench to the Bedside. Gastroenterology. 132: 1127-1151, 2007. Journal Article.
-
Lucey MR et al.: Alcoholic Hepatitis. NEJM. 360: 2758-2769, 2009. Journal Article.
-
Garcia-Tsao G, et al.: Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis. Hepatology. 46: 922-938, 2007. Journal Article.
Instructional Methods:
- Clinical Experience - Ambulatory
- Clinical Experience - Inpatient
- Discussion-Small Group (<= 12)
- Independent Learning
- Patient Presentation - Learner
- Self-Directed Learning
- Ward Rounds
Knowledge/Skills:
- Describe the American Cancer Society recommendations for colon cancer surveillance in high, medium, and low risk patient populations.
- Cite the appropriate diagnostic tests to obtain on the paracentesis fluid of a patient with new onset ascites.
- Explain the use of the serum-ascites albumen gradient and total protein of the ascitic fluid in developing a differential diagnosis for the ascites.
- Describe the lifestyle modifications, medication, and complications in management of gastroesophageal reflux disease.
- Compare and contrast the different etiologies for peptic ulcer disease (H. pylori, NSAIDs, and gastrinoma) with respect to mechanism of injury, treatment, and prevention.
- Discuss the approach to evaluating a patient with chronic diarrhea.
- Compare and contrast the clinical features of Crohn's disease and ulcerative colitis.
- Perform a complete digestive diseases history and physical examination.
- Explain the rationale for the uses of the various drugs available for treating inflammatory bowel disease.
- Discuss the approach to the diagnosis of a jaundice patient.
- Describe the differential diagnosis and evaluation of a patient with abdominal pain and an elevated amylase.
- Determine the most cost efficient method for diagnosing and treating the most commonly seen gastrointestinal disorders.
- Determine the best diagnostic or treatment options based on the risk to the patient versus the benefit s/he would receive.
- Describe the methods available to reduce or prevent the frequency of colon cancer in the general population, methods to prevent the spread of hepatitis B and C, and the use of available vaccines against GI diseases.
- Have the opportunity to follow patients seen as inpatients into the outpatient environment.
Main Course Topics :
- Ascites
- Gastroesophageal reflux disease
- Acute and chronic diarrhea
- Acute and chronic hepatitis
- Acute and chronic pancreatitis
- Occult gastrointestinal bleeding
- H. Pylori and acid-peptic disease
- Colonic polyps
- Colon cancer and colon cancer screening
- Gastrointestinal infections
- Inflammatory bowel disease (ulcerative colitis and Crohn's disease)
- Gastrointestinal hemorrhage
- GI complications of AIDS
- Gallstone disease
- Nutritional assessment and management
- Constipation
- Motility disorders of the gastrointestinal tract
- Metabolic liver diseases
- Complications of cirrhosis (portal hypertension, esophageal varices, hepatorenal syndrome)
- Jaundice
- Abnormal liver chemistries
- Gastrointestinal malignancy
- Ethical issues in gastroenterology
Procedures:
- Go through the mechanics of performing a flexible sigmoidoscopy. Skill and experience will depend on interest of the student and the availability of patients.
- Go through the mechanics of performing an abdominal paracentesis. Skill and experience will depend on interest of the student and the availability of patients.
SAMPLE WEEK
Monday:
7:30AM |
8:00AM |
Inpatient Rounds |
8:00AM |
12:00PM |
Procedures & Procedure Evaluation Clinic |
1:00PM |
4:30PM |
Consults/Library Time/Procedures |
Tuesday:
7:30AM |
8:00AM |
Inpatient Rounds |
8:00AM |
12:00PM |
Procedures & Procedure Evaluation Clinic |
1:00PM |
4:30PM |
GI Clinic |
Wednesday:
7:30AM |
8:00AM |
Inpatient Rounds |
8:00AM |
12:00PM |
Procedures & Procedure Evaluation Clinic |
12:00PM |
1:00PM |
Grand Rounds |
1:00PM |
4:30PM |
Liver Clinic |
Thursday:
7:30AM |
8:00AM |
Inpatient Rounds |
8:00AM |
12:00PM |
Procedures & Procedure Evaluation Clinic |
1:30PM |
2:30PM |
Journal Club |
3:00PM |
5:30PM |
GI Weekly Conference |
Friday:
7:30AM |
8:00AM |
Inpatient Rounds |
8:00AM |
12:00PM |
Procedures & Procedure Evaluation Clinic |
1:00PM |
4:30PM |
Consults/Library Time/Procedures |
ATTENDANCE AND ABSENCE POLICY
Session Attendance for M4 Students
- Students may miss no more than two days of planned excused absences on a four week rotation without being required to make-up the work, at the discretion of the clerkship/elective/course director or his/her designee.
- Non-AI Rotations - Per the Student Duty Hours Policy, an average of one day (24 hours) in every seven must be free of clinical responsibilities (including seminars, clinic, rounds, lectures) averaged over a four week period. These days off are assigned by the clerkship director to best align with the site schedule. Students may request to schedule 1 or more of these 4 days for planned absences that fall under 1 of the categories listed below for excused absences during non-AI rotations, in consultation with the course/elective director, who may or may not approve such planned absences.
- AI Rotations - Per the Student Duty Hours Policy, an average of one day (24 hours) in every seven must be free of clinical responsibilities (including seminars, clinic, rounds, lectures) averaged over a four week period. These days off are assigned by the course director to best align with the site schedule. Students may request to schedule 1 or 2 of these days for planned absences that fall under 1 of the categories listed below for excused absences during AI rotations, in consultation with the course director, who may or may not approve such planned absences. Students must avoid scheduling Step 2 examinations during an Acting Internship.
- Excused Absences - The following will be considered excused absences:
- Diagnostic, preventative, and therapeutic health services (e.g. doctor appointments, physical therapy, counselling, etc).
- Personal illness, accident or a major catastrophic event
- Death or serious illness of immediate family members. Immediate family members, as defined by UC, are Grandparents, Brother, Sister, Brother-in law, Sister-in-law, Daughter-in-law, Son-in-law, Father, Mother, Mother-in-law, Father-in-law, Step-sister, Step-brother, Step-mother, Step-father, Spouse or domestic partner, Child, Grandchild, legal Guardian or other person who stands in place of parent (in Loco Parentis)
- Whenever possible, planned absences should be requested a minimum of six weeks in advance of the start of the clerkship/elective/course in which the absence will occur; this enables the clerkship/course/elective to help plan for educational event scheduling (e.g. a known appointment could be scheduled around with enough notice and the student might not have any required coursework to make up). Absences requested less than 1 week prior to the planned absence may not be considered for a possible excused absence unless extenuating circumstances prevented the student from providing timely notification per the policy. Students should first submit their request for a planned absence to the clerkship/elective/course director using the online MSSF. All planned/excused absences for any reason should be documented on the MSSF.
- The COM abides by the UC Religious Observance Policy that respects the religious diversity of its students by providing opportunities, where possible, for accommodation in cases where conflicts exist between students’ religious beliefs/practices and educational activities. In clinical settings, such accommodations must honor the primacy of a commitment to patient care and avoid unduly burdening faculty, staff and the general student population involved in the affected educational and/or patient care activity.
- The following items are explained in detail in the Medical Student Handbook:
- Excused/unexcused/unplanned absence, religious holidays, jury duty, and make-up work
See Attendance and Absences Policy, Religious Observance Policy, Medical Student Handbook.