GASTROENTEROLOGY

Department of Medicine

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Overview

The Division of Gastroenterology at Queen’sUniversity oers a nationally recognized two-year residency program that prepares graduatesfor stimulating careers as independentconsultants and academic physicians.

Our residents benefit from an outstandingeducational experience. The Gastroenterologyprogram provides exposure to a wide diversity ofcases and procedures while strongly supporting

research at the same time. The program’s size is its strength, creating a supportive and collegialenvironment where residents are highly valuedmembers of the Division.

Queen’s Gastroenterology is fully accredited by the Royal College of Physicians and Surgeons of Canada and maintained this status during its most recent review in 2018.

Program Structure

The two years of GI training are broken down intostages. In the first year of the program, time is spenton the Inpatient consult service, in AmbulatoryCare, and in inpatient and outpatient Endoscopy (I-C/A Endo) activities. Additionally one block isdedicated to GI radiology and GI pathology as corerotations, as well as one elective block

During the second year of the program, residentsagain concentrate on I-C/A Endo activities, whilealso completing a mandatory community rotation,one elective and an optional research block.Motility unit activities are integrated into theambulatory experience.

The Queen’sGI Training program provides instructionin all aspects of endoscopic intervention. Traineesacquire competence in the cognitive and technicalaspects of upper endoscopy, colonoscopy, andsigmoidoscopy. Senior residents in good standingwho are dedicated to further training in advancedendoscopy and therapeutics are oered additionalpreparatory training in endoscopic retrogradecholangiopancreatography (ERCP) and usuallyperform 50-70 cases under supervision. In the firststages of training, residents focus on foundationalendoscopic performance skills while core stages oftraining focus on diagnostics and therapeutics inupper and lower endoscopy. Later stages provideexposure to more complex procedures, such asdilations, enteral stenting, complex polypectomy,and pneumatic dilations.

The GI inpatient ward activities enable residents toact as junior consultants in a graded manner underattending supervision until required competenciesare achieved. They are progressively entrusted indecision-making and patient care in complex cases.Residents perform all of the inpatient proceduresand are expected to execute formal nutritionassessments for cases requiring nutritional support.

The Inpatient Consultation Service allows GItrainees to supervise and lead a team of learnersthat includes senior and junior internal medicineresidents while triaging all inpatient consultations,routine and emergent, and reviewing the cases withthe responsible attending. Consults are formallyrecorded with a management plan and residentsare expected to follow up all consults through toresolution of the identified problems.

Residents gain ambulatory care experience byattending up to 7 half-day clinics each week duringtheir ambulatory blocks. These include general and urgent GI clinics and specialty clinics (Liver,IBD and Motility). Trainees are entrusted withprogressive responsibilities in the weekly urgentGI clinic over the course of training leading to their Transition to Practice stage of training.

The Hotel Dieu Hospital GI function lab is a busyunit performing upper and lower motility studies,breath tests, fecal fat analysis and VCE and is fullysupported by the GI faculty. Dedicated times arespend with attending physicians to interpretmotility studies.

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New for 2017 and Onwards

Queen’s University received approval for a pilotproject to adopt a competency-based MedicalEducation model in all specialty programs,beginning July 1, 2017. The Gi training programhas now completely migrated to the competencybased model.

Residents attending Queen’s in July 2017 andbeyond will use time as a framework rather thanthe basis for progression. It is not anticipated thatthe duration of training will change for themajority of trainees. Residency programs havebeen broken down into stages, and each stage willhave a series of entrustable professional activities(EPAs) based on required competencies. TheseEPAs will create more targeted learning outcomesand involve more frequent, formative assessmentswithin the clinical workplace to ensure residentsare developing and receiving feedback on the skillsthey need.

The following chart illustrates the proposedstructure for Gastroenterology.

Educational Activities

Dedicated weekly education half-days occur weeklythroughout the year to ensure that residents haveample opportunity to cover the entire curriculum ina comprehensive manner. These half-days include:a summer bootcamp to cover essentials for newtrainees which is aligned with the Transition toSpecialty Stage of training, directed Independinglearning in key areas of GI physiology evidence-based clinical rounds delivered by residents, acritical appraisal journal club to further expandclinical knowledge and consolidate critical appraisalskills, GI Pathology rounds covering liver disordersand GI diseases and faculty-led case based learning.GI Oncology rounds provide broad coverage ofcase-based GI oncological topics. Hepatocellularcarcinoma tumor board rounds occur bi-weekly asdo TPN rounds. Weekly Medicine Grand Roundscover general topics while monthly Health SciencesEducation Rounds cover broader topics in medicaleducation that span across programs and healthprofessions.

In addition, a national program of videoconferencessponsored by the Canadian Association ofGastroenterology (CAG) addresses additionaltopics in basic science of the GI tract and the liverand biopsychosocial aspects of GI practice.Gastroenterology

Time-Based System PGY4 (13 Blocks) and PGY5 (13 Blocks)

CBME Stages of Training Transition to Discipline Foundations of Discipline Core of Discipline Transition to Practice

Proposed Number of Blocks

2 blocks 5 blocks 15 blocks 4 blocks

Focus of Stage Concentration on orientation

Focus on foundationalskills required to move onto more advanced andspeciality-specificcompetencies within the discipline

Training concentrates onthe core competenciesrequired for the particulardiscipline

Junior Attending. The finalphase of training wherethe resident will berequired to demonstratetheir ability to transition to autonomous practice R

CPSC EXAM

Excellence in Teaching

Our Queen’s GI specialists were the first full GIDivision at a Canadian academic health sciencescentre to be formally trained as educators. Seekingto become more actively involved in the learningprocess, the faculty members completed an intensiveTrain-the-Trainer course. The goal was to furtherdevelop the faculty members’ ability to anticipate,problem-solve, and reflect critically on their teachingstyle in endoscopy and colonoscopy, and their ownpractice. By creating a new roadmap for teaching,the program will continue to graduate better-trainedcompetent gastroenterologists who in turn will beable to provide a better patient experience.

Research

Research is a key strength of the GI program atQueen’s and our residents are strongly supported inall of their research endeavors. Assistance isprovided throughout the entire process, from thedevelopment of an idea, through to grant application,REB submission and approval, execution, analysis,and ultimately publication and presentation. Our residents are encouraged to conduct researchsimultaneously with their other clinicalresponsibilities, and a research block has beenintroduced in the second half of training if additionalprotected time is required. A quality improvementexercise will now become a core component of thetraining program.

The Gastrointestinal Diseases Research Unit(GIDRU) at Queen’s University is internationallyrenowned as a leading centre for GI research.Residents directly benefit from the broad base of

expertise and its researchers are proactive inrecruiting interested residents for wet lab work.

We are proud of the research accomplishments of our graduates, many of whom have had sophisticatedresearch careers and now hold important academicappointments across North America.

Simulation

When the new Queen’sMedical School buildingopened in 2011, it included a greatly enlargedClinical Simulation Centre (CSC) dedicated toexcellence in clinical care and patient welfare. Ourresidents directly benefit from this state-of-the-artfacility which recognizes the importance of patientsimulation and surgical skills in medical education.The CSC spans more than 8,000 square feet andincludes four simulation labs for high fidelitymannequin scenarios including a complete operatingroom and two emergency rooms. There are also twolarge surgical skills labs for partial trainers, virtualreality-style simulators, and four debriefing classroomslinked to the simulation labs by one-way mirrors.Endoscopy simulators provide early additional skillsconsolidation during the Transition to Discipline stage.

Conferences and Workshops

New residents attend the annual two-day IntensiveIntroduction to Endoscopy course oered each yearat McMaster University, and all residents receivefunding to attend the annual Gastroenterology Residentin Training (GRIT) course at the CAG annual meeting.A variety of additional opportunities are providedsuch as the Medical Education Seminar Series.

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Training Hospitals

The Kingston Health Sciences Centre

The Kingston General Hospital (KGH) site is aregional gastroenterology resource for a population of about 750,000 which is continually expanding.Facilities include a busy emergency department, a large multi-functional ICU, coronary care andneurological intensive care specialty units and renaldialysis. In addition to a busy inpatient consultservice, Gastroenterology maintains a dedicatedinpatient CTU. The case mix includes patientsawaiting special procedures, inflammatory boweldisease patients, patients with unstable GI bleeding,and liver failure cases. A well equipped endoscopysuite with dedicated endoscopy nursing sta providesall endoscopic services 24 hours a day. The KGHexperience is designed to provide trainees withsupervised opportunities to evaluate and manage sick GI cases requiring hospital-based care and todevelop additional skills critical to the ecient use of hospital resources.

The Hotel Dieu Hospital (HDH) site is an ambulatorycare facility, providing medical care or treatment thatdoes not require an overnight stay and that includesservices such as specialized clinic visits, day surgeries,and diagnostic or therapeutic procedures usingadvanced technology and equipment.

The objectives of ambulatory training are to providesupervised exposure to both common and unusualambulatory GI problems and to instruct residents inthe organization and operation of an ambulatory GI care. HDH has excellent well-staed clinic space.

Program Strengths

Teaching and dedication to Competency Based MedicalEducation: The GI faculty under the leadership of Dr Ropeleski have made the transition of the GItraining program to a CBME format as of July 1, 2017 a reality and an early success. This was echoed in our2018 accreditation review. Each resident will nowhave a dedicated academic advisor who will meetwith them to review and appraise their learningactivities and assessments towards the achievementof entrustable competencies across the Transition to Discipline, Foundations, Core and Transition toPractice stages of the new curriculum.

Size: Our program oers a collegial and supportiveenvironment. The small size of the program facilitatesa close working relationship with faculty who are able to oer frequent formal and informal feedback.Meeting requirements for numbers of procedurescompleted is never a concern.

Faculty: All faculty members are academicgastroenterologists, dedicated to both teaching and research. They place a high priority on teachingresidents.

Research: The program strongly encourages researchand residents directly benefit from their access to the internationally-respected GIDRU members.

Clinical Exposure: There is high volume and excellentmix of patients with both common and less commonGI problems, enabling residents to achievecompetence over the course of their training.

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DIVISION OF GASTROENTEROLOGYQueen’s UniversitySydenham 4, Hotel Dieu Hospital 166 Brock Street Kingston ON K7L 5G2

deptmed.queensu.ca/divisions/gastroenterology