I. Patient Care

The pediatric gastroenterology fellow will be capable of providing state of the art family-centered care to infants and children of all ages with health problems or concerns referable to the gastrointestinal tract.

Objectives:
By the end of the first year of fellowship training, the following are expected.

1. Fellows have a thorough knowledge of history taking, including basic pediatric, family, genetic, psychosocial, and environmental histories and the ability to perform a comprehensive and accurate physical examination.
2. Fellows communicate effectively, and demonstrate caring and respectful behavior when interacting with patients and their families.
3. Fellows developed skills in assimilating patient information and up-to-date scientific evidence in order to develop a differential diagnosis for different gastrointestinal diseases and carry out an appropriate diagnostic and therapeutic plan.
4. Fellows effectively present results of a consultation orally and are able to defend a differential diagnosis and treatment management plan.
5. Fellows have state-of-the-art knowledge and developed clinical problem-solving skills in the management of different disorders. This will include the knowledge in the value, efficacy and role of different diagnostic and therapeutic methods.
6. Fellows know how to counsel and educate patients and their families.
7. Fellows know how to utilize other consultants and refer appropriately.
8. During the 3-year subspecialty training period, fellows learn the appropriate indications, risks, and benefits of diagnostic and therapeutic procedures and shall be able to perform the following procedures in a safe, competent and independent manner:
   • Diagnostic and therapeutic upper gastrointestinal endoscopy
   • Percutaneous endoscopic gastrostomy tube placement
   • Diagnostic and therapeutic flexible sigmoidoscopy
   • Diagnostic and therapeutic colonoscopy
   • Percutaneous liver biopsy
   • Rectal biopsy
   • Small bowel biopsy
   • Esophageal pH monitoring
   • Establishment and maintenance of patients on enteral and parenteral nutrition.

   They shall be exposed to the following procedures:

   • Anorectal manometry
   • Esophageal manometry
   • Breath Hydrogen analysis
9. Fellows know how to use information technology to support patient care decisions and patient education.
10. Fellows are proficient at ordering parenteral nutrition.

By the end of the 2nd and 3rd years of fellowship training, the following are expected.

1. Fellows have expanded their ability to perform a comprehensive interview in order to gather essential and accurate information about their patients.
2. Fellows learned to fine tune physical examination skills and develop particular expertise in the examination of the abdomen.
3. Fellows have refined their skills in assimilating patient information and current scientific evidence to develop a differential diagnosis for different gastrointestinal diseases, develop and carry out appropriate cost-effective diagnostic and therapeutic plans.
4. By the end of the training period, fellows are able to perform various common GI procedures in a safe and competent manner with minimal, if any, assistance from the attending. At the end of the fellowship, fellows are expected to have completed 1) the minimum number of endoscopic procedures as outlined in the NASPGN Training Guidelines, JPGN, vol. 29, Suppl.1, 1999: S19 (which is included in this handbook), 2) all inpatient and outpatient responsibilities, and 3) appropriate scholarly activity monitored by an appointed Scholarly Oversight Committee.