Pediatric Gastroenterology Selective
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American Board of Pediatrics Top Ten List for GI Topics for Pediatrics Training
John Kerner, M.D.
Professor of Pediatrics
Department of Pediatrics
Division of Gastroenterology, Hepatology and Nutrition
Stanford University Medical School of Medicine
750 Welch Road 116
Palo Alto, CA 94304
Phone: 650.723.5070
jkerner@stanfordmed.org
Selective Contact:
Carolyn Futagaki
Work Phone: 650. 725.9813
Fax: 650. 498.5608
Introduction
Pediatric Gastroenterology is an integral part of pediatric training. Many G-I and nutrition issues will frequently present to primary pediatricians (e.g., constipation, chronic diarrhea, abdominal pain, failure to thrive, in addition to questions about optimal infant nutrition, how to progress the diet, and to deal with feeding problems).
The pediatric gastroenterology selective provides an opportunity for the resident to develop an understanding of the pathophysiology, clinical manifestations and management of both common and unusual disorders of the gastrointestinal tract, liver and pancreas. Residents participate in both the outpatient and inpatient (consults only) settings and emphasis is placed on the performance of a detailed and focused history and physical examination and the interpretation of laboratory and imaging studies in children with symptoms of gastrointestinal tract, liver and pancreatic disorders. Following completion of the elective, residents will be able to evaluate and manage common gastrointestinal problems in pediatric patients and recognize and initiate the initial evaluation and management of children with complex disorders that may require sub-specialty consultation.
We have established 8-1/2 days of G-I clinic to accomplish these goals. To enhance the variety of patients for residents to see, residents will attend G-I clinic at SCVMC as well as 2-1/2 days per month at PAMF in their new G-I clinic, in addition to the 7-1/2 days of G-I clinic at LPCH. Further, residents will attend Nutrition Support Team Rounds on Wednesday mornings to see the unique multidisciplinary team approach to nutritional care at LPCH. Friday mornings residents will have the unique opportunity of attending Pediatric Obesity Clinic. The remainder of time will be devoted to reading and inpatient consultations.
Goals
To develop the knowledge, skills, and attitudes to acquire competency in patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice applicable to the pediatrician dealing with common gastrointestinal problems.
Objectives
I. To develop the knowledge and skills needed to recognize, evaluate and manage the following common pediatric gastrointestinal problems:
- Uncomplicated gastrointestinal reflux Recurrent abdominal pain Fecal retention – encopresis
- Acute diarrhea and dehydration
- Chronic diarrhea Cow and soy protein allergy
- Rectal bleeding due to anal fissures or milk-associated colitis
- Acute uncomplicated viral hepatitis Uncomplicated neonatal jaundice Failure to thrive
To develop the following nutrition skills:
- Resident asks age appropriate questions regarding a child’s diet and provides accurate information to parents regarding healthy intake for children of different ages. (Addresses Medical Knowledge and Interpersonal and Communication Skills)
- Resident is aware of the prevalence of iron deficiency and other nutritionally related pathology in the patient populations he or she serves. (Addresses Patient Care, Medical Knowledge, and Systems-based practice)
- Resident asks age appropriate questions to assess patient’s intake of milk, juice, and soda and knows the AAP position on soft drink consumption. (Addresses Medical Knowledge and Interpersonal and Communication Skills)
Methods Used to Accomplish Objectives:
Residents evaluate patients in pediatric gastroenterology clinics at LPCH, PAMF, and SCVMC and review the findings and plan with the attending gastroenterologist. In addition, lectures are given on the above subjects and copies of relevant publications are provided.
Methods Used to Evaluate Completion of Objectives:
Resident performance (including knowledge base, diagnostic skills, and ability to formulate a plan of management) is evaluated during the outpatient clinic experience and by a written examination modeled after the ABP certifying examination.
II. To recognize and initiate the initial evaluation and appropriate referral of complicated gastrointestinal and hepatic disorders such as:
- Congenital anomalies of the gastrointestinal tract
- Gastrointestinal bleeding
- Chronic inflammatory bowel disease
- Cholestatic liver disease
- Chronic hepatitis
- Acute and chronic liver failure
- Peptic ulcer disease
- Pancreatic exocrine insufficiency and acute pancreatitis
- Short bowel syndrome
Methods Used to Accomplish Objectives:
Residents will evaluate patients in the outpatient clinics and as members of the inpatient pediatric gastrointestinal consultation service. The clinical experience is supplemented by lectures and reading material.
Methods Used to Evaluate Completion of Objectives:
Resident performance is evaluated during the inpatient consultation service and by a written examination modeled after the ABP certification examination.
III. To understand the indications, limitations and potential complications of the standard pediatric gastrointestinal diagnostic and therapeutic procedures such as:
- Upper endoscopy
- Colonoscopy
- Endoscopic biopsies
- Polypectomy
- Percutaneous liver biopsy
- Percutaneous endoscopic gastrostomy (PEG)
- Suction rectal biopsy
- 24-hr pH probe
IV. Competently performs procedures commonly used by the pediatrician in practice:
- Gastrostomy tube replacement
- Nasogastric or orogastric (NG or OG) tube placement
- Rectal swab for culture
Methods Used to Accomplish Objectives:
Residents are included in the pre-procedure evaluation and assist, as appropriate, during the performance of procedures. Endoscopic findings are reviewed on the video monitor and the clinical correlation is discussed. In addition, histologic findings are reviewed with pathology faculty.
Methods Used to Evaluate Completion of Objectives:
Residents are asked to formulate diagnostic plans for complicated patients, including the use of diagnostic procedures. Questions concerning the indications, complications and limitations of diagnostic and therapeutic procedures are included in the written examination.
V. To appreciate current research and recent developments in pediatric gastroenterology.
Methods Used to Accomplish Objectives:
Residents attend the weekly GI teaching session where recent publications are reviewed, divisional research projects are discussed, and reviews of pertinent G-I/Liver/Nutrition topics are presented; study design, data collection and evaluation of results are reviewed.
Methods Used to Evaluate Completion of Goals:
Questions involving recent advances in gastroenterology, study design and evaluation of data are included in the written examination.
Additional “Tools” for Evaluation of Competencies:
- Each resident will give an oral presentation either on an “AAP Top Ten List” topic or a journal article of particular relevance or a relevant case presentation with discussion.
(Faculty evaluation of the presentation will be added to the resident’s portfolio.)
- Each resident will keep a journal recording a running list of the diagnoses of all outpatients and consults seen so the faculty can help assure there is a broad exposure to Pediatric G-I cases over the course of the rotation.
American Board of Pediatrics Top Ten List for GI Topics for Pediatrics Training
This list of disorders is offered by the ABP Subspecialty Board as its “Top Ten List” for the general pediatrics resident. The list overlaps with the Goals and Objectives and could serve as a set of content areas in preparation for the Certifying Examination in General Pediatrics of the American Board of Pediatrics.
- 1. constipation/encopresis
- chronic abdominal pain
- gastroesophageal reflux/recurrent vomiting
- gastrointestinal bleeding
- chronic diarrhea/toddlers diarrhea
- neonatal cholestasis/hyperbilirubinemia
- malabsorption
- hepatitis
- inflammatory bowel disease
- chronic diarrhea
- enteral and parenteral nutrition
Orientation
Immediately after morning report, the resident will go to 750 Welch Road, Suite 116 where Dr. Kerner will orient the resident to the selective rotation.
Faculty Preceptor:
John Kerner, M.D.
Phone: 650.723.5070
Fax: 650.498.5608
john.kernere@medcenter.stanford.edu
Resident Roles and Responsibilities
1. Attend all outpatient clinics. During the clinic, the main focus will be on seeing as many patients as possible. Residents will be asked to take histories and perform physicals on most patients and then present them to the attending. On some patients, the resident will observe as the attending takes the history. The resident’s role will be determined by the attendings in clinic that day and be based on which patients have the best physical findings, on the best and most educational use of the resident’s time, and on the need to keep the flow of patients moving on busy clinic days.
2. Participate in selected consults. Guidelines for consults: inpatients that are new to the G-I service. Priority for resident time is to remain outpatient.
Schedule
Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
|---|---|---|---|---|
8-9:30 a G-I/Liver Meeting 750 Welch Rd. 116 |
8-8:30 am Morning Report |
8-8:30 am Morning Report |
8-8:30 am Morning Report |
8-9 am Grand Rounds |
9:30 am – noon G-I Clinic |
Inpatient Consults/Directed Reading | Inpatient Consults/Directed Reading 10 am – 12 noon Nutrition Support Rounds (3 East Conference Room) |
9 am – noon G-I Clinic |
9 am – 12 noon Pediatric Obesity Clinic. Mt. View Commons |
| Noon Conference | Noon Conference | Noon Conference | Noon Conference | 12:15 pm – 1 pm G-I Teaching Seminar |
1 pm – 5 pm G-I Clinic |
1 pm – 5 pm G-I Clinic |
G-I Clinic (SCVMC)* |
1pm – 5 pm G-I Clinic 1st and 3rd Thursday of each month: 1:30 pm – 5:30 pm G-I Clinic (PAMF)** |
1:30 pm – 5 pm G-I Clinic |
*Attending: Dr. Manuel Garcia/Dr. Missy Hurwitz
**Attending: Dr. Dorsey Bass
References
Each resident will receive a folder including:
- A CD with current articles on all aspects of pediatric G-I, liver, nutrition, and transplantation.
- Listing of all faculty and ancillary staff, including phone and pager numbers.
- A review article on Failure to Thrive and on Parenteral Nutrition.
- A Pediatric Formula Guide, a pediatric nutrition handbook and supplementary information on formulas available at LPCH.
