Gastroenterogist Program
The Medical Education department under the leadership of the Director works to ensure that our system of postgraduate medical education is established according to the internationally acceptable criteria and meet all the requirements of the College of Physicians and Surgeons Pakistan (CPSP).
Program Director Message
Shifa International Hospital (SIH) Islamabad offers state of the art Gastroenterology, Hepatology, Hepato-pancreato-biliary and Liver Transplant facilities, which is the only sustainable and indigenous in the whole country and is backed by excellent and state of the art diagnostic and interventional radiology as well as laboratory. Gastroenterology residency programme iR03; s designed to develop academically oriented gastroenterologists who would serve as specialists in the area on completion of three years phased out and graded exposure to handle routine as well as complex gastroenterological and hepatological cases. The GI training is fully recognised by the College of Physicians and Surgeons, Pakistan.
At the completion of training, the graduate will be able to manage common gastrointestinal disorders in a cost-effective manner. S/he will be experienced in history taking, physical examination and judicious use of investigations and making appropriate management decisions. S/he will be expected to know applied basic sciences (pathophysiology, pharmacology, molecular biology, etc), relevant to basic gastroenterology as well as clinical gastroenterology, hepatology, transplant hepatology and nutrition. The resident will be on-call in rotation with other residents to attend inpatients, GI emergencies, endoscopic procedures and outpatients. The three years GI training programme is designed to enable the graduate to be able to function as an independent consultant in gastroenterology in Pakistan, provided s/he he clears his/her FCPS in gastroenterology from CPSP. GI residency programme takes research as mandatory part of the training and the trainee will be expected to take active part in departmental research in addition to the mandatory CPSP research requirement. SIH has on campus research department which arranges different research related workshops with help of PGME for the trainees.
- Program Director
- Assistant Program Director
- Chief Resident
- Program Coordinator
- Total duration of the training is 5 years, which includes rotations in allied specialties.
- The first two years of training (Intermediate Module) will be in General Medicine, at the end of which the trainee will have to appear in the Intermediate Module Examination. Those who pass this examination will be awarded diploma of MCPS in Medicine.
- The last three years of training will be in Gastroenterology.
- The prescribed rotational training for each subject shall be undertaken within the specified period of respective specialty.
ROLE AND RESPONSIBILITIES
- Supervisor will ensure and monitor adequate training but also provide continuous helpful feedback (Formative) regarding the progress of the training.
- He/ She will observe the trainee’s performance and rapport with all the people within his work environment.
- He / She will teach the trainee and help him / her overcome the hurdles during the learning process.
- Supervisor will make the trainee develop the ability in response.
- The supervisor will provide guidance in writing dissertation / research articles, which are essential components of training.
- Every supervisor keeps abreast of the innovations in their field of expertise and ensure that this information percolates to trainees of all years under them.
- The supervisor will maintain regular contact with the college regarding training and the conduct of various mandatory workshops and courses.
- Supervisors will establish direct contact with relevant quarters of CPSP if any problem arises during the training process, including the suitability of trainee.
- They will be able to coordinate with the administration of their institution/ Organization in order to ensure that their trainees do not have administrative problems hampering their training.
- He /She will ensure that the trainees have completed the yearly logbooks and have submitted the summary sheets within these logbooks.
- They will provide assessment reports to the college at the end of each year or training period. The report will contain positive and negative aspects of the trainee’s performance and any extra academic endeavors made by them. Prolonged absence will also be mentioned in sufficient detail. Report will be discussed and signed by both the trainer and the trainee before it is sent to the college.
- The supervisor may submit confidential reports on trainee’s progress to the college.
ROLE AND RESPONSIBILITIES
- Given the provision of adequate resources by the institution, trainees will accept responsibility for their own learning and ensure that it is in accord with the relevant requirements.
- Will seek reasonable infrastructure support from their institution and supervisor, and use this support effectively.
- Will ensure that they undertake training diligently.
- Will work with their supervisor in writing the synopsis / research proposal within six months of registration with RTMC.
- Will accept responsibilities for the dissertation, and plan and execute the research within the time limits defined.
- Will be responsible for arranging regular meeting with the supervisor to discuss any hindrances to progress and documents progress etc.
- Prior to submission of dissertation, the student should ensure that the supervisor has all the raw data relevant to the thesis.
- Will submit the completed approved dissertation or publish two research papers in the indexed journal or JCPSP before the last year of training. The synopsis of both papers must be approved by the RTMC. The trainee will also be the first or second author.
- Will complete all requirements for sitting an examination.
- Will submit yearly summary sheets of logbooks, duly filled and signed by supervisor.
The Fellowship training program focuses on a few key pages of viable training; these are knowledge, skills and attitudes.
The learning outcomes will all be at the application level since that is the gold standard. Therefore, the trainee will be able to:
- Relate how body function gets altered in diseased states.
- Request and justify investigation and plan management for medical disorders.
- Assess new medical knowledge and apply it to their setting.
- be up to date with all diagnostic modalities in the field of gastroenterology and have a comprehensive knowledge of their applications and interpretations.
- Apply quality assurance procedures in their daily work.
WRITTEN COMMUNICATION SKILLS:
The trainee will be able to;
- Correctly write update medical records, which are clear, concise and accurate.
- Write clear management plans, discharge summaries and competent letters for out patients after referral from a general practitioner.
- Demonstrate competence in academic writing
The trainee will be able to:
- Establish professional relationships with patient and their relatives or caregivers in order to obtain a history, conduct a physical examination and provide appropriate management.
- Demonstrate usage of appropriate language in seminars, beside sessions outpatients and other work situations.
- Demonstrate the ability to communicate clearly, considerately and sensitively with patients, relative, other health professionals and the public.
- Demonstrate competence in presentation skills
The trainee will be able to:
- Perform an accurate physical examination in medical and other complex health problems.
- Interpret physical signs after physical examination so as to formulate further management.
- Interpret and integrate the history and examinations findings and arrive at an appropriate differential diagnosis and final diagnosis.
- Demonstrate competence in problem identification, analysis and management of the problem at hand by the use of appropriate resources, interpretation of lab results.
- Apply the knowledge of the therapeutic interventions used in the field of gastroenterology for patient management.
- Prioritize different problems within a time frame.
TOWARDS PATIENTS
The trainee will be able to:
- Establish a positive relationship with all patients in order to ease illness and suffering.
- Demonstrate, consistency, respect for every human being irrespective of ethnic background, culture, socioeconomic status and religion.
- Deal with patient in a non-discriminatory and prejudice- free manner.
- Deal with patient with honesty and compassion.
- Demonstrate flexibility and willingness to adjust appropriately to changing circumstances.
- Foster the habit and principle of self-education and reflection in order to constantly update and refresh knowledge and skills and as a commitment to continuing education.
- Recognize stress in self and others
- Deal with stress and support medical colleagues and allied health workers.
- Handle complaints including self-criticism or criticism by colleagues or patients.
- Understand the importance of obtaining and valuing a second opinion.
- Understand the social and government aspects of health care provision.
- Offer professional services while keeping the cost effectiveness of individual forms of care.
- Apply an understanding of hospital and community-based resources available for patients and care givers in underserved areas.
The three years of specialty training will consist of rotations within the specialty units (internal rotations) and in allied disciplines.
SECTION I
Anatomy, Physiology, Biochemistry and Pathology of the GIT and liver.
Pharmacology of drugs used in the GIT and liver.
SECTION II
Clinical Gastroenterology:
- Clinical evaluation of the GIT.
- Management of gastrointestinal emergencies, e.g. gastrointestinal bleeding, acute abdomen.
- Diseases of the esophagus, i.e. infections, gastroesophageal reflux disease, stricture, motility disorders, non-cardiac, chest pain, achalasia.
- Gastroduodenal disease, i.e. peptic ulcer, gastritis, H. pylori, infection, complications of peptic ulcer disease.
- Small bowl diseases, i.e. acute, chronic diarrhea, maldigestion and malabsorption syndrome.
- Infections and parasitic infestations of the GIT.
- Inflammatory and functional bowel diseases.
- Pancreatobiliary disease.
- GIT malignancies.
- Vascular disease of the GIT.
- Gastrointestinal hormones and their related disorders.
- Disorders of the support structures, peritoneum.
- GIT manifestations of systemic disease
Liver diseases
- Liver diseases with history, physical examination, follow up of patients and proper use of laboratory investigations.
- Acute and chronic hepatic diagnosis and management.
- Management of hepatic failure.
- Drug and chemical induced liver diseases.
- Metabolic liver diseases.
- Evaluation of cirrhosis of liver, basic concepts, diagnosis and management.
- Liver neoplasms, congenital, parasitic diseases.
- Pregnancy and liver diseases.
- Liver transplantation.
Nutrition
- Assessment of nutritional status.
- Enteral and parenteral nutrition.
The trainee is required to acquire training in procedures for diagnosis and therapy, flexible and rigid sigmoidoscopy, colonoscopy, polypectomy, achalasia balloon dilatation, paracentesis, sphincteromoy, ERCP, ERCP with nasobiliary drainage and stent placement, esophageal prosthesis insertion, percutaneous endoscopic gastrostomy, liver biopsies, abscess aspiration and esopheal motility. These procedures will be performed under various level of supervision.
The dissertation must be submitted to the CPSP at least nine months before the examination in which the candidate intends to appear. For preparing dissertation see “Guidelines for dissertation” (available at the College office).
X-ray abdomen, barium UGI series, barium enema, small bowel series and enterolysis, CT scan, interpretation of PTC, ERCP X rays, isotope scanning, angiography. MRCP Ultrasound abdomen: recognition of the main findings. The objectives of the training may be achieved through different modes, some of which are listed below:
Graded responsibility in patient care e.g.
⦁ Ward duties
⦁ OPD duties
⦁ Emergency duties
⦁ Morbidity/mortality review meetings
⦁ Journal club
⦁ Seminars, conferences and lectures
⦁ Research projects
1. Observer status
2. Assistant status
3. Performed under supervision
4. Performed independently
A trainee will be expected to attain the laid down level of competence for the following procedures by the end of each year as given below:
| Year 1 | Year 2 | Year 3 | Min. # of Cases | |
|---|---|---|---|---|
| A – Patient Management | ||||
| 5Eliciting pertinent history | 4 | 4 | 4 | – |
| Performing physical examination | 4 | 4 | 4 | – |
| Ordering appropriate investigations | 2 | 3 | 4 | – |
| Interpreting the results of investigations | 2 | 3 | 4 | – |
| Deciding and implementing appropriate treatment | 2 | 3 | 4 | – |
| Maintaining follow-up | 4 | 4 | 4 | – |
| B-Procedures | ||||
| Peracentesis | 4 | 4 | 4 | 50 |
| Liver biopsy | 3 | 4 | 4 | 30 |
| Fine needle aspiration | 3 | 4 | 4 | 25 |
| Liver abscess drainage | 4 | 4 | 4 | 10 |
| Flexible sigmoidoscopy | 3 | 4 | 4 | 75 |
| Upper GI endoscopy | 3 | 4 | 4 | 100 |
| Total colonoscopy | 2 | 4 | 4 | 30 |
| Ultrasonography, liver, gall bladder, pancreas, abdomen (pertinent, basic) | 1 | 2 | 2 | 50 |
| Intubation of Sengstaken Blakemore tube | 3 | 4 | 4 | 10 |
| Variceat sclerothery (sessions) | 3 | 3 | 4 | 50 |
| Stricture dilatation (sessions) | 2 | 3 | 4 | 25 |
| Polypectomy (no. of polyps) | 2 | 3 | 4 | 10 |
| Balloon dilatation of achalasia | 2 | 3 | 3 | 2 |
| ERCP | 2 | 3 | 4 | 5 |
| Endoscopic stent placement | 2 | 2 | 3 | 5 |
| ERCP with stone extraction, pappilotomy, nasobiliary drainage (NBD) | 2 | 2 | 3 | 5 |
| Laparoscopy | 1 | 1 | 1 | 5 |
| PTC | 2 | 3 | 3 | 10 |
- Facilitate the transfer of information important to the management and prevention of disease.
- Demonstrate awareness of bio-psycho-social factors in the assessment and management of a patient.
- Demonstrate sensitivity in performing internal examination. It is important to explain to the patient why an intimate involve. The patient’s permission must be obtained and, where possible, the patient should be invited to bring a relative or friend. The patient should have privacy to dress avoid unnecessary personal comments. Questions and feedback should be encouraged.
- Consistency show consideration of the interests of the patient and the community as paramount with these interests never subservient to one’s own personal or professional interest.
Each resident does an average of one night in four on-calls within the Hospital premises, although occasionally one night in three or two may be necessary.
Residents are evaluated by faculty every month, based on their rotation. Feedback is provided by the Programme Director and Coordinator, every 3 months.
Annual TOACS and Year end PGME exams are conducted. In addition, formative assessments based on assorted topics may be arranged every 2-3 months.
Candidates are required to fill on-line application form. Please follow the steps mentioned below:
1. Register yourself by defining user name and password.
2. After your account is created, you will need to login to fill the Application Form. Programs offered will be displayed after registration.
3. A candidate can apply for only one program at a time.
4. Candidate may partially fill the form and save it on-line for resuming filling out the form later using login credentials.
5. Once the on-line application form is filled and submitted, candidate would be able to take a printout.
6. The hard copy of the on-line application form along with the required documents mentioned in the Application Form must be submitted to the PGME Office, Medical Staff Affairs either personally, through friends/relatives or through reliable courier service.
7. Check your junk emails (in case of email not received).
If there is still confusion, then follow these Steps
Step 1. Register yourself
Step 2. Check your email address and click on the received link
Step 3. Login
Step 4. Fill the Profile necessary information
Step 5. Submit
Step 6. Ok
Step 7. Online Application Form
Step 8. Select Program or Medical Officer
Step 9. Select specialty
Step 10. Submit
Step 11. Print application form.
All residents are encouraged to get involved in audits and research projects, however research project as per CPSP requirements is mandatory for all.
- MBBS or equivalent
- One-year House Job
- FCPS Part 1
Candidates applying for the program must have completed their M.B.B.S. from a recognized institution, one year of internship (House job) and should have cleared their F.C.P.S. part I examination.
their F.C.P.S. part I examination.
