Digestive Diseases and Nutrition

Swallowing Center

1. Patient Care
a. Develop focused interview skills to record a detailed history and perform a complete physical examination for patients with the following conditions
· Dysphagia with emphasis on oropharyngeal and esophageal dysphagia
· GERD and its atypical manifestations involving the upper aerodigestive tract
· Eosinophilic esophagitis
· Post-surgical and post- chemo and or radiation treatment effects on the swallowing mechanism and the esophagus
· Unexplained chest pain
b. Develop a thorough assessment and differential diagnosis for the above mentioned conditions.
c. Understand the pharmacology and appropriate dosing schedules for medications indicated for esophageal disorders (for acid suppression, poorly absorbed oral steroids, low dose antidepressants, smooth muscle relaxants).
d. Demonstrate the ability to understand the indications, appropriately order and interpret esophageal and swallowing physiologic testing, radiographic imaging which include the following:
· 24 hour ambulatory single and dual channel esophageal pH studies
· 24 hour ambulatory combined esophageal pH and impedance studies
· Pharyngeal and esophageal motility
· Modified barium swallows with emphasis on the oropharyngeal normal and abnormal physiology of swallowing
· Barium and esophagram with emphasis on food bolus challenges
· Timed barium emptying study
e. The ability to competently perform and understand the nature and potential complications for endoscopic procedures used to manage esophageal strictures or dysphagia from other causes.
· Dilation of strictures in the esophagus with various techniques
1. Bougienage with and without a guidewire and fluoroscopy
2. Hydrostatic or pneumatic balloon dilation
3. Retrograde dilation using Tucker dilators
4. Adjuncts to stricture management using stents or steroid injections
· Injection of Botulinum Toxin A into the esophagus for achalasia or hypercontractile esophageal motility disorders.
f. The ability to properly insert esophageal manometry catheters and 24 hour pH probes.
2. Medical Knowledge
a. Develop knowledge base through participation in weekly multidisciplinary CSD Clinical Care Conferences.
b. Develop the necessary knowledge base to identify the different causes of esophageal and pharyngeal stenosis and dysfunction and in a collaborative team-based approach develop a therapeutic plan to manage these conditions.
c. Develop the knowledge base to understand the gastroesophageal reflux disease and its spectrum of clinical manifestations from typical esophageal symptoms to atypical upper aerodigestive symptoms.
d. Develop the knowledge base to recognize the appropriate management among patients with columnar-lined (Barrett) esophagus, develop appropriate plans for intervention in patients with dysphagia.
e. Develop the knowledge to recognize the clinical, radiographic and endoscopic features of pharyngeal and esophageal dysphagia referred to the Joy McCann Culverhouse Center for Swallowing Disorders.
3. Practice Based Learning
a. The subspecialty resident will be provided with a compilation of PDF files of selected articles and book chapter relevant to esophageal and swallowing disorders.
b. The subspecialty resident will be provided a list of web-based learning tools for gastroenterology (general principles, radiology, pathology, case-based learning tools).
c. The subspecialty resident will develop a presentation about a topic/research endeavor which will be presented during the last week of his/her rotation.
d. When the duration of the rotation is sufficient, the subspecialty resident will be encouraged to pursue a research project in depth, which can be accomplished during or immediately after the rotation.
4. Interpersonal and Communication Skills
a. Special emphasis will be placed on taking a comprehensive history related to dysphagia.
b. Demonstrate effective communication with patients, families, Center staff and colleagues.
c. The subspecialty resident will receive and will be asked to give his/her feedback during the mid-point of the rotation and at the end of the rotation.
5. Professionalism
a. Adherence to USF COM Department of Medicine Housestaff Policy of conduct and dress
b. The subspecialty resident will receive specific instructions about appropriate decorum and professionalism in the endoscopy unit.
c. The subspecialty resident will participate actively in clinic appointments, laboratory and endoscopic procedures with attention to responsibility and accountability in timely completion of all necessary paperwork, electronic health record entries and reports.
d. The subspecialty resident will demonstrate an open and responsive attitude to feedback from members of the multi-disciplinary team at the Joy McCann Culverhouse Center for Swallowing Disorders.
6. Systems Based Practice
a. The subspecialty resident will participate actively in the multi-disciplinary (speech pathologist, nursing staff, physician and nurse practitioner staff) patient care conferences during which relevant clinical material (radiographs, endoscopic images, photographic images, and physiologic studies) will be presented and discussed.
b. The cost effectiveness and the need to base recommendations on the best available medical evidence will be given special emphasis during the multi-disciplinary team meetings to formulate the combined therapeutic plan.
c. Feedback will be provided about the initial diagnostic and therapeutic plan initially developed by the subspecialty trainee.