PCP OBE-CBTP IN INTERNAL MEDICINE

LEARNING CONTRACT
Section of Gastroenterology
City of General Trias Doctors Medical Center

Name of Resident:__________________________________
Inclusive dates of rotation:____________________________
Section Chief:______________________________________
Section Training Officer:______________________________

I. Expected general outcome of rotation: After the one month sub-specialty rotation in Gastroenterology during YL II, the
medical resident is expected to acquire the competences for YL II in Gastroenterology for conditions listed under
Digestive System in the Contents of Terminal Competencies of Internists (PCP OBE-CBTP Document #2) in
Gastroenterology encountered in the Medical Ward, Emergency Room, and OPD; as well as special issues related to
Program Outcomes # 2 to 8 like ethical issues on caring for the chronically and terminally-ill patients, education on
hepatitis B ( patients, families and community) and addressing the nutritional requirements of patients with gastrointestinal
disorders.
II. Expected specific outcomes of rotation or (intermediate competencies and corresponding contents):

1. Intended for Program Outcome # 1: Clinical competence in Gastroenterology:

A. Diagnose and initiate management of common but complicated medical conditions / diseases of the Digestive
System and refer to appropriate subspecialists (Gastroenterologists):

Medical Conditions / Diseases Recommended ( # ) Actually Certified

Minimum Number of encountered Correct by
Cases Encountered for ( X ) Read only Section Chief
Clinical Competence (  ) No idea ( signed:initials)

1. Caustic Injury - Alkali / Acid 1

2. Gastroparesis (Chronic gastritis / H. pylori / 5
portal hypertensive gastropathy / Stress)
3. Peptic Ulcer Disease (ASA / NSAID / H. pylori 5
negative / Complications – hemorrhage /
penetration / perforation / obstruction)
4. Acute / Chronic Pancreatitis, Complicated 2
5. Complicated Gallstone Disease 4
6. Fulminant Hepatitis / Drug induced liver injury 2
7. Portal Hypertension - Esophageal / Gastric 2
Varices
8. Hepatic Encephalophathy 2
9. Hepatorenal Syndrome 2
10. Hepatocellular Adenoma / Cavernous 1
Hemangioma / Focal Nodular Hyperplasia /
Hepatic cysts
11. Irritable Bowel Syndrome with Constipation / 1
Diarrhea / Mixed Type
12. Intestinal Obstruction 2

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 B. Diagnose and manage common emergency conditions in Gastroenterology:

Emergency Conditions Recommended ( # ) Actually Certified

Minimum Number of encountered Correct by
Cases Encountered for ( X ) Read only Section Chief
Clinical Competence ( ) No idea ( signed:initials)
1. Acute Abdominal Pain 2
2. UGIB 2
3. Severe Diarrhea 2
4. Severe Vomiting 2

C. Diagnose and initiate management of common but complicated emergency conditions in Gastroenterology and
refer to appropriate subspecialists:

Emergency Conditions Recommended Minimum ( # ) Actually Certified Correct

Number of Cases Encountered encountered by Section Chief
for Clinical Competence ( X ) Read only ( signed: initials)
( ) No idea
1. Upper Bleeding: Non- Variceal / 1 each
Variceal
2. Lower GI Bleeding: Diverticular 1 each
Bleeding / Angiodysplasia
3. Caustic Injury of Esophagus: Acid / 1 each
Alkali
4. Foreign Bodies Ingestion 1
5. Boerhaeve's Syndrome 1
6. Acute Abdomen: Perforated Viscus, 1 each
Acute Appendicitis, Acute
Necrotizing Pancreatitis, Acute
Complicated Diverticulitis, Intestinal
Obstruction, Toxic Megacolon,
Intussusception, Volvulus,
Mesenteric Ischemia/Infarction
7. Acute Hepatic Encephalopathy 1
8. Acute Liver failure 1
9. Ascending cholangitis 1

D. Perform common diagnostic and therapeutic procedures in Gastroenterology:

Procedures Recommended Minimum ( # ) Actually Certified Correct

Number of Cases Encountered done by Section Chief
for Clinical Competence ( X ) Assist only ( signed: initials)
( ) No idea
1. NGT with gastric aspiration 5
2. Saline Load Test 1
3. Paracentesis 2

2. Intended for Program Outcomes 2 to 8:

A. Teach nutrition screening and risk assessment

B. Discuss nutrition in different disease states namely with intensive care unit patients, perioperative patients, and
those with gastrointestinal conditions namely cirrhosis, malabsorption syndromes and pancreatitis.
C. Conduct education sessions to patients, families and local communities regarding chronic hepatitis B; its
transmission, screening and progression to chronic liver disease
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 D. Conduct education sessions to patients, families and local communities regarding colon cancer screening
E. Discuss quality of life care for critically and chronically ill cirrhotic patients

3. Duration of rotation: 1 month

4. Schedule of teaching-learning activities and workplace assessment processes:

Mondays Tuesdays Wednesdays Thursdays Fridays

1 Week
st
*Orientation *Department of *Rounds / answer *Department of *Rounds / answer
*Discussion on Medicine referrals from Medicine referrals from
how the ‘Learning Conference other areas Conference other areas
Contract will be *Rounds At ward *Rounds At ward *Rounds / answer *Rounds / answer
accomplished and specialty care and specialty care referrals with referrals with
*Rounds / answer units units gastroenterologists gastroenterologists
referrals from * RCI with * RCI with * RCI with * RCI with
other areas gastroenterologists gastroenterologists gastroenterologists gastroenterologists
*Rounds At ward * Gastroenterology
and specialty care OPD clinic
units
* RCI with
gastroenterologist

2nd Week *Rounds / answer *Department of *Rounds / answer *Department of *Rounds / answer
referrals from Medicine referrals from Medicine referrals from
other areas Conference other areas Conference other areas
*Rounds At ward *Rounds At ward *Rounds At ward *Rounds / answer *Rounds / answer
and specialty care and specialty care and specialty care referrals with referrals with
units units units gastroenterologists gastroenterologists
* RCI with * RCI with * RCI with * RCI with * RCI with
gastroenterologists gastroenterologists gastroenterologists gastroenterologists gastroenterologists
* Gastroenterology
OPD clinic

3rd Week CbD and/or Mini- *Department of *Rounds / answer *Department of *Rounds / answer
CEX Medicine referrals from Medicine referrals from
*Rounds / answer Conference other areas Conference other areas
referrals from *Rounds At ward *Rounds At ward *Rounds / answer *Rounds / answer
other areas and specialty care and specialty care referrals with referrals with
*Rounds At ward units units gastroenterologists gastroenterologists
and specialty care * RCI with * RCI with * RCI with * RCI with
units gastroenterologists gastroenterologists gastroenterologists gastroenterologists
* RCI with * Gastroenterology * Subspecialty
gastroenterologists OPD clinic Presentation -
* Lay forum on Gastroenterology
hepatitis B/colon
cancer

4th Week *Rounds / answer *Department of *Rounds / answer *Department of *Rounds / answer
referrals from Medicine referrals from Medicine referrals with
other areas Conference other areas Conference gastroenterologists
*Rounds At ward *Rounds At ward *Rounds At ward *Rounds / answer * RCI with
and specialty care and specialty care and specialty care referrals with gastroenterologists
units units units gastroenterologists
* RCI with * RCI with * RCI with * RCI with *Prepare and do
gastroenterologists gastroenterologists gastroenterologists gastroenterologists endorsement to
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 * gastroenterology * Gastroenterology next rotator
quiz OPD clinic
*Completion of
Learning Contracts
*Topics fulfilled/not
fulfilled /
completed/not
completed
*Feedback
*Filling-up of
MSF/Self-
Assessment
*Submission of
documents to Dept
of Medicine

I. Additional cases, topics and procedures that the rotating resident is interested to acquire.

I learn from other peers and gastroenterologists that there are demands for internists to be ‘physicians on duty’ in at ward
and specialty care unitss. In order for me to be competent assuming this task, I am planning to stay and spend more time
in the at ward and specialty care units after I have done my routine daily tasks. I want to learn the technical aspects of
hemodialysis, address complications among patients during actual hemodialysis, and interact more with hemodialysis
patients to better understand their situation and better learn their perspectives about their illness.

Date of initial discussion of this learning contract:_____________________

Signed:

Date of initial discussion of this learning contract: ______________

Signed:

___________________ ____________________ ___________________

Gastroenterology Rotator Section Head, Gastroenterology Training Officer

Date of final discussion / assessment / feedback / completion of learning contract:___________

Signed:

___________________ ____________________ ___________________

Gastroenterology Rotator Section Head, Gastroenterology Training Officer