Fellowship Course in Surgical Gastroenterology

1 year

MD (General Medicine) or MS (General Surgery)

2

A total of 2 candidates per year will be selected for each course. Selection will be based on performance at interview 30%, University level academic merits (20%) publications if any (20%) and recommendations from teacher PG teacher (30%) or by university rules and regulations.

The GI Endoscopy fellowship is designed to :

1. Provide comprehensive training and acquisition of skills in diagnostic and therapeutic endoscopy procedures
2. Help in integration of endoscopy in diagnosis and management of gastrointestinal and hepatobiliary disorders
3.  Training in research
4.  Inculcate appreciation of humanistic (cost conscious, caring) and ethical (accountability, integrity) aspects of medicine.
5. Develop ability to work as part of a multidisciplinary team

1. Understanding basic physics and principles of endoscopy
2. Understand the features of various types of endoscopes and accessories
3. Reprocessing and maintenance of endoscopes and accessories
4. Understanding the principles, techniques and complications or conscious sedation /analgesia as well as patient monitoring during and after endoscopy
5.  Obtain familiarity with informed consent and medical ethics, and explaining risk of endoscopy to patients
6. Antibiotic prophylaxis
7. Cognitive understanding of diagnostic /therapeutic procedures interpreting the findings and understanding the clinical indications / contraindications as well as complications.
8. Integrate endoscopic Knowledge with patient care
9. Motility studies – Esophageal & anorectal and 24 hr pH study

A. Acquire technical skills in performing the following diagnostic / therapeutic procedures, interpreting findings, recognizing and treating complications:

1. Management of gastrointestinal bleed : lesion identification and appropriate therapy – adrenaline injection, APC, variceal sclerotherapy , variceal Band ligation and cyanoacrylate injection of fundal varices
2. Luminal dilatation (strictures, achalasia cardia ,webs ): Savary Guillard, pneumatic, CRE
3. Stent placement – esopyageal, small bowel, colonic
4. Percutaneous endoscopic gastrostomy tube placement and exchange
5. Nasogastric and nasojejunal tube placement
6. Foreign body removal
7. Polypectomy
8. Pancreatic pseudocyst drainage
9. Side viewing endoscopy
10. ERCP- biliary and pancreatic duct connulation , biliary and pancreatic sphincterotomy ,biliary and pancreatic and pancreatic stent placement , stone removal, biliary stricture dilatation, nasobiliary drainage tube placement.
11. Pediatric endoscopy
12. EUS

B. Minimum number of procedures for minimum competence:

C. Night call on rotation for observing / assisting ./performing emergency endoscopies and in ICU

D. See consultations for endoscopy procedures and follow up patients after the procedures

E. Supervising and teaching basic endoscopy skills to D. M trainees

F. Regular discussion with radiologists ,pathologists

G. Regular presentation of journal articles and seminars in the departmental Weekly academic meetings.

H. Integrate endoscopic knowledge with patient care

I. Research presentation at national conferences

J. Clinical research in endoscopy and evidence based practice. Regular Meeting will be held between fellows and faculty members to design and Conduct research. The fellows are required to complete a minimum of one research project in endoscopy during the one year training under the supervision of faculty members. The project proposal should be submitted within a month of joining the fellowship to the project proposal should joining the fellowship to institute review board for obtaining ethical clearance and funding if required

A. Books :

1. Practical gastrointestinal endoscopy :The Fundamentals -6thedition , P .B. Cotton, C. Will
2. Endoscopy related topics from Sleisenger and Fordtran’ s Gastrointestinal and liver disease. 7th edition
3. Robert H, Hawes : Endosonography (Elsevies , Saunder )
4. Sugano K Double balloon endoscopy – Therapy and practice (Springer )
5. M . Classon. Gastroenterological endoscopy (Thieme )
6. Tytgat GWK. Practice of therapeutic endoscopy W.W.Saunders )
7.  Sivak Gastroenterologic endoscopy (W.B. Saunders )
8. J. H. Siegal . Endoscopic Retrograde Cholangio pancreatography
9. Barkin . Advanced therapeutic endoscopy (Raven press )
10. Van Dam , Sivak . GI Endosonography (w. B. Saunders )
11. Wilcox . Atlas 0f Clinical G.I. Enodscopy (Saunders )
12. Keeffe E.B. Atlas of G.I. Endoscopy (Current Med. Ins)
13. Klaus . Atlas of G.I. Endoscopy and pathology (Blackwell)
14. Kenchel .Atlas of video capsule endoscopy (Springer )
15. Messmann H. Atlas of colonoscopy (Thrieme )
16. Advanced therapy in gastrointestinal and liver disease.
17. Sohendre . Colour atlas of prerative techniques – Therapeutic endoscopy (Thieme )

B. Journals :

1. Endoscopy
2.  G. I Endoscopy

a. The performance of the fellow will be monitored carefully during the course of training

b. Formal evaluation by the faculty members on a regular basis. This includes the performance of procedure. of findings and planning/ performance of appropriate therapy. These will be recorded in the log book maintained by the candidate. Procedure Number done Documentation of competence by the faculty member

c. At the end of the course there will be :

• Written exam
• Practical test: Skill assessment in performing endoscopies
• Orals: radiology/ instruments, clinical reasoning and selection of endoscopic procedures in different case scenarios. The candidate should secure a minimum of 50%marks each in written and practical tests and 50% in orals to pass the examination.
• Evaluation of research project

d. To successfully complete the fellowship

• The candidate should pass the exit exam with at least 50%marks
• The research project should be complete and approved by external Faculty
• The log book containing documented competence in endoscopic procedures should be approved by the external faculty.

Each year an examination coordination committee (ECC) consisting of three teachers running Fellowship / certificate courses will be nominated by the director of the Institute. Both theory and practical Examinations will be concluded within 15 days of the end of the course. Examination will be conducted in individual institutions. Each examination will have one internal and one external (approved by the ECC.)

1. Theory : 100 marks. Passing marks 50%. All theory examinations will be held on a single day for all courses of similar lengths.
2. Practicals : Each candidate will examined by both examiners simultaneously for between 60 and 90 mins. This will cover a viva – voce and practical. Passing marks 50%. Candidates have to pass individually in both theory and practical.

Results will be announced on the Website and Notice board within one week of the conclusion of the examination. The result will be only “Fellowship granted / Denied and marks will not be displayed. Repeats will be at the end of on earlier then 3 -6 months depending on the length of the course.

Certificates will be awarded by the Gujarat University after the results will be sent to the GU. The University (with signature of the Registrar) will award the certificate.

 Note – The decision of the Examination Co- ordination Committee will be binding on all matters pertaining to the examinations.

Allopathic doctors holding valid MBBS, DNB or MD degree in India or equivalent (with valid MCI registration) and atleast 2 years of hospital experience after internship (of which atleast 1 yr is in critical care units) are eligible to register for this Fellowship program. From 2017, MD candidates with 2 years ICU Experience can apply for exemption from Part 1 examination (in specific form). Those MD Candidates exempted from Part 1 Examination can directly register for Part-2 course A letter from the Institute/ teacher to this effect must be submitted along with every application.

Total duration of the course is 24 months.

a. The term for part-1 (Primary) starts from 1st January at hospitals recognized by the College for this training. Candidates selected by the institutes must register
for the examination with the “College of Critical Care Medicine” at unit-F, Gemini Park, V. N. Purav Marg, Mankhurd, Mumbai-400088, Maharashtra from 1st Jaunary upto latest by 31st March for the Part 1 Examination.
Candidates cannot be enrolled after 1st April without special approval from the College (with late fee of Rs 8000) on a case by case basis but not later than 30 April. The Part 1 Examination is held at one location anywhere in India usually in the months of Dec/Jan (theory) and Jan/Feb (practical) in the following year. (see Calendar of College of Critical Care Medicine for details).

b. After successful completion of Part-1 candidates can register for part-2 (Fellowship). They will need to continue to work in ICU during their part 2 training in their hospital. (see Calendar of College of Critical Care Medicine for details).

c. The term for part-2 (Fellowship) starts immediately after completion of the Part 1 Examination. Candidates who have passed part 1 can register for the
Part 2 examination with the “College of Critical Care Medicine” at unit-F, Gemini Park, V. N. Purav Marg, Mankhurd, Mumbai-400088, Maharashtra from date of passing upto 30th April. Candidates cannot be enrolled after 30th April without special approval from the College (with late fee Rs. 8000). The Part 2 Examination is held at one location anywhere in India usually in the months of Oct-Dec in the same year. (see Calendar of College of Critical Care Medicine for details).

The training program will be a residency program and the trainee should be responsible for patient care and procedures. A minimum 80% attendance at the locally organized teaching programs is mandatory for the candidates. A record of such teaching programs must be maintained (in form of register). All recognized teachers must significantly contribute to their teaching program

A Half yearly report (6 monthly) of lectures taken must be sent to the college as an email to admin@icudoctor.in or office@icudoctor.in . This should include topics, speakers, and students attendance. Failure to submit academic reports atleast 2 times a year can result in disqualification of the centre.

a. Selection and Registration of the Trainee-Fellow: The candidates will be selected by individual institute provided they fulfill the eligibility requirements mentioned in (1) above. The name of all such selected candidates
must be immediately forwarded to the Chairman, College of Critical Care
Medicine in prescribed registration form downloadable from www.icueducation.com (in the download section); through the institute along with the candidates application/fees/photos etc mentioned in the application form latest by dates specified in (2) above. (see Calendar of College of Critical Care Medicine for details).

b. Examination registration form must be submitted by post to the College along with the photos and examination fee as determined by the College of Critical Care Medicine by DD/ multicity cheque. See the latest Examination
application form for details of payment (downloadable from www.icueducation.com in the download section). This fee is non-refundable even if candidate does not appear for the examination for whatever reason.

c. Membership form and fee for membership: This is one time payment only during registration for part 1 examination. Membership is preferably completed online at www.icueducation.com

Candidates selected will need to work in the ICU. They will receive a monthly stipend at least on par with other doctors of that designation in the department. It is recommended that candidates training for the Fellowship be given a token academic bonus at discretion of the institute. They should be spared from duties to attend academic programs in critical care as best possible without compromising patient care (in rotation).

All trainees must submit a log book as prescribed by the College as documentation of work done during their tenure in the ICU. This must strictly be in the prescribed format. Templates, examples and instructions are available at www.icueducation.com and can be downloaded from this site’s download section.

Rule for candidates who fail to pass the examinations: Candidates who fail in Part 1 examination will not have to wait one full year to reappear for the exam. (see Calendar of College of Critical Care Medicine for details).

The examination will be a common examination which will consist of :

a. Theory Papers: 2 papers of 2 hours each and conducted approximately 1 month before the practical examination

b. Practical Examination: 4-6 viva and 1-2 bedside ICU cases and 6-8 OSCE stations (Objective Structured Clinical Examinations) as detailed in other document. Part 2 candidates will be evaluated for “communication with relatives” and ICU procedures and drugs/equipments among other components of the examination.