Inpatient/Outpatient US Clinical Experience in Gastroenterology in Orlando

Information about this clinical experience:

You will be under the supervision of a physician board-certified in internal medicine and gastroenterology. This attending has approximately 20 years of experience teaching medical students and international medical graduates and is presently an Assistant Professor of Medicine at the University of Central Florida College of Medicine. He has also been actively involved in resident education in the past as a core faculty member of an IMG-friendly internal medicine residency program in Orlando. The preceptor holds hospital appointments at hospitals within the Advent Health and Orlando Health systems. The doctor is a member of the American College of Gastroenterology.

The attending stays current with the latest technological advances in gastroenterology, and utilizes these techniques for optimal diagnosis and treatment. During four days of the week, your day will begin at one of two surgical centers where the doctor performs various endoscopic procedures of the upper and lower GI tract. This will be an excellent opportunity to understand the role of endoscopic procedures for patients presenting with different GI complaints, including dysphagia, abdominal pain, diarrhea, constipation, nausea, vomiting, and iron deficiency anemia, among others. You will observe how pre-procedure assessments are performed, gain an understanding of how sedatives are administered pre-procedure, and learn about post-procedure care. By the end of the rotation, you should have a firm understanding of the indications and contraindications of endoscopic procedures, bowel preparation prior to procedures, proper use of conscious sedation and monitoring, and procedural complications.

Following your time in the surgical center, you will either accompany the attending to the clinic or to the hospital for rounds. For one week of every month, you will take call in the afternoons at the hospital with the nurse practitioner where you will see patients with acute gastrointestinal complaints. This part of the rotation will allow you to broaden your exposure to encompass both acute and chronic problems. The hospital component of the rotation will familiarize you with the type of issues you will see as a resident and how you can collaborate with gastroenterologists to ensure your patients receive the highest quality of care. Several high-yield articles to read to prepare you for the hospital component include the following:

Upper Gastrointestinal Bleeding in Adults: Evaluation and Management

Lower GI Bleeding: Diagnostic Modalities

In the clinic, you will see patients with a variety of GI complaints. The most common complaints you will encounter in the clinic will be abdominal pain, diarrhea, vomiting, nausea, bleeding, constipation, and anorectal symptoms (in descending order of frequency). An important part of this rotation will be developing your approach to the evaluation of these symptoms, an exercise that will serve you well when you see patients in your general medicine clinic during residency.

Of note, approximately 3 days of your rotation will be with the attending and the other two days will be with the nurse practitioner. Since residency programs expect that you have an understanding of the roles of other healthcare professionals on the team, this will be an excellent opportunity to communicate that understanding to programs through the ERAS application and in the interview.

During your experience, you will learn the following U.S. medical practices under the preceptor’s supervision:

• Taking patient histories.

• Performing exams under the physician's supervision.

• Presenting patients.

• Entering clinic notes (eClinicalWorks)

• Researching the literature to answer clinical questions at the point of care.

• Educating patients.

• Giving talks about topics in medicine.

• Teaching other team members.

• Spending time with other healthcare professionals in the office to understand their roles and responsibilities.

The activities above will mostly take place in the outpatient setting. As a result of hospital policies, inpatient activities will be more observational.