Gastroenterology And Hepatology Curriculum
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Gastroenterology And Hepatology Curriculum
Transcript of Gastroenterology And Hepatology Curriculum
Gastroenterology
And
Hepatology Curriculum
Preface
T he High Committee of Medical Specialties and the gastroenterology Scientific
Council worked collaboratively and closely to make this curriculum available
for trainees’ guidance and support.
Postgraduate medical education world wide are now governed by sets of academic
standards that describe the qualities and abilities of graduates. In addition, there are
standards for the training processes , trainers’ selection and assessment systems.
standards ensure transparency and clarify expectations.
The High Committee of Medical Specialties has already defined and published its
standards for the general and professional competencies expected from our gradu-
ates in different specialties upon successful completion of training. These expecta-
tions are clearly reflected in the gastroenterology/hepatology curriculum.
The curriculum describes knowledge, skills , attitudes and behaviors that trainees
will possess upon successful completion of training. In additions, methods of teach-
ing and learning needed to deliver the curriculum are outlined. The curriculum also
describes in details, expectations from trainees during their rotations in “The train-
ing rules and regulations section”. Methods of assessment and examination regula-
tions are also available in the last section of the curriculum.
All topics covered during practical and theoretical study are outlined. This will
help trainees to guide their readings and their choice of learning activities. In addi-
tion, all required clinical cases and procedures are listed together with expected per-
formance at various stages of training
The GIT council representatives defined mandatory courses that must be at-
tended by trainees and the Egyptian Fellowship administration will work closely with
the GIT scientific council to ensure proper organization and implementation of these
courses.
We hope that all our trainees, trainers and educational supervisors will follow
the guides provided in the curriculum and cooperate with The High Committee of
Medical Specialties and the Gastroenterology Scientific Council to implement the
curriculum in the best ways. Esmat Ahmed Sheba
General Secretary
The High Committee of Medical Specialties
Ministry of Health and Population
Acknowledgement
The Gastroenterology curriculum has been created through collaboration between the Gas-
troenterology scientific council and the Egyptian fellowships’ curriculum committee. The
High Committee of Medical Specialties would like to acknowledge the significant efforts
and the substantial contribution of
Professor Dr Mohammed Sakr, Professor of Gastroenterology , Ain
Shams University and Training Coordinator of the Gastroenterology sci-
entific council
Professor Dr Aly Farag , Professor of Gastroenterology , Cairo University
The Committee in charge of curriculum preparation consulted international and na-
tional curricula in gastroenterology. The external references for the development of
this curriculum are:
1. The Joint Committee on Higher Medical Training gastroenterology curriculum
approved by Postgraduate Medical Education and Training Board UK 2007
2. The American gastroenterologists association , Training gastroenterologists of
the future: the gastroenterology core curriculum published in ——
3. Egyptian Fellowship Guidelines for curriculum development issued June 2007
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CONTENTS………………….
The Structure and Regulation of Gastroenterology/ Hepatology
Training………………………………………………………….... 9
Trainees duties and obligations ……………………………..…… 11
Specific Requirements and Obligations ………….………………….. 11
Rational Statement ……………………………………………….. 13
Aims & Intended Learning Outcomes ………………………….. 15
1. Knowledge..………………………………………………………….. 15
2. Intellectual and professional skills ………………………………..…. 16
3. Attitude………………... …………………………………………….. 16
LIST OF MAJOR TOPICS ……………………………………… 17
1. GIT Motility disorders.………….………….………….………….. 18
2. Acid peptic diseases.………….………….………….…………….. 19
3. Pancreatic diseases,.………….………….………….……………… 21
4. Biliary diseases.………….………….………….………………….. 23
5. GIT inflammation.………….………….………….……………….. 25
6. GIT malignancy.………….………….………….…………………. 27
7. Hepatology.………….………….………….………………………. 29
8. GIT endoscopy and GIT bleeding.………….………….…………., 32
9. Nutrition………….……………....………….………….…………. 34
10. Gastrointestinal and hepatic pathology.………….………….…….. 35
11. Gastrointestinal and hepatic radiology.………….………….……… 36
12. Gastrointestinal surgery.………….………….………….…………. 37
13. Liver Transplantation ………….………….………….……………. 38
Training methods…………………………………………………. 39
Learning and reference martial………………………………….. 41
Methods and regulations of assessment………………………..... 42
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The Gastroenterology/ hepatology board requires two years of supervised
training program that must be conducted in accredited hospitals before sitting for
the final examination. The board will announce a list of accredited hospitals
yearly. Entry to gastroenterology training requires any of the following qualifica-
tions
Diploma in General Medicine with evidence of recent training or practice in
recognized internal medicine hospitals.
Master in General Medicine with evidence of recent training or practice in
recognized internal medicine hospitals.
M.D. in General Medicine with evidence of current practice in general inter-
nal medicine services recognized by the MOHP.
M.R.C.P. with evidence of current practice in general internal medicine ser-
vices recognized by the MOHP.
At least two years of training in Egyptian fellowship of general internal medi-
cine with successful completion of the first part exam.
During the entire training program, the candidate must be dedicated full time
and must be fully responsible for patient care under supervision.
The Structure and Regulation of
Gastroenterology/Hepatology Training
Description of Gastroenterology
/Hepatology rotations
Hepatology Gastroenterology
Hepatology inpatients and outpatients
8 months
Gastroenterology inpatients and out-
patients
8 months
Ultrasound Unit
4 months
Endoscopy Unit
4 months
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The purpose of this rotation is to provide clinical experience in the assessment &
management of patients with common and important gastrointestinal diseases.
The purpose of this rotation is to provide trainees with technical supervised
instructions and training in gastrointestinal endoscopy.
The purpose of this rotation is to introduce trainees to practice routine ultra-
sonographic examination of the liver and GIT & ultrasound guided liver biopsy.
It is, however, expected that trainees will continue to practice these skills
throughout the program to achieve the required competencies.
The purpose of this rotation is to provide clinical experience in the assessment &
management of patients with common and important hepatological disorders of
significance to the Egyptian and Arab societies.
Important notice
Trainees must pass successfully all foundation courses before being pro-
moted to the second year of training. Full information about foundation
courses is available at the EF website & administration office.
Gastroenterology services
Hepatology services
Endoscopy Unit
Ultrasound Unit
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1. Trainees must attend at least 75% of lectures and other academic activities
relevant to gastroenterology and hepatology subjects.
2. They should be actively involved and fully responsible for patient care
including sharing in making decisions about diagnosis and management
under supervision of the consultants.
3. They must also attend 75% of weekly clinical activities including clinical
rounds, morning endorsement and grand staff rounds.
4. Their performance will be evaluated regularly by their trainers and an ap-
praisal report will be submitted on monthly basis to the training monitoring
and evaluation office affiliated to the High Committee of Medical Special-
ties.
5. All trainees will work as residents in the training specialty & they must
fulfill all residents jobs defined by supervisors and trainers.
6. They should be responsible under supervision for outpatient and in
patients' routine work.
7. They must take supervised shifts according to the hospitals requirements
and regulation.
1. The trainees will be responsible for supervised admission of patients from
the outpatient department or emergency.
2. They will share in the completion of the following documents under
supervision
a. Complete history and physical examination form.
b. Investigation requests, (laboratory, radiology, pathology, etc.).
c. Reporting results of the investigations
d. The plan of management after consultation and approval from supervi-
sors
e. Daily progress notes.
f. Order and medication sheets
g. Order the necessary diagnostic procedures
h. Discussion of the case with the trainer and consultants
i. Discharge summaries.
j. Sick leaves and medical reports
3. The trainee should inform the senior staff of any high-risk patient
admission.
Specific Requirements and Obligations
1. Towards the admitted patients:
Trainees' duties and obligations
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The trainees should attend the gastroenterology/hepatology outpatient clinics as
requested by trainers & supervisory staff. They should participate in different
patients' interviews and share in management under supervision.
The trainees should attend and participate in the mandatory academic and clini-
cal activities of the department. Attendance and participation should not be less
than 75% of the total number of activities within any training rotation / period
including.
Daily morning patients' rounds and meetings.
Clinical round presentation, at least once weekly to cover various topics,
problems or research.
Journal club meeting.
Interdepartmental meetings/ morbidity and mortality meetings.
Grand staff rounds .
The trainees must keep & update the logbook where they record all activities &
skills performed & learned during the training program. The activities should be
dated & categorized to whether been performed by the trainee him/herself or as
an assistant or participant. The trainer should counter sign each activity regis-
tered in the logbook. The trainer and educational supervisor must sign the com-
pleted logbook. The educational supervisor must sign important activities and
check the logbook for completion at least monthly.
Before the completion of the training program
The trainee should have completed all the rotations described in the structure of
the program and satisfactory completed all logbook requirements before being
eligible for the final certifying exam.
Holidays and on call duties
According to Ministry of Health and Population regulations.
3. Mandatory clinical activities:
2. Obligations in the outpatients' clinics:
4. The log book:
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It is not permissible to interrupt such a structural training program except in
major unavoidable circumstances. Such circumstances should be convincing &
approved by the Secretary General. The interruption once approved should not
be for more than one year. Interruption of the training program for more than
one year shall result in dismissal from the program and cancellation of the
preceding training period.
The gastroenterology/ Hepatology training program is concerned with the
preparation of trainees for pursuing their role in the provision of comprehensive
health care services in these fields. In addition to adequate knowledge and
understanding of the specialty, the program aims to develop gastroenterologists
who are competent in skills necessary for patient management, decision making
& safe performance of procedures that are integral to field ( like ultrasound
guided liver biopsy, diagnostic and therapeutic endoscopies).
Gastroenterologists graduated from the program will work independently and
within multidisciplinary team. They will be involved in the continuous care for
gastroenterology patients at various care settings like hospitals, outpatients and
critical care units.
The curriculum has been formulated through joint work between gastroenterol-
ogy experts and medical education experts. In addition, the curriculum has been
revised by representatives to the scientific council and gastroenterology practi-
tioners. Lastly the curriculum has been approved in a council meeting January
2009.
Interruption of training
Rationale Statement
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I. Aims
To provide trainees with the necessary knowledge and understanding of
gastroenterology/hepatology conditions and diseases as well as related basic
medical science.
To enable trainees to assess, diagnose, manage and monitor treatment of
various gastrointestinal / hepatic disorders and related multisystem disor-
ders in acute and chronic settings.
To help them to develop the attitudes and behaviors expected in good medi-
cal practice .
At the end of the program, trainees should be able to:
1. Demonstrate adequate knowledge of basic medical science relevant to
proper understanding of gastroenterology/hepatology diseases, their investi-
gations and therapeutic lines.
2. Describe the epidemiology, causes, pathophysiology, natural history &
complications of different gastroenterology/hepatology presentations and
diseases.
3. Explain the clinical manifestations and diagnosis of different gastroenterol-
ogy/hepatology presentations and diseases.
4. Describe appropriate management of different gastroenterology/hepatology
diseases, including acute & long term management and follow up when
required.
5. Outline the methods that can be used for promoting health & preventing
disease relevant to the field of gastroenterology/hepatology.
6. Describe the principles, indications, requirements, preparation, peri-
operative and long term management of hepatic transplantation.
II. Intended Learning Outcomes
A. Knowledge
AIMS AND INTENDED
LEARNING OUTCOMES
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8. Take appropriate history and conduct proper clinical examination of
patients with different gastroenterology/hepatology disorders.
9. Select, use & interpret appropriate investigations needed for the diagno-
sis & follow up of patients with different gastroenterology/hepatology dis-
orders. These include laboratory, imaging and pathological investigations.
10. Use data from clinical assessment and investigation results to diagnose
and develop management plans for patients with different gastroenterol-
ogy/hepatology disorders.
11. Monitor disease course, response to therapy & development of
complications & modify patient management accordingly.
12. Use adequate methods for prevention, diagnosis and management of
infectious conditions in gastroenterology/hepatology patients.
13. Perform competently the technical procedures necessary for acute or rou-
tine management of gastroenterology/hepatology patients (e.g. advanced
life support, routine medical procedures, ultrasonography, ultrasound
guided liver biopsy, diagnostic and therapeutic endoscopies).
14. Apply and interpret international and national guidelines in the diagno-
sis, classification & management of gastroenterology/hepatology patients
15. Use the best available scientific evidence to inform decisions on patient
management and integrate this with clinical experiences and patients
values and preferences.
16. Plan for & conduct community and primary care based screening surveys
for conditions which may present prospects for preventive and/ or early
intervention .
17. Demonstrate respect and consideration for patients and their interests.
18. Communicate effectively with patients regarding the different aspects of
patient care (e.g. natural history, management options and their
implications, potential complications, long-term management & lifestyle
modifications, inherited and familial disorders, breaking bad news).
19. Integrate relevant ethical and legal requirements in the management of
patients.
20. Recognize the role of other physicians, nurses and paramedics in the
multidisciplinary management of gastroenterology/hepatology patients
and work closely with them.
21. Demonstrate appropriate professional attitudes, self-confidence and
recognition of personal limitations.
C. Attitudes and behaviors
B. Professional Skills & Intellectual skills
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1. GIT Motility disorders.
2. Acid peptic diseases.
3. Pancreatic diseases,.
4. Biliary diseases.
5. GIT inflammation.
6. GIT malignancy.
7. Hepatology.
8. GIT endoscopy and GIT bleeding.
9. Nutrition.
10. Gastrointestinal and hepatic pathology.
11. Gastrointestinal and hepatic radiology.
12. Gastrointestinal surgery.
13. Liver Transplantation.
LIST OF MAJOR TOPICS
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The trainee will be able to carry out comprehensive, competent, specialist as-
sessment and management of GIT motility disorders.
Trainees should demonstrate adequate knowledge and deep understanding
of the following:
1. The anatomy of the contractile apparatus of the GIT.
2. the physiology of GIT motility including the enteric nervous system, brain – gut
interaction, esophageal motor physiology, gastric emptying…..etc.
3. The causes and pathophysiology of common and important varieties of GIT
motility disorders.
4. The clinical presentations, which might suggest a motility disorder.
5. The diagnostic procedures in the field of Motility disorder, their indications and
limitations and basics of the emerging technologies and approaches.
6. The guidelines for management of motility disorders and how to apply them
properly.
7. Apply knowledge in the clinical evaluation of patients having picture suggestive
of a motility disorder.
8. Plan for and interpret laboratory investigations, imaging studies and specific tests
aiming at the diagnosis of motility disorders.
9. Participate with endoscopists and surgeons in planing for management.
1. Globus hystericus.
2. Diffuse esophageal spasm & nutcracker esophagus.
3. Achalasia of the cardia.
4. GERD.
5. Gastroparesis.
6. Chronic pseudo intestinal obstruction.
7. IBS.
GIT Motility disordersGIT Motility disorders
Main Goal
Intended learning outcomes
Intellectual and professional skills
Knowledge
Cases and conditions that must be
managed competently by trainees
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The trainee will be able to carry out comprehensive, specialist assessment and
treatment of patients with various Acid– peptic diseases.
Trainees should demonstrate adequate knowledge and deep understanding
of the following:
1. Anatomy, physiology and pathophysiology of the esophagus, stomach
and duodenum.
2. Gastric secretions and indications for gastric analysis.
3. The indications for serum gastrin measurement and secretin testing for
the diagnosis of gastrinoma and consequences of hypergastrinemia in both
hypersecretory and achlorhydric states.
4. The mechanisms involved in the development of secondary hypergas-
trinemia due to low acid states.
5. The natural history, epidemiology, and complications of acid-peptic
disorders, including recognition of premalignant conditions .
6. The role of H. pylori infection in acid-peptic diseases.
7. The role of NSAIDs in the pathogenesis of gastroduodenal ulcers and
their complications.
8. The pharmacology, adverse reactions and appropriate use of drugs for
acid-peptic disorders.
9. Endoscopic and surgical treatments of acid-peptic disorders.
10. Nonulcer dyspepsia and its diagnostic / therapeutic approaches.
11. The use and interpretation of esophageal PH probes.
12. Take an accurate clinical history.
13. Perform a reliable and accurate clinical examination of the patient.
14. Plan for and interpret laboratory investigations, imaging studies & stud-
ies of specific entities like hypersecretory states, mucosal resistance and
H pylori diagnosis.
15. Perform diagnostic and therapeutic gastrointestinal endoscopy.
16. Plan appropriate treatment, including (where appropriate) long term
treatment/ follow up, prevention of recurrence and management of
complications .
Acid-Peptic diseases
Main Goal
Intellectual and professional skills
Knowledge
Intended learning outcomes
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Acid-peptic cases / conditions that must be managed competently by trainees
1. Non cardiac chest pain (esophageal and non esophageal).
2. Heart burn and regurgitation.
3. Dysphagia, odynophagia and globus sensation.
4. Extraesophageal symptoms of reflux.
5. Gastritides and gastropathies.
6. Zollinger Ellison syndrome/ other hypersecretory states.
7. Duodenitis.
8. Dyspepsia (organic and functional).
Gastroenterology/Hepatology Curriculum Egyptian Fellowship Boards
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The trainee will be able to carry out competent specialist assessment and
treatment of patients with pancreatic disorders .
Trainees should demonstrate adequate knowledge and deep understanding
of the following:
1. The embryological development and anatomy of the pancreas and the
pancreatic duct system.
2. The physiological processes involved in pancreatic exocrine secretion of
digestive enzymes, water, and electrolytes.
3. The types of digestive enzymes secreted by the pancreas, their mecha-
nisms of activation and their roles in the digestive process.
4. The factors that protect the pancreas from autodigestion.
5. The epidemiology, etiology, pathophysiology, natural history, and
management of acute pancreatitis and its complications.
6. The epidemiology, etiology, pathophysiology, natural history, and
management of chronic pancreatitis.
7. The epidemiology, etiology, natural history, and management of pancreatic
cancer and its complications.
8. Radiographic evaluation of the pancreas: basic principles, indications, and
lesion recognition (Ultrasonography, EUS, CT, MRI, MRCP).
9. Principles, indications, and complications of pancreatic surgery.
For patients with acute pancreatitis trainees must:
10. Establish the diagnosis and assess the degree of severity.
11. Perform initial volume resuscitation, prescribe appropriate medical or sur-
gical treatment and monitor for different complications .
12. Treat appropriately patients with pancreatic necrosis, pancreatic pseudo-
cyst, pancreatic ascites, and hemorrhage.
13. Provide appropriate nutritional support when indicated .
Pancreatic diseases
Main Goal
Intended learning outcomes
Intellectual and professional skills
Knowledge
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For patients with chronic pancreatitis trainees must:
14. Establish the diagnosis and differential diagnosis, specifically from pan-
creatic cancer.
15. Manage associated problems like abdominal pain and exocrine/endocrine
insufficiency.
16. Diagnose and manage associate complications like ascites, pleural effu-
sion, pseudocyst and vascular complications.
For patients with pancreatic cancer trainees must:
17. Establish the diagnosis using appropriate cost effective diagnostic stud-
ies.
18. Assess for operability and manage associate complications within a
multidisciplinary team.
19. Diagnose and manage associate complications like ascites, pleural
effusion, pseudocyst and vascular complications.
1. Acute and chronic pancreatitis.
2. Pancreatic malignancy .
3. Hereditary pancreatic diseases.
Pancreatic conditions that must be man-aged competently by trainees
Gastroenterology/Hepatology Curriculum Egyptian Fellowship Boards
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Biliary Tract diseasesBiliary Tract diseases
Main Goal
Intended learning outcomes
Knowledge
The trainee will be able to carry out competent specialist assessment and treat-
ment of patients with biliary disorders.
Trainees should demonstrate adequate knowledge and deep understanding
of the following:
1. Basic embryology and anatomy of the biliary tree.
2. Hormonal and neural regulation of bile flow and gallbladder function.
3. Physiology of bile secretion and its derangement in cholestatic disorders.
4. Bile composition in health and disease.
5. Cholelithiasis—epidemiology, etiology, clinical manifestations, complica-
tions and treatment modalities.
6. Other disorders of the bile ducts, including recurrent pyogenic cholangitis,
parasitic and opportunistic infections.
7. Other inflammatory disorders of the gallbladder such as acalculous
cholecystitis.
8. Neoplastic diseases of the gallbladder and bile ducts.
9. Motility disorders including gallbladder dyskinesia, sphincter of Oddi
dysfunction.
10. Radiographic evaluation of the biliary tree.
11. Principles, indications, and complications of biliary surgery.
For patients with Biliary disorders, trainees must:
12. Assess patients appropriately through history taking and physical
examination. He should also establish a diagnosis or differential diagnosis
and be able assess the degree of severity.
13. Order appropriate diagnostic investigations (procedural& non-procedural)
and be able to interpret the results.
14. Prescribe appropriate medical or surgical treatment and monitor for
different complications .
15. Provide appropriate nutritional support when indicated .
Intellectual and professional skills
Gastroenterology/Hepatology Curriculum Egyptian Fellowship Board
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1. Cholelithiasis.
2. Cholangitis.
3. Acalculous cholecystitis.
4. Gall bladder neoplasia.
5. Bladder motility disorders.
Trainees should observe and participate in the performance of the following
procedures:
1. ERCP.
2. Percutaneous transhepatic cholangiography.
They should recognize their indications, contraindications, limitations and com-
plications. In addition, they should be able to interpret their results.
Biliary conditions that must be man-aged competently by trainees
Procedural skills relevant to Pancreatic and Biliary/conditions
Gastroenterology/Hepatology Curriculum Egyptian Fellowship Boards
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To prepare gastroenterologists who competently manage various causes and
presentations of gastrointestinal inflammations whether infectious or non infec-
tious or idiopathic. Three themes will be addressed under these module:
Infectious causes of gastrointestinal inflammation.
Inflammatory bowel disease.
GIT inflammation in HIV infected persons.
Trainees should demonstrate adequate knowledge and deep understand-
ing of the following:
1. The mechanisms of inflammation.
2. Elements of the mucosal defense system (mucosal immune system and the
components of intestinal barrier functions).
3. The composition and function of normal enteric flora and the effect of
antibiotics on it.
4. The pathophysiology of diarrheal diseases.
5. The prevalence, clinical manifestations and virulence factors of gastroin-
testinal pathogens.
6. The clinical manifestations, differential diagnosis and treatment options
for inflammatory bowel diseases .
7. The principles of diagnosis (invasive and non invasive).
8. The indications, contraindications and complications of antimicrobial
therapy .
9. The mechanisms of microbial drug resistance .
10. The prevention and management of travelers diarrhea .
11. The spectrum of gastrointestinal diseases in HIV positive patients .
12. Assess, diagnose and manage patients presenting with gastrointestinal
inflammation whether infectious or non infectious .
13.Interpret competently the results of investigations whether laboratory , im-
aging or pathology reports .
14.Modify the list of differential diagnosis based on the results of investiga-
tions .
Gastrointestinal InflammationGastrointestinal Inflammation
Main Goal
Intended learning outcomes
skills
Knowledge
Gastroenterology/Hepatology Curriculum Egyptian Fellowship Board
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15.Perform judiciously and competently various diagnostic procedures needed
to establish or confirm the diagnosis of gastrointestinal inflammation, these
might include:
Endoscopy and mucosal biopsy .
Ultrasound examination.
16.Prepare management plans for patients with various gastrointestinal inflam-
matory conditions, the plan should be evidence based, prioritized, cost effec-
tive and take into considerations available resources and service constrains.
17.Immediately recognize symptoms and signs of life threatening condi-
tions and timely manage them.
18.Prescribe various drugs appropriate for the management of various GIT in-
flammatory conditions and be cautious and monitor for possible side effects .
19.Provide care and followup within a multidisciplinary team for pregnant
women with gastrointestinal inflammatory diseases.
20.Manage nutritional problems associated with chronic gastrointestinal inflam-
matory conditions.
1. Esophagitis (fungal, viral, bacterial).
2. Ulcer disease and gastritis.
3. Diarrhea (acute, chronic, hemorrhagic and travelers).
4. Bacterial overgrowth.
5. Gastrointestinal infections in immunocompromised hosts.
6. Hepatic inflammation (liver abscess, cholangitis, hepatitis) .
7. HIV related gastrointestinal inflammation.
8. Inflammatory bowel disease.
Ulcerative colitis.
Crohns disease.
Other non infectious inflammatory bowel diseases .
Gastrointestinal inflammatory cases / conditions that must be managed competently by trainees
Gastroenterology/Hepatology Curriculum Egyptian Fellowship Boards
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The trainee will be able to carry out comprehensive, competent, specialist as-
sessment of GIT malignancy.
Trainees should demonstrate adequate knowledge and deep understanding of:
1. The principles and theory relevant to tumor biology
2. The epidemiology, primary prevention, and methods of screening for
colorectal cancer .
3. The recommended guidelines for screening for gastrointestinal neoplasia
and the literature supporting these recommendations.
4. Recent literature about the emerging technologies and approaches in the
diagnosis and management of GIT neoplasia.
5. The clinical genetic basis and familial forms of GIT malignancies and
various approaches to the genetics diagnosis of such diseases.
6. The clinical characteristics of malignant GIT diseases, the distinctions
among the familial forms of cancer, the specific diagnostic and screening
tests for each, and the rational approaches to their treatment.
7. The principles of neoplastic growth which represents the basis for therapy
including, endoscopic treatment as well as traditional surgical approaches.
8. The management of relevant premalignant conditions .
9. The distinctions among the varieties of colorectal polyps and dysplastic
lesions and their management.
10. The initial management of those patients in whom the diagnosis of gas-
trointestinal cancer has just been made including chemotherapy and radia-
tion treatment.
11. The principles and importance of genetic counseling in case of GIT ma-
lignancy.
12. The prognoses associated with different types of gastrointestinal cancer.
13. The technical considerations in the therapy of colorectal adenomas and
carcinomas.
14. The capabilities and limitations of endoscopic mucosectomy for early
gastrointestinal cancers.
GIT MalignancyGIT Malignancy
Main Goal
Intended learning outcomes
Knowledge
Gastroenterology/Hepatology Curriculum Egyptian Fellowship Board
28
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Intellectual and professional skills
15. The appropriate surveillance and surveillance intervals for patients at high
risk for developing cancer and those in whom premalignant epithelium has
already been detected.
By the end of training, Trainees should be able to:
16.Take accurate clinical history and perform proper, reliable clinical examina-
tion.
17.Have the endoscopic skills necessary for:
Identification of Barrett metaplasia and flat lesions of the GIT.
Screening for colon cancer is average and high-risk individual and
IBD patients.
Polypectomy including saline injection.
16.Have the know-how of emerging endoscopic imaging techniques for sur-
veillance of GIT malignancies such as chromoendoscopy.
17.Plan for and interpret laboratory investigations (including tumor markers),
and imaging studies (including the appearance of GIT cancer in different
imaging modalities).
18.Participate with oncologists and surgeons regarding the plan for treatment
and prevention of recurrence.
19.Perform competently and without assistance colonoscopic polypectomy of
pedunculated and sessile polyps and ablative therapies for sessile lesions.
20.Counsel patients who have had gastrointestinal neoplasia and respond ap-
propriately to their inquiries about the positive family histories of gastroin-
testinal cancer.
21.Gain additional experience and advanced training, in the placement of en-
doscopic stents, fine-needle aspiration of tumors and endoscopic mucosec-
tomy (optional for trainees who requested advanced training).
Gastroenterology/Hepatology Curriculum Egyptian Fellowship Boards
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Hepatology
Intended learning outcomes
skills
Knowledge
To produce gastroenterologists who are competent to manage the broad
spectrum of hepatology problems encountered in typical gastroenterology
practice. To reach this goal, trainees are required to spend eight months as full
time residents under training in hepatology units that serve outpatients,
inpatients and attached to a critical care units.
Trainees should demonstrate adequate knowledge and deep understanding
of the following:
1. The development and anatomy of the liver and biliary system.
2. The etiology, epidemiology, pathophysiology and clinical presentation
of common and important hepatic diseases.
3. The methods of diagnosis and approaches for management of hepatic
injuries/illnesses mentioned the case list.
4. The complications associated with hepatic diseases, their detection,
prevention and management.
5. The principles for pre/post operative care for patients with hepatic
disorders.
6. The concepts and principles of care for pregnant women with hepatic
diseases within a multidisciplinary team.
7. The principles and practices of care for patients awaiting liver
Transplanation and post-Transplanation management.
8. Take complete history and perform full/focused clinical examination for
patients presenting with possible hepatic illness.
9. Identify Problem (s), generate a differential diagnosis and request
appropriate cost effective diagnostic studies.
10. Interpret competently the results of investigations whether laboratory ,
imaging or pathology reports .
11. Modify the list of differential diagnosis based on the results of
investigations .
Main Goal
Gastroenterology/Hepatology Curriculum Egyptian Fellowship Board
30
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12. Perform judiciously and competently various diagnostic procedures
needed to establish or confirm the diagnosis of hepatic diseases, these
might include:
Abdominal Paracentesis.
Ultrasound guided liver biopsy.
Upper/lower endoscopic studies .
13. Prepare management plans for patients with various hepatic problems,
the plan should be evidence based, prioritized, cost effective and take
into considerations available resources and service constrains.
14. Immediately recognize symptoms and signs of life threatening
hepatic conditions and timely manage them.
15. Prescribe appropriate drugs for hepatology patients, including drug han-
dling and dose modifications in patients with acute or chronic liver im-
pairment .
16. Recognize the side effects of various drugs on liver functions and be
cautioned with drugs that might results in exacerbation of liver injury.
17. Use competently antiviral therapy and immunosuppressive medications
when indicated.
18. Participate in the preoperative evaluation and postoperative care of
patients with hepatic diseases.
19. Provide care and followup within a multidisciplinary team for pregnant
women with hepatic diseases.
20. Provide care and followup within a multidisciplinary team for patients
awaiting liver transplantation or posttransplant recipients.
21. Manage nutritional problems associated with chronic liver illnesses .
Lectures on the topics.
Clinical hepatology rotation with inpatients and outpatients attendance
and participation in care.
Ultrasound Course and unit attendance.
Attendance and training in endoscopy units on the management of
portal hypertension.
Tutorials, journal clubs and staff meetings.
Interdepartmental meetings.
Liver transplant center visits/ rotation.
Conferences and workshops.
Other self directed learning activities (based on study plans prepared by
trainees and agreed on by trainers and supervisors.).
Teaching / Learning Methods
Gastroenterology/Hepatology Curriculum Egyptian Fellowship Boards
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Hepatic cases / conditions that must be managed competently by trainees
1. Acute hepatitis (viral, drug induced and toxic).
2. Fulminant hepatic failure including all associated complications.
3. Chronic hepatitis and cirrhosis.
4. Complications of liver diseases:
Ascites .
Hepatic encephalopathy.
Spontaneous bacterial peritonitis.
Hepatorenal syndrome.
Bleeding and non bleeding esophageal varices.
Gastropathy.
5. Chronic non viral hepatic diseases (e.g. alcoholic liver, Wilson disease,
autoimmune hepatitis, primary biliary cirrhosis, hemochromatosis and
alpha one antitrypsin deficiency).
6. Hepatocellular carcinoma and other hepatic tumors.
7. Hepatobiliary diseases with pregnancy.
8. Pre and post operative care of hepatic patients.
9. Vascular diseases of the liver.
10. Liver abscess.
11. Liver transplantation.
12. Hepatosplenomegaly for D.D.
13. Jaundice for D.D.
14. Abdominal mass/swelling for D.D.
Gastroenterology/Hepatology Curriculum Egyptian Fellowship Board
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GIT Endoscopy and GIT BleedingGIT Endoscopy and GIT Bleeding
Main Goal
Intended learning outcomes
The trainee will be able to perform GIT endoscopic procedures based on rele-
vant scientific background, proper decision making and technical proficiency.
Trainees should gain adequate knowledge and deep understanding of the
following:
1. The components of the endoscopy equipment and how it works. The
trainee should be familiar with the care, cleaning and proper maintenance
of the equipments.
2. The pathophysiology of common GIT diseases and the expected
endoscopic findings.
3. The etiology of acute and chronic upper and lower GIT bleeding and how
to screen a patient with obscure GIT bleeding.
4. The indications and contraindications of the different diagnostic and
therapeutic endoscopic procedures.
5. The risk factors attendant to endoscopic procedures and possible compli-
cations and how to manage them.
6. Recent emerging endoscopic technologies including capsule endoscopy.
By the end of Training, trainee should be able to:
7. Properly perform pre endoscopic clinical evaluation including indications,
contraindications and risk factors for endoscopy.
8. Appropriately use various sedation techniques including the administration
of deep sedation ( as propofol).
9. Perform specific diagnostic and therapeutic endoscopic procedures safely
and completely, including proper management of GIT bleeding.
10. Correctly interpret important and common endoscopic findings.
11. Appropriately Integrate endoscopic findings or therapy into the patient
overall management plan.
Knowledge
professional skills
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Two levels of endoscopic training should be recognized:
Level 1: Routine "standard" endoscopic procedures including esophagogastric
duodenoscopy, colonoscopy. Capsule endoscopy is an option. Level one;
include as well specific therapeutic procedures (e.g., polypectomy,
esophageal dilatation, percutaneous endoscopic gastrostomy placement,
hemostatic procedures and management of GIT bleeding.
Level 2: include "advanced" endoscopic procedures (e.g., ERCP, endoscopic
mucosal resection, endoscopic ultrasound) Optional based on trainees
interest and available training placements.
Training Process
Gastroenterology/Hepatology Curriculum Egyptian Fellowship Board
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The trainee will be able to carry out competent assessment of the nutritional
status of patients with GIT and liver disease and provide the proper dietary
management.
The trainee should have adequate knowledge and deep understanding of:
1. The basic principles of nutrient requirements, ingestion, digestion
absorption and metabolism in the healthy and diseased gut.
2. The physiological consequences of underfeeding, the metabolic response
to starvation and the clinical effects of specific nutrient deficiencies.
3. The metabolic responses to illness and injury and the nutrient
requirements during stress states.
4. The principles and indications of nutrition support.
5. The physiological principles of oral rehydration.
6. The indications and methods of enteral and parental nutritional support
and the expected complications.
7. Drug- nutrient interactions.
8. The pathogenesis of obesity , its medical complications and the principle
of weight management ( including an idea about endoscopic and surgical
procedures for weight reduction).
9. The indication and composition of certain diet regiments concerning
some diseases (e.g. celiac disease, diverticulosis…etc).
10. Conduct appropriate and relevant history taking and physical examina-
tion to assess the nutritional status including specific nutrient deficiencies,
protein – energy malnutrition and obesity.
11. Plan for and interpret specific tests needed to confirm nutritional
deficiencies or excesses.
12. Appropriately determine when a patient is at risk for malnutrition.
13. Apply and monitor enteral & parantral feeding.
14. Correctly place feeding tubes, including PEG tube.
Intellectual and professional skills
Knowledge
NutritionNutrition
Main Goal
Intended learning outcomes
Gastroenterology/Hepatology Curriculum Egyptian Fellowship Boards
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Trainee will be able to recognize the endoscopic, gross pathological and/or his-
tological characteristics of common and important GIT diseases.
Trainee should have adequate knowledge and deep understanding of:
1. The normal histology of gastrointestinal tissues and the patterns of histo-
pathological change in GIT disorders.
2. the indications and limitations of various types of biopsies including fine
needle aspiration and brush biopsy.
3. The mechanism and usefulness of specific special techniques and stains
(e.g. in situ hybridization, immunohistochemistry flow cytometry, etc).
4. The emerging technologies that may optimize traditional biopsy
techniques such as supravital staining, magnification endoscopy…..etc.
Trainees should be able to:
5. Recognize the appropriate indications for biopsy and how it may aid the
diagnosis .
6. Take adequate biopsy sample.
7. Follow the appropriate steps to submit biopsies to the pathology labora-
tory (the when and how) specially under certain circumstances e.g. the use
of saline as a preservative for lymphoma evaluation, electron microscopy
fixative…..etc.
8. Assist and guide the pathologist in interpretation of biopsy tissue :
By providing relevant clinical background.
By providing appropriate macroscopic description of tissue.
5. Properly make use of the pathological findings to guide the diagnosis and
treatment of the patient.
professional skills
Knowledge
Gastrointestinal and Hepatic PathologyGastrointestinal and Hepatic Pathology
Main Goal
Intended learning outcomes
Gastroenterology/Hepatology Curriculum Egyptian Fellowship Board
36
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The trainee should acquire an understanding of radiological principles and will
be familiar with the appropriate use of imaging studies and have the ability to
interpret images demonstrating gastrointestinal disease.
Trainees should gain adequate knowledge and deep understanding of:
1. The radiological tests that is appropriate for evaluation of patients with
GIT, biliary and liver diseases including ultrasound, computed
tomography, magnetic resonance tomography, vascular radiology, contrast
radiology and nuclear medicine.
2. The indication, contraindications, and cost of different diagnostic and
interventional imaging procedures.
3. The methods by which radiographic studies performed.
4. The advantages and limitations of imaging studies compared to endoscopy
and other diagnostic modalities.
Trainees should be able to:
5. Interpret different imaging studies and indentify structural and functional
defect.
6. Request logically and in appropriate sequence necessary imaging studies
for evaluation of GIT and liver diseases baring in mind the cost – benefit of
each technique.
7. Integrate the diagnostic and interventional imaging procedures into the
general plan of patient's management.
professional skills
Knowledge
Gastrointestinal and Hepatic RadiologyGastrointestinal and Hepatic Radiology
Main Goal
Intended learning outcomes
Gastroenterology/Hepatology Curriculum Egyptian Fellowship Boards
37
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professional skills
The trainee will be able to participate in conjoint teamwork with surgeons and
will understand the importance of interdepartmental relationship.
Trainee should have basic knowledge of:
1. The surgical anatomy of the gastrointestinal tract.
2. The indications, contraindications and possible post – operative compli-
cations of common operations conducted for the gastrointestinal disorders.
3. The ways by which common GIT surgical procedures are conducted.
Trainee will have the capability to:
4. Judge whether a surgical procedure is necessary, what type of operation is
indicated, and when it should be performed.
5. Assess the surgical fitness and participate in the pre- operative preparation.
6. Participate in the medical management of patients under surgical care for
gastrointestinal or hepatic disorders within a multidisciplinary team.
7. Participate in the postoperative care and provide on request consultations
for gastroenterology patients undergoing major & minor surgical
procedures whether relevant to their GIT illness or not.
Gastrointestinal SurgeryGastrointestinal Surgery
Main Goal
Intended learning outcomes
Knowledge
Gastroenterology/Hepatology Curriculum Egyptian Fellowship Board
38
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The trainee will be knowledgeable about liver transplantation and can conduct
the hepatologists’ role in transplantation teamwork.
The trainee should have adequate knowledge about:
1. The development and surgical anatomy of the liver and biliary system
2. The indications, limitations of liver transplantation and the proper patient's
selection
3. The different comorbid diseases (cardiac, pulmonary, renal …etc) which
may interfere with or even delay or preclude liver transplantation
4. The complications associated with liver transplantation, their detection,
prevention and management.
5. The principles for pre / postoperative care for transplanted patients includ-
ing the immunosuppressive agents
The trainee should be able to:
6. Evaluate patients with liver disease in a proper systematic way
7. Request relevant cost effective diagnostic studies and interpret their results
competently.
8. Conduct an optimal patient selection and properly judge the timing of
transplantation
9. Participate in the preoperative evaluation and assessment of patients
awaiting liver transplantation within a multidisciplinary team.
10. Modify immunosuppression, provide care, recognize and properly manage
complications in post – transplant recipients within a multidisciplinary
team.
Intellectual and professional skills
Knowledge
Liver TransplantationLiver Transplantation
Main Goal
Intended learning outcomes
Liver TransplantationLiver Transplantation
Gastroenterology/Hepatology Curriculum Egyptian Fellowship Boards
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Lectures would provide candidates with
Appropriate knowledge and understanding of relevant basic medical
science.
An overview of patient assessment including history, examination,
communication and diagnostic tests.
Knowledge and understanding of diseases and their management.
Provision of patient care under supervision with feedback is the main learning
method. Trainees will be involved in patient care during different clinical
rotations. During this, learner centered & trainer centered activities will provide
the necessary intellectual, clinical and procedural skills, attitudes and behaviors
as well as opportunities for application & enhancement of knowledge.
Responsibilities of trainees in patient management shall increase as they
develop more competencies. In addition, Rotations would include regular
formal clinical teaching sessions.
Participation in different outpatient clinics including the assessment of
new and follow up patients.
Comprehensive assessment & management planning for admitted pa-
tients, including complicated cases.
Ward rounds, management and follow up of admitted patients.
Consultant led ward rounds.
Assessment of patients referred for consultation from other specialties.
Participation in patient management in acute settings, including intensive
care.
Participation in the perioperative management of gastroenterology/
hepatology cases.
Training in skills & procedures through observation, performance under
supervision with feedback then independent practice.
Training methodsTraining methods
Training methods descriptionTraining methods description
1. Lectures
2. On the job training
On the job, learning activities include:
Gastroenterology/Hepatology Curriculum Egyptian Fellowship Board
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Case taking, presentation and discussion.
Journal clubs.
Joint specialty meetings.
Trainees are expected to participate in at least two scientific meetings
relevant to the field of gastroenterology/hepatology. These include conferences,
seminars, workshops and other similar activities. Proof of attendance will be
required .
Trainees are expected to use self-learning activities such as independent
reading and internet search for relevant EBM resources. They are also expected
to be able to identify their learning needs & target them through discussion with
trainers and/ or appropriate self-learning activities.
Clinical teaching activities represent
formal teaching sessions that include:
3. Other activities
Participation in scientific meetings
Self-learning activities
Gastroenterology/Hepatology Curriculum Egyptian Fellowship Boards
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1. Practical gastroenterology and endoscopy (Cotton , 2008).
2. Principles of clinical gastroenterology (Yamada, 2008).
3. GIT subspecialty consult.
4. Manual of GIT (Avunduck, 2008).
5. GI & liver secrets.
1. Comprehensive clinical hepatology (2006).
2. Laurence textbook of liver disease.
3. Hepatology text book and atlas 2008 ( Kunts, 2008).
1. Advanced digestive endoscopy (Cotton, 2008).
Learning and Reference Martial
GIT Books
Hepatology books
Endoscopic books
Gastroenterology/Hepatology Curriculum Egyptian Fellowship Board
42
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The general rules and regulations of assessment approved by the Egyptian
fellowship board and published at the training handbook and the board website
apply for the Gastroenterology/hepatology specialty. In addition to the
successful completion of the training program and submission of the
logbook, each candidate must pass two examinations in order to receive his/
her fellowship certificate.
This is a written examination testing all theoretical topics covered in the curricu-
lum including knowledge, understanding, application to clinical case studies and
problem solving. Candidates are allowed to sit for the exam after at least eight-
een months of training
Each candidate has three chances to pass the exam & one more chance may be
granted in exceptional circumstances approved by the secretary general of the
higher committee of medical specialties.
The applied knowledge examination consists of two written papers that will
include case studies.
Paper 1 (3 hours): composed of multiple choice questions with a single
best answers.
Paper two (2 hours): a written paper including short answer essay
questions
Methods of Assessment
Regulations
Applied Knowledge Exam
Pre-requisites to be eligible to sit for the exam
Candidates must complete the following:
Complete at least eighteen months of the training program.
Pass the following courses:
Local TOEFEL with a score of at least 500.
Computer courses in word processing, internet and power point.
Exam structure
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This is the final clinical examination. Each candidate has THREE chances to
pass this exam and one more chance may be granted in exceptional circum-
stances approved by the secretary general of the higher committee of medical
specialties.
The examination consists of four components:
A. Long Clinical Case: This component tests the ability of the candidate to
obtain data from history taking and clinical examination, to present and inter-
pret these data, to discuss patient management and to demonstrate appropriate
attitudes. The candidate will be required to take a history and examine the pa-
tient while being observed by two examiners who will not interfere. Subse-
quently, the candidate will orally present the findings and discuss clinical data
and proposed patient management. Scoring is based on a predetermined weight
for each component of the exam
B. Objective Structured Clinical Exam (OSCE): This is composed of 10-12
stations. In each station, the candidate will be required to perform a specific
clinical or procedural task. Tasks will test different clinical and procedural skills
included in the curriculum. Scoring of each station will be based on a prede-
fined scheme
C. Tracing Exam: This is composed of 10-20 items testing data interpretation
skills. Items will include different diagnostic tests and pictures. The candidate
will be required to make an open-ended written comment or to answer MCQ
questions on each item.
The clinical exam
Pre-requisites to be eligible to sit for the clinical exam
Candidates must complete the following:
Complete the whole training program successfully.
Pass successfully the written exam (applied knowledge exam).
Submit her/ his logbook and portfolio for final assessment and
both approved by the scientific council .
