Outpatient at Veterans Affairs San Diego Healthcare System (VA Out)

On the gastroenterology outpatient rotation at the Veterans Affairs San Diego Healthcare System (VASDHS), the first-year fellows are expected to be very closely supervised by attending physicians in terms of outpatient gastroenterology and hepatology consults, presentations, and endoscopic procedures. They present every case to the attending physician. Fellows are learning how to conduct outpatient gastroenterology consultations efficiently and how to perform basic EGD and colonoscopies. They are starting to learn therapeutic procedures (i.e., not actively bleeding variceal and non-variceal hemostasis and non-complex polypectomy). They usually do not participate in advanced procedures such as ERCP. All endoscopic procedures are supervised by an attending physician who is present in the endoscopy unit.

Second- and third-year fellows who rotate on this rotation are expected to need less supervision by the attending physician than first-year fellows in terms of consults, presentations, and endoscopic procedures. Second- and third-year fellows are expected to provide more complete gastroenterology consultations, to be comfortable performing basic EGD and colonoscopies, and to be comfortable performing therapeutic procedures (i.e., actively bleeding variceal and non-variceal hemostasis and complex polypectomy). They may participate in advanced procedures such as ERCP. All endoscopic procedures are supervised by an attending physician who is present in the endoscopy unit.

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