nmrcgp for consultants

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Gastroenterology

This is what our GP trainees need to achieve during their time at your department. We've classified them under the six main compentency domains for general practice..

1. PRIMARY CARE MANAGEMENT

• Manage primary contact with patients who have a digestive problem.
• Demonstrate a consistent, evidence-based approach to prescribing for dyspepsia.
• Explain the indications for urgent referral to specialist services, especially for patient with suspected GI cancer.

The knowledge base

Symptoms
• Dyspeptic symptoms (epigastric pain, heartburn, regurgitation, nausea, bloating)
• Abdominal pain
• Nausea, vomiting, anorexia, weight loss
• Haematemesis and melaena
• Rectal bleeding, tenesmus
• Jaundice
• Diarrhoea & constipation
• Dysphagia

Common and/or important conditions
• Gastro-oesophageal reflux disease (GORD)
• Non-ulcer dyspepsia, gastritis, peptic ulceration
• Gall stones
• Irritable bowel syndrome
• Gastroenteritis
• Constipation
• Coeliac disease
• GI cancers (oesophageal, gastric, hepatic, pancreatic, colonic)
• Inflammatory bowel disease
• Diverticulosis
• Acute abdominal conditions e.g. Appendicitis, cholecystitis, pancreatitis
• Perianal disease (e.g. haemorrhoids, perianal haematoma, pilonidal sinus)

Investigations
• Liver function tests
• Amylase
• H. pylori testing – serology, breath test, stool antigen testing
• Coeliac antibody screening
• Stool testing
• Faecal occult bloods
• Abdominal ultrasound
• Knowledge of secondary care investigations including endoscopy (oesophago-gastro-duodenoscopy, sigmoidoscopy, colonoscopy), abdominal imaging techniques (Barium swallow, barium enema, CT), liver biopsy, ERCP, jejunal biopsy

Treatment
• Understand principles of treatment for common conditions managed largely in primary care
• Be aware of secondary care management of digestive problems, including surgical options

Emergency care
• Recognition of the acute abdomen
• Acute management of heamatemesis and melaena

Prevention
• Dietary advice to include five portions of fruit or vegetables daily
• Smoking cessation and alcohol reduction to prevent GI cancers

2. PERSON CENTRED CARE

• Recognise that some patients may find digestive problems, particularly lower GI, difficult to discuss openly.
• Demonstrate a non-judgmental, caring and professional consulting style to minimise embarrassment of patients with digestive problems.

3. PROBLEM SOLVING SKILLS

The knowledge base

Treatment
• Understand principles of treatment for common conditions managed largely in primary care
• Be aware of secondary care management of digestive problems, including surgical options

Emergency care
• Recognition of the acute abdomen
• Acute management of heamatemesis and melaena

Prevention
• Dietary advice to include five portions of fruit or vegetables daily
• Smoking cessation and alcohol reduction to prevent GI cancers

Specific problem-solving skills
• Intervene urgently when patients present with an acute abdomen
• Recognise and respond urgently to red flag symptoms, which may indicate GI cancer
• Demonstrate a structured, logical approach to the diagnosis of abdominal pain, e.g. to enable a positive diagnosis of irritable bowel syndrome to be made, rather than making the diagnosis by exclusion.

4. COMPREHENSIVE APPROACH

• Advise patients appropriately regarding lifestyle interventions that have an impact on gastrointestinal health, such as advice on diet and on stress reduction
• Describe the gastrointestinal side effects of common medicines.
• Modify the form or modalities of treatment to cater for the patient’s GI function and preferences.

5. COMMUNITY ORIENTATION

• Evaluate the arguments for and against a national screening programme for colorectal cancer.
• Discuss the rationale for restricting referrals for upper gastrointestinal endoscopy in the management of dyspepsia.
• Recognise the need for increased availability of lower gastrointestinal endoscopy for the diagnosis of colorectal cancer.
• Recognise the place of simple therapy and expectant measures in cost-effective management, whilst ensuring that the patient’s condition is adequately monitored.

6. HOLISTIC APPROACH

• Recognise the effects psychological stress can have upon the gastrointestinal tract, especially with functional disorders e.g. non-ulcer dyspepsia, irritable bowel syndrome, abdominal pain in children
• Recognise the impact of social and cultural diversity and the important role of health beliefs relating to diet, nutrition and gastrointestinal function.

All these 6 domains have a

7. Contextual Aspect

• Recognise how common digestive problems are amongst the general population.
• Summarise the debate about the role of upper gastrointestinal endoscopy in the management of dyspepsia.
• Summarise the debate about the role of rapid access GI investigation, including imaging and endoscopy

8. Attitudinal Aspect

• Recognise the embarrassment and reluctance of some patients to undergo rectal examination and respect the patient’s autonomy.

9. Scientific Aspect

• Understand and implement the key national guidelines that influence healthcare provision for digestive problems