Components of Training

Core Training
A minimum of two years must be spent in full-time clinical training positions with responsibility for patient care under the supervision of a trained gastroenterologist. Training should include management of gastrointestinal and hepatological emergencies. A suitable training position should include the care of outpatients (ambulatory care) and inpatients in gastroenterology and hepatology at a training site that provides regular clinical meetings, quality assurance activities and meetings with other departments particularly diagnostic and therapeutic imaging, histopathology and surgical groups.

It is desirable that trainees gain experience and exposure in as many as possible of the following areas:

• Gastrointestinal motility disorders, diverticular disease and functional illnesses including oesophageal motility and intestinal transit studies.
  
• Acid-peptic disease.
  
• Diseases of the pancreas and gastrointestinal hormones.
  
• Gastrointestinal inflammatory disorders including idiopathic inflammatory bowel disease and disorders caused by infection including those associated with human immunodeficiency.
  
• Malabsorption syndromes including breath gas analysis.
  
• Gastrointestinal malignancy and pre-malignant disorders.
  
• Disorders of the biliary tract and ERCP.
  
• Viral hepatitis.
  
• Immunological disorders of the hepatobiliary tract.
  
• Drug induced disorders of the liver and gastrointestinal tract.
  
• Chronic liver disease, portal hypertension and liver biopsy.
  
• Hepatobiliary malignancy.
  
• Gastrointestinal endoscopy and gastrointestinal bleeding.
  
• Clinical nutrition.
  
• Alcoholism and drug addiction.
  
• Imaging of the gastrointestinal and hepatobiliary systems including performance of abdominal ultrasound examinations.
  
• Liver transplantation.

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Procedural Skills
It is desirable that trainees should become proficient in upper gastrointestinal endoscopy and liver biopsy. Many trainees will also undertake training in colonoscopy and some will undertake advanced endoscopic training including ERCP. Attainment of technical competence will usually require completion of a specified number of procedures with appropriate success rates under supervision. These must be recorded in a log-book which will be used to help plan further training.

Trainees must, in addition to technical proficiency, have a clear understanding of the role of endoscopy in patient management achieved by attendance at radiological and histopathological teaching sessions and relevant operations. Trainees must develop an understanding of the principles and practice of disinfection and sterilization of modern endoscopic instruments. Training in gastrointestinal endoscopy is assessed independently by the Conjoint Committee for Recognition of Training in Gastrointestinal Endoscopy, a national committee with representatives of the Gastroenterological Society of Australia, Royal Australasian College of Physicians and the Royal Australasian College of Surgeons. Those trainees who satisfactorily complete the requirements of the Conjoint Committee will normally be given formal recognition at the completion of advanced training. Applications should be addressed to the Conjoint Committee for Training in Gastrointestinal Endoscopy at the RACP.

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Elective Training
The SAC may approve a maximum of one year of elective training which may be undertaken in clinical training in other disciplines (e.g. psychiatry, general medicine, immunology, microbiology, etc), or research.

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Research
Trainees are strongly encouraged to undertake a period of supervised research in basic or clinical sciences. Training in research can be conducted as an elective period of training and may be part of a research program conducted with the aim of achieving a doctorate (PhD, MD) or other higher degree(s). If a trainee applies for approval to conduct research for periods of greater than 12 months (as advanced training), then the application will be referred to the CPT. Extended periods of research will not be regarded as part of core advanced training in gastroenterology and hepatology.

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Other Specific Requirements
The SAC recommends that each advanced trainee be site visited by a gastroenterologist from another institution at least once in their training program, preferably in the first or second year of training.

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Training Posts
Any site for advanced training in gastroenterology and hepatology must provide the staff and facilities necessary to provide the content of the training program outlined above. This means that advanced core training will usually be undertaken in UTHs but other positions will be considered individually and may be suitable for a period of training.

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