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Case of the month: Jelly belly?

15 Nov, 16 | by abhichauhan

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Case of the month:

A 75 year old man presents with a 2 month history of abdominal distension and lethargy. Clinical examination demonstrates shifting dullness and investigations reveal he has a microcytic anaemia with raised tumour markers (CA19-9-208 U/ml , CEA-88 µg/L)  Ascitic aspiration yields a gelatinous fluid, the coronal section of his abdominal CT scan is shown above. What is the diagnosis (hint:the arrows point to the primary pathology)

Submitted by N. Patodi

#FGDebate GI Consequences of Cancer

30 Sep, 16 | by Kelly Horwood, BMJ

GI Consequences of Cancer: Cancer cured – all back to normal now?’

Date: Tuesday 4th October 2016
Time: 8-9 BST
Guest: Dr Ana Wilson @GIWolfsonunit

Dr Ana (Ignjatovic) Wilson BA(Hons) MD MRCP
Consultant Gastroenterologist and Endoscopist

Dept:   Wolfson Unit for Endoscopy
Tel:      020 8869 5277
Email:  smita.patel5@nhs.net

wilson-ana-1Dr Ana Wilson is out featured guest for this months #FGDebate on GI consequences of cancer. Dr Ana Wilson is a luminal gastroenterologist and specialist gastrointestinal endoscopist. Her specialist interests include early diagnosis, prevention and treatment of pre-cancerous lesions and cancer, through colonoscopy, in patients with inflammatory bowel disease and those at increased risk of developing colorectal cancer. Dr Wilson specialises in advanced endoscopic imaging and complex therapeutic

endoscopy. She has a special interest in managing patients with gastrointestinal consequences of cancer treatment (eg. Low anterior resection syndrome, pelvic radiation disease) and leads the service at St Mark’s Hospital.

Dr Wilson qualified from University of Oxford in 2002. She obtained Membership of the Royal College of Physicians in 2005 and trained in gastroenterology and general internal medicine in Oxford Deanery. She spent three years at the Wolfson Unit for Endoscopy, St Mark’s Hospital undertaking research in the use of colonoscopy in diagnosis and assessment of dysplasia under the supervision of Prof Brian Saunders that led to an MD thesis at the Imperial College, London, and has published widely on the subject. After completing her training, Dr Wilson specialised further in management of complex inflammatory bowel disease and endoscopy at University College Hospital, London. She was appointed as Consultant Gastroenterologist and Specialist Endoscopist at St Mark’s Hospital in December 2012.

She has been an invited speaker at numerous national and international meetings and has contributed to a number of guidelines on the use of advanced imaging in lesion recognition including in inflammatory bowel disease.

 

Case of the month-A scalp lesion with anaemia?

6 Sep, 16 | by abhichauhan

Melanoma_stitched

A 79 year old man underwent a upper GI endoscopy for dark stools and anaemia (top left), histology from lesions (top right) is presented. Further examination revealed a scalp lesion (bottom left), which was also biopsied (bottom right). What is the unifying diagnosis?

Submitted by GJ Webb.

Assessment strategies in gastroenterology by Neel Sharma

22 Aug, 16 | by abhichauhan

All doctors regardless of specialty are assessed regularly – after all assessment drives learning. From a UK standpoint assessment comprises the MRCP (UK) examinations and SCE. During GI training there is the JAG accreditation of simple and more advanced endoscopic intervention as well as portfolio based records.

In the field of medical education there are currently talks concerning the lack of potential value in a high stakes examination. In essence the current argument is that such a form of assessment can potentially limit a supervisor’s judgement if the candidate is unsuccessful. In this regard, the concept of programmatic assessment has come to the forefront where in essence a more holistic judgement of a candidate’s performance takes place. In brief continuous forms of learning, assessment and feedback are offered. And all elements of the learning/ assessment process are compiled to provide a fairer judgment of a learner’s abilities.
The next movement that has occurred in the US is that of entrustment or entrustable professional activities. Whilst competency based medical education has been cemented for some time, there have been concerns with the lack of entrustment decisions. Here supervisors would make the added assessment of when a learner can be entrusted to perform a competency unsupervised. The GI curriculum in the US has embedded this approach and it is likely that this phenomenon will snowball globally.

Further reading
Van der Veluten et al. A model for programmatic assessment. https://www.amee.org/getattachment/AMEE-Initiatives/ESME-Courses/AMEE-ESME-Face-to-Face-Courses/ESME/ESME-Online-Resources-China-Dec-2015/A-model-for-programmatic-assessment-fit-for-purpose.pdf

Neel Sharma is currently a gastroenterology trainee in Singapore having worked in a medical education setting across the UK, Asia and the US

‘The flipped classroom’-future of endoscopic training?

8 Aug, 16 | by abhichauhan

Read our latest blog on pedagogical strategies in gastroenterological training from Dr Neel Sharma. Neel Sharma is currently a gastroenterology trainee in Singapore having worked in a medical education setting across the UK, Asia and the US

Medical education is now a well-recognised academic discipline. However, compared to traditional basic science it is still fairly premature having recently celebrated 50 years in the making.

Despite this prematurity, we must start to understand the advances in the field and attempt to uncover the potential evidence or lack of in terms of pedagogy. Here I highlight some current trends in the hope that the GI community can determine their potential worth.

Team based learning is one example where by learners are provided cases and problem solve with the addition of written assessments and expert feedback. In gastroenterology there has been little formal research into the value of TBL. One of its positives is that of feedback, unlike its counterpart PBL where feedback was typically lacking.

The next movement making waves is that of the flipped classroom. In fact this approach has been adopted wholeheartedly by Harvard Medical School during their recent curriculum reform. In brief videos are provided to learners pre class, with class time spent problem solving. Its potential benefits have been the ability to receive the so called ‘homework’ element before class so that in class learners can focus more on problem solving applications. Again little has been done in the form of flipped learning in gastroenterology.

How can such pedagogies be utilised? Well countless examples exist but one potential use is in image enhanced endoscopy – with the advances in NBI, confocal imaging and OCT, problem solving cases could prove useful, particularly as the classification systems in endoscopy become more complex.

I look forward to further movement in the field.

Acute-on-Chronic Liver Failure: All you need to know

25 Apr, 16 | by Kelly Horwood, BMJ

Following the March #FGDebate with Dr Richard Hansen and Ms Joan Gavin ‘Nutrition in IBD – what to do in theory and practice’, we are delighted to announce our next #FGDebate will be on Thursday 28th April 2016 8-9 BST with Dr Gautam Mehta. The topic this month will be ‘Acute-on-Chronic Liver Failure: All you need to know’.

GM pic

Dr Mehta is a Hepatologist, with interests in cirrhosis, acute-on-chronic liver failure and alcohol-related liver disease. He completed his PhD in portal hypertension at UCL, and has recently been appointed Honorary Consultant and Senior Lecturer in Hepatology at UCL. Gautam tweets regularly @drgautammehta, and also has an interest in Digital Health – starting one of the first secondary prevention m-Health trials in the UK @alcochange.

This #FGDebate @FrontGastro_BMJ promises to be an interesting and educational one and we look forward to hearing your questions.

Missed the #FGDebate with Dr Anton Emmanuel? Catch up with the Podcast and Storify summary of the debate here – ‘Frontline IBS: An approach to treatment pathways?’

18 Jan, 16 | by Dr Philip J Smith, Frontline Gastroenterology Trainee Editor

If you missed the #FGDebate with Dr Anton Emmanuel, ‘Frontline IBS: An approach to treatment pathways?’ you can catch up with the Storify summary of the #FGDebate at:

 

https://storify.com/FrontGastro_BMJ/frontline-ibs-an-approach-to-treatment-pathways

 

The podcast with Dr Anton Emmanuel can be listened to here:

 

https://soundcloud.com/bmjpodcasts/frontline-ibs-an-approach-to-treatment-pathways?in=bmjpodcasts/sets/frontline-gastroenterology

 

Don’t forget to join us for the next #FGDebate which is with Ms Kay Greveson (@IBDPassport) on Tuesday 19th January 2016, at 8-9pm GMT and will discuss, ‘Frontline IBD: Travel and IBD – advice from IBD Passport’.

 

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Missed the #FGDebate with Dr David Patch and Dr Dhiraj Tripathi? Catch up with the Podcast and Storify summary of the debate here – ‘Frontline Hepatology: Variceal Bleeding Guidelines’

7 Dec, 15 | by Dr Philip J Smith, Frontline Gastroenterology Trainee Editor

If you missed the #FGDebate with Professor Rebecca Fitzgerald on ‘Frontline Barrett’s: Screening, surveillance and therapy,’ you can catch up with the Storify summary of the #FGDebate at:

https://storify.com/FrontGastro_BMJ/frontline-hepatology-variceal-bleeding-guidelines 

The podcast with Dr David Patch can be listened to here:

 

 

Don’t forget to join us for the next #FGDebate which is out Xmas Special Debate with Dr Anton Emmanuel (@AntonEmmanuel2) on Tuesday 29th December 2015, at 8-9pm GMT and will discuss, ‘Frontline IBS: An approach to treatment pathways’.

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Missed the #FGDebate with Professor Rebecca Fitzgerald? Catch up with the Storify summary and the Podcast of the debate here – ‘Frontline Barrett’s: Screening, surveillance and therapy’

22 Nov, 15 | by Dr Philip J Smith, Frontline Gastroenterology Trainee Editor

If you missed the #FGDebate with Professor Rebecca Fitzgerald on ‘Frontline Barrett’s: Screening, surveillance and therapy,’ you can catch up with the Storify summary of the #FGDebate at:

https://storify.com/FrontGastro_BMJ/frontline-barrett-s-screening-surveillance-and-the

The podcast with Professor Fitzgerald can be listened to here:

https://soundcloud.com/bmjpodcasts/frontline-barretts-screening-surveillance-and-therapy

Don’t forget to join us for the next #FGDebate which is with Dr David Patch (@DavidPatch1) and Dr Dhiraj Tripathi (@dtrip2015) on Tuesday 24th November 2015, at 8-9pm GMT and will discuss, ‘Frontline Hepatology: Variceal Bleeding Guidelines’.

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Missed the #FGDebate with BSG-SWiG team? Catch up with the Podcast and Storify summary of the debate here – ‘Frontline Gastroenterology: Supporting Women in Gastroenterology’

5 Oct, 15 | by Dr Philip J Smith, Frontline Gastroenterology Trainee Editor

If you missed the #FGDebate with the BSG-SWiG team on ‘Frontline Gastroenterology: Supporting Women in Gastroenterology,’ you can catch up with the:

Podcast after the #FGDebate at

https://soundcloud.com/bmjpodcasts/supporting-women-in-gastroenterology/s-Xkqfj

Or the Storify summary of the #FGDebate at

https://storify.com/FrontGastro_BMJ/frontline-gastroenterology-supporting-women-in-gas

Don’t forget to join us for the next #FGDebate is with Professor Rebecca Fitzgerald (@RC_Fitzgerald) on Tuesday 6th October 2015, at 7-8pm GMT and will discuss, ‘Frontline Barrett’s: Screening, surveillance and therapy’.

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