M2 Sequence Overview
Sequence Directors

Rebecca W. VanDyke, M.D.
Professor, Internal Medicine
Email: wynne@umich.edu

Henry D. Appelman, M.D.
Professor, Pathology
Email: appelman@umich.edu

Sequence Description

The overall objectives of this 2.5-week sequence are listed below. The purpose is to outline the core of gastrointestinal knowledge and skills that are fundamental for all medical students. In addition to acquiring knowledge, a major learning objective of this sequence is that students will practice and improve skills in using the knowledge they acquire to solve patient problems.

Knowledge Objectives
The students will learn:

  1. The pathophysiologic basis of the common types of disorders of the gastrointestinal tract including the gut, liver, gallbladder and pancreas and basic aspects of the major diseases of the pharynx, larynx and esophagus.
  2. The clinical signs of symptoms of the major classes of diseases that affect the gastrointestinal tract.
  3. The use (and limitations) of tests (biochemical, radiologic, endoscopic and pathologic) for the identification and/or progression/improvement of these diseases.
  4. The use (and limitations) of algorithms for evaluation of patients with symptoms that indicate the likely presence of diseases of these organs but are themselves relatively non-specific and have a broad differential diagnosis (such as jaundice, elevated alkaline phosphatase level, diarrhea).
  5. Principles and approach to diagnosis/management of acute gastrointestinal emergencies: acute abdominal pain and acute gastrointestinal bleeding.
  6. The pathologic appearance (gross and microscopic) of diseases of the gastrointestinal tract to achieve integration of knowledge about the pathophysiologic basis for diseases and their signs and symptoms as well as an understanding of when tissue biopsies may or may not be useful in establishing a diagnosis or monitoring disease progression.
  7. The radiologic appearance of diseases of the gastrointestinal tract to achieve integration of knowledge about the pathophysiologic basis for diseases and their signs and symptoms as well as an understanding of when radiologic studies may/should be employed to establishing a diagnosis or monitor disease progression.
  8. The biologic basis of cancers of the gastrointestinal tract including the molecular biology of colon cancer and the translation of this information into population prevention strategies.
  9. Barriers and challenges to implementing population prevention strategies.
  10. The impact of inflammatory bowel disease or inherited colon cancer syndromes on the lives of individuals through discussion/presentations by individuals with these disorders.
  11. Principles of pharmacology of drugs used for acid-peptic diseases and of liver metabolism/excretion of drugs as well as liver-mediated drug-drug interactions and the origins of drug-induced liver diseases.
  12. Principles of nutrition for children and how these differ from nutrition for adults.
  13. Principles of inpatient assessment of nutrition/malnutrition and inpatient nutritional replacement strategies.
Skills Objectives
  1. The student will acquire increasing competence in the following areas by actively participating in small group discussions and case-based problem solving sessions. Students will apply the knowledge acquired during the course to solve patient problems. Competence will be assessed by performance on the final exam which includes many questions designed to test these skills.
  2. Identifying patient data (signs, symptoms, physical exam findings, biochemical test results, etc.) that indicate a disease process that involves one or more elements of the gastrointestinal tract.
  3. Preparing a broad differential diagnosis of possible diseases to explain the abnormal findings (this is generation of a hypothesis) and arranging this differential diagnosis in order of probability.
  4. Subjecting their hypotheses to testing by planning further history questions, laboratory tests and/or other procedures to obtain information likely to help prove or disprove diagnoses in their differential and subsequently altering their differential diagnosis. A component of this skill is to be able to justify in an evidence-based way (when possible) the choice of tests and the order to obtain them.
  5. Plan a treatment strategy for the patient and be able to identify ways to monitor the patient’s response to treatment with alternative plans (if applicable) if response is not adequate.
Professionalism Objectives
The student will be expected to:
  1. Demonstrate self-education skills by viewing on-line lectures if they did not attend the lectures in person, and preparing for small group discussions.
  2. Attend mandatory class exercises that are interactive (small group discussions, multi-disciplinary conferences, the interactive lecture on acute abdominal pain). Make-up options are available through preparation of written essays for the occasional student who has to miss a session.
  3. Demonstrate respect and empathy with patients who participate in the multi-disciplinary conferences.