GIMDN instruction is an eight-week block covering the basics of the digestive and metabolic system anatomy, physiology, pharmacology, biochemistry and clinical medicine. An additional three weeks of Capstone are divided up into one-week segments and distributed between two three-week GIMDN sessions and one two-week GIMDN sessions.
The following GIMDN topics are listed by week:
- Gastrointestinal (GI) anatomy, histology, embryology, physiology and biochemistry, including the mouth and oral health and digestive organs, specifically the oropharynx, esophagus, stomach, small and large intestines.
- Gastrointestinal disorders and malignancies, including both gross and histopathology and pertinent radiological imaging.
- The GI microbiome, infectious diseases of the digestive tract and GI pharmacology.
- Gallbladder, biliary and pancreatic anatomy, histology, physiology, metabolism, disease, neoplasms and endoscopic interventions.
- Liver disease, including hepatitis, cirrhosis and malignancy; urea/heme/iron metabolism.
- Insulin/glucagon actions/physiology and principles/pharmacology of diabetes mellitus.
- Metabolism: Normal metabolism and growth, including biochemistry, metabolic disorders, micronutrients and vitamins.
- Nutritional science: Macronutrients, calorie and energy metabolism, medical nutrition therapy, obesity, malnutrition and complex eating disorders.
Educational Program Objectives are a subset of more broadly defined physician competencies, which represent general domains of performance for which the profession and the public hold physicians accountable.
Upon completing the Gastrointestinal, Metabolism, Diabetes and Nutrition Block (GIMDN), students should be able to:
- Describe normal gastrointestinal (GI) anatomy, histology and embryology. Recognize developmental GI malformations that can occur.
- Describe gastrointestinal pathology and recognize basic abnormalities in radiological images, including radiograph, CT and ultrasound.
- Describe the functions of gastrointestinal organs and key structures with respect to:
- Endocrine and/or exocrine functions.
- Homeostasis of nutrients, electrolytes, fluid, etc.
- The role of the liver in drug metabolism and detoxification of exogenous compounds.
- Features of the microbiome in the gut.
- Relationship to other systems, e.g., circulatory, immune, lymphatic.
- Control by the nervous system.
- Illustrate biochemical pathways in carbohydrate, protein, and fat/lipid metabolism and describe the consequences of genetic mutations in key metabolic enzymes, including lysosomal enzyme disorders/sphingolipidoses and malabsorption disorders.
- List key GI, liver and metabolic disorders and describe their etiology (genetics, lifestyle, etc.), incidence and risk factors (including gender or ethnic disparities), and socio-behavioral components, including the following: oral and esophageal disease, gastric ulcers, gastritis, gastroesophageal reflux, hernias, inflammatory bowel disease, celiac disease, Whipple disease, lactose intolerance, intestinal diverticula, cholecystitis, cholelithiasis, appendicitis, GI and oral cancers, GI infections and hepatitis, liver disease, including cirrhosis and ascites, hepatocellular cancer, pancreatitis, malabsorption disorders, type 1 and type 2 diabetes mellitus, disorders of lipid metabolism and others as deemed appropriate by the faculty.
- Describe the differential diagnostic process for distinguishing these various GI, liver and metabolic disorders and recognize new advances in diagnostics, such as genomic testing, that provide novel opportunities for diagnosis, screening and prevention.
- Recognize the contributions of diet, genetics, adverse childhood events (ACEs) and lifestyle to the development of GI, eating and metabolic disorders. Distinguish treatments for these disorders, including preventative care, lifestyle and dietary changes, and how communication with the patient can facilitate adherence to such therapies.
- Outline the key role of vitamins in metabolic and antioxidant pathways and recommend daily intake of necessary vitamins. Describe the clinical manifestations of vitamin deficiencies and toxicities.
- Determine carbohydrate, protein and fat requirements as well as daily caloric needs for the human body based on age, body weight and metabolism. Understand medical nutrition therapy and make recommendations for patient intake based on dietary restrictions and needs. Prescribe dietary choices and exercise when appropriate for both a healthy lifestyle and disease prevention.
- Recognize the complex patterns of disordered eating and understand the physical effects of anorexia nervosa, bulimia nervosa and binge eating disorder. Describe the physiology of fasting/starvation and differentiate the types of malnutrition. Explain the role of diet, lifestyle and genetics in the development of obesity and its association with type 2 diabetes and other complications.
- List appropriate pharmacological drugs and describe their mode of action, indications, contraindications and major side effects or risks: Antibiotics, antivirals, anti-inflammatories, antacids, anti-tumor, anti-emetics, laxatives, GI motility agents, immunomodular therapy, anti-diabetic medications and insulin, and others as deemed relevant by the faculty.
- Recognize the GI/metabolic side/adverse effects of pharmaceutical drugs commonly used for other disorders, such as: NSAIDs, opioids, bisphosphonates, antihypertensives, etc.