Curriculum for General Practice - The Royal New Zealand College ...

G Gastroenterology
Gastroenterology can also cover liver and pancreatic
disease. The various forms of hepatitis, and in particular
hepatitis B, are often first diagnosed in general practice.
Chronic hepatitis B remains more common in Māori,
Pacific and Asian adults and will continue to be a risk
for immigrants and those who have not had hepatitis
B immunisation as children. Early detection (screening,
diagnosis, risk assessment) advice for patients about
lifestyle, screening and immunisation of partners and family/
whānau, continuing surveillance and appropriate referral are
important to prevent cirrhosis and primary liver cancer.
Additionally, inflammatory bowel disease, irritable bowel
syndrome, gastro-oesophageal reflux disease, coeliac
disease and the various other gastrointestinal diseases all
present to the general practitioner initially and need to be
investigated thoroughly and treated appropriately. A wide
knowledge of these conditions, skills in both communication
and examination and an open-minded attitude to the often
multiple consultations that may be required are essential to
managing these long-term conditions.
Communication
The GP will demonstrate the ability to:
• take a comprehensive history related to change in
bowel habit and negotiate appropriate management
• use recognised communication skills techniques when
breaking bad news
• describe the results of investigations to patients
• illicit the ideas, concerns and expectations of a patient
presenting with gut-related symptoms
• describe physical examination findings to patients
and their family/whānau or carers
• manage long-term conditions, maintaining ongoing
communication with patients their family/whānau and
other health professionals involved in care.
Clinical Expertise
The GP will demonstrate the ability to:
• determine a differential diagnosis for a variety of upper
and lower gastrointestinal symptoms
• use practice-based equipment available for investigating
bowel symptoms, such as a proctoscope
• perform a comprehensive, condition-appropriate
abdominal examination
• prescribe appropriate medications for gastrointestinal
conditions that present in general practice
• apply knowledge of symptoms and signs of bowel cancer,
recognition of red flags, investigations and referral
• discuss the impact of gastrointestinal conditions on
nutrition and, conversely, the impact of nutrition on the gut.
• describe the conservative management of sub-acute
bowel obstruction, with further consideration if in the
rural setting, and appropriate subsequent follow-up and
investigation
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Curriculum for General Practice