IER Placement: Gastroenterology

As part of the McMaster Physician Assistant Education Program curriculum, each student shadows a professional in the field relevant to the unit being studied that month. These are called IER placements and students are assigned a half-day shift at a hospital/clinic in Hamilton. IER stands for Interviewing, Examining and Reasoning.

For this IER Placement:

  • Medical Foundation Unit: Gastroenterology
  • Professional Shadowed: Gastroenterologist
  • Date of Placement: Fri. Jan 30, 2015
  • Where: McMaster University Medical Centre – GI Clinical

Read more about what I learned in my placement!

Seeing Patients

This IER placement with the physician was strictly observing. He had new patient consultations in the morning and follow up appointments closer to the afternoon. Of the patients I saw with the physician, most were coming in with complaints of epigastric pain, reflux, constipation, and diarrhea. These are all familiar symptoms that we learned in tutorials and in IER.

The physician has a very structured way of conducting his interviews. Taking a patient history is something I have been struggling with. Some people like the interview to be more conversational rather than structured, but I think it is important to find what works for the person. For example, we were taught to ask the History of Present Illness first and then delve into the Family History and Past medical history. For the physician, he finds out the latter first, and then assess the History of Present Illness.

Endoscopy Unit at Hamilton General Hospital

This is basically what it looks like inside the room. Notice the controller in the physician’s left hand! It is big and probably very difficult to maneuver. Most physicians would say they had to do hundreds of colonoscopies before they got the hang of it.

I was a bit disappointed that this placement was strictly observing consultations (just like my last IER placement in hematology). Most patients we saw received a requisition for an upper GI endoscopy or colonoscopy and I was very interested in seeing some. At the end of my placement, I asked the physician if I can observe some endoscopies if he is doing any in the next week. He agreed and had me come in next Wednesday to watch him “scope” at the Hamilton General Endoscopy Unit.

The physician said that colonoscopies are very hard to perform, that I would most likely never will do one (which is true, I probably won’t), and that I won’t learn much from observing it. I personally disagree with that last part. I think it is a good experience to observe one or two endoscopies. In my career as a Physician Assistant, I will have to refer my patients for endoscopies. If my patient ever asked me what is it, how it is done, etc, at least I can describe it from my own experience from observing one.

How a biopsy is taken


In a colonoscopy, a long tube with a camera at the tip is inserted into the rectum and pushed in all the way to cecum. The procedure is done to see the lining of the colon, assessing for polyps, bleeding, and other abnormalities. Colonoscopies can be used to diagnose bowel disorders (eg. Celiac Disease, Crohn’s Disease, etc) and colon cancer. For more information, visit the Canadian Cancer Society or my post on Canada’s Colon Cancer Screening Initiative (the Fecal Occult Blood Test).

I observed two colonoscopies that took around 45 min each to complete. Just a side note, all patients undergoing endoscopies have to do some preparation the day before (eg. no eating solids to ensure the colon is empty). The patient is put under conscious anesthesia. Once the scope was in, the goal was to get it all the way to the cecum. Then, the scope is slowly pulled out and the surrounding lining is observed carefully. The nurse said that the colon lining is healthy if it is smooth, shiny and you can see blood vessels. Any polyps seen will be removed and taken for biopsy.

Healthy colon lining on the left. Polyp on the right.

Just something that I noticed: even though the patient was put under conscious anesthesia and they usually don’t remember what happens during the procedure, the pain tolerance is quite variable between patients. The first colonoscopy I observed, the patient was crying and screaming. The nurses tried to encourage her to endure it. During the second colonoscopy, the patient was totally okay with it. I think part of the reason the patient is not completely knocked out for the procedure is because sometimes they are required to change positions (eg. turn over to the left or right) in order for the scope to be able to get through the colon.

Overall Experience

Gastroenterology is my favourite unit so far. There’s just something about constipation and diarrhea that really gets me (I’m kidding). I am excited to follow how the physician takes his patient history and see if it works for me. He said that everyone starts off a bit rough but eventually I will find my own style and get better at it. I think this IER placement was a good experience, especially getting to observe some endoscopies (good thing I asked!). I really just wanted to see one or two just to know what goes on in one.


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