Family Medicine Clerkship

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Dyspepsia

OVERVIEW

Dyspepsia is defined as pain or discomfort centered in the upper abdomen and may be characterized by or associated with upper abdominal fullness, early satiety, bloating, or nausea, according to the Rome II criteria. Dyspepsia is a common presenting symptom that affects up to one-fourth of the general population of all industrialized countries and leads to 3% of all primary care visits. Dyspepsia is a costly disease, both in terms of medical and pharmaceutical costs and in terms of indirect costs of absenteeism or diminished productivity. All students completing a clerkship in family medicine should have a clear understanding of the definition, approach to the patient, diagnosis, and treatment of the various causes of dyspepsia.

LEARNING GOALS AND OBJECTIVES
(Organized by ACGME Competencies)

Patient Care

GOAL: Students will accurately take a history for a patient with undifferentiated dyspepsia.

OBJECTIVES: Students will be able to:

• Define dyspepsia.
• Ask appropriate questions to determine the cause of dyspepsia.

GOAL: Students will accurately conduct a physical exam on a patient with undifferentiated dyspepsia.

OBJECTIVES: Students will be able to:

• Perform an appropriate physical exam on a patient with undifferentiated dyspepsia.

Medical Knowledge

GOAL: Students will understand the pathophysiology and major causes of dyspepsia.

OBJECTIVES: Students will be able to:

• Describe the major identifiable causes of dyspepsia and their prevalence.
• Describe the pathophysiology of gastroesophageal reflux disease and peptic ulcer disease, including the relationship between gastroesophageal reflux disease and esophageal cancer.

GOAL: Students will demonstrate the use of appropriate diagnostic tests in the patient with dyspepsia.

OBJECTIVES: Students will be able to:

• Describe an algorithm for the cost-effective diagnosis of gastroesophageal reflux disease, peptic ulcer disease, and functional dyspepsia.
• Explain the predictive value of various symptoms of dyspepsia in diagnosing the underlying cause.

GOAL: Students will understand when and how to refer a patient who has dyspepsia to a gastroenterologist.

OBJECTIVES: Students will be able to:

• Identify potentially dangerous symptoms and signs requiring urgent referral to a gastroenterologist.

GOAL: Students will know the treatment of causes of dyspepsia.

OBJECTIVES: Students will be able to:

• Detail appropriate treatment for peptic ulcer disease, gastroesophageal reflux disease, and functional dyspepsia.
• Describe pharmacology and cost-effectiveness of different treatments for gastroesophageal reflux disease.
• Describe the appropriate use of surgical interventions for gastroesophageal reflux disease.

Practice-Based Learning and Improvement

GOAL: Students will demonstrate the ability to investigate and evaluate their care of patients with dyspepsia.

OBJECTIVES: Students will be able to:

• Demonstrate use of evidence-based materials to support their clinical practice.
• Reflect on the importance of evidence-based use of pharmacological therapies for the patient with dyspepsia.

Interpersonal and Communication Skills

GOAL: Students will communicate appropriately with the patient and family.

OBJECTIVES: Students will be able to:

• Discuss the diagnosis, treatment plan, and follow-up with the patient and family and verify patient comprehension and agreement with the diagnosis and plan.
• Discuss lifestyle modification strategies with patient and family for treatment of gastroesophageal reflux disease.

Professionalism

GOAL: Students will demonstrate sensitivity to diverse patient populations.

OBJECTIVES: Students will be able to:

• Explain different cultural and ethnic perspectives that affect patient beliefs about the cause and treatment of dyspepsia.

Systems-Based Practice

GOAL: Students will effectively utilize system resources to provide optimal care for the patient with dyspepsia.

OBJECTIVES: Students will be able to:

• Demonstrate effective use of pharmacological and lifestyle interventions.
• Reflect on the system-wide cost of appropriate and inappropriate pharmacological therapy for dyspepsia.

EDUCATIONAL METHODS AND RESOURCES

Published Material

• Purchase information from the STFM Web site
  Essentials of Family Medicine, Fourth Edition. Chapter 29, Dyspepsia.

Lead Author: Lauren Oshman, MD
Clerkship/Post-Clerkship Workgroup members: Ann O'Brien-Gonzales, PhD (Chair), Alexander Chessman, MD (EC Liaison), Caryl Heaton, DO, Janice Nevin, MD, MPH, Lauren Oshman, MD, Deborah McPherson, MD, Mark. E Quirk, EdD, David Schneider, MD, MSPH, William B. Shore, MD, Richard Usatine, MD

Family Medicine Curriculum Resource (FMCR) Project HRSA Contract 240-00-0107.

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This page last updated November 6, 2004