Inflammatory bowel disease (IBD) is increasingly prevalent in the United States, driving demand for gastroenterologists who are specially trained to treat the disease’s unique challenges. However, IBD-focused training in general gastroenterology fellowships has been inconsistent nationwide. In response, NYU Langone’s Lisa B. Malter, MD, and colleagues have launched a national introductory IBD course for first-year gastroenterology fellows. She also was a member of a team proposing a new standardized IBD curriculum.
Fellowship Programs Can Lack IBD-Focused Training
Currently, the quality of IBD training across gastroenterology fellowship programs is closely tied to local resources, including the presence of experts, specialized centers, and diverse patient populations. The complexity of the disease and rapidly evolving therapeutic options—which now include anti-integrins, interleukin-12/23 inhibitors, and Janus kinase (JAK) inhibitors—highlight the need to equip trainees with the most up-to-date clinical management skills.
Some institutions offer visiting electives for trainees to immerse themselves in IBD, but opportunities are limited, says Dr. Malter, associate professor in the Department of Medicine and director of education at the Inflammatory Bowel Disease Center at NYU Langone. A recent increase in IBD-focused educational conferences and web-based tools, such as the American College of Gastroenterology’s Education Universe training pathway, can help bridge the educational gap for those wishing to supplement on-site learning.
“Unfortunately, many opportunities occur during the second and third years of training, and trainees who come from programs without access to IBD training often don’t hear about these learning platforms in time to apply or are unable to be away from their home institution to participate,” Dr. Malter explains.
Course Launched for First-Year Gastroenterology Fellows Nationwide
NYU Langone launched a national IBD course for first-year gastroenterology fellows this year. IBD 101: Physicians and Patients Providing Pearls and Perspectives is a one-day introduction to IBD diagnosis and treatment that features rotating didactic roundtable sessions, a patient forum, and clinical case simulations using standardized patients.
The inaugural course—directed by Dr. Malter along with David P. Hudesman, MD, co-director of the Inflammatory Bowel Disease Center; Sunanda V. Kane, MD, MSPH, chair of quality, Division of Gastroenterology and Hepatology, Mayo Clinic; and David T. Rubin, MD, section chief of gastroenterology, hepatology, and nutrition at University of Chicago Medicine—was taught by leading IBD specialists, providing a primer on diagnosis, treatment, and clinical management.
“We hope it will spark early interest in IBD as a subspecialty and encourage some fellows to pursue additional education,” says Dr. Malter. Attendance was by invitation only the first year and, starting in 2020, will open up to all first-year gastroenterology fellows across the country on a first-come, first-served basis.
Building a New Standardized IBD Curriculum
To further address the educational gap within IBD, Dr. Malter, Dr. Rubin, and team have proposed an update in the IBD curriculum for categorical gastroenterology fellows. The concept is centered on eight proposed IBD-focused entrustable professional activities (EPAs) to include in gastroenterology fellowship training. These will help individual programs prioritize important aspects and recognize limitations of IBD management. Details of the proposed update were published in the September 2019 issue of Inflammatory Bowel Disease.
In addition to identifying the type and extent of IBD, the EPAs include competency in interpreting results, recommending appropriate therapies, knowing when to refer to an IBD specialist, and working on interdisciplinary teams. The objectives are designed to be achievable by all programs, regardless of the level of access to IBD patients and experts. It suggests that if trainees have limited exposure during their general gastroenterology fellowship but intend to manage IBD patients, they should consider supplemental training.
“With this proposed new curriculum, we hope to minimize variation between programs and produce specialists who are well-versed in the basics of IBD management strategies and therapies, and seek additional training if they intend to care for IBD patients in their practice,” Dr. Malter says.
Disclosures: Lisa B. Malter, MD, has received medical education grants or sponsorships from AbbVie, Gilead, Janssen, Pfizer, Prometheus Laboratories Inc., Salix Pharmaceuticals, and Takeda.