The Whys and Hows of Fourth-Year Inflammatory Bowel Disease Fellowships

Assessment of Benefit of Advanced Inflammatory Bowel Disease Training: Challenges and Solutions

Background

Advanced inflammatory bowel disease (IBD) fellowships are available for gastroenterologists who wish to increase their expertise in complex IBD. However, little is known about the outcomes of such training. The aims of this study were to assess clinical and academic outcomes following advanced training in IBD.

Methods

We surveyed gastroenterologists who completed advanced IBD fellowships and compared competency and outcomes to gastroenterologists focusing in IBD who completed gastroenterology training alone. Participants completed a survey via REDCap. Continuous variables were compared using the Wilcoxon rank-sum test. Categorical variables were compared using chi-square or Fisher's exact tests.

Results

A total of 104 physicians participated in the study. IBD fellowships were completed by 31 physicians (30%), of whom 29 (94%) felt their training was excellent. Management of complicated IBD (84%), research mentoring (74%), and career mentoring (71%) were felt to contribute most highly to professional development. Compared to non-advanced trained physicians, advanced trained physicians expressed higher levels of comfort with management of IBD during pregnancy (P = 0.003), complicated IBD (P = 0.057), and peri-operative IBD (P = 0.057). No significant advantage was detected in academic productivity. Common barriers to participation in IBD fellowships included feeling it was unnecessary (45%) and desire to begin a faculty position (42%).

Conclusions

This study suggests there may be clinical benefit to advanced IBD training. Importantly, this study identified that there are also unique challenges to the assessment of clinical competency in IBD training. Efforts by the IBD community to establish a registry of advanced trainees and improve competency assessments are needed.

Inflammatory Bowel Disease Training During Adult Gastroenterology Residency: A National Survey of Canadian Program Directors and Trainees

Background

Clinical training in inflammatory bowel disease (IBD) is a mandated component of adult gastroenterology fellowship. This study aims to assess methods of instruction in IBD and identify priorities and gaps in IBD clinical training among residents and program directors (PDs).

Methods

Using both an online and in-person platform, we administered a 15-question PD survey and 19-question trainee survey that assessed the methods of IBD teaching and trainee perceptions of knowledge transfer of 22 IBD topics. The survey was previously developed and administered to US gastroenterology trainees and PDs.

Results

Surveys were completed by 9 of 14 (62.3%) PDs and 44 of 62 (71%) trainees. Both trainee years were equally represented (22 residents in each year of training). All respondents were based at university teaching hospitals with full-time IBD faculty on staff. Dedicated IBD rotations were not offered by more than half of training programs, and IBD exposure was most commonly encountered during inpatient rotations. Overall, only 14 (31.2%) trainees were fully satisfied with the level of IBD exposure during their training. Thirty-six (81.8%) trainees reported being comfortable with inpatient IBD management, whereas only 23 (52.3%) trainees reported being comfortable with outpatient IBD management. There was strong concordance between the proportion of PDs ranking an IBD topic as essential and trainee comfort in that area (Pearson’s rho 0.59; P=0.004). Fewer than half of trainees reported comfort in 11 of 22 (50%) proposed IBD topics. Identified areas of deficiency included phenotypic and endoscopic classification of IBD, inpatient management of severe active IBD, perianal disease management, monitoring biologic therapy and extra-intestinal manifestations of IBD.

Conclusions

Only one-third of Canadian gastroenterology trainees are fully satisfied with the level of IBD exposure under the current training model. Furthermore, several IBD topics appear to be inadequately covered during training. Our findings, which are similar to previously published US data, highlight the need for additional focus on IBD during gastroenterology residency.