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Cohen BL, Gallinger ZR, Ha C, Holubar SD, Hou JK, Kinnucan J, Mahadevan U, Moss AC, Raffals LE, Regueiro M, Szigethy E, Wolf D, Dubinsky MC, Patel A, Shah BJ, Ehrlich OG, Hanauer SB. Development of Entrustable Professional Activities for Advanced Inflammatory Bowel Disease Fellowship Training in the United States. Inflamm Bowel Dis 2020; 26:1291-1305. [PMID: 32820340 DOI: 10.1093/ibd/izaa177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND The level of inflammatory bowel disease (IBD) training in general gastroenterology fellowship is often insufficient to prepare trainees to deliver advanced IBD care in practice. Advanced IBD fellowships have been developed to fill this training gap, but there is no established curriculum, and significant variability exists across programs. Entrustable professional activities (EPAs) are practical and realistic objectives that define essential tasks of a specialty that physicians should master to be competent during independent practice. The American College of Gastroenterology (ACG) and Crohn's & Colitis Foundation (Foundation) established a task force to develop and appraise EPAs for advanced IBD fellowship. METHODS Entrustable professional activities were developed using a multistep approach in a similar manner to other specialties. Initial EPAs identified via focus groups were evaluated, critiqued, and changed using an iterative model of feedback. The final EPAs were selected after the task force conducted a 3-phase modified Delphi method consisting of 2 sequential rounds of web-based voting and an in-person consensus meeting. RESULTS Ten EPAs for advanced IBD fellowship were established including detailed descriptions with the associated knowledge, skills, and attitudes for each that can serve as curricular milestones. CONCLUSION Ten EPAs describing the core work of an advanced IBD fellowship-trained physician have been established by a multisociety task force. Creating EPAs for an advanced curriculum comes with unique challenges, particularly the need to prevent duplication of prior training competencies while demonstrating the potential for unique milestones.
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Affiliation(s)
- Benjamin L Cohen
- Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.,Department of Gastroenterology, Hepatology, and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Zane R Gallinger
- Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.,Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Christina Ha
- Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Stefan D Holubar
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jason K Hou
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Uma Mahadevan
- Division of Gastroenterology, University of California, San Francisco, CA, USA
| | - Alan C Moss
- Department of Medicine and Section of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Laura E Raffals
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Miguel Regueiro
- Department of Gastroenterology, Hepatology, and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eva Szigethy
- Department of Gastroenterology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Douglas Wolf
- Atlanta Gastroenterology Associates, Atlanta, GA, USA
| | - Marla C Dubinsky
- Department of Pediatrics, Mount Sinai Hospital and Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center, New York, NY, USA
| | - Anish Patel
- Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.,Division of Gastroenterology, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Brijen J Shah
- Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | | | - Stephen B Hanauer
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Yu A, Friedman S, Ananthakrishnan AN. Characteristics and Long-Term Outcomes of Pregnancy-Onset Inflammatory Bowel Disease: A Case-Control Study. Inflamm Bowel Dis 2020; 27:476-481. [PMID: 32426824 PMCID: PMC7957219 DOI: 10.1093/ibd/izaa096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) frequently affects women during their reproductive years. Although the impact of pregnancy in patients with established IBD has been widely studied, the characteristics and outcomes of patients who develop a new diagnosis of IBD during pregnancy or the postpartum year ("pregnancy-onset") is not well characterized. METHODS We identified all patients with pregnancy-onset IBD between 2006 and 2018 at 2 major academic referral centers. Patient and disease characteristics were abstracted and compared to those of control patients with IBD not diagnosed during pregnancy or postpartum. Diagnostic and therapeutic interventions were noted, as were long-term outcomes including disease treatment course, hospitalizations, and surgery. RESULTS We identified 50 patients with pregnancy-onset IBD and 100 control patients matched for year of diagnosis. The mean age of diagnosis and duration of follow-up was similar among both patients and control patients (aged 30.4 vs 28.5 years). Among patients with pregnancy-onset disease, 30% noted symptom onset in the first trimester, 22% in the second, 24% in the third, and 24% in the postpartum year. Patients with pregnancy-onset IBD were more likely to be diagnosed with ulcerative colitis compared with control patients (76% vs 56%; P = 0.02). On multivariable analysis, pregnancy onset-disease had a 4-fold increase in the risk of hospitalization (28% vs 13%; adjusted odds ratio 4.18; 95% confidence interval, 1.26-13.91). This increased risk persisted even after excluding any index hospitalizations during pregnancy. CONCLUSIONS Patients with pregnancy-onset IBD more commonly develop ulcerative colitis and have a higher risk of disease-related hospitalizations.
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Affiliation(s)
- Amy Yu
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, USA
| | - Sonia Friedman
- Division of Gastroenterology, Brigham and Women’s Hospital, 75 Francis Street, Boston, Massachusetts, USA
| | - Ashwin N Ananthakrishnan
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, USA,Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA,Address correspondence to: Ashwin N. Ananthakrishnan, MD, MPH, Division of Gastroenterology, Massachusetts General Hospital, 165 Cambridge Street, 9th Floor, Boston, MA 02114 ()
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Cushing KC, Adar T, Ciorba M, Ananthakrishnan AN. Assessment of Benefit of Advanced Inflammatory Bowel Disease Training: Challenges and Solutions. CROHN'S & COLITIS 360 2020; 2:otaa019. [PMID: 34825180 PMCID: PMC8607547 DOI: 10.1093/crocol/otaa019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Indexed: 02/05/2023] Open
Abstract
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.
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Affiliation(s)
- Kelly C Cushing
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
| | - Tomer Adar
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew Ciorba
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ashwin N Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Malter LB, Israel A, Rubin DT. Proposal to Update the Curriculum in Inflammatory Bowel Diseases for Categorical Gastroenterology Fellows. Inflamm Bowel Dis 2019; 25:1443-1449. [PMID: 31115448 DOI: 10.1093/ibd/izz107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Indexed: 12/25/2022]
Abstract
Education in inflammatory bowel disease (IBD) varies widely between categorical gastroenterology (GI) programs and is largely related to the presence of expert clinicians, patient population, and the presence of an IBD center. The treatment of IBD is becoming increasingly complex at a rapid pace, widening this educational divide. This manuscript outlines all the current US educational offerings in IBD for GI fellows, including how to obtain supplemental education during the 3-year training period and beyond. It reviews how to assess trainee knowledge in the field of IBD and proposes 8 clinically anchored, entrustable professional activities that should help prioritize important aspects of IBD management to incorporate during categorical GI training.
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Affiliation(s)
- Lisa B Malter
- New York University Langone Medical Center, Department of Medicine, Division of Gastroenterology, New York, NY, USA
| | - Amanda Israel
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA
| | - David T Rubin
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA
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Zezos P, Panisko D. Web-based learning in inflammatory bowel diseases: General truths and current specifics. World J Clin Cases 2018; 6:410-417. [PMID: 30294605 PMCID: PMC6163148 DOI: 10.12998/wjcc.v6.i11.410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/25/2018] [Accepted: 06/27/2018] [Indexed: 02/05/2023] Open
Abstract
In a field rapidly evolving over the past few years, the management of inflammatory bowel diseases (IBD), Crohn’s disease and ulcerative colitis, is becoming increasingly complex, demanding and challenging. In the recent years, IBD quality measures aiming to improve patients’ care have been developed, multiple new medical therapies have been approved, new treatment goals have been set with the “treat-to-target” concept and drug monitoring has been implemented into IBD clinical management. Moreover, patients are increasingly using Internet resources to obtain information about their health conditions. The healthcare professional with an interest in treating IBD patients should deal with all these challenges in everyday practice by establishing, enhancing and maintaining a strong core of knowledge and skills related to IBD. This is an ongoing process and traditionally these needs are covered with additional reading of textbook or journal articles, attendance at meetings or conferences, or at local rounds. Web-based learning resources expand the options for knowledge acquisition and save time and costs as well. In the new era of communications technology, web-based resources can cover the educational needs of both patients and healthcare professionals and can contribute to improvement of disease management and patient care. Healthcare professionals can individually visit and navigate regularly relevant websites and tailor choices for educational activities according to their existing needs. They can also provide their patients with a few certified suitable internet resources. In this review, we explored the Internet using PubMed and Startpage (Google), for web-based IBD-related educational resources aiming to provide a guide for those interested in obtaining certified knowledge in this subject.
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Affiliation(s)
- Petros Zezos
- Division of Gastroenterology, Department of Internal Medicine, Thunder Bay Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, Ontario P7B 6V4, Canada
- Master Teacher Program, Department of Medicine, University of Toronto, Toronto, Ontario M5S 1A1, Canada
| | - Daniel Panisko
- Master Teacher Program, Department of Medicine, University of Toronto, Toronto, Ontario M5S 1A1, Canada
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