Apprenticeship-based training in neurogastroenterology and motility

Abstract

Although neurogastroenterology and motility (NGM) disorders affect 50% of patients seen in clinics, many gastroenterologists receive limited NGM training. One-month apprenticeship-based NGM training has been provided at ten centers in the USA for a decade, however, outcomes of this training are unclear. Our goal was to describe the effectiveness of this program from a trainees perspective. Areas covered: We describe the training model, learning experiences, and outcomes of one-month apprenticeship-based training in NGM at a center of excellence, using a detailed individual observer account and data from 12 consecutive trainees that completed the program. During a one-month training period, 302 procedures including; breath tests (BT) n = 132, anorectal manometry (ARM) n = 29 and esophageal manometry (EM) n = 28, were performed. Post-training, all trainees (n = 12) knew indications for motility tests, and the majority achieved independence in basic interpretation of BT, EM and ARM. Additionally, in a multiple-choice NGM written-test paper, trainees achieved significant improvements in test scores post-training (P = 0.003). Expert commentary: One-month training at a high-volume center can facilitate rapid learning of NGM and the indications, basic interpretation and utility of motility tests. Trainees demonstrate significant independence, and this training model provides an ideal platform for those interested in sub-specialty NGM.

Curriculum for neurogastroenterology and motility training: A report from the joint ANMS‐ESNM task force

“…Tier 2 training can also include expertise and resources for the use of a multidisciplinary approach for the management of NGM disorders, including recommendations for complementary and alternative therapies. The best available example of Tier 2 training is the Clinical Training Program (CTP) provided by the ANMS, where trainees with interest in NGM are assigned for 1‐month observerships in 1 of 10 NGM centers of excellence in the US . A third of trainees enrolled in the nationwide CTP program went on to Tier 3 training and practice, while 9 of 12 motivated trainees at 1 CTP site showed similar interest in NGM .…”

“…The best available example of Tier 2 training is the Clinical Training Program (CTP) provided by the ANMS, where trainees with interest in NGM are assigned for 1‐month observerships in 1 of 10 NGM centers of excellence in the US . A third of trainees enrolled in the nationwide CTP program went on to Tier 3 training and practice, while 9 of 12 motivated trainees at 1 CTP site showed similar interest in NGM . This shows that a dedicated Tier 2 experience can spark in‐depth interest in the field, leading to academic careers in NGM …”

“…The Tier 2 trainee could acquire skills and knowledge for interpretation of gut function and motility studies by participating in specialized training. In the US, such training can be achieved from fellowship training in a center of excellence with motility expertise, from participating in a Tier 2 CTP, or from a Tier 3 motility fellowship. In Europe, this is currently achieved by apprenticeship (3 months to 2 years) at a training center with motility expertise, but there are significant differences in duration and organization between countries, including other parts of the world such as Latin America and Asia.…”

“…Therefore, it is anticipated that the curriculum can be adapted to these special circumstances to ensure quality of the NGM services provided. Furthermore, the 1‐month CTP is only the point of initiation of advanced training and may not be adequate for interpretation of all gut function and motility studies; limited data available suggest that skills in interpretation of breath tests and anorectal manometry are the simplest to acquire, but interpretation of other function tests is more complex . The Tier 3 trainee is expected to gain skills in advanced interpretation of gut function and motility studies relevant to their chosen NGM domain(s) of expertise.…”

“…One such niche area is neurogastroenterology and motility (NGM), which encompasses the study of the brain, the gut, and how they interact; the trainee is expected to develop an understanding of gastrointestinal motility, pain and sensation within the gut, NGM disorders, and their management. Within the field of NGM, apprenticeships remain the main mode of training both within the US and around the world (Figure ), with outcomes varying by quality of the training institution and the mentor …”