Barriers in Neurogastroenterology and Motility Training Experience for Pediatric Gastroenterology Fellows

Abstract

Background: Neurogastroenterology and motility (NGM) disorders are common and have a high health care burden. Although pediatric gastroenterology fellows are expected to obtain comprehensive training in the diagnosis and management of NGM disorders, there is ongoing concern for unmet training needs and lack of exposure in treating patients who suffer from NGM problems. Study Design: We conducted a cross-section survey of trainees listed as pediatric gastroenterology fellows in North American training programs in 2018 via direct e-mail and the pediatric gastroenterology listserv. Eighty-one pediatric gastroenterology fellows responded to the anonymous survey. Results: A total of 53.1% of the fellows reported interest in NGM, however, 75.1% of the fellows believed they had not been adequately trained in NGM during their fellowship. Eighty percent of fellows with two weeks or less of dedicated motility training reported that they received inadequate NGM training, compared to 46.2% fellows who received one or more months of dedicated motility training (p=0.0148). The majority of fellows reported not being comfortable in performing gastrointestinal (GI) motility studies. The majority of fellows also reported not being comfortable in interpreting GI motility studies. Conclusion: While most pediatric gastroenterology fellows expressed interest in NGM, the lack of exposure and dedicated training in motility during fellowship were identified as barriers to pursuing motility-focused careers. Furthermore, most fellows reported limited comfort with performing and/or interpreting motility studies. Changes are needed to encourage fellows to develop their interest and expertise in NGM.

How to Incorporate Esophageal Manometry Teaching in Your Fellowship Program

“…This feeds a self-perpetuating cycle: when GI fellows with limited motility training graduate and join an academic faculty, they will be less likely to teach on GI motility or develop motility curricula. 5 Their future fellows will therefore also experience inadequate motility training, and the cycle will continue.…”

Functional abdominal pain in adolescents: case-based management

“…In a recent survey of paediatric gastroenterologists in training, 53.1% of the fellows reported an interest in neurogastroenterology; however, less than 25% believed they had been adequately trained in this subspecialty during their fellowship. 9 Only approximately one-third of them felt very comfortable dealing with patients with functional dyspepsia or IBS, two of the most common paediatric FGIDs.…”

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“…Indeed, according to recent research, competency-based training in motility should be focused on objective performance evaluations rather than the number of operations or the amount of time spent in training. 2,3 Given the high prevalence of NGM problems in children, it's crucial to have paediatric gastroenterology fellows who are well-versed in neurogastroenterology and gastrointestinal (GI) motility disorders, as well as encouraging individual fellows and students to pursue NGM as a career path. 2,3 Despite the high prevalence and financial burden of functional GI and motility problems, only 25% of adult gastroenterology fellowship programmes include any motility training, and only 12% provide comprehensive motility training.…”

“…2,3 Given the high prevalence of NGM problems in children, it's crucial to have paediatric gastroenterology fellows who are well-versed in neurogastroenterology and gastrointestinal (GI) motility disorders, as well as encouraging individual fellows and students to pursue NGM as a career path. 2,3 Despite the high prevalence and financial burden of functional GI and motility problems, only 25% of adult gastroenterology fellowship programmes include any motility training, and only 12% provide comprehensive motility training. One way to improve fellow training is to create programmes that allow for dedicated time for motility during fellowship.…”

“… 2 , 3 Given the high prevalence of NGM problems in children, it's crucial to have paediatric gastroenterology fellows who are well‐versed in neurogastroenterology and gastrointestinal (GI) motility disorders, as well as encouraging individual fellows and students to pursue NGM as a career path. 2 , 3 …”