NASPGHAN Guidelines for Training in Pediatric Gastroenterology

Abstract

and the NASPGHAN Training Committee 1. OVERVIEWT he field of pediatric gastroenterology, hepatology, and nutrition (referred to subsequently as pediatric gastroenterology) continues to expand and evolve and is far different from 1999, when the previous guidelines on fellowship training in this field were published (1). Although still a relatively young field, this subspecialty is increasingly recognized and accepted throughout the world (2), albeit with varying degrees of medical resources and access to care. Tremendous medical advances, especially in the fields of genetics, infectious disease, pharmacology, and immunology, have changed our fundamental understanding of pathophysiology, and along with technological innovations, such as wireless imaging technology and intraesophageal impedance monitoring, have affected the way we diagnose and manage disease. At the same time, economic factors have become increasingly important in discussions of health care and graduate medical education (3). With rapidly escalating health care costs, care must be demonstrated to be not only high in quality but also cost-effective. Moreover, in response to pressure from the public to ensure practitioners are competent, accrediting agencies are imposing new and increasingly complex constructs for assessing the competency of our trainees. These factors demand that the training of pediatric gastroenterology fellows be continuously revised and reevaluated.

An ANMS‐NASPGHAN consensus document on anorectal and colonic manometry in children

“…It is obvious that interpretation of colon manometry studies requires experience and sub‐specialty training. In the Guidelines for Training in Pediatric Gastroenterology by NASPGHAN published in 2013 it is stated that pediatric GI fellows should be exposed to this procedure but the numbers of studies required for the training were not specified . The recommendations also state that for the practice of sub‐specialties like Neurogastroenterology and Motility advanced training “could be obtained in 1 of 3 ways: within the context of a standard 3‐year fellowship, assuming all of the basic requirements for clinical training and scholarship are met; during an additional, dedicated fourth year of fellowship training; or postfellowship in the course of mentored, specialized practice.” There are no specified metrics to assess such training, because those only exist currently for transplant hepatology.…”

“…In the Guidelines for Training in Pediatric Gastroenterology by NASPGHAN published in 2013 it is stated that pediatric GI fellows should be exposed to this procedure but the numbers of studies required for the training were not specified. 37 The recommendations also state that for the practice of sub-…”

Paediatric gastroenterology fellows’ self‐assessment of endoscopy skills

“…This includes exposure to a variety of gastrointestinal disorders that would require various endoscopic interventions, both diagnostic and therapeutic, and adequate technical and cognitive skills to lead an endoscopy unit. The 2013 North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) guidelines for training in paediatric gastroenterology recognise that completing the minimum number of recommended endoscopic procedures alone does not ensure competency . Competency varies based on multiple factors including training intensity, training aids and the quality of instruction received in addition to the innate ability of the trainee .…”

A Procedural and Educational Experience Following Creation of an Advanced Pediatric Endoscopy Service

“…Challenges in meeting suggested procedure volumes during fellowship have recently been discussed in the literature (6). Whereas relatively new, advanced techniques such as endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) require supplemental training, other advanced procedures are not formally learned after primary training (7). To investigate the state of advanced endoscopic procedural education, Lerner et al recently surveyed 12 pediatric gastroenterology fellowship programs in the United States (U.S.) comprising 27% of trainees nationwide (8).…”