PTU-122 A National Survey of GI Physiology & Motility Services in The UK and Ireland

Abstract

IntroductionClinical demands and advances in diagnostics and therapeutics have seen a rapid growth in GI physiology/motility services. We surveyed the practice, training and attitudes towards services nationally, to determine if these aspects have kept pace with expansion and to identify areas for development.MethodsAn online survey developed by a multi-disciplinary panel with medical, surgical and GI physiology representation was circulated to all GI clinicians and physiologists in the UK & Ireland by their national societies BSG, AGIP, AUGIS and ACPGBI. The survey included both generic questions and specific ones signposted for ‘specialists’ (GI physiologists/clinical leads).Results313 responses (59% Gastroenterologists) were received, with 221/313 (71%) from 98 institutions having an on-site GI physiology unit. Most units (88/98) had a clinical lead (60% Gastroenterologists, 34% with ‘subspecialty interest’). Figure 1 summarises the services available nationally. GI physiologists/nurse specialists conduct the majority of studies (69%) and biofeedback (84%). GI physiologists report most studies (Upper GI 71%, Lower GI 69%), however cases are often discussed with a lead clinician prior to finalising (Upper GI: 34% discuss all cases and 38% selected cases; Lower GI: 27% discuss all cases and 27% selected cases), 45% have dedicated multidisciplinary team meetings (MDT) for reporting (held weekly in 72%) and of those without an MDT, 72% felt introducing one would improve provision of therapeutic recommendations. 54% of ‘specialists’ reported that therapeutic recommendations are not routinely made (50% citing reasons such as; no subspecialist clinician/ ‘not qualified’ or ‘not necessary’). Moreover, 70% of ‘specialists’ felt a ‘subspecialist’ clinician is best placed to make such recommendations, whilst only 4% of clinicians without subspeciality interest are comfortable interpreting the data. Overall, very few felt that services (26%), research opportunities (15%) and training (14% for GI physiologists and 10% for clinicians) were adequate, with most GI physiologists (83%) and clinicians (96%) recommending changes with suggestions including an accredited clinical training programme.Abstract PTU-122 Figure 1ConclusionThe survey highlights that GI physiology/motility is a rapidly emerging sub-specialty with limited exposure during clinical training. An MDT approach with subspecialist clinical input facilitates interpretation of complex data and provision of therapeutic recommendations. Percieved deficiencies in current services and training systems have been identified, providing an opportunity to raise awareness nationally via AGIP/BSG and to build on existing training pathways.Disclosure of InterestNone Declared

Gastrointestinal dysmotility: A qualitative exploration of the journey from symptom onset to diagnosis

“…A finding was the need for a more coherent understanding of GID by HPs which would help them to diagnose the condition sooner and help in validating participant experiences. Consistent with our patients reported experiences, recent studies in North America and the United Kingdom have recognized that medical education in gastrointestinal motility is deficient . It is, therefore, plausible that this lack of coverage of GID within training curricula could lead to delays in making confident diagnoses by non‐specialist HPs, especially given the non‐specificity of GID symptoms and lack of awareness could potentially lead to delays in referral to tertiary services.…”

“…Consistent with our patients reported experiences, recent studies in North America and the United Kingdom have recognized that medical education in gastrointestinal motility is deficient. [43][44][45][46][47] It is, therefore, plausible that this lack of coverage of GID within training curricula could lead to delays in making confident diagnoses by non-specialist HPs, especially given the non-specificity of GID symptoms 1 and lack of awareness could potentially lead to delays in referral to tertiary services. Similarly, in chronic fatigue syndrome, Chew-Graham et al 48 concluded that until HPs feel comfortable making a diagnosis and facilitating management of medically unexplained conditions, there will continue to be delays in confirming the diagnosis and patients will continue to not receive appropriate treatment.…”

Competency based medical education in gastrointestinal motility—the UK perspective

“…The UK survey of 313 respondents representing 98 motility labs has shown that GI clinician input in motility study reporting is infrequent and that therapeutic recommendations are provided by fewer than half of those who report studies. 5 The most common reasons for not providing therapeutic recommendations included respondents not feeling 'qualified' or that there was 'no subspecialty clinician'. 5 Furthermore, only 4% of 163 non-specialist GI clinicians surveyed are able to interpret motility study data themselves.…”

“…5 The most common reasons for not providing therapeutic recommendations included respondents not feeling 'qualified' or that there was 'no subspecialty clinician'. 5 Furthermore, only 4% of 163 non-specialist GI clinicians surveyed are able to interpret motility study data themselves. 5 Provision of therapeutic recommendations from diagnostic tests should be a standard of care and these data highlight an acute need for improved core training in motility investigations for Gastroenterologists and an alternative advanced subspecialty training pathway.…”

Apprenticeship-based training in neurogastroenterology and motility

“…Despite this, most gastroenterologists are not adequately trained in the evaluation and management of these disorders [4,5,6]. Recent surveys in the UK have highlighted this problem and the need to improve training [7,8,9]. In the USA, a defined curriculum outlines the standards for basic and advanced training in gastrointestinal motility [10].…”