American Foregut Society Education Committee: Development of the Advanced Foregut Fellowship Program for Gastroenterology Trainees

Background: Foregut disorders, including gastroesophageal reflux disease (GERD), esophageal motility disorders, and obesity, represent a significant and growing clinical and economic burden. The evolution of nuanced diagnostics (eg, impedance planimetry) and advanced endoscopic therapeutics (eg, per-oral endoscopic myotomy [POEM], transoral incisionless fundoplication, endobariatrics) has created a training gap not addressed by standard gastroenterology or advanced endoscopy fellowships. Specialized expertise in managing these complex foregut disorders is a critical area of clinical need. Methods: The American Foregut Society (AFS) Education Committee developed a core curriculum for a 1-year advanced fellowship program focused on foregut disorders. This advanced program is designed for graduates of 3-year accredited gastroenterology fellowship training programs. We define a competency-based assessment framework based on domain-specific Entrustable Professional Activities (EPAs) that integrate the six Accreditation Council for Graduate Medical Education (ACGME) Core Competencies. Results: The Advanced GI Foregut Fellowship curriculum is comprised of three domains: esophageal motility; reflux, mucosal disease, and cancer; and, obesity and metabolic disorders. Fellows will be expected to achieve Level 4 (practice-ready) entrustment in at least two of these domains. Each domain features training to independent proficiency in patient evaluation, diagnostic testing, and therapeutic intervention. Conclusion: The AFS-sponsored Advanced GI Foregut Fellowship is proposed as a pilot program to formally train gastroenterologists to lead interdisciplinary foregut centers. We describe the curriculum, a novel GME assessment framework, and a strategy for implementation and evaluation. The pilot program will be used to determine appropriate training threshold volumes required to achieve competence.