NASPGN Guidelines for Training in Pediatric Gastroenterology

NASPGN Guidelines for Training in Pediatric Gastroenterology Introduction S1 Task Force on Overview of Training in Pediatric Gastroenterology and Nutrition S2 Task Force on Training in Gastrointestinal Motility and Functional Disorders S6 Task Force on Training in Acid–Peptic Disease S8 Task Force on Training in Short-Bowel Syndrome and Congenital Abnormalities of the Gastrointestinal Tract S10 Task Force on Training in Inflammatory Bowel Diseases S11 Task Force on Training in Infectious and Immunologic Diseases of the Gastrointestinal Tract S12 Task Force on Training in Pancreatic Disease S14 Task Force on Training in Hepatobiliary Disorders S15 Task Force on Training in Endoscopy S18 Task Force on Training in Nutrition S21 Task Force on Training in Research S23 Task Force on Pediatric Training in Adult Gastroenterology S24 Pediatric gastroenterology is now an established pediatric subspecialty in medical centers across North America. The discipline was initially devoted to cataloging the various disorders that affect the gastrointestinal tract and liver in pediatric patients. It now comprises an extensive knowledge of pathophysiology, numerous diagnostic options, and therapeutic interventions that contribute to the clinical care of infants, children, and adolescents (pediatric patients) with gastrointestinal and nutritionally based disease. Acquisition of specific skills and knowledge is essential for the subspecialist to practice pediatric gastroenterology. Recently, the emergence of this specialty was recognized by the American Board of Pediatrics as a pediatric subspecialty requiring completion of a 3-year fellowship and successful passage of a sub-Board examination in Pediatric gastroenterology to be certified as a subspecialist. The Royal College of Physicians and Surgeons of Canada recognizes this pediatric subspecialty similarly. Historically, individual training directors determined the structure of their respective training programs, including the body of knowledge and technical skills required for graduation. Not surprisingly, graduation requirements vary greatly at present. It is the purpose of this document to define the core body of knowledge and technical skills that must be acquired by all pediatric gastroenterology trainees to assure that the care of pediatric patients with gastrointestinal and liver disorders is of the highest quality. The investment in training experts in pediatric gastroenterology and the special skills required to practice pediatric gastroenterology will be under increasing scrutiny as economic issues drive decisions in patient care and as practitioners with insufficient training compete to care for pediatric patients. Accessibility to competent pediatric gastroenterologists is essential in the current economic and managed medical care environment. Therefore, the Executive Council of the North American Society for Pediatric Gastroenterology and Nutrition has established this Core Curriculum in Pediatric Gastroenterology and Nutrition to define the skills and knowledge required of a pediatric gastroenterologist and to differentiate this training from that defined by the Gastroenterology Leadership Council for training in adult gastroenterology (1). This core curriculum may be of benefit to the Accreditation Council for Graduate Medical Education, which certifies training programs, and to directors of training programs who are accountable for the quality of trainees and their performances. Although the minimum skills and knowledge required to diagnose and manage gastrointestinal and nutritional disorders affecting pediatric patients are defined, individual programs vary according to differences in the career goals of trainees. Three years of training are mandated, but a longer period may be required to acquire skills and knowledge in areas of specialization such as liver transplantation, certain endoscopic techniques, motility disorders, pancreatic diseases, nutrition, and hypothesis-based research. The NASPGN Training and Education Committee provided oversight for development of the Core Curriculum in Pediatric Gastroenterology and Nutrition. The discipline was divided into 11 areas encompassing the cognitive knowledge and procedural skills required for the practice of the subspecialty. The categories include disease-oriented content, gastrointestinal procedures, nutrition, research, and adult gastroenterology. For each category, a recognized expert was enlisted to chair a working group to achieve consensus on the essential cognitive knowledge and procedural skills to be achieved during training. Each group provided recommendations about the process of training, including the role of inpatient and outpatient care, teaching rounds, and conferences. Each section was submitted to the Training and Education Committee and then to expert pediatric reviewers for comment. The research training section was also submitted to the NASPGN Research Committee for review and approval. A revised version of the entire document was submitted by the Training and Education Committee to the NASPGN Executive Council for approval. The Executive Council reviewed the document in detail and resolved controversial issues identified during the review process. This process assured that the final document represents a balanced and reasonable consensus among subspecialists throughout North America and defines the skills and knowledge that should have been acquired by all trainees on completion of their training programs. The NASPGN Executive Council and the experts enlisted to prepare this document believe that this core curriculum will evolve to meet the changing needs of patients and to incorporate new concepts and technologies. Many intangibles make an outstanding training program. 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