The European Training Syllabus in Pediatric Gastroenterology, Hepatology, and Nutrition

Pediatric gastroenterology developed rapidly in the late 1960s and 1970s. As a consequence, the European Society of Pediatric Gastroenterology (ESPG) was founded in 1968 by a group of individuals actively engaged in gastroenterologic research. In the mid-1970s, with the development of pediatric nutrition, the society became the European Society of Pediatric Gastroenterology and Nutrition (ESPGAN), and in the 1990s it became ESPGHAN to reflect the growth in hepatology. The drive and interest of ESPGHAN has largely focused on scientific research. However, during the 1990s, ESPGHAN began an educational initiative with the development of Summer Schools in Gastroenterology, Nutrition and Hepatology, traveling summer courses, and with the Millennium Eastern Summer Schools in Eastern Europe. Study days throughout Europe have been features of this initiative. Interaction with our colleagues who work with adults has developed through the United European Gastroenterology Federation (UEGF), of which ESPGHAN is one of the founding seven sisters. In 1996, the first UEGF postgraduate course in pediatric gastroenterology and hepatology was held. Despite these European-wide scientific training initiatives, formal training in pediatric gastroenterology, hepatology, and nutrition is not standardized across Europe, and, despite the preeminent standing of ESPGHAN in the world of pediatric gastroenterology, pediatric gastrology, hepatology, and nutrition, is not recognized in Europe as a board-certified pediatric subspecialty, as it is in Australia and in North America. Pediatric gastroenterology, hepatology, and nutrition must be recognized as a pediatric subspecialty. With the introduction of standardized general pediatric training in Europe, an opportunity exists to develop further training in pediatric gastroenterology, hepatology, and nutrition and to introduce uniform standards through Europe. In 1995, the Confederation Europeenne des Specialistes en Pediatrie (CESP) set up a European Board of Paediatrics (EBP) to standardize all aspects of pediatrics across European. As the predominant body for pediatric gastroenterology, hepatology, and nutrition in Europe, ESPGHAN has set standards in training approved by CESP and EBP. These standards are contained in the training syllabus published in this issue of the journal. A pediatric gastroenterologist and hepatologist is a trained pediatrician who specializes in the investigation and treatment of children with gastrointestinal, liver, and nutritional disorders (pediatric gastroenterology, hepatology, and nutrition). Most pediatric gastroenterologists and hepatologists practice within a tertiary care setting, which offers a full range of diagnostic procedures and the facilities for treating intestinal, liver, or nutritional failure. The aims of this training syllabus are 1) to harmonize training in pediatric gastroenterology, hepatology, and nutrition among the various European countries; 2) to establish clearly defined standards of knowledge and skill for tertiary pediatric gastroenterology, hepatology, and nutrition care; 3) to foster the development of a European network of competent tertiary care centers in pediatric gastroenterology, hepatology, and nutrition; and 4) to further enhance the European contribution to international scientific progress in pediatric gastroenterology, hepatology, and nutrition. The trainee in pediatric gastroenterology, hepatology, and nutrition should, before beginning the specialty training described in this document, have completed training in basic pediatrics. At the end of pediatric gastroenterology, hepatology, and nutrition training, the trainee should be suitable for appointment as a specialist in pediatric gastroenterology, hepatology, and nutrition at a tertiary center. Duration of training in the specialty should be a minimum of 2 years. A period of full-time research, preferably leading to a higher degree, is desirable. An opportunity also should be available to vary the gastroenterologic, hepatologic, and nutritional training components depending on the trainee's requirements. During the period of training the trainee should have received: The trainee will gain experience with and understanding of the following: Diagnostic and therapeutic procedures required for examination of the gastrointestinal tract and liver: Nutritional skills that include knowledge of the following: Current general professional training in pediatrics is not adequate for the tertiary specialist in pediatric gastroenterology, hepatology, and nutrition. The boundaries must be defined between the skills and competence of general pediatricians and those of the specialist. The content of this syllabus details the additional training required for a specialist in pediatric gastroenterology, hepatology, and nutrition and thus also defines the boundaries between general pediatricians and pediatric gastroenterology, hepatology, and nutrition specialist pediatricians. Training requirements for tertiary specialists include 1) basic knowledge; 2) clinical, technical, and management skills and competencies; 3) attitudes; and 4) the ability to diagnose and treat particular disorders. Basic knowledge in gastroenterology will include understanding of the following: Basic knowledge of hepatology will include understanding of the presentation, investigation, and treatment of the following: Basic knowledge in nutrition will include understanding of the following: Basic investigative knowledge include understanding of the following: Clinical skills will include the following: Technical skills will include the following: Management skills include the following: Research skills include the following: The trainee will gain the ability to recognize and initiate diagnostic tests, and outline management of the following: The syllabus is arranged as a series of modules that can be completed in one or several different training centers. The training should be performed at no more than four centers. Each module contains training in a specific area, expertise, or skill. Most trainees should complete all modules. However, if an individual will practice only hepatology, the program can be varied to include more hepatology and less gastroenterology, without the necessity for learning inappropriate technical skills. Trainees in pediatric gastroenterology, hepatology, and nutrition will complete all modules. Trainees in gastroenterology will complete the following modules: basic gastroenterology knowledge, basic hepatology knowledge 1 through 5, basic nutritional knowledge, clinical skills, technical skills (excluding skills 6:6), attitudes, and particular disorders. Trainees in hepatology only will complete the following modules: basic gastroenterology knowledge 1 through 5, basic hepatology knowledge, basic nutritional knowledge, clinical skills, technical skills (excluding skills 1, 3–5, and 9–11), attitudes, and particular disorders 5, 9, 10, 13, 18, 21, 23, and 27. Each trainee's progress is monitored by the trainee and an assigned tutor. The trainee will maintain a personal logbook, in which he or she will document relevant training experiences, and will complete a self-assessment for each module / topic. The logbook and the trainee's progress will be discussed with the tutor at 3-month intervals. Successful completion of a training module/topic will be certified by the tutor in the trainee's logbook. A suggested scheme of self-assessment for gastroenterology, hepatology, and nutrition is given herein, with notes for trainers and trainees. Principles for assessing research and content of the logbook also is suggested. Because research experience is an essential part of training in pediatric gastroenterology, hepatology, and nutrition, each trainee must meet the following objectives: Evidence of meaningful accomplishment in research must be submitted. Acceptable evidence could include one of the following: A research progress report (signed by both the applicant and supervisor), no more than five pages in length, to include the following: The trainee's supervisor is responsible for ensuring appropriateness of the research activity and will be involved in research planning. Note to Trainee: This self-assessment is designed to help you and your supervisor review your training and experience, and to identify any gaps. To assess your knowledge and understanding, ask yourself, “Could I explain this condition/treatment/procedure clearly, logically, and persuasively to a consultant colleague in another specialty who may seek advice about a child?” During training, a trainee may expect to encounter the conditions chosen in this exercise. Therefore, these experiences act as a marker of the breadth of training opportunities available to them in their post. Please fill in the following assessment, in pencil initially so that you can change it if necessary, and discuss it with your local tutor or mentor before your annual review. Note to supervisor: Please go through this with the trainee and discuss whether you agree with his or her self-ratings. If you do not agree, discuss the reasons for your assessment. Recognition as a European Specialist in pediatric gastroenterology, hepatology, and nutrition at either secondary or tertiary level will require satisfactory completion of a recognized, certified training program. Where national training programs in pediatric gastroenterology, hepatology, and nutrition already exist or are at an advanced state of development, they should be considered compatible with this European program if they have a comparable syllabus, a similar duration, and a means of assessing the trainee. Where no training program exists, national professional training bodies should be encouraged to adopt a national training program in PG&H that is closely compatible with this European program. Until such a program exists, individuals who have undergone a period of documented training compatible with this program could obtain European recognition by voluntarily taking and passing a board examination in a European country as laid down by the European Board of Paediatrics. Certification as a European specialist in pediatric gastroenterology, hepatology, and nutrition could be obtained as above.