Competency based medical education in gastrointestinal motility

Abstract

Traditional apprenticeship based medical education methods focusing on subjective evaluations and case-volume requirements do not reliably produce clinicians that provide high-quality care in unsupervised practice. Consequently, training approaches are shifting towards competency based medical education, which incorporates robust assessment methods and credible standards of physician proficiency. However, current gastroenterology and hepatology training in the US continues to utilize procedural volume and global impressions without standardized criteria as markers of competence. In particular, efforts to optimize competency based training in gastrointestinal (GI) motility are not underway, even though GI motility disorders account for nearly half of outpatient gastroenterology visits. These deficiencies compromise the quality of patient care. Thus, there is a great need and opportunity to shift our focus in GI motility training towards a competency based approach. First, we need to understand rates of learning for individual diagnostic tests. Next, integrated systems that standardize training and monitor physician competency for GI motility diagnostics are required. In addition, certification processes to credential competent physicians need to be developed. These advances are critical to optimizing the quality of GI motility diagnostics in practice.

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.…”

A System to Assess the Competency for Interpretation of Esophageal Manometry Identifies Variation in Learning Curves

“…Although hands-on motility training is offered at select centers of excellence in the US, these programs are unable to meet the training needs of thousands of trainees and gastroenterologists in practice. 16 Deficiencies in formal structured training and assessments of competency results in marked variation in practice quality and compromises patient care. Interpretation of esophageal HRM is complex, and an individualized competency based training approach is needed.…”

“…Interpretation of esophageal HRM is complex, and an individualized competency based training approach is needed. 16 …”

Benchmarks for the interpretation of esophageal high‐resolution manometry

“…This exam can be used in training programs to augment the deficiency in competency assessment for gastrointestinal motility. 1,12 Our intention is that this exam will be a mechanism to familiarize trainees with esophageal HRM, provide meaningful and personalized self-assessment, and prompt focused improvement. The cut scores are meant to represent benchmarks for assessment toward the end of training.…”