P-127 Pediatric Gastroenterology Trainee and Program Director Inflammatory Bowel Disease Needs Assessment Survey

Abstract

The clinical care of the pediatric Inflammatory Bowel Disease (IBD) patient is an evolving and complex field. The Crohn's and Colitis Foundation of America (CCFA) and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) co-sponsored a needs assessment survey of pediatric gastroenterology trainees and program directors to help inform educational programing. A web-based, self-completed survey was provided to North American pediatric gastroenterology trainees and program directors during the 2013–2014 academic year. Standard descriptive statistics summarized demographics and overall responses. 97 of 328 (30%) eligible trainees (58% female; 1st year = 26%, 2nd year = 33%, 3rd year = 41%) and 22 of 75 (29%) eligible program directors have responded. Mean number of trainees per program = 6.1 ± 3.0 and mean number of total faculty was 12 with 3.3 ± 2.7 IBD experts and 19% of programs without faculty self- identified as an “IBD expert.” 65% had dedicated IBD nurse(s), 66% research coordinator(s), 51% a dietitian and 25% had other IBD staff (social worker, pharmacist, psychologist). Twenty-four percent had a dedicated IBD training rotation, with only 19% having an outpatient IBD rotation. Most programs participate in IBD clinical trials (82%), an IBD-based consortium (73%), and have a dedicated IBD clinic (64%). For 44% of respondents, IBD patients represent 30% or more of inpatient consults/care at their institution. Seventy percent of trainees were confident in their IBD inpatient training, 75% were somewhat confident or confident in outpatient training. Fourteen percent had no formal IBD-centered didactics and 32% had monthly teaching. CCFA materials (20%) and NASPGHAN guidelines (56%) were used at least some of the time. Activities identified by trainees that would most improve their education included: didactics (60%), interaction with regional/national experts (49%), trainee-centered IBD web resources (43%), increased exposure to patients (36%), 15% were satisfied with current level of exposure. Trainees were most confident in managing active Crohn's disease, phenotype classification, using clinical disease activity indices, and managing immunomodulator and biologic therapies. They were the least confident in managing J-pouch complications and performing pouchoscopy, managing extra-intestinal manifestations and managing ostomy related complications. Eighty percent would like an IBD-focused training elective. While almost all directors rated most knowledge competencies as “very important,” 4 areas were rated only as “somewhat important” by 36% to 41% of directors: (1) medical management of J-pouch complications, (2) perform, identify landmarks, findings on pouchoscopy, (3) manage ostomy, related complications, and (4) classify endoscopic disease severity in IBD using endoscopic indices. Finally, the majority of directors (86%) found it feasible to allow trainees to do 1-month training electives at other institutions. This first IBD needs assessment survey of both pediatric gastroenterology trainees and program directors demonstrated a strong resource commitment to IBD training and clinical care. Specific areas for potential educational enrichment emerged including pouch and ostomy complications. Educational tools identified as possible enhancements included more case-based didactics and interaction with regional experts perhaps through month long rotations or web based sessions.