Entrustable Professional Activities Established for Advanced IBD Fellowships

On the purpose, process and results

A task force formed by the American College of Gastroenterology (ACG) and The Crohn’s & Colitis Foundation and led by Cleveland Clinic’s Benjamin Cohen, MD, MAS, has established entrustable professional activities (EPAs) for advanced inflammatory bowel disease (IBD) fellowship training in the United States. The 10 EPAs were published simultaneously in The American Journal of Gastroenterology and Inflammatory Bowel Diseases.

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“We’ve had advanced IBD fellowships for years now that try to bridge the gaps in knowledge gained in a gastroenterology fellowship and knowledge required to be an IBD specialist,” notes Dr. Cohen, Clinical Director for Inflammatory Bowel Disease in the Department of Gastroenterology, Hepatology & Nutrition of Cleveland Clinic’s Digestive Diseases & Surgery Institute. “But there has been no common curriculum, no established outcomes and no consensus as to what constitutes an IBD specialist. The task force set out to change that.”

Methods of development

The task force developed the EPAs using a multistep approach with a three-phase modified Delphi method. Focus groups developed an initial set of EPAs, which were critiqued using an iterative model of feedback from program directors and other experts. The resulting EPAs then underwent two rounds of digital voting, which narrowed the pool to 15 potential EPAs. The task force then narrowed the selection to 10 EPAs via two rounds of web-based voting and a live consensus meeting. Once the final 10 were established, the task force mapped EPAs to curricular milestones.

“The process was interesting and methodical because at every step of the way we were including feedback from a diverse, carefully selected task force. The task force included IBD experts at different points in their career paths, from many geographic practice locations and practice types, fellowship directors and medical educators,” says Dr. Cohen. “It took time to do it in this manner, but we wanted to make sure we got it right.”

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The EPAs

EPAs are part of the competency-based medical education approach that has occurred in graduate medical education in the last decade. EPAs distinguish a particular subspecialty by defining what tasks a practitioner should be capable of performing unsupervised in a clinical setting. “We gave special consideration to what an EPA for a general gastroenterologist should be — which all IBD specialists should already have since they’ve completed a fellowship — as distinguished from what EPAs are required to be an IBD specialist,” notes Dr. Cohen. “Defining these skills will be important not only for trainees, but also for patients who expect a high level of expertise.”

The 10 EPAs are:

  1. Classify IBD phenotype, disease activity and extraintestinal manifestations.
  2. Utilize advanced diagnostic and therapeutic endoscopic and radiographic techniques in the management of IBD.
  3. Prescribe and manage evidence-based IBD therapies utilizing clinical pharmacological principles in clinical practice.
  4. Manage adverse events and complications of IBD and IBD therapies.
  5. Manage hospitalized patients with IBD.
  6. Manage pre- and postoperative care for IBD patients.
  7. Manage IBD in special populations.
  8. Recognize the importance of psychobehavioral health in IBD and implement psychosocial support strategies.
  9. Evaluate and manage nutritional health status in IBD patients
  10. Apply preventive health strategies for IBD patients in accordance with guidelines.

For detailed descriptions of each, as well as the knowledge, skills and attitudes (KSAs) that determine competency, read the full article in Inflammatory Bowel Disease.