Training the gastroenterologist of the future: The gastroenterology core curriculum

TY - JOUR

T1 - Training the gastroenterologist of the future

T2 - The gastroenterology core curriculum

AU - Ryen, Rebecca

AU - Friedman, Lawrence

AU - Gress, Frank

AU - Kaplan, Lee

AU - Katz, Philip O.

AU - Ouyang, Ann

AU - Richter, Joel

AU - Rosen, Hugo

AU - Sherman, Kenneth

AU - Feldman, Mark

AU - Lee, Sum P.

AU - Banks, Peter F.

AU - Richard Boland, C.

AU - Ahnen, Dennis J.

AU - Burt, Randall W.

AU - Itzkowitz, Steven H.

AU - Bass, Nathan M.

AU - Brown, Russell

AU - Stevens, Peter

AU - Klein, Samuel

AU - Aranda-Michel, Jamie

AU - Buchman, Alan

AU - Floch, Martin

AU - Heizer, William

AU - Winter, Harland

AU - Scharschmidt, Bruce F.

AU - Brenner, David A.

AU - Hoofnagle, Jay H.

AU - Hulley, Stephen B.

AU - Lieberman, David A.

AU - Peura, David A.

AU - Benya, Richard V.

AU - McGuigan, James E.

AU - Rao, Mrinalini C.

AU - Sternini, Catia

AU - Valentine, John F.

AU - Hall, Karen E.

AU - Attar, Bashar

AU - Holt, Peter

AU - Lee, Makau

AU - Prather, Charlene

AU - Proctor, Deborah D.

AU - Anderson, James M.

AU - Fisher, Rose Marie L.

AU - Wolf, Jacqueline L.

N1 - Funding Information: Importance The subspecialty of gastroenterology is dedicated to continued progress in the prevention, diagnosis, and treatment of gastrointestinal disorders. This mission requires the availability of talented and committed physician-investigators appropriately trained to elucidate biological mechanisms and the natural history of gastrointestinal diseases and to develop outcome-based approaches to treatment and the use of resources. It further requires that all future gastroenterologists be familiar with research principles and methods. It is therefore recommended that all gastroenterology training be performed in institutions where research opportunities are readily available either on site or through programmatic affiliation with a research institution. It is further recommended that all gastroenterology trainees, including those preparing for a career in clinical practice (i.e., clinical track trainees), participate in research for a period of at least 6 months. This document summarizes specific skills that trainees in gastroenterology who wish to pursue investigative careers (i.e., research track trainees) will need to acquire, elements of the training curriculum necessary to acquire these skills, and approaches to evaluating the training program and trainees to help ensure that the program objectives are met. Goals of training Research may be either basic (i.e., laboratory-based) or clinical (i.e., patient-based). The specific skills or competencies that trainees seeking careers in basic research or clinical research need to acquire are summarized below. Basic Research Trainees seeking careers in basic research require an advanced understanding of the physiology of the digestive tract and of the principles of cellular and molecular biology. They also must acquire basic laboratory skills and become competent in identifying the research question and formulating a working hypothesis and study design and in using biostatistics, in the appropriate use of animals, and in state-of-the-art techniques in cellular and molecular biology. They must develop a clear understanding of the current body of knowledge in their areas of interest, of unanswered questions most relevant to gastrointestinal biology and disease, and of research ethics. They need to acquire practical experience in critical analysis of current scientific literature, in the use of computers (e.g., literature review, gene or protein sequence analysis), in scientific writing and presentation, and in the preparation of research proposals for funding and for evaluation by institutional review boards. Clinical Research Trainees seeking careers in clinical research, which includes patient-oriented research, epidemiology research, and outcomes research, need to acquire advanced and practical skills in state-of-the-art clinical research methods, including literature study, formulation of research questions and study design, use of cost-effectiveness and quality-of-life models, approaches to sampling populations and making clinical measurements, techniques of biostatistics and sample size estimations, methods for optimizing quality control and data management, and ways to avoid bias. They must develop a clear understanding of the current body of knowledge and important unanswered questions in their areas of interest and of the ethics of research and human investigation. They need to acquire practical experience in the critical analysis of current literature, in the use of computers (e.g., literature review, database management and analysis, communication), in the presentations of their work in written and oral forms, and in preparations of proposals for funding and for evaluation by institutional review boards. Training Process The Research Mentor Research mentors are extremely important elements of the training experience. They must have a commitment to and experience in the training of fledgling investigators and an established record of productivity in sponsored research and excellence in their fields. Mentors may be faculty members in the gastroenterology training program or in another division or department in the institution engaged in research pertinent to gastrointestinal biology or disease. Mentors must be aware of opportunities for collaborative interaction locally and nationally in the areas under study by the trainees and be principally responsible for fostering the development of the trainees into independent investigators. Structured Curriculum Trainees should have the opportunity to participate in formal course work, taught by qualified faculty, to acquire the specific skills outlined above in laboratory-based research, including course work in cell biology, molecular biology, and molecular genetics. In patient-based research, this includes course work in clinical research methods, biostatistics, epidemiology, and ethics. Protected Time While preparation for a successful independent investigative career will typically require one or more years of supervised research experience beyond the period of training required for subspecialty board eligibility, trainees must have sufficient protected time during the training period to participate in the course work outlined above and to initiate a well-defined, prospective, hypothesis-driven research project. The period of protected time may vary depending on a variety of factors, including the specific career objectives of the applicants and the funding mechanism. For the research track trainees, the period of protected time should be no shorter than 18 months and may appropriately include the entire period of subspecialty training beyond that required to acquire the core cognitive and technical skills outlined elsewhere in the curriculum. Program directors should be given sufficient flexibility in the organization of clinical training activities so as to comply with current National Institutes of Health guidelines pertaining to trainees supported by individual or institutional National Research Service Awards. For clinical track trainees, the minimum period of participation in research is 6 months. This time should be allocated in sufficiently large blocks to permit meaningful scholarly activity. Research Environment The training should be conducted in a stimulating and intellectually rich research environment that provides scientific background in the particular discipline. Faculty of the training program must include individuals with established skills in basic or clinical research. Trainees should have the opportunity to participate in critical analysis of the current scientific and clinical literature, in research conferences during which they present and defend their own work, and, under the supervision of their mentors, in the peer review of articles submitted for publication. The trainees should acquire practical experience in the development of questions, the conduct of basic and/or clinical research designed to answer these questions, and the preparation of abstracts, scientific reports, and funding proposals. An integral feature in success within a research career is the ability to direct a laboratory and to mentor students, fellows, and technical and administrative staff. This aspect of research should be a topic of formal discussion between mentors and trainees, and trainees should be exposed to the styles and skills of more than one mentor. It is also recommended that training programs develop documents and workshops to instruct trainees on appropriate management and mentoring skills. These should include attention to the following: Responsibilities of members of the research team to design studies, communicate plans, and plan evaluative data Record-keeping, including notebooks and storage and cataloging of data Dos and don'ts of planning collaborations and sharing research materials Consideration of scope and feasibility of research projects for graduate students and fellows Information about important landmarks in doctoral and postdoctoral level training Mechanisms to formally and informally evaluate the performance of individuals who are placed under the direction of the trainees Conflict management skills Appropriate behavior in the workplace as it relates to possible problems due to discrimination based on race, ethnicity, gender, or sexual orientation or to sexual harassment. Humane treatment of animals and ethical treatment of patients are increasingly important topical issues. Although current ethics training courses address the theoretical basis and legalities of these issues, most trainees never see an application for Institutional Animal Care and Use Committee approval or Institutional Review Board approval until they become independent investigators. It is recommended that trainees participate in the preparation of such a document or receive some form of formal instruction in planning and preparing such documents as part of their training programs. Assessment of Competence Monitoring and evaluating the trainees' progress should begin before they select mentors and projects, and it should continue throughout the training period. This monitoring and evaluation should be conducted by a group of individuals, including the mentors and other experienced faculty, who have had direct interaction with the trainees (e.g., coursework instructors, participants in the research conferences at which the trainees present and defend their own research hypotheses and results, faculty familiar with work being prepared or submitted by the trainees to peer-reviewed publications). Evaluation and feedback should occur sufficiently frequently, at least twice yearly, so that corrections or adjustments in the training curriculum may be made when necessary and appropriate. Update Task Force on Training in Research • BRUCE F. SCHARSCHMIDT, M.D. (Chair) San Francisco, California • NATHAN M. BASS, M.D. San Francisco, California • DAVID A. BRENNER, M.D. Chapel Hill, North Carolina • JAY H. HOOFNAGLE, M.D. Bethesda, Maryland • STEPHEN B. HULLEY, M.D. San Francisco, California • DAVID A. LIEBERMAN, M.D. Portland, Oregon • DAVID A. PEURA, M.D. Charlottesville, Virginia • JOEL E. RICHTER, M.D. Cleveland, Ohio

PY - 2003/4/1

Y1 - 2003/4/1

UR - http://www.scopus.com/inward/record.url?scp=0037380913&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0037380913&partnerID=8YFLogxK

U2 - 10.1053/gast.2003.50160

DO - 10.1053/gast.2003.50160

M3 - Review article

C2 - 12671902

AN - SCOPUS:0037380913

VL - 124

SP - 1055

EP - 1104

JO - Gastroenterology

JF - Gastroenterology

SN - 0016-5085

IS - 4

ER -