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Original Articles: Nutrition

European Society for Pediatric Gastroenterology Hepatology and Nutrition's Educational Offer and the Training Syllabus

Maglione, Marco; Finizio, Daniela; Veres, Gabor; Pop, Tudor L.§; Continisio, Grazia I.; Papadopoulou, Alexandra||; Guarino, Alfredo

Author Information
Journal of Pediatric Gastroenterology and Nutrition: November 2017 - Volume 65 - Issue 5 - p 584-587
doi: 10.1097/MPG.0000000000001663

Abstract

What Is Known

  • The basic knowledge necessary for a pediatric gastroenterologist/hepatologist/nutritionist is summarized in the training syllabus compiled by the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition.
  • European Society for Pediatric Gastroenterology, Hepatology, and Nutrition's educational initiatives are aimed at improving theoretical and practical skills of young European pediatric gastroenterologist/hepatologist/nutritionist professionals.

What Is New

  • The training needs listed in the syllabus have only partially been met by the educational events organized by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition between January 2013 and September 2016, and there is a degree of redundancy among items.
  • A coordinated educational plan is desirable to harmonize the requirements of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition Syllabus with the Society's educational initiatives.

A declared mission of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) is “the dissemination of science-based information, the promotion of best practice in the delivery of care and the provision of high-quality education for pediatric gastroenterology, hepatology and nutrition (PGHN) professionals in Europe and beyond.” To achieve this mission, ESPGHAN provides a broad spectrum of educational initiatives: Summer Schools, Postgraduate Courses, as stand-alone events or associated with ESPGHAN's annual meetings, Monothematic Conferences, and E-learning Courses. The main targets of these initiatives are young physicians and researchers specifically interested in PGHN. These events differ greatly in terms of number of participants, costs, duration, and level of specificity. The main purpose of such initiatives is to provide updated training on specific topics that are considered important and in need of widespread knowledge by the proposers of the events. These are generally proposed and organized by leading scientists and are either clinical or research oriented. ESPGHAN events, however, play a unique role in training and specializing PGHN professionals.

The evolving needs of high-level care of children with complex gastroenterological and/or liver and/or nutritional conditions require high-level education in this particular area of pediatrics. The goal of harmonized postgraduate training that leads to a subspecialty diploma is a priority in Europe (1) in particular for employment purposes across the European Community.

A PGHN specialist must acquire broad expertise in both general pediatrics and pediatric gastroenterology. High-level knowledge and confidence in managing nutritional, growth, and developmental issues are needed, as is a multidisciplinary approach given the intricate links between gastroenterological, endocrine, metabolic, and psychosocial elements. Moreover, as in other pediatric subspecialties, a thorough grounding in communication skills is required to provide adequate care to patients from early childhood to adolescence.

The North American Society of Pediatric Gastroenterology, Hepatology and Nutrition has developed a training program in pediatric subspecialties, based on competencies (2). A standardized PGHN fellowship program is still lacking in the European Community, and the paths for subspecialty qualification in this field differ among European countries. This heterogeneity prompted ESPGHAN, together with national European PGHN societies, to develop a standardized training syllabus (TS) aimed at harmonizing the educational programs in European countries. The first TS was published in 2002 (3) and was updated in 2014 (4). The updated TS consists of 4 main sections: basic knowledge; clinical, technical, and management skills and competencies; attitudes; and particular problems (4). The basic knowledge section is divided into 4 major fields (Gastroenterology, Hepatology, Nutrition and Investigations) that cover the wide pattern of theoretical and practical skills required for PGHN qualification.

The aim of the present study was to assess to what extent ESPGHAN's educational initiatives meet the requirements for the PGHN subspecialty. To this aim, we retrospectively assessed the ESPGHAN educational initiatives organized between January 2013 and September 2016 and evaluated whether they met the 57 items listed in the “Basic Knowledge” section of ESPGHAN's updated TS.

METHODS

All training events organized by ESPGHAN between January 2013 and September 2016 were retrospectively analyzed. Data regarding the type and duration of courses were recorded and the program of each event was analyzed to identify topics that were included in the Basic Knowledge items of the TS. We identified 3 types of matches: an item was deemed “fully met” when the event program included all the main aspects of the item; an item was “partially met” when the event program included several aspects of the item, but left some relevant elements unaddressed, or dedicated limited time to them; and the item was “unmet” when it was not included in the event program. Items met in more than one event were defined “redundant.” Attribution of each item to 1 of the 3 categories was made in consensus by 3 authors with experience in ESPGHAN educational initiatives as participants or organizers (M.M., G.I.C., and A.G.).

The results were interpreted in 2 meetings organized to discuss the Pediatric Implementation of Core Curriculum training through E-Learning program and the overall ESPGHAN educational platform.

Statistical Analysis

Statistical analysis was carried out with the SPSS statistical software package for Windows (13.0; SPSS Inc, Chicago, IL). The Chi-square and Fisher exact tests were used to compare proportions among the groups, and a value of P < 0.05 was considered significant.

RESULTS

Thirty-six educational initiatives (3 monothematic conferences, 10 summer schools, 11 postgraduate courses, and 12 online courses) were analyzed (Fig. 1A). Supplemental Digital Content, Table 1, https://links.lww.com/MPG/B36, summarizes the main features of summer schools, monothematic conferences, and postgraduate courses. Although the characteristics of the various educational activities are not clearly defined in the ESPGHAN Rules and Regulations, they are generally open to 20 to 50 participants and are organized by an ESPGHAN committee or working group. Unlike summer schools and postgraduate courses, which usually deal with general issues and feature a higher degree of interaction between participants and faculty, monothematic conferences are aimed at providing a focus for discussion and networking on a specific topic. Moreover, summer schools were usually longer than postgraduate courses and monothematic conferences.

F1
FIGURE 1:
Distribution of the types of initiatives included in the analysis (A), and proportions of Syllabus items fully met, partially met and unmet by ESPGHAN's educational offer (B).

The distribution of the initiatives within the fields (gastroenterology, hepatology, and nutrition) was well balanced, with 12 events (33%) focusing on gastroenterological topics, 9 (25%) dealing with hepatological issues, and 10 (28%) with nutritional topics. Five (14%) events (4 summer schools and 1 postgraduate course) were classified “general” because their programs did not coincide with 1 area. No matching with the field “investigations” was found. Of the 57 basic knowledge syllabus items, only 12 (21%) were fully met by the educational offer, whereas 31 (54%), were partially met and the remaining 14 (25%) were unmet by any of the initiatives (Fig. 1B and Supplemental Digital Content, Table 2, https://links.lww.com/MPG/B37, which shows the basic knowledge syllabus items classified as met, partially met, and unmet by ESPGHAN's educational offer between 2013 and 2016). Ten out of the 14 unmet items focused on gastroenterology and represented 37% of all the gastroenterology items, the remaining 4 focused on nutrition (25% of all the nutritional items) (P = 0.3). None of the items in the Hepatology or Investigations sections was completely unmet by ESPGHAN's educational offer. Two-thirds of the gastroenterology initiatives were E-learning courses, whereas 40% of the educational initiatives in the field of nutrition and none in the field of hepatology were addressed in online events.

Distribution of the fully met items was balanced among the fields of gastroenterology, hepatology, nutrition. Indeed, 5 of 27 gastroenterology items (18.5%), 3 of 12 hepatology items (25%), and 4 of 16 nutrition items (25%) were fully met by the educational offer (P > 0.4). The 2 items listed in the TS under “Investigations” were only partially met by the educational offer (Supplemental Digital Content, Table 2, https://links.lww.com/MPG/B37).

An interesting aspect of the educational offer was the redundancy of some items (Table 1). Indeed, some topics were proposed more than once, sometimes in different educational settings and with different approaches. In particular, a partial overlap was recorded for such relevant topics as acute gastroenteritis, which was addressed in detail during the Baltic Summer School in September 2016, and was also the topic of a dedicated 5-module E-learning course, whose efficacy in terms of impact on physicians’ clinical practice has been documented (5). Similarly, the hepatology and portal hypertension items were the focus of a Monothematic Conference (Hannover, 2013) and a Summer School (Vietri sul Mare, 2014).

T1
TABLE 1:
Training syllabus items proposed in more than one educational initiative between 2013 and 2016

DISCUSSION

ESPGHAN is the only professional society that acts in the field of Pediatric Gastroenterology, Hepatology and Nutrition throughout Europe. As a consequence, ESPGHAN plays a major role in the professional development of PGHN specialists in Europe. The aim of this study was to explore the correspondence between ESPGHAN's educational platform and its TS for PGHN professionals. We found that approximately one-fourth of the basic knowledge items of the TS were not included in the educational events offered by ESPGHAN between January 2013 and September 2016. This finding highlights the need to improve the coordination of ESPGHAN's educational offer.

Currently, training events seem to be more teacher-centered than learner-centered. In fact, the educational program has been traditionally shaped based on the fields of interest and experience of the speakers and organizers who propose the program, rather than on the learning requirements of the participants, which help to guide training initiatives (6). Surprisingly, items that are relevant in the clinical management of pediatric patients with typical gastroenterology/hepatology/nutrition conditions requiring tertiary care such as “the differential diagnosis of bilious vomiting,” “how to differentiate and investigate abdominal masses,” or “how to investigate and manage a parenterally fed patient with pyrexia,” are not included in the 3-year learning offer analyzed. In contrast, we found redundancies in the educational offer, even though each item is suitable for multiple approaches and different educational settings.

A stronger match between educational initiatives and the items included in the TS would enable young specialists to improve specific aspects of their PGHN education. In this context, it would be useful to list the syllabus items addressed by an event in the scientific program. Also postcourse quality assessments by participants can help to improve the educational offer. In the present study, we were able to trace feedbacks for a small number of examined events. The feedback revealed a very good average perception of the quality and usefulness of ESPGHAN courses (Supplemental Digital Content, Table 3, https://links.lww.com/MPG/B38). These measures could help trainees to select appropriate courses and would pave the way to the development of individualized core curricula, officially recognized by ESPGHAN, that certify knowledge and skills as defined in the syllabus.

Recent years have seen a growing need throughout Europe for highly specialized pediatric health professionals, and a standardized, reliable, and verifiable professional preparation is increasingly becoming an educational priority. In this setting, a widely accepted diploma certifying knowledge and skills and released by a prestigious society like ESPGHAN would be a valuable tool to improve the match between job offer and request, and help young health professionals to find employment in their home country or in the European community.

Our study has several limitations. First, the period considered was relatively limited; however, the data of 3 years should provide a sufficiently accurate picture of the match between ESPGHAN's educational offer and TS. Moreover, we did not include in our evaluation the “hands on” events recently added to the ESPGHAN educational offer, because we focused on the basic knowledge section of the TS. Finally, the definitions we adopted to establish when items were “partially met” and “fully met” are somewhat subjective and may have led to misinterpretation if a topic had been fully or less than fully covered during events. This drawback is, however, unlikely to have affected our main finding, namely, the absence of several relevant topics in the scientific programs of the analyzed events.

Although we could not judge whether the items “met” by the educational offer were adequately translated into daily practice, preliminary results of an ongoing study on self-assessment of professional confidence of PGHN trainees show that items more often covered by training initiatives result in greater confidence than the unmet items (Supplemental Digital Content, Table 4, https://links.lww.com/MPG/B39).

In conclusion, a significant proportion of the Basic knowledge items listed in ESPGHAN's TS are not met by the society's educational initiatives organized within the last 3 years. “Top-down” planning of the educational initiatives based on the training needs would result in a better match between the content and format of events and the educational needs of young PGHN professionals. Moreover, the programs of educational initiatives should include a clear description of the main features, including target, match between contents and syllabus requirements, and expected professional achievements. This could provide each participant with a sort of personal learning portfolio aimed at building widely recognized diplomas throughout Europe that may be useful in job application.

REFERENCES

1. Pettoello-Mantovani M, Ehrich J, Romondia A, et al. Diversity and differences of postgraduate training in general and subspecialty pediatrics in the European Union. J Pediatr 2014; 165:424–426.
2. Leichtner AM, Gillis LA, Gupta S, et al. NASPGHAN Training Committee. NASPGHAN Guidelines for Training in Pediatric Gastroenterology. J Pediatr Gastroenterol Nutr 2013; 56 (suppl 1):S1–S8.
3. Milla PJ. The European training syllabus in pediatric gastroenterology, hepatology, and nutrition. J Pediatr Gastroenterol Nutr 2002; 34:111–115.
4. D’Antiga L, Nicastro E, Papadopoulou A, et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition syllabus for subspecialty training: moving towards a European standard. J Pediatr Gastroenterol Nutr 2014; 59:417–422.
5. Nicastro E, Lo Vecchio A, Liguoro I, et al. The impact of E-learning on adherence to guidelines for acute gastroenteritis: a single-arm intervention study. PLoS One 2015; 10:e0132213.
6. Lin HC, Kahana D, Vos MB, et al. Assessment of nutrition education among pediatric gastroenterologists: a survey of NASPGHAN members. J Pediatr Gastroenterol Nutr 2013; 56:137–144.
Keywords:

educational initiatives; ESPGHAN; syllabus; training needs

Supplemental Digital Content

Copyright © 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition