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Novel strategies in clinical training of young specialists and resident physicians in a non-tertiary centre of Inflammatory Bowel Disease – implementing treat to target therapy

Main institutions: Gastroenterology Department, Mures County Clinical Hospital, Targu Mures, Romania

Introduction

IBD including ulcerative colitis (UC) and Crohn’s disease (CD), is a chronic inflammatory disorder of unknown etiology. The development of chronic inflammation in the gut involves several genetic, environmental and immunological factors which influence the production of cytokines, which are related to the variability in health or disease. With the recent advancement in IBD therapy, and the use of newer biological agents, treatment and management started focusing on more objective parameters which include: endoscopic, radiologic, histologic targets and patient reported outcomes, with the paraclinical corelation of non-invasive biomarkers. Studies have shown that treat-to-target approach in IBD addresses underlying inflammation and minimises disease activity at early stages of IBD, limits the progression and improves the long-term outcomes.

The overall goal of our proposal is increasing the quality of expertise in inflammatory bowel disease (IBD) and treat to target therapy in young specialists and resident physicians.

Both the research opportunities and clinical training for resident physicians are not specifically focused on the treatment, management and paraclinical assessment of IBD patients. Therefore, we consider of utmost importance including in the clinical training a specific module of IBD management, focused on treat-to-target therapy.

 

Overall Goals and Objectives of the Fellowship

Overall goal: Increasing the quality of expertise in inflammatory bowel disease (IBD) and treat to target therapy in young specialists and resident physicians

Specific objectives:

1. Implementing treat to target therapy in current clinical practice, focusing on the practice of resident physicians and young specialists

2. Increasing the level of expertise in intestinal ultrasound of young specialists and resident physicians

3. Increasing the level of expertise in colonoscopy of young specialists and resident physicians

4. Including patients in follow-up ultrasound programme with close monitoring every 6 months

5. Including patients in follow-up colonoscopy programme with annual colonoscopy in patients with more than 10 years since the moment of diagnosis

6. Supporting young fellows in publishing quality articles in journals with IF > 1,5 regarding IBD area of expertise

The overall goal of the fellowship is to implement treat-to-target therapy in the practice of young specialists and resident physicians training in Gastroenterology in a non-tertiary centre of IBD.

Treat-to-target therapy European guideline recommendations in IBD are applied nowadays by gastroenterologists in Romania to a limited extent. Whether that extent is set by their personal experience in IBD management, or the limitation of National Guidelines of IBD which recommend a step-up therapeutic approach (even in moderate to severe cases of IBD), young specialists and resident physicians require proper training in these novel principles.

This specific training could only be achieved through different methods of research opportunities and/or clinical training, as described in the Methodology section.

The Residency programme in the Department of Gastroenterology, under the direct coordination of Prof. Dr. Dobru Daniela, and the University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” currently trains a number of 25 resident physicians found in their first till their fifth year of clinical training.

Their training curriculum, previously approved by the Ministry of Health includes a 3-year Gastroenterology module, which is divided in 4 months of Ultrasonography Module, 4 months Endoscopy and 31 months of Clinical Gastroenterology. Their practical activity minimal requirements include performing 200 upper gastrointestinal endoscopy and 200 colonoscopies with/without therapeutical techniques and 200 ultrasonographies, which are performed during their Basic Training as resident physicians.

Both the research opportunities and clinical training for resident physicians are not specifically focused on the treatment, management and paraclinical assessment of IBD patients, based on the curriculum training. Therefore, we consider of utmost importance including in the clinical training a specific module of IBD management, focused on treat-to-target therapy, as described in Methodology.

Methods

The mentoring process includes a 10-month clinical, endoscopy and ultrasonography training focused on the management of IBD patients and implementing treat-to target therapy.

The training will be divided into 6 modules of training, taking place in specific course rooms, the Endoscopy and Ultrasonography Units located in the Department of Gastroenterology and the University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade”. The duration of a module is 6 weeks (excepting the last module – 12 weeks) and the attendance for each module is restricted by an overall grade higher than 70% in the previous module final examination.

The application for the participants is previously approved by the training mentors and include an online registration form, a letter of intent and a curriculum vitae.

The registration is open for resident physicians in Gastroenterology, specialists in Gastroenterology found in their I-III year of Speciality. No participation fee is required.

The modules will follow the curriculum described in Table 1.

Module

Duration

Method of examination

Number of participants

Module 1

Clinical training in IBD – implementing treat to target therapy

6-weeks

Written examination – questionnaire and case-based studies

15-30

Module 2

Theoretical approach in performing endoscopy in IBD patients

6-weeks

Written examination – questionnaire and case-based studies

15-30

Module 3

Practical approach in performing endoscopy in IBD patients

6-weeks

Practical examination

15-30

(divided into small groups)

Module 4

Theoretical approach in performing ultrasonography in IBD patients

6-weeks

Written examination – questionnaire and case-based studies

15-30

Module 5

Practical approach in performing ultrasonography in IBD patients

6-weeks

Practical examination

15-30

(divided into small groups)

Module 6

Methodology and practical aspects of writing research articles in the IBD area of expertise

12-weeks

Written examination – questionnaire and article reviewing

15-30

Table 1: Curriculum of training

By dividing the clinical, practical and research training into 6 modules, we hope to achieve our primary goal and secondary objectives, as described in the first section.

Feedback questionnaires will be applied during each module, in order to objectively quantify the mentoring process, and the improvements suggested by the participants will be implemented during the following modules.

The communication with the participants will take place on an online platform in which messages, file sharing and calendar of the curriculum will be available. Lecture notes and additional presentations will be at the disposal of the participants in due time before the final examination.

Module

Timeline

1

1st January 2022 – 15th March 2022

2

29th March 2022-10th May 2022

3

31st May 2022 - 12th July 2022

4

2nd August 2022- 13th September 2022

5

20th September 2022 - 1st November 2022

6

8th November 2022 - 31st December 2022

For submitting a request to participate, please contact:

Adina Roman: adina.roman91@gmail.com