Episode 9: Harmonising Gastroenterology Training Across Europe

00:00:06: Hello and welcome back to UIG Journal podcast.

00:00:08: You quick dive into latest, most impactful research in gastroenterology.

00:00:13: I'm Dr Mohsen Subani Treini Associated Editor of UIG journal And a Gastroenterologist based at University Hospital Nottingham UK.

00:00:30: We are back for the latest episode and we're pleased to be joined by two special guests Sophie and Harriet.

00:00:38: I will appreciate in turn if you can introduce yourself, thankyou.

00:00:42: Hi i'm Henrietta ,I am the chair of UIG education committee And a guest renderologist with focus on interventional endoscopy.

00:00:52: Hello, I'm Sophie from Redensburg.

00:00:55: I am attending there and focused on topology and interprofessional care education.

00:01:03: Wonderful so just grab a coffee and join us for fastened focus roundup of what's new in GI.

00:01:10: Great, so I feel Hanyarat and Sophie from your position.

00:01:14: It is very interesting article because we all been through training phases to discuss you latest publication in UG journal talking about harmonizing gastroenterology Training across Europe.

00:01:25: So to begin with can you please shed some light on that?

00:01:29: what was the origin of this work?

00:01:30: And where these idea came from?

00:01:40: And lots of people from Europe were complaining about their training.

00:01:46: So we thought let's go back to the basics and look at all the curriculas that are out there in The National Societies, really compare what is there... ...to then a step further say What Are The Gaps?

00:01:58: How Can UEEG Help?

00:02:00: to fill those gaps.

00:02:01: And I think the strongest incentive for doing this though, it was actually trying to learn from each other because there are curricula which have different focuses and we found out during analysis that in every curricula is quite good and then we can benefit from each others knowledge.

00:02:22: And UEG is a platform to combine all of these positive things.

00:02:27: just bring them together.

00:02:30: Wonderful, Ariette.

00:02:31: And when you look across all these countries and curricula what stood out to U.S.

00:02:36: biggest challenge facing gastroenterology training in Europe today?

00:02:40: Yeah!

00:02:40: What really stood out for us was the sheer heterogeneity of training seminars with a broad agreement on whatever every gastroentrologist should know but huge variation.

00:02:55: teach non-technical skills, assess competence or ensure qualities through trainer and center accreditation.

00:03:02: And this

00:03:02: fragmentation

00:03:03: limits flexibility mobility and most importantly consistency in training quality.

00:03:10: so the core challenge is clear Europe needs harmonized competency based training frameworks?

00:03:16: I think that's exactly why structures like The National Societies Forum of the EEG are so essential because they bring national societies together, create alignment and make this kind of harmonisation possible.

00:03:32: So Henriette taking on your point that there's some good aspect in all the curriculums but we're aware that a certain aspects of training which is not well covered by these curriculum and part of their training programmes.

00:03:45: in certain areas gastroenterology trainees specifically struggle with such aspects like.

00:03:51: I give you an example from UK her trying struggle to get an access through therapeutic endoscopy for upper GAE, bleed management.

00:03:58: So any thoughts on that aspect and how do you think this can be covered if we take a single platform?

00:04:04: I think the heterogeneity is very common in what your mentioning as that the axis is difficult.

00:04:12: usually therapeutic endoscopy to certain extent included it every curriculum but of course the analysis doesn't provide us with effects on how it's implemented.

00:04:24: So Axis is a different story, which we might be able to answer in a second survey because implementation is something a lot different than actually writing down into curriculum and say that UK probably has the most extensive well-documented curricula of all European countries.

00:04:45: but what lacked for me I think was formalized training in soft skills, non-technical skills research.

00:04:56: And what the biggest finding for me is that there's actually no framework for trainers.

00:05:04: There are very few curricula to specify which trainer should know and how a trainer should be trained In order make sure they train them right way.

00:05:17: So there's a cluster of things that need to be covered in the future.

00:05:25: Yeah, I fully agree with you Henriette and you also examine emerging areas such as gender climate health and also artificial intelligence.

00:05:34: How do we see these fields being incorporated into future GI training programs?

00:05:39: So yeah, one of the most striking findings of our study was how rarely these emerging fields appear in current curricular despite their growing importance from modern clinical practice.

00:05:51: And at Professor Mila Schilling's department in Regensburg we have already integrated gender medicine or AI.

00:05:58: I had a blasher today to do a seminar and our clinic on AI for students can also climate health into medical student curriculum.

00:06:07: but implementing That's innovations in residency training.

00:06:11: However, that is far more challenging than implementing these things and training for the students.

00:06:19: so yeah we need a strong joint initiatives and sharing best practices really within the National Societies Forum.

00:06:27: I think it would be a call of all those societies to accelerate this process.

00:06:33: And yeah, I'm very thankful that Henrietta Heinrich and Martina Müller Schilling started this process.

00:06:40: With the help of the National Societies Forum and The Magic Group, Henrietta just started... We started!

00:06:47: the process.

00:06:49: And yeah, we will define evidence-based minimum standards for future GI curricula and integrate these emerging fields.

00:06:58: I think that's great!

00:07:04: And

00:07:07: thanks for taking initiative to create these platforms, and I think this is the future of gastrointology.

00:07:12: So we touched on some of the issues, and i think a major issue around implementation probably need more grass root level work.

00:07:19: You touched on platform for the trainer.

00:07:22: so Is there any initiative from UEG or any other platform where you can come up in near-future or coming days sort things?

00:07:33: I

00:07:33: think not in the coming days, because i think the awareness for necessity to properly train trainers and also define what a training centre should look like is still very much into making.

00:07:46: And that's part of the magic initiative we started at UIG Education Committee together with the National Societies Committee that different countries can refer to, this is the minimum standard of what should be included in a curriculum.

00:08:07: Because it's also political statement.

00:08:11: people take into their local governments and say well... ...this is what UUG says.

00:08:16: we really need to include and provide funds for it because we shouldn't fool ourselves education is expensive you know, training people properly takes time.

00:08:29: And in a cash-strapped health service that is often hard to justify whether you should include all the structured training.

00:08:38: and another finding of our survey or analysis was that structured assessment of competency be it for trainees or trainers is not implemented.

00:08:50: These assessments take time and people need to be trained.

00:08:53: To use them into integrate them in every day care.

00:08:57: so i think we need start with what you said grass roots work write down the minimum standard is then help, different settings really include this in a daily practice.

00:09:09: i think that u k already offers train trainer courses were also working on different scenarios to become stronger in that area, too.

00:09:18: To provide train the trainers courses and this is also something That the GI community when surveyed by UIG very strongly asked for... ...that there's training For The People Training The Next Generation Of Gastroenterologists.

00:09:34: So There Is A Lot of Work To Cover.

00:09:37: But I Think The Two Projects One Published And Now The magic initiative in the making will lay the groundwork to make this possible over the next couple of years.

00:09:48: Wonderful, and despite throwing evidence supporting competency-based assessments like for example EPAs, DOPs and simulation training these tools are still rarely used right?

00:10:00: What do you think are the main obstacles to implementing these methods more broadly?

00:10:04: So, what we found is that the biggest obstacles to product implementation of competency-based assessment are structural rather than conceptual.

00:10:14: The evidence for tools like APASTOP's simulation training is strong but most countries simply don't have the institutional framework to support at the fewer.

00:10:24: then a third curricula specify trainer requirements or center accreditation standards.

00:10:30: so basic infrastructure for reliable assessments was missing.

00:10:34: A second challenge is that many curriculars still don't define how competencies should

00:10:40: be assessed

00:10:41: and documentation as inconsistent benchmarks of unclear, without explicit competence in mapping or digital tools these methods become difficult to operationalize.

00:10:53: so... And you all know there's the human factor!

00:10:58: faculty overload, workload limited resources cultural resistance.

00:11:04: It's much easier to stick to case numbers even though we know they don't guarantee competence.

00:11:11: Thank you.

00:11:12: now coming back to another difficult area I knew that most of us are especially the group who is sitting here proactive in research.

00:11:19: but not everyone get any cool opportunity and you need to either go out of your own way or sort make special arrangement, get engaged in research during the GI training.

00:11:30: So how we can overcome that?

00:11:33: trainees?

00:11:33: To some extent at least get access to good quality research training to analyze evidence they're applying in daily practice.

00:11:40: not everyone has to do their research but atleast a stage where are competent enough to analyse day-to-day evidence.

00:11:47: Yeah when we analysed curricula there was As you said, a strong variability in the implementation of research training.

00:11:56: And I think we can all agree that understanding the evidence and then applying it to our daily practice is the basis In some curricula's just visiting at conference.

00:12:06: in some curriculum You need to do a publication whether there'd be case report or something like That.

00:12:13: Some curricula say you need an evidence-based medicine course But To Be Short It All Over The Place This again leads to the magic initiative where we want to define the minimum standards and, We have a group focusing on this area.

00:12:31: To really put out or layered statements of what research training should look like for people who don't want to go research full time but to define basis off water gastroenterologist or hepatologists needs to know on a research level to be able to assess the evidence and go into clinical practice.

00:12:55: But then, of course also answer the question is how if research time should be included in curriculum that goes more into direction over clinical scientist or something like that is being addressed by the magic group.

00:13:13: And I think what we will find.

00:13:14: there are a couple of statements, they say well if you don't want to go into research... You still need to know this.

00:13:20: and then more layered statements really stepwise increase the intensity of research training.

00:13:28: This also gives huge boosts for the research activities across Europe, because I also think that research is not included enough in the curricula and not consistently enough.

00:13:40: And this why we always chose to highlight this area so that we can support its implementation into European curricula.

00:13:49: Wonderful!

00:13:50: Looking ahead how could European societies better nurture the next generation of clinician-scientists in gastroenterology?

00:14:01: So I think the key is creating real flexibility, both in time and place.

00:14:07: And right now only seven percent of curriculum allow part-time training on Manchinet and very few offer early subspecialization or structured academic tracks.

00:14:20: Without protected research time and their ability to train part times across centers we lose enormous potential.

00:14:30: harmonized European research pathways and also political commitment to flexible training models.

00:14:37: And that really requires strong cross-country coordination, a strong political power like the national societies

00:14:46: have.".

00:14:46: I know I emphasize in an emphasis on the power of the National Societies but this is the big friend of UEG.

00:14:57: Let all the societies are working together and create things, move gastroenterology forward.

00:15:05: And I think this is very important that we stick to that and work together continue working together.

00:15:14: So, when looking into the curriculum at their important area which is least consistently come across in this curriculum as non-technical skills and one of them Sophie was slightly touching about like human factor or maybe some soft skill around leadership.

00:15:30: What are your thoughts on that?

00:15:33: And how do you think these can be covered?

00:15:37: You know, I don't think that leadership is necessarily a soft skill.

00:15:41: It's non-technical skills.

00:15:43: Soft skill always implies something like touchy feely and it actually undervalues it.

00:15:50: And i think the term nontechnical skill its much more to the point because it comprises so many things can be about communication or should be about leadership finding your place in team also asserting yourself and it can be things like time management.

00:16:10: And I think what's going to happen is that we're going to weigh the evidence, there's probably not gonna be a lot but we are also looking at how new technologies and how new requirements are shaping education or training in other specialties something that we're going to get lots of information on.

00:16:36: So the non-technical skills need to be pushed or the new, our gastroenterologists in the future will not be ready to become resilient to the one constant in our job which is going to become more prominent as we go along with just change.

00:16:52: it's going to be a constant change and constant emerging of new topics that we need to relate too new technologies to adapt to robots, AI whatever.

00:17:04: So I think the most important non-technical skill is probably resilience leadership and communication And there are some literature out there that this improves training.

00:17:17: so This Is Something That You're Probably Gonna Find In The Magic Statements.

00:17:21: Yeah something like with what you just said Henriette.

00:17:24: If you had the chance to redesign a non-technical training component from the ground up, what elements would you include to best prepare future gastroenterologists?

00:17:34: It's cool.

00:17:35: We already talked about it that Henry at the Education Committee founded The Magic Initiative and there are five working groups to define evidence-based minimum standards for future GI curricula, unlucky for you.

00:17:52: I am part of group three led by Professor Müller Schilling And we are dedicated through the non technical skills component.

00:18:02: We agreed on a core set of the following competences and right now we are systematically gathering evidence for each.

00:18:10: And yes, Henrietta unfortunately forced us to limit our sesh... ...to ten points!

00:18:17: Yeah it was really hard.

00:18:19: so we negotiated away to very disciplined list.

00:18:24: Sorry Sophie

00:18:26: I hope you're sorry.

00:18:28: It included basic health, economics management and leadership.

00:18:34: Communication skills resilience and well-being.

00:18:37: I think this is very important in the UAT podcast had an episode on it last week's interprofessional collaboration and patient advocacy that my focus also into error prevention.

00:18:51: Very important at management especially in endoscopy sustainability gender medicine, AI and competencies for the treatment of disabled persons.

00:19:03: So this are our ten topics here And I think these skills are essential for safe modern patient-centered gastroenterology.

00:19:12: Our goal is to deliver an evidence based framework so that European societies can directly implement.

00:19:20: Excellent, I think we had a great discussion and hope over viewer and listeners would enjoy this discussion around.

00:19:26: So as the final word of wisdom, Henriette and Sophie how do you think harmonisation in the DI curriculum across Europe will work?

00:19:34: It'll take time!

00:19:36: And it...I think that needs exactly to be done right now which is collaboration between committees network of national societies that share information, that learn from each other.

00:19:53: And this is all made possible by a strong representation of National Societies also the Specialist Societies and I think UEG as an umbrella provides that... ...and then it will take time because Information needs Time to be distributed into.

00:20:10: Information needs time to be implemented.

00:20:12: so i think We will reap the fruits of our labor in about three to five years, I guess.

00:20:19: Another step that we're going to take is... ...we are also going to interrogate GI trainees and trainers how happy they are with their training.

00:20:26: And i hope we'll be able after five years to follow it up and really see these changes have been implemented.

00:20:35: so It will take time, but I'm very confident that we are laying the groundwork for change and especially continuing to learn from each other.

00:20:46: So...I really like The Project although i limited the group's questions to ten.

00:20:53: We're going to achieve a lot thanks to hard work of everyone in those groups And also through networking between national societies.

00:21:03: it took us a record short time for the Education Committee and NSC.

00:21:09: We literally had a couple of weeks until we have all curricula on board, everyone contributed freely in very short period of time.

00:21:21: that makes me confident.

00:21:22: I think we can implement this change in reasonable timeframe.

00:21:28: Thank you And I think this is an excellent initiative and hopefully we will see the magic of magic soon.

00:21:36: Yeah, thank you very much!

00:21:37: This interview was really inspiring... ...and i really think that these efforts are super important for our future generation of gas technologies.

00:21:46: Thank You Very Much.

00:21:47: So to all listeners thanks for joining us.. ..I hope that you'll enjoy today's special episode around training curriculum and harmonising training across Europe including UK And please feel free to leave us a comment and also leave any comments for the UAG Training Committee which you would like

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00:22:04: or been discussed in our meetings.

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