GI Training Curriculum
A Journey Toward Excellence: Training Future Gastroenterologists
The Gastroenterology Core Curriculum, Third Edition
American Association for the Study of Liver Diseases, American College of Gastroenterology, AGA Institute, and American Society for Gastrointestinal Endoscopy
The Gastroenterology Core Curriculum was first published in 1996; this document contains the third edition of the Gastroenterology Core Curriculum for gastroenterology fellowship training. The Core Curriculum constitutes a living document that represents the four societies’ vision of best practices in gastroenterology training. It provides a framework for developing an individual plan of study and growth that should be tailored to meet the needs of each individual trainee based on the strengths and special qualities of each individual training program. The curriculum will continue to evolve with time as new knowledge, methods of learning, novel techniques and technologies, and challenges arise.
This edition has been divided into an overview of training and 17 chapters encompassing the breadth of knowledge and skills required for the practice of gastroenterology. These areas include not only the traditional curricular content of gastroenterology and hepatology but also associated disciplines such as pathology, radiology, and surgery. New areas that have been incorporated into the third edition of the Gastroenterology Core Curriculum include new antireflux techniques, advanced training (certificate of added qualification [CAQ]) in hepatology, moderate sedation, novel techniques and technologies, and CT colonography. Additionally, all areas have been linked to the Accreditation Council on Graduate Medical Education (ACGME) Outcome Project’s General Competencies.
This edition of the curriculum represents a joint collaborative effort among the national gastroenterology societies—the American Gastroenterological Association (AGA) Institute, the American College of Gastroenterology (ACG), the American Association for the Study of Liver Diseases (AASLD), and the American Society for Gastrointestinal Endoscopy (ASGE). The training committees of each of the four sponsoring societies, as well as several subject matter experts, made specific recommendations for revising the core curriculum. Each society then named two representatives who were charged with overall responsibility for developing, communicating, and distributing the curriculum (see page 3). Additionally, the Gastroenterology Steering Committee received input on the draft curriculum from several training directors and faculty members and extends its sincere gratitude for their support. Those who provided substantive editorial contributions to this edition are featured in Appendix I, along with the names of contributing editors for the previous edition that was published in 2003.
Throughout this document, the paramount importance of practice and research based on the highest principles of ethics, humanism, and professionalism is reinforced. This document links trainee assessment to the ACGME Outcome Project’s General Competencies and as such recommends a number of tools that can be used to assess the competence of trainees, including direct observation by qualified faculty, log books, periodic patient care record reviews, portfolios, patient surveys, 360° global rating evaluations, and formal examinations. Numerical guidelines provide only a minimum standard for competency and instead should be viewed as a threshold level after which competency-based assessment should be instituted. Regardless of the duration of training, the number of patients seen, or the number of procedures performed, the ultimate goal must always remain excellence in all aspects of patient care, scholarship, and a commitment to lifelong learning.
The Quality Initiative in Medicine
The Quality Initiative in American medicine is an effort to improve outcomes, maximize safety, and simultaneously increase the value of care for healthcare consumers. Severe cost pressures in the U.S. healthcare delivery system over the past several decades have forged alliances among corporate payers to maximize the cost-effectiveness of care (e.g., the Leapfrog Group, 2000). Reports related to medical errors and patient safety (To Err Is Human, 1999) raised concerns and drew the attention of many public and private entities. The Institute of Medicine’s recommendations for an improved health care system (Crossing the Chasm a New Health System for the 21st Century, 2001) urged the alignment of payment with quality improvement.
The Center for Medicare and Medicaid Services’ (CMS) took up that challenge and continues efforts to contain expenditures for its beneficiaries. Clinical quality data around the variability of care (e.g., CABG rates in different regions of the country) and outcomes (e.g., CAD mortality rates unchanged, despite uneven intensity of care), have also spurred public demand for a more transparent and predictable standard of care. In recent years, the growth of evidence-based medicine has contributed to healthcare quality and its measurement. Training programs must assure that fellows understand the importance of quality measurement in their future practice of gastroenterology and that fellows are familiar with the techniques used to measure quality and with methods used to enhance performance. For more information on quality in gastroenterology, please visit www.gastro.org, Clinical Practice section.