European Section and Board Of

The European Section and Board of Gastroenterology and Hepatology

Speciality Training Programme

and

Curriculum for Gastroenterology and Hepatology

The Blue Book

2011 (Draft 6)

The Blue Book

Presidents and Secretaries

Dr Jean Paul Jacques

President, European Section of Gastroenterology & Hepatology

11, rue Gabriel Péri

F- 31 000 Toulouse

FRANCE

Email:

Dr Luke O’Donnell

President, European Board of Gastroenterology & Hepatology

Dept of Gastroenterology

Mayo GeneralHospital

Castlebar

Co Mayo

IRELAND

E-mail:

Dr Albin Luetke

Secretary General, European Board/Section of Gastroenterology

Loehr Center

D-56068 Koblenz

GERMANY

Email:

Dr Jan Lillienau

Treasurer, European Board/Section of Gastroenterology

Head of Gastroenterology and Nutrition
Associate Professor, DeptGastroenterology and Nutrition

SkaneUniversityHospital

SE-221 85 Lund

SWEDEN

Email:

Dr Ian Barrison
Chair, CME Committee
Associate Dean
Schoolof Postgraduate Medicine
University of Hertfordshire
Hatfield, AL10 9AB
UNITED KINGDOM
Email: / Professor Nurdan Tozun
Chair, TRC Committee
Vice Rector & Dean of MedicalSchool
AcibademUniversitySchool of Medicine
AcibademKozyatagiHospital
Inonu Cadd. Okur
Sok.No:20 Kozyatagi
34 742 Istanbul
TURKEY
Email: / Professor Gian Dorta
Chair, Manpower & Public Affairs Committee
Department of Gastroenterology & Hepatology
CHUV
1011 Lausanne
SWITZERLAND
Email:

Contents

UEMS & The EBGH

UEMS

The Union of European Medical Specialities was founded in 1958, one year after the European Economic Committee (EEC) was formed by the Treaty of Rome. It is the official representative body of all Medical Specialities to the European Commission. Its membership is comprised of delegates from 35 Countries and it operates through its 37 Specialist Sections and Boards. The mission of the UEMS is to promote the highest level of professional autonomy and training for medical specialists so that they can provide the highest possible quality of healthcare services for the benefit of all European citizens. The UEMS promotes harmonisation of postgraduate specialist medical training in Europe by setting standards for all aspects of postgraduate medical training. The UEMS co-ordinates the accreditation of international CME/CPD in Europe by setting standards for these activities and providing critical evaluation of these activities in conjunction with the Speciality Boards. The UEMS achieves this objective through an institution of the UEMS, EACCME (European Accreditation Council for Continuing Medical Education). The UEMS also promotes the harmonisation of postgraduate medical specialist qualifications in the various specialities.In addition to the promotion of standardisation and evaluation of postgraduate specialist medical training and CME/CPD in Europe, the UEMS promotes quality assurance assessment of specialist’s medical practice at a European level. The UEMS is the official representative body of all medical specialists to the European Commission and has contacts with the European Institutions to promote its objectives.

The Gastroenterology & Hepatology Section of the UEMS

Shortly after the formation of the UEMS, the Gastroenterology Section was formed. This is composed of two delegates from each of the 30 UEMS member countries (the 27 EU countries plus Norway, Iceland and Switzerland) and a representative from the Junior Doctors Organisation (PWG). The delegates are appointed by the National Medical Association. Armenia, Croatia, Israel and Turkey are Associate Members and Azerbaijan, Belarus, Bosnia and Herzegovina, Georgia, Russia and Ukraine are Observer Countries. Two organisations associated with Gastroenterology are represented by Observers (European Association for the Study of the Liver and The Association des Sociétiés Nationales Europeéannes et Méditerranéennes de Gastroentérologie).

The European Board of Gastroenterology & Hepatology

In its early years, the Section of Gastroenterology & Hepatology was predominately concerned with general professional matters. However, with increasing focus in the UEMS on postgraduate training and CME, Speciality Boards were formed and The European Board of Gastroenterology and Hepatology was founded in 1992 as a Working Party composed of the two National Delegates, one of whom is appointed by the National Medical Association and the other by the National Gastroenterology & Hepatology Specialist Society. Thus the two delegates from each country are selected to provide a balanced between pure clinicians and academics. In practice, there is no distinction between the Section and Board of Gastroenterology & Hepatology and the Section and Board work jointly on all initiatives.

The primary functions of the EBGH are to:

Define and secure the standards of training in Gastroenterology and Hepatology in Europe

To evaluate the quality of International Cross Border CME/CPD in Europe in conjunction with EACCME

To promote exchange of trainee gastroenterologists

To collect and analyse workforce demographics and statistics in Gastroenterology.

The EBGH has the following working Committees:

The Training & Recognition Committee

The CME Committee

The Manpower & Public Relations Committee

Evaluation of CME activities (event based activities and e-learning activities) are carried out by a joint EBGH UEGF CME Evaluation Committee under the auspices of the EBGH CME Committee.

The routine business of the Section and Board of Gastroenterology & Hepatology is carried out by an Executive Committee composed of:

The President of the Section

The President of the Board

The Secretary General

The Treasurer

The Section & Board meet twice a year, in the spring and at the annual UEGW Meeting.

Certification of High Quality Training – The FEBGH (The Fellowship of the European Board of Gastroenterology & Hepatology)

To improve the quality of gastroenterology training, the EBGH accredits well-trained gastroenterologists and hepatologists and certifies training centres in EUMS countries.

• Until 31st December 2011, Gastroenterologists and Hepatologists who started their specialty training before 1st January 2004 and are actively practising in gastroenterology can have their training recognised retrospectively (‘Retrospective Certificate’).

• Candidates who started training after 1st January 2004 must either be trained in a Training Centre certified by the European Board of Gastroenterology & Hepatology and/or have been trained fully according to the requirements – that is, including common trunk and ultrasound training.

• After 1st January 2011, all candidates must have been trained in certified training centres, must have their training evaluated prospectively and must comply fully with the European requirements of training.

Candidates who fulfil these requirements will be awarded the Certificate of Fellowship of the European Board of Gastroenterology & Hepatologyand can call him/herself Fellow of the European Board of Gastroenterology & Hepatology.

According to the rules of the EUMS, the Certificate of Fellowship of the European Board of Gastroenterology & Hepatology cannot be obtained for at least two years after accreditation and the award of a National Diploma.

Training Centres and Site-Visits

To ensure the quality of a training centre, the EBGH encourages visitation of training centres. Site-visits are the key component for the EBGH to secure the quality of training in Gastroenterology. They are considered as a most valuable contribution to maintaining high standards of training, against the competition of service requirements and in the face of shrinking resources.

At current or prospective teaching centres, the teachers are encouraged to apply for the Certificate of Fellowship of the European Board of Gastroenterology & Hepatology (Retrospective Certificate).

To be effective, inspection must be conducted, within published guidelines, by two external assessors, nominated by the Board. The assessors should be from other countries and be themselves working in institutions subject to the same process.

Re-evaluation in the form of a questionnaire should be carried out every five years. Major changes in the institution should be reported to the Training Recognition Committee.

A diploma will be issued to a training centre fulfilling all EBGH requirements, approving it as a Training Centre of the European Board of Gastroenterology & Hepatology.

A certificate of visitation with a letter of commendation will be issued to a visited training centre, fulfilling most but not all EBGH requirements.

The site-visits are meant to encourage the establishment of national training programmes, inspectors and diplomas. The quality of every national specialist training programme is of key importance. The reports should provide examples of good practice that can be followed by other training centres.

Speciality Training Programme for Gastroenterology & Hepatology

Training Centre

Training in Gastroenterology should be based in University affiliated institution or those with an equivalent education and research programme and the full complement of Medical, Surgical and Diagnostic services commensurate with aUniversityHospital. The Training Centre should be housed in quality buildings which are well maintained. The Training Centre must have facilities for inpatients and outpatients and must contain an Endoscopy Unit and a Gastrointestinal Clinical Investigation room/laboratory. Satisfactory premises for education are needed with teaching space, library and contemporary information technology and audio visual teaching aids. The equipment in the gastroenterological, surgical, radiological and pathological departments must be of a standard to provide good clinical and education training. The Gastroenterology Training Centre should be located in a Hospital or Institution which also has surgical, intensive care, radiology, histopathology, biochemistry, microbiology and haematology laboratory facilities. The Hospital/Institution should also have a broad array of other medical subspecialty services such as cardiology, pulmonary, endocrinology/diabetes, haematology, nephrology, infectious disease and oncology.

Faculty and Trainers

The Gastroenterology & Hepatology Faculty of Trainers should show itself to be committed to specialist education and provide appropriate space, facilities and funding to protect the needs of education from the demands of service. The majority of the faculty should be Fellows of European Board of Gastroenterology & Hepatology.

The members of the faculty should be experienced both as gastroenterologists and teachers, committing time, effort and enthusiasm to the training programme. They should regularly attend interdisciplinary meetings with surgeons, pathologists and radiologists. The faculty should be large enough to supervise the clinical and practical work of the trainees.

Each trainee should usually have a named supervisor. The optimal ratio between trainees and trainers should be close to one.

Organisation of Training Programme

Duration of Training

The training programme should be of least six years duration including at least two years of common trunk training and at least three years full-time gastroenterology training. One year might be used for scientific work or optional, specialised training, e.g. in advanced endoscopy or hepatology.

Multi Centre and One Centre Training

Training Centres may be recognised by The European Board of Gastroenterology & Hepatology to be of sufficient quality to provide sufficient training for the total four year period of speciality gastroenterology/hepatology training. However some Units, with high quality gastrointestinal and hepatology clinical facilities and training, may lack the full complement of training facilities and opportunities. However, it may be recognised by the EBGH as a Centre of sufficient merit such that a Gastroenterology Trainee will receive sufficient training for either a period of one year or a period of two years. A trainee may therefore fulfil the four year programme of training by rotating between a number of recognised training centres. Although the training will be supervised, assessed and documented by a number of different trainers in different centres, the trainee must organise in advance overall supervision, assessment and documentation of their training by one nominated supervisor, usually the supervisor at the initial training centre. A supervising trainer who takes on this responsibility must ensure overall supervision and mentoring of the trainee during their four year training period by the liaising with other training centre to ensure that the trainee undertook the full multi centre training programme.

Expand Enrolement and ongoing Documentation of Training

Adequate Clinical Experience during Training Period

Throughout the training period, there should be appropriate clinical exposure as judged by an adequate number of both inpatients and outpatients and a wide breadth of clinical experience in all aspects of the speciality.

Teaching Activities

Case Conferences, Journal Clubs, In-service Meetings, Multi Disciplinary Meetings (especially surgical, radiology & histopathology), Hospital Staff Rounds and Seminars should take place regularly. Trainees should attend and on occasions contribute and present at these educational activities. In addition, trainees should be encouraged to attend and eventually to present at local, regional, national and international gastrointestinal and hepatology meetings.

Facilities for Endoscopy and Gastroenterology/Hepatology Procedures

The training centre Endoscopy Unit should contain well functioning up-to-date endoscopy equipment with appropriate decontamination equipment. It should be staffed by appropriately trained endoscopy nurses and assistants and should undergo regular quality control assessment according to either local, national or international criteria. The Unit should be adequately equipped with well maintained video system endoscopes (?? insert above). The Training Centre Endoscopy Unit should perform at least one thousand upper GI endoscopies a year including relevant therapeutic procedures. At least two hundred Colonoscopies including therapeutic colonoscopies should also be carried out in the Unit.

Facilities for Ultrasound and Liver Biopsy must be available to the Training Centre.

Trainee Posts – Entry, Clinical Responsibilities and Timetable

Trainees should be employed in substantive paid, higher postgraduate medical positions entry to which is by a competitive process. Trainee posts should provide adequate and appropriate clinical responsibility for both inpatient and outpatients but the hours of work should not be so great as to deny the trainee adequate time for personal study and attendance at formal educational activities. At least half the trainee’s time should be devoted to clinical work; the remainder might be divided between personal study, formal educational activities, teaching, audit and research.

Study Leave

During their training programme, trainees should be facilitated to be completely relieved of their clinical duties in order that they can take study leave to attend conferences and other educational activities outside their training unit.

Documentation of Training

Trainees must document their training on an ongoing basis throughout their training period by means of a logbook, which may be paper based or electronic. This logbook, which may be published nationally or by the local training centre, should log information regarding experience, competencies and non experiential education (e.g. formal teaching sessions, educational courses attended etc).

Experience to be logged includes volume and nature of clinical interaction with patients (emergency, elective, inpatient and outpatient), endoscopy and other procedures, communication and ethical matters, teaching sessions personally delivered, research, audit and administration (e.g. rota management, representative duties etc).

Supervision of Training

Trainees require supervision of their clinical duties. In addition, supervision of their training programme and schedule is required to ensure they are making sufficient progress, that milestones are being achieved and the training curriculum is being covered. Thus the trainee needs Clinical Supervision and Educational Supervision. One supervisor may undertake both roles or the roles may be undertaken by separate people depending on local arrangements. It is advisable, however, that if there is a separate Educational Supervisor, he or she should be a clinician in the speciality team and not be remote from the clinical environment in which the trainee works.

A Clinical Supervisor oversees the trainee’s ongoing work and provides constructive feedback. Although all elements of work in training posts must be supervised, as training progresses the trainee should have the opportunity for increasing autonomy, consistent with safe and effective patient care.

An Educational Supervisor oversees the trainee’s educational progress in the context of the speciality curriculum. He or she reviews the trainee’s logbook, set goals and provides direction and advice on a regular basis. Educational Supervisors should be familiar with the use of assessment tools, how to support trainees in difficulty and how to give effective feedback including goal setting and career advice. Ideally, Educational Supervisors should have attended a ‘Train the Trainers’ course.

Assessment and Appraisal of Training

Educational Supervisors should have an induction session for trainees soon after enrolment during which the training programme and curriculum are explained and how the various clinical aspects of training can be completed over a 3-4 year period. In addition, each trainee should on a yearly basis discuss and document a detailed training plan for the forthcoming year personally with their Educational Supervisor. This yearly plan will take into account what training has been completed successfully previously and what areas need to be developed on an ongoing basis.

Established assessment tools for appraisal of clinical knowledge, skills and professional attributes should be used on an ongoing basis during training and documentation of these appraisals should be maintained in association with the trainee’s logbook. The assessment of clinical skills, especially problem orientated history taking, physical examination, diagnostic decision making ability, appropriate selection of investigations, investigation interpretation and overall clinical judgements, is particularly important. Assessment of procedural skills, particularly endoscopic skills need to be documented by each trainee in conjunction with his/her trainer.

Appraisal of training progression should be performed formally on a yearly basis jointly by the trainee and Educational Trainer by reviewing the trainee’s logbook, evidence of attainment of competencies in knowledge, clinical skills and professional attributes and discussing other matters of relevance to completion of training. The appraisal of training before entering into the finalyear of training is particularly important as deficits in training can be identified and plans made to correct them; for this reason it is advisable that this particular appraisal involves an external/extra Educational Supervisor as well as the usual Educational Supervisor.

CURRICULUM

Objectives

The training curriculum of the EBGH is a programme of training such that doctors who successfully complete the specialist training programmewill be enabled to practice autonomously as a Gastroenterologist, without ongoing supervision from another Gastroenterologist. The curriculum is designed to train across the entire discipline of clinical Gastroenterology, so although trainees may develop particular clinical interests, they will also have acquired core knowledge and skills. The programme and curriculum aims to produce broadly trained specialists who will be able to deliver high quality general gastroenterology and hepatology care to their patients.