Managing Disorders of Gut–Brain Interaction and the "Uncomfortable" GI Trainee

An illuminating study published in May in Neurogastroenterology & Motility evaluated gastroenterology fellows' perceptions of disorders of gut–brain interaction (DGBI; also known as functional GI disorders) and their comfort with the management of patients with these disorders.¹ Nearly half of surveyed trainees reported not feeling “comfortable” or “very comfortable” with initiating central neuromodulation for patients with DGBI, and 70% of trainees expressed some preference to not manage patients with DGBI in their clinical practices. Limitations in education and training around the diagnosis and management of DGBI may contribute significantly to these findings.

Particularly given the high prevalence of DGBI in GI clinical practice, these startling findings highlight the need for gastroenterology fellowship programs to better train fellows to develop experience and competency in the management of patients with DGBI, which, in turn, may help improve comfort with and attitudes toward DGBI. In fact, survey data have revealed that as few as one-fifth of GI fellowship programs may be meeting standards across the spectrum of motility training based on the Gastroenterology Core Curriculum.²

To better address these shortcomings and guide both trainees and fellowship programs in streamlining training in these areas, on behalf of the American Neurogastroenterology and Motility Society (ANMS) and the European Society of Neurogastroenterology and Motility (ESNM), we developed structured, three-tiered, competency-based training curricula spanning eleven domains across neurogastroenterology and motility.³ Specifically, Tier 1 knowledge and training should be expected of all GI trainees, while Tier 2 knowledge and training is appropriate for those trainees who anticipate managing DGBI disorders as part of their careers, and Tier 3 is intended for those pursuing dedicated careers in this field.

Beyond the training and expertise available in their training programs, there are resources and opportunities that trainees and early-career GI providers have found helpful in learning more about and in managing DGBI. Here is a non-comprehensive list:

• ANMS-ESNM Curriculum for Neurogastroenterology and Motility Training (onlinelibrary.wiley.com/doi/10.1111/nmo.13341)
• AGA Clinical Guidance (https://gastro.org/clinical-guidance/)
• ACG Guidelines (https://gi.org/guidelines/)
• ANMS Clinical Training Program (https://motilitysociety.org/wp-content/uploads/2016/11/ANMS_CTP_Brochure.pdf )
• ACG's Virtual Functional School (https://gi.org/education/acg-functionalschool/)
• Dedicated DGBI and NGM programming at Digestive Diseases Week, ANMS, and ACG conferences
• Rome Foundation education program and materials (https://theromefoundation.org/resources/
  presentations-videos)