Faculty Bibliography

The Bellevue IBD clinic serves a radically different patient population than is treated in most US healthcare settings, represented in most clinical trials, or reflected in current management guidelines. Here we discuss the complexity of providing care to these individuals, areas of disparity in IBD care and resources to assist our patient population

BACKGROUND: Inconsistencies in adherence to evidence-based medicine practice guidelines and quality indicators for inflammatory bowel disease (IBD) have been a recognized limitation in the quality of care afforded to IBD patients. We designed an Objective Structured Clinical Examination (OSCE) to assess many of the core competencies and to provide GI fellows with a simulated, case-based learning experience in the management of IBD patients. To supplement this experience, we provided GI fellows with an easily accessible educational resource in the form of a pocket-sized guide to highlight key evidence-based concepts in IBD education stressed in the OSCE. We assessed the utility of the NYU Gastroenterology Fellowship Training Program Pocket Guide's usefulness, functionality, utilization, and the GI fellows' satisfaction with this educational resource. METHODS: The NYU Gastroenterology Fellowship Training Program's OSCE course included 4 real life IBD clinical scenarios. Five New York City GI training programs and 12 second-year GI fellows participated. Following the OSCE, each fellow was given a pocket guide entitled "NYU Gastroenterology Fellowship Training Program Pocket Guide: Key Concepts in Managing Patients with Inflammatory Bowel Disease." In addition, the pocket guide was given to the remaining 8 NYU GI fellows who did not participate in the OSCE. The white coat pocket-sized guide is comprised of 5 front and back laminated pages, with approximately 2 pages devoted to each OSCE case. Three months following the distribution of the pocket guide, 20 fellows were invited to participate in an online survey about the pocket guide in general as an education tool, and about its specific elements, and the fellows' answers were collected. RESULTS: Sixteen of 20 (80%) fellows responded to the survey. Nearly 94% (15/16) of responders found the pocket guide to be a useful supplement to their fellowship IBD training, and 100% agreed that the guide would have been a useful reference tool to have at the s!

BACKGROUND: Experiential learning in medical education, as exemplified by objective structured clinical examinations (OSCEs), is a well-validated approach for improving trainee performance. Furthermore, the Accreditation Council for Graduate Medical Education (ACGME) has identified OSCEs as an ideal method for assessing the core competency of interpersonal and communication skills. The field of inflammatory bowel disease (IBD) challenges clinicians to communicate effectively due to the complex multidisciplinary nature of its management. Here, we describe a novel educational tool (the IBD OSCE) to assess and improve this clinical skillset in Gastroenterology (GI) fellows. METHODS: Twelve second-year GI fellows from 5 fellowship programs participated in a 4-station OSCE. Previously validated OSCE checklists were used to assess the GI fellows' performance in IBD-specific cases. In the first case ("New Diagnosis") the goal of the GI fellow was to educate a patient on her recent diagnosis of ulcerative colitis and to navigate a complex conversation about her risk of colon cancer. In the second case ("Shared Decision Making") the objective was to evaluate a patient with Crohn's disease who would benefit from combination therapy with infliximab and azathioprine. A third case ("Emergency Department Flare") involved evaluating how the fellow performs in the initial triage and management of an ulcerative colitis patient in flare through an observed telephone encounter with an actual emergency department physician. In the final case ("Pre-conception Counseling"), the fellow was asked to discuss the pre-conceptive management of active ulcerative colitis with a "real-life" obstetrician/gynecologist. Each station was videotaped and observed live by faculty gastroenterologists. Checklists were scored independently by a physician-observer and the Standardized Patient (SP), who both provided feedback to the fellow immediately following each case. Fellow performance was scored across multiple domains and individ!