Giving Pediatric GI Fellows a Better Grounding in Nutrition

Nutrition plays a key role in the development of a wide range of gastroenterology and systemic diseases, and is a major component in customized treatment plans for conditions such as cystic fibrosis, metabolic disorders, extreme prematurity and many more. Yet despite the common requirement for GI fellows and specialists to create and manage complex nutrition-related care plans and diseases, exposure to formal nutrition education rotations during fellowships is inconsistent and frequently leaves fellows feeling uncomfortable with decision-making involving advanced nutrition concepts.

“As part of caring for patients we often prescribe special diets and  nutritional formulas, and make recommendations for changes in caloric intake and food additives,” says Ala Shaikhkhalil, MD, a member of the Division of Gastroenterology, Hepatology and Nutrition and a physician nutrition specialist at Nationwide Children’s Hospital. “But we don’t often find that current fellowship training is completely sufficient to get physicians to a good comfort level with these nutritional measures.”

Hoping to remedy this gap in knowledge, Dr. Shaikhkhalil collaborated with fellow members of the Nutrition Committee for the North American Society for Pediatric Gastroenterology and Nutrition (NASPGHAN) to develop a pilot curriculum and implemented it via customized nutrition rotation programs at five hospitals. The project, described in the Journal of Pediatric Gastroenterology and Nutrition, included pre- and post-tests to evaluate knowledge (on 15 topics covered in the curriculum) and self-assessed comfort levels (for 25 nutrition topics).

The comprehensive curriculum was developed based on nutrition guidelines and knowledge objectives for trainees published by NASPGHAN, the American Board of Pediatrics, the American College of Gastroenterology and the American Gastroenterology Association. Fellowship programs self-selected for participation and worked with the research team to customize rotations based on each institution’s clinical, didactic and faculty resources.

Although the differences in test scores between fellows who did and didn’t participate in the new rotation did not achieve statistical significance for the small group, there was a trend in improvement of knowledge and comfort with nutrition-related topics, particularly in the nutritional management of cystic fibrosis, refeeding syndrome and cholestasis.

Formal nutrition training could be especially valuable for fellows who will end up practicing in institutions with varying levels of expert dietitian support.

“The role of a dietitian is complimentary and closely knit with our role as gastroenterologists,” says Dr. Shaikhkhalil, who is also an assistant professor of Clinical Pediatrics at The Ohio State University College of Medicine. “We want our trainees to know when to refer their patient to a dietitian and how to enhance that collaboration through a solid understanding of the medical aspects of nutritional needs.”

The curriculum is now available as a formal rotation option for fellows at Nationwide Children’s and the other participating institutions. Dr. Shaikhkhalil and other members of the NASPGHAN nutrition committee have also begun working on a series of electronic modules and lectures intended to comprise the didactic portion of a fellowship rotation in nutrition that will be available through NASPGHAN in the future.

“With the increasing complexity of GI diseases, there are multiple areas of subspecialty for fellows to take in during a limited educational time period,” says Dr. Shaikhkhalil. “We want fellows to know the basics, but more importantly, we want them to know the resources they can go to in order to find the knowledge and clinical direction when they need it. We need to focus on giving trainees the correct tools they need to continue the lifelong learning process, and that’s one thing we are hoping this curriculum will do.”

Dr. Shaikhkhalil also expects that other highly complex aspects of gastroenterology — such as hepatology, pancreatology, motility and intestinal support — might move to a similar model of training.

Reference:

A, Jump C, Goday PS. Development and Pilot Implementation of a Nutrition Curriculum and Rotation in Pediatric Gastroenterology Fellowships. Journal of Pediatric Gastroenterology and Nutrition. 2019 Feb; 68(2): 278-281.