What makes someone an IBD expert

Have you ever wondered what makes someone an inflammatory bowel disease (IBD) expert? Some have described it as, “You know one when you see one.” However, there hasn’t been a set definition of what it truly means. The Crohn’s & Colitis Foundation and the American College of Gastroenterology (ACG) recently partnered together to actually define what sets apart an IBD expert from a general gastroenterologist in their recent publication in Inflammatory Bowel Diseases, “Development of Entrustable Professional Activities for Advanced Inflammatory Bowel Disease Fellowship Training in the United States.”  

IBD management is complex and rapidly evolving as new treatments become available. While general gastroenterology training provides broad exposure to IBD, studies have shown that this training may be insufficient to prepare gastroenterologists for complex IBD care. Advanced IBD fellowships have been created to help fill this training gap. During an advanced IBD fellowship, gastroenterologists commit to an additional year of IBD focused training at a high-volume expert center. However, significant variability in training still exists across advanced fellowships as there is no common curriculum or requirements for training.  

The Foundation and ACG formed a diverse multi-society task force consisting of IBD-focused gastroenterologists, surgeons, and psychiatrists to identify the professional tasks and roles, also known as entrustable professional activities (EPAs), an advanced IBD expert should be capable of performing. The task force met virtually and in person over a year to define detailed core knowledge, skills, and attitudes for each EPA. The published document provides a common set of training goals for fellowship programs around which to build their educational programs. This will help to standardize expert IBD care in the United States. Importantly, the EPA document can also be used to construct training programs for IBD focused advanced practice providers as well as develop continuing medical education modules for general gastroenterologists seeking further IBD training without doing an advanced year. 

The EPAs created by the Foundation and ACG task force are:

1. Classify inflammatory bowel disease phenotype, disease activity, and extraintestinal manifestations
2. Utilize advanced diagnostic and therapeutic endoscopic and radiographic techniques in the management of inflammatory bowel disease
3. Prescribe and manage evidenced-based inflammatory bowel disease therapies utilizing clinical pharmacologic principles in clinical practice
4. Manage adverse events and complications of inflammatory bowel disease and inflammatory bowel disease therapies
5. Manage hospitalized patients with inflammatory bowel disease
6. Manage pre- and postoperative care for inflammatory bowel disease patients
7. Manage inflammatory bowel disease in special populations
8. Recognize the importance of psycho-behavioral health in inflammatory bowel disease and implement psychosocial support strategies
9. Evaluate and manage nutritional health status in inflammatory bowel disease patients
10. Apply preventive health strategies for inflammatory bowel disease patients in accordance with guidelines

For patients, the EPAs can help set expectations for the type of care they will receive when being referred to an IBD expert. While the EPAs will help ensure that IBD specialists have expertise and knowledge in treating Crohn’s and colitis, I also encourage patients to learn as much as they can about their disease in order to act as an informed partner in their care. 

While the EPAs begin to be implemented, patients can look for an IBD specialist by visiting the Crohn’s & Colitis Foundation’s directory of medical experts or contact the IBD Help Center at [email protected] or 888MGUTPAIN. 

Dr. Benjamin Cohen is a gastroenterologist and Co-Section Head and Clinical Director for Inflammatory Bowel Diseases in the Department of Gastroenterology, Hepatology, & Nutrition at the Cleveland Clinic. He is a member of the Foundation's National Scientific Advisory Committee.