Why You Should Consider an Advanced Training Fellowship in Inflammatory Bowel Disease.

It is an exciting time for the study of inflammatory bowel disease (IBD). When Burrill Bernard Crohn published his manuscript titled “Regional Ileitis: A Pathologic and Clinical Entity” in 1932 in the Journal of the American Medical Association, he likely could not have anticipated the subsequent intrigue and discoveries in the study of IBD.1 As a gastroenterology trainee, I have learned of the significant research and clinical opportunities in the field of IBD. Whether it is the discovery and implementation of new medications such as vedolizumab or ustekinumab, novel modalities to improve diagnosis including magnetic resonance enterography and fecal calprotectin, or the emergence of the “treat-to-target” approach to care, there is never a dull moment when learning about this disease. This excitement has prompted me to pursue advanced training in IBD, and encourage you to consider this, too.

According to a recent time-trend analysis based on systematic reviews, there is increasing incidence and prevalence of IBD.2 This rise was further elucidated by a recent report completed by the Centers for Disease Control using National Health Interview Survey data, which suggested that 1.3% of U.S. citizens, or 3.1 million people, have been diagnosed with IBD.3 As the number of patients with IBD increases, more specialists will be needed to treat this chronic condition. While all gastroenterologists should be proficient in IBD treatment, studies have shown that there is significant variation in the treatment of IBD.4 The emergence of new medications and shifting treatment paradigms has made it increasingly important to be well versed in the latest evidence-based approaches. Accordingly, many institutions have created advanced training programs to train the next generation of IBD specialists.

Advanced training provides trainees the opportunity for increased exposure to both ambulatory and inpatient care of patients with IBD. As treatment options and response monitoring evolve, decisions surrounding care can become increasingly challenging. Many patients with IBD have complicated medical and surgical histories that require a thoughtful and informed approach. Training programs provide trainees with the chance to see a large number of patients and learn from a wide range of mentors and allied health care staff. An IBD fellowship is an excellent opportunity to learn about a multidisciplinary approach, with many programs providing learning opportunities with dieticians, nurses, and surgeons. Advanced training can also provide an opportunity to fill gaps in knowledge by surrounding yourself with mentors who have years of experience treating IBD.

IBD training programs provide not just excellent clinical experience, but also an opportunity to build an academic career in clinical and translational IBD research. A few popular topics of interest include IBD and the microbiome, quality indicators in the care of patients with IBD, clinical trials and comparative effectiveness studies for new IBD medications, and the use of precision medicine in IBD. When interviewing for these programs, be sure to ask about research opportunities, potential mentors, and whether there is a dedicated research experience.

IBD training programs may also provide an opportunity to hone teaching skills and pursue interests in medical education. Being able to teach trainees, physicians, and patients about the diagnosis and management of IBD can be an excellent asset for any program. A recent study identified potential deficiencies in IBD education among trainees and noted a lack of IBD experts and dedicated rotations in many training programs.5 When interviewing at IBD programs, ask about opportunities to teach residents and patients.

If you consider applying for an advanced IBD training program, I recommend starting the process early in your training. Go online and search the various programs’ application processes and deadlines. Make an early effort to reach out to the programs. Consider a site visit or apply for the Crohn’s and Colitis Foundation of America (CCFA) Visiting IBD Fellow Program.6 Currently, there is no centralized application process, and each program decides independently who they accept. Additional details on advanced IBD training programs can be found in the informative article by Dr. David Rubin published in Gastroenterology.7

Good luck!