ECCO IBD Curriculum
Topic outline
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ECCO IBD Curriculum
ECCO's Education Committee and the e-Learning Taskforce have prepared an IBD Curriculum that will serve as the framework
for ECCO's educational activities, particularly the e-CCO e-learning tools.
The goal was to create a concise yet complete curriculum, outlining what gastroenterologists need to know to develop expertise in the IBD field.
How can the ECCO IBD Curriculum be of service to you?
Choose a topic in the Curriculum that interests you and that you would like to know more about - this will open an inventory of e-CCO learning content about this topic. Find e-Courses, ECCO Guidelines, IBD Blue Book chapters and webcasts from live educational courses recorded at ECCO Congresses! As you will notice, some of the topics don't have any associated content yet - this is a signpost for ECCO where to focus future efforts in the development of educational content.
Acknowledgments
The ECCO IBD Curriculum is adapted from the Specialty Training Curriculum for Gastroenterology with agreement from the Joint Royal Colleges of Physicians Training Board. The ECCO IBD Curriculum has been developed with participation of ECCO Officers and National Representatives.
Find out more about the development of the ECCO IBD Curriculum in the ECCO Position statement published in JCC.
ECCO IBD Curriculum
Advanced training in the diagnosis and management of inflammatory bowel diseaseFull content only available after log-in via the ECCO Portal
1. General Understanding of DiseaseUnderstanding the state of knowledge of pathogenesis of IBD, and the principles underlying treatment
1.1. Knows the science underlying the pathogenesis of IBD, in particular relating to genetic and environmental factors involved, and differences between ulcerative colitis (UC) , Crohn’s disease (CD) and IBD unclassified
1.2. Understands the natural history of UC and Crohn’s disease, including its variability and the impact of therapy on the natural history
1.3. Understands the importance of communicating with patients and educating them about their disease and its natural history as well as the principals of management
1.4. Understands the basic immunology of IBD and mechanism of action (as far as it is understood) and rationale for using different treatment types in IBD
1.5. Able to use knowledge of modifiable and non-modifiable risk factors to underlie management decisions and to stratify risk for patients
2. DiagnosisTo understand the methods of diagnosis including major differentials and to provide advice in cases where the diagnosis is unclear
2.1. Knows the major differential diagnoses of IBD, including infection – (viral, bacterial, and amoebic), vasculitis, ischaemia, Behcet’s disease, irritable bowel syndrome (IBS) etc.
2.2. Knows the appropriate investigations to distinguish the above, and their limitations
2.3. Knows the differential when a patient with known IBD presents with symptoms including – active IBD, bacterial overgrowth, bile salt malabsorption, obstruction, enteric infection, sepsis, non-inflammatory symptoms (IBS) etc.
3. AssessmentThe assessment of disease activity and extent including complications
3.1. Understands the appropriate investigations for assessing disease activity and extent including:
· Inflammatory markers in blood and stool
· Upper and lower GI endoscopy / capsule endoscopy / enteroscopy
· Imaging techniques, including: CT, MRI, barium imaging and ultrasound
3.2. Phenotypic classification of CD and UC
3.3. Understands the circumstances in which disease activity and extent should be reassessed
3.4. Knowledge of complications and appropriate action in terms of investigation and management
4. IBD Multidisciplinary Team (MDT)To understand the methods of diagnosis including major differentials and to provide advice in cases where the diagnosis is unclear
4.1. Understands the importance of multidisciplinary decision making including when radiological, histopathological and surgical opinions should be sought.
4.2. Understands the importance of involving other specialities in the care of IBD.
4.3. Recognises the importance of other healthcare professionals in providing high quality care including nurses, dieticians, stoma therapists, psychologists, and pharmacists
5. Surgery and IBDUnderstanding the state of knowledge of pathogenesis of IBD, and the principles underlying treatment
5.1. Understands the role of surgery in the management of disease-associated dysplasia
5.2. Understands the natural history of UC and Crohn’s disease, including its variability and the impact of therapy on the natural history
5.3. Understands the importance of pre-operative optimisation
5.4. Understands the impact of concomitant medication on surgical outcome.
5.5. Understands different surgical approaches such as:
· Methods of bowel-preserving surgery in Crohn’s disease
· The different long term options after subtotal colectomy in UC
5.6. Recognises that early liaison with surgeons is important in high quality patient management
6. Treatment Options and Individualized CareTo understand the treatment options available and be able to discuss them appropriately to provide individualised patient care
6.1. Knows the different treatment modalities for IBD taking into account disease extent, activity, previous history and complications
6.2. Knows the modes of delivery of different drug therapies and their advantages and disadvantages
6.3. Recognises the importance of patient choice in deciding therapy and in helping to ensure adherence
6.4. Understands the evidence base behind different therapeutic strategies and when they might be appropriate (conventional step care, optimised step up, top down and treat to target)
6.5. Appreciates the monitoring requirements for specific therapies
6.6. Appreciates common side effects and complications of therapy, their frequency and how to manage them
6.7. Appreciates the importance of on-going disease monitoring to confirm efficacy
6.8. Understands when surgery is the most appropriate therapeutic option
6.9. Is up to date with the evidence base from current clinical trial and real world data sets for the use of available therapies
6.10. Has knowledge of the role of optimising therapy including interpretation of therapeutic drug monitoring for conventional and biological therapies
6.11. Appreciates the role of stopping medical therapies in IBD and the appropriate timing / patient population in whom drugs can be stopped
7. Special situationsTo understand the management of special situations in IBD
7.1. Understands the management of refractory proctitis
7.2. Understands the assessment and treatment of pouchitis
7.3. Understands the management of stricturing Crohn’s Disease
7.4. Recognises specific medical and surgical requirements for fistulising and perianal CD
7.5. Understands the principles of and evidence base for prevention of recurrence after surgery for Crohn’s disease
7.6. Appreciates the options available for managing acute severe UC
7.7. Understands the problems associated with and the management of short bowel syndrome
7.8. Understands the problems associated with stomas
7.9. Understands the assessment and management of oral and other extraintestinal sites of Crohn’s disease
7.10. Understands the management of extraintestinal manifestations of IBD
7.11. Understands the problems associated with the management of IBD in patients who are travelling
7.12. Understands the management of inflammatory bowel disease in the elderly
8. Endoscopy in IBD8.1. Understands the core data that are required in an endoscopy report
8.2. Understands the different disease scoring systems that are used in clinical practice and research
8.3. Knows the principles of colorectal cancer surveillance in IBD
8.4. Knows the principles of chromoendoscopy and its application to IBD
8.5. Understands the appearances of and management of dysplasia during surveillance colonoscopy
8.6. Understands the indications for and complications of stricture dilatation in IBD
8.7. Understands how to perform pouchoscopy
8.8. Understands the indications for small bowel capsule endoscopy and enteroscopy
8.9. Understands the indications for operative endoscopy in IBD
8.10. Understands the importance of close liaison with histopathologists in interpreting biopsies
9. Fistulising Crohn’s DiseaseTo understand complex fistulising Crohn’s disease
9.1. Knows the pathogenesis and complications of fistulising Crohn’s disease including perianal, enteroenteric, enterocutaneous, enterovesical and rectovaginal fistulae
9.2. Is aware of the importance of joint medical-surgical management of complex fistulae, and of nutritional support for high output fistulae
9.3. Understands the different imaging modalities for fistulising CD
9.4. Understands the basic immunology of IBD and mechanism of action (as far as it is understood) and rationale for using different treatment types in IBD
10. Reproductive Health, Pregnancy and LactationUnderstanding the effect of IBD and its treatment on reproductive health, pregnancy and lactation
10.1. Knows the effect of active IBD, drug therapy and surgery on fecundity and pregnancy, specifically issues relating to immunosuppressants, biological therapy and surgery
10.2. Knows the effect of IBD and its treatment on breastfeeding
10.3. Appreciates when to alter treatment to take account of pregnancy and breastfeeding
10.4. Knows the effects of the disease and its treatment on the chances of conception for men with IBD
10.5. Understand the issues relating to vaccination of neonates
10.6. Is able to provide appropriate advice about the effect of disease, treatment and surgery on fecundity, pregnancy and lactation
10.7. Understands the role of genetic counselling
11. Co-Morbidity and IBDUnderstanding of the effects of concurrent medical conditions on the treatment of IBD
11.1. Knows the importance of assessing co-morbidities in patients with IBD
11.2. Knows the risks relating to a previous history of malignancy or the development of malignancy in IBD, in particular how this affects treatment options
11.3. Knows the risks relating to infections such as tuberculosis, hepatitis B, hepatitis C and HIV in relation to the treatment of IBD
11.4. Knows the circumstances in which patients should be screened for or immunised against infectious diseases before commencing therapy
11.5. Is aware of the appropriate investigations and vaccination strategy for patients with a new diagnosis of IBD
12. NutritionTo understand the nutritional principles underlying IBD
12.1. Knows the role of nutrition as a therapy for active IBD
12.2. Knows the role of dietary intervention in the management of symptoms associated with active IBD
12.3. Understands the role of nutritional manipulation to treat non inflammatory symptoms of IBD
12.4. Knows the mechanisms of nutritional deficiency in IBD (including vitamin deficiency) and the role of nutritional support
12.5. Understands the circumstances when nutritional support should be provided by enteral or parenteral routes, the various methods of delivery and the complications associated with nutritional support
12.6. Understands the possible methods of maximising bowel preservation including appropriate medical therapy, endoscopic therapy and bowel preserving surgery
13. Psycho-social effects of disease13.1. Understands the effects of IBD on educational achievement
13.2. Understands the effects of IBD on work and careers
13.3. Understands how IBD can result in disability
13.4. Understands the burden of psychological morbidity in IBD and how to treat it
13.5. Understands the effects of IBD on relationships and sexual function
13.6. Understands the effects of IBD on social activities
14. Non-inflammatory Symptoms in IBDTo understand the aetiology and treatment of non-inflammatory symptoms in IBD
14.1. Understands the mechanisms by which IBD can cause fatigue and how this can be managed
14.2. Understands the mechanisms by which IBD can cause non inflammatory pain and how this can be managed
14.3. Understands the prevalence of IBS (functional symptoms) in IBD and how to manage them
14.4. Understands the prevalence of incontinence in IBD and how to manage it
15. Paediatric to Adult TransitionTo understand the issues facing adolescents with IBD and the handover of care to adult gastroenterologists
15.1. Appreciates the differences in approach between paediatric and adult IBD management
15.2. Knows the importance of maintaining adequate growth
15.3. Knows the importance of minimising the adverse of effects of IBD on education
15.4. Has awareness of the particular issues concerning IBD in adolescents and appreciates the practical problems in transition to adult care
15.5. Is aware of the different models of paediatric to adult transition in IBD
16. Novel TherapiesExperience novel therapies in IBD, and of clinical trials used to pilot their introduction
16.1. Understands the different types of evidence – clinical trial / cohort study / systematic review/ etc.
16.2. Knows the evidence that supports the use of currently unlicensed therapies in IBD