Development of Entrustable Professional Activities for Advanced Inflammatory Bowel Disease Fellowship Training in the United States

Benjamin L Cohen 1 2, Zane R Gallinger 1 3, Christina Ha 4, Stefan D Holubar 5, Jason K Hou 6, Jami Kinnucan 7, Uma Mahadevan 8, Alan C Moss 9, Laura E Raffals 10, Miguel Regueiro 2, Eva Szigethy 11 12, Douglas Wolf 13, Marla C Dubinsky 14, Anish Patel 1 15, Brijen J Shah 1, Orna G Ehrlich 16, Stephen B Hanauer 17


Author information

  • 1Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
  • 2Department of Gastroenterology, Hepatology, and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
  • 3Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
  • 4Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
  • 5Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
  • 6Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
  • 7University of Michigan, Ann Arbor, MI, USA.
  • 8Division of Gastroenterology, University of California, San Francisco, CA, USA.
  • 9Department of Medicine and Section of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
  • 10Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
  • 11Department of Gastroenterology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
  • 12Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
  • 13Atlanta Gastroenterology Associates, Atlanta, GA, USA.
  • 14Department of Pediatrics, Mount Sinai Hospital and Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center, New York, NY, USA.
  • 15Division of Gastroenterology, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
  • 16Crohn's & Colitis Foundation, New York, NY, USA.
  • 17Northwestern University Feinberg School of Medicine, Chicago, IL, USA.


Background: The level of inflammatory bowel disease (IBD) training in general gastroenterology fellowship is often insufficient to prepare trainees to deliver advanced IBD care in practice. Advanced IBD fellowships have been developed to fill this training gap, but there is no established curriculum, and significant variability exists across programs. Entrustable professional activities (EPAs) are practical and realistic objectives that define essential tasks of a specialty that physicians should master to be competent during independent practice. The American College of Gastroenterology (ACG) and Crohn's & Colitis Foundation (Foundation) established a task force to develop and appraise EPAs for advanced IBD fellowship.

Methods: Entrustable professional activities were developed using a multistep approach in a similar manner to other specialties. Initial EPAs identified via focus groups were evaluated, critiqued, and changed using an iterative model of feedback. The final EPAs were selected after the task force conducted a 3-phase modified Delphi method consisting of 2 sequential rounds of web-based voting and an in-person consensus meeting.

Results: Ten EPAs for advanced IBD fellowship were established including detailed descriptions with the associated knowledge, skills, and attitudes for each that can serve as curricular milestones.

Conclusion: Ten EPAs describing the core work of an advanced IBD fellowship-trained physician have been established by a multisociety task force. Creating EPAs for an advanced curriculum comes with unique challenges, particularly the need to prevent duplication of prior training competencies while demonstrating the potential for unique milestones.

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