Gastroenterologists are frequently asked to advise on nutrition support issues. Wide variation exists in training available to specialist registrars (SpR) in nutrition and it can be difficult to gain sufficient experience. The nutrition support team (NST) provides exposure to principles such as determination of nutritional state and nutritional requirements, modalities of feeding, monitoring and complications that may arise. The NST also advises on management of the complex patient with, for example, fluid-balance problems or fistulas. In order to address training needs, a training portfolio of requirements for nutrition has been suggested, which could be included for review as part of the annual assessment process.
An initial survey was conducted of SpR training in gastroenterology on the South West Thames (SWT) rotation in order to determine the current nutrition training experience and what changes to current practice may be required to ensure adequate training is achieved.
A twelve-point questionnaire was devised and electronically sent to thirty-five SWT trainees. This process was followed up on a regional training day, at which trainees were given a further opportunity to complete the questionnaire. The questionnaire included questions relating to current and previous posts on the rotation and was a combination of open questions and yes or no answers.
Fourteen trainees (40%) completed the questionnaire. Five trainees (36%) had attended a nutrition course during their training to date; all were in the final or penultimate year of training. In their current and previous posts eleven (79%) trainees had participated in the NST. Five trainees (36%) had utilized a nutrition screening tool and five (36%) were confident to assess nutritional status. Two trainees (14%) felt confident to assess nutritional requirements. In terms of satisfaction with nutrition training, four trainees (28%) were satisfied with the training they had received in nutrition to date. Further experience in the management of complicated cases of intestinal failure and inflammatory bowel disease within the multidisciplinary setting of the NST were particular aspects in which further training was desired.
Despite 79% of trainees having worked within the NST, only 28% were satisfied with their nutrition experience to date. Few were confident in utilizing fairly simple tools for nutritional assessment and calculating nutritional requirements. It did not appear true that trainees simply attended a course to fulfil their training needs but that the majority were exposed to practical nutrition support within at least one post on the rotation. In terms of implications for clinical practice, efforts could be concentrated on ensuring good core knowledge of dietetic principles, screening tools and nutritional requirements in particular, as these areas are likely to have been omitted from the training of doctors in the past.
