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The WGO Education and Training Initiative

An Interview with Professor James Toouli,
Chair of the Core Education & Training Committee

James Toouli James Toouli, MD, MBBS, PhD, FRACS

WGO Co-ordinator of Education and Training
Flinders University
Adelaide, Australia
Justus Krabshuis

Highland Data
Tourtoirac, France

Q1: Professor Toouli – you are the intellectual engine behind starting and developing the WGO Education and Training Initiatives. These have been an overwhelming success with our member societies and their members. Your initiatives embody the core WGO global mission and  without doubt the Training and Education initiatives represent WGO’s crown jewels. Can you briefly describe these two initiatives?

A: Firstly I wish to acknowledge the enormous support and advice I have had from many colleagues, including many of the current Executive of WGO for any success that can be attributed to the educational activities of WGO. As an organization we made a decision some years back that education of the profession and the public in our areas of expertise, i.e. Gastroenterology and GI Surgery, would form the focus of our activities. I have been fortunate to have coordinated many of these activities and delighted with the way that they have been accepted by our colleagues in Gastroenterology.

Training Centers (TCs) form the core of our educational activities: these centers have been developed in GI centers of excellence in developing countries which have been able to provide local experts who have been able to lead these initiatives. The centers train gastroenterologists from less developed parts of their country as well as from surrounding countries. The training is provided by in-house specialists as well as invited faculty or volunteer faculty who attend the center for significant periods of time. The trainees receive instruction to either gain full training in  the specialty of Gastroenterology or GI Surgery or up skill in areas of perceived need. Currently we have 14 of these centers in all continents and we have trained hundreds of very grateful colleagues who have returned to their countries to deliver much needed services. This activity is partly funded from WGO funds (acquired following successful congresses), donations, and most importantly though partnerships with governments, some National Societies and the biomedical industry. Our Foundation has as one of its main tasks, acquisition of funds to further support and expand the activities of the centers. In addition I would like to invite all of our member National Societies to join us in supporting the activities of these centers as three of our member National Societies already have done to date. Contributions “in kind” by facilitating the involvement of volunteers from their society are gratefully accepted. The activities of the various training centers are reviewed annually through a rigorous accreditation process which all the centers fulfill as part of their own ongoing development. In recent years through the generosity of the American College of Gastroenterology (ACG) we have introduced access for some of the centers to the ACG Education Universe Program which has provided a core curriculum for the training in gastroenterology. Furthermore through equally generous support from Fukuoka University and the Japanese government we have access to the academic internet network which allows for an increasingly large number of internet based educational events linking our various centers.

I do believe that future objective evaluation of the results from the activities of the centers will show that WGO is having a significant impact in the training of gastroenterology in areas of the world where this is needed.

Train the Trainers (TTT) is the second of our major and ongoing educational efforts. This program has now been running for over 10 years. It is aimed at the educators in Gastroenterology, Hepatology, Endoscopy, and GI Surgery. It is a four day workshop which is run annually. It is limited to 50 participants who are nominated by their National GI Society so as to ensure that we do indeed reach out to the educators.

The basis and success of the workshop is that it is designed to be interactive. Underpinning the discussion are a number of modules which are introduced via lectures, which then lead to related discussion groups and concluded by presentation on the topics from the participants. Thus we all learn from each other, hence no one TTT workshop is the same as the last, and as the years have passed we have often changed the modules as well as the content within the modules. These changes have been made as a result of feedback and also as knowledge has advanced.

Educational modules which comprise the workshop include: Concepts of Adult Education, Techniques for Group Discussion, Teaching Procedural Skills, EBM and Trial Design, Critical Appraisal of the Literature, How to Prepare a Paper for Publication, Hints on Preparation of an Abstract, Assessment and Appraisal, Credentialing and Professionalism, which incorporates aspects on leadership and management skills.

Some of these modules have expanded into longer workshops which have been conducted on separate occasions. These include a workshop on Trial Design which has been run twice and a new workshop on Leadership and Management which we will run next year in Porto, Portugal. We have also had expression of interest in running a longer Procedural Skills workshop and one on Assessment and Appraisal.

The participants and faculty who have taken part in these workshops have formed professional bonds which have been a very important side benefit of this activity. Alumni functions have been held at each of the last World Congresses and we hope to hold another in Shanghai.

Q2: But it has not all been plain sailing has it? What were the major changes since you started and what, today, do you consider the key achievements?

A: This type of volunteer work is never without problems. I have been blessed by working with some very generous people who have volunteered their time and skills for the benefit of our profession and the patients that we hope to help. However finances and financial constraints are always a problem. The need is enormous. There is this incredible volunteer spirit of my medical colleagues and it is with this in  mind that I again invite our member National Societies to consider partnering with us in some of these projects. In particular at the Training Centers – to be the go between and to reach out to their members for volunteers to help us in these educational activities.

The key achievements are self evident in the smiles and gratitude expressed from those colleagues who have either attended courses at the training centers or have participated in a TTT workshop.

Q3: These WGO schools and TTTs have a strong focus on topics such as Assessment and Appraisal, Teaching Procedural Skills and Credentialing and of course on Evidence-Based Medicine. What do attendees like best? Why?

A: The participants who attend TTT are now well aware that we do not teach gastroenterology but introduce them to educational techniques of how to teach gastroenterology. And yet they are amazed and wide-eyed when they are actually exposed to the modules offered. As a teacher and coordinator of the event this is always very encouraging and pleasing.

As a witness to our success I am pleased to say that many of our Alumni have reproduced either full versions or parts of TTTs back in their countries once they have returned. For me there is no greater compliment than to say “I got so much out of the workshop that I wanted to share what I learned with my colleagues”. By the way, we provide all of the material to all participants so that if they wish they can share and reproduce it.

I am not sure that I can say one module is more popular than others. I do believe that the current mix works well and whilst not every participant rates all modules equally high, the responses we obtain suggest that more than 90% of the attendees would rate most of the modules as very good to excellent in meeting their needs.

With regards to the Training Centers, a number of our alumni from these are now eminent gastroenterologists in their country, including heads of departments. It is again of enormous pleasure when at a meeting e.g. the WCOG, when one of our past trainees approaches me to say where they are at with their career and how the training received in one of the training centers had contributed to their advancement in the profession.

Q4: In the TTTs, Trial Design and Critical Appraisal, Publication and Presentations are added as skill related modules that may or may not be taken up dependent on people’s background. Can you say a little more about this? Who wants what?

A: By and large, 100% of the people who attend Train the Trainers view these modules as the ones that they would be most interested in. We run a pre-workshop questionnaire which interrogates the participants of their interest in attending the workshop and these are the ones that usually head the list.

What is also fascinating is that prior to attending the workshop, the modules on Credentialing and Professionalism do not often rank highly. However on the post-workshop evaluation these modules reach the level of appreciation equal to the others. I expect that it may be due to a lack of perceived relevance of the topics of Credentialing and Professionalism until the participants become exposed to them.

Most of the colleagues who attend TTTs are interested in Trial Design, reading journal articles critically and publishing as well as  presenting at meetings. Thus it is no surprise that they are attracted to these modules and rank them highly after the workshop.

Q5: Do you foresee any changes in content or emphasis for your next three TTTs in 2013?

A: There will be three workshops in 2013, a regular TTT in Colombia and two running back-to-back in Porto, Portugal. In Porto we will have an English language regular 4-day workshop which will have some changes but substantially be very similar to the successful one we ran earlier this year in Xi’an, China. One very important change however shall be in the overall coordination of this workshop in that I have passed on the “baton” to my colleague Damon Bizos, from South Africa who will take over from me as TTT Coordinator.

The second workshop in Porto, which will follow on the regular TTT, will be one that I shall coordinate as my “swan song” and this will be a new two-day workshop on Leadership and Management. It promises to be a fascinating workshop as we hope to incorporate in our faculty high profile leaders from the political, business and sporting world, just to see how they do it and what relevance this may have to us as clinician leaders.

In Colombia, we will be running our second Spanish language 4-day TTT in Bogotá. The first Spanish language TTT was run in Porto Alegre, Brazil (Yes, Brazil, where the spoken language is Portuguese!!) last year. It was highly successful and thus leading to the second next year.

I anticipate that in future, as opportunities arise, we will run TTT workshops in other common languages. Two come to mind: French and Mandarin Chinese. I am very thrilled by the opportunity to run this program in other common languages for two reasons. Firstly, it illustrates our commitment to world gastroenterology; and secondly it permits us to communicate complex issues and ideas as in professionalism, to name one area, in the languages used by our colleagues from the non-English speaking countries. Believe me, the release from the restrictions of language make these workshops very invigorating. For just a moment I would like to sing the praise of WGO; I wish to point out that we are the only organization that I know which runs programs in languages other than English, in not only this area but of course in the very successful Global Guidelines as well.

Q6: Do you foresee any changes in content or emphasis for the WGO schools in the near future?

A: The future is looking very bright for our training centers. The generous donation from the American College of Gastroenterology (ACG) of the Education Universe Program is a very exciting and significant event. It is my vision that through this electronic medium we may be able to develop a GI curriculum for the world. Our colleagues in the ACG responsible for its development share this vision, and we hope that together and through the teachers and trainees at the training centers we can achieve this outcome. Wouldn’t it be wonderful if we had an international curriculum recognized for its quality that may serve as the basis for allowing professional recognition of qualifications throughout the world?

An expansion of our internet based educational activities using the academic network is another project which I would hope shall expand through our centers. All of the centers run educational events. My vision is that we may develop a program, such as a television program which will document the activities occurring at each center every week. With the aid of this program any one center might then link-in to the others (time difference permitting) and hence be able to share the educational activities between the different centers.

Q7: After people have attended a TTT or WGO School – suppose one of the attendees goes home and starts the long and arduous process of designing and building an RCT or even a systematic review, or help is needed with writing proposals and writing or translating abstracts or even organizing an evidence base - what help can WGO provide with such projects?

A: Our WGO Research Methodology group has been very productive in trying to help people who desire this help. They have produced extensive documents which are accessible via the WGO website on research methodology. These guidelines are aimed to help anyone who  needs assistance in the conduct of clinical research. In addition to the documents, the Chair of the Research Methodology Committee has offered to assist anyone in trouble either by connecting them with an appropriate person from the WGO community or directing them to further internet based guidelines. I am very grateful to the Chair and the Research Methodology Committee for this generous offer. However as you very well know, to do meaningful research one needs to be taught in a similar way as one is taught to be a good gastroenterologist. Thus, for a person who wants to devote themselves to a career which may include research, then relevant training is very important. Some of this training can be provided at some of our specialist training centers. Our Secretariat would be very pleased to direct any queries to the relevant center.

With regards to accessing published information, the WGO “Ask a librarian” service is a fantastic facility which I believe is unique to our organization. Again I am very grateful to you  for having the foresight to develop such an innovative program.

Q8: And a final more personal question if you allow me - you are based at Flinders University in Adelaide, Australia – do you see gastroenterology in Asia Pacific taking center stage in the next decade? I am asking for a ‘GUT feeling’ – from the gastroenterology ‘heartland.’

A: I am very optimistic about what is happening in gastroenterology in Asia as well as in our local Australia and New Zealand region.

Earlier this year we held a TTT in Xi’an, China. Xi’an was the first capital of a unified China and the home of the Terracotta warriors. Most   importantly for gastroenterology it is also the home base of our host (Professor Fan) for the next WCOG in Shanghai. Those of us who participated at this workshop were very impressed by the enthusiasm of the up and coming Chinese Gastroenterologists, their enquiring minds and their wish to succeed. Furthermore it was impressive to see the support which was provided by their superiors which augurs well for the future of the specialty.

The advances in gastroenterology seen in other Asian countries also mirrors this enthusiasm and will to succeed and contribute. Whether it be Japan, South Korea, India or Hong Kong, to name a few, gastroenterology is progressing in leaps and bounds as evidenced by the enormous volume of research publications coming from the region. As Asian countries emerge as the economic powerhouses of the world, I am  convinced that similar advances will be seen in the academic GI world.

Australia and New Zealand are geographically fortunate to be in this vibrant region and through our Asia Pacific associations and personal connections are an integral part and contributor to this activity in gastroenterology as in other areas of medicine and society.

Locally, our annual Australian Gastroenterology Week remains a very vibrant, attractive and successful meeting. The Gastroenterology Society of Australia (GESA) is central to the training of gastroenterologists and is a very important catalyst for GI research. It has very successfully continued to maintain all of the subspecialties of gastroenterology under the one umbrella organization to the obvious benefit of all. It is a model that others around the world might wish to copy as unity and collaboration leads to extraordinary efficiencies and strength but also great collaborations which in the end not only benefit us as individuals but also serves the needs of the profession and the patients we treat.

Concluding Note

Thank you very much Professor Toouli for talking to e-WGN – we are most grateful to you for sharing your views and vision with our readers.

A. Thank you for allowing me to highlight what are some very unique activities in the world of gastroenterology. Activities which reflect the ethos of this organization we call WGO. You may conclude that I am very biased, and of course I am, but I also feel very fortunate to be able to serve in such a unique and extraordinary organization.