Introduction

While there is increasing awareness of the importance of microbiota education for healthcare professionals (HCPs), there is variability in the extent of coverage and accessibility of educational resources across different settings and regions.

Aims & Methods

We aimed to evaluate the effectiveness of an online educational program with the learning objectives to understand the critical role of gut microbiota (GM) in health and disease, recognize its significance across the lifespan, and apply evidence-based approaches to clinical practice.
We implemented an enduring on-demand continuing medical education (CME) program consisting of 6 independent 1-hour courses. It is accessible on an EACCME®-accredited CME platform and is delivered by expert faculty in a video micro-learning format, available in 7 languages.
After each course, learners completed an evaluation survey and a 10-question multiple-choice test. AI-based analysis was conducted on survey responses to identify learners’ intention to change. A pre- vs post-assessment model, using 3 multiple-choice questions per course, was employed to evaluate educational effectiveness, with statistical analysis conducted using a paired samples t-test and Cohen’s d with correction to estimate effect size. Data collection spanned from the program launch in July 2021 through April 2024.

Results

5,216 learners from 118 countries enrolled in the program, primarily physicians (led by gastroenterologists, and followed by family medicine and general practice), with nurses also represented.
Evaluation survey ratings (n=1195) indicated high levels of satisfaction, with scores of 4.5/5 for 'Fulfillment of expected learning outcomes,' 4.6/5 for 'Usefulness for professional activity,' and 4.6/5 for 'Scientifically based and balanced information.
91% of participants agreed to implement the learnt information in their practice. We identified the following common themes reflecting intentions to change after completing the courses:

• Patient education (use of probiotics, treatment expectations, importance of GM for health)
• Enhanced management of gastrointestinal conditions such as irritable bowel syndrome
• More cautious use of antibiotics
• Greater emphasis on maternal and child health (breastfeeding, use of probiotics)
• More active probiotics incorporation in daily clinical practice
• More careful probiotic selection (strain specificity, individual patient needs)

Across the program, participants achieved an average of 77% correct responses in the multiple-choice test, with 70.41% correctly answering at least 80% of questions. Analysis of pre- and post-course assessments (n=224; collected Feb-April 2024), showed that the average percentage of correct answers increased from 54.8% at the baseline (pre-course tests) to 73.0% in the post-course tests (p < 0.001), and revealed a moderate educational impact, with a Cohen’s d of 0.59. The percentage of learners who correctly answered all three questions in a course increased from an average of 19.9% at the baseline to 42.1% in the final assessment.

Conclusion

The comprehensive online microlearning-based program saw significant participation from a global audience, attracting not only gastroenterologists but also a diverse range of HCPs. Our data revealed significant improvements in clinicians' knowledge, and intentions to change patient care practices. These findings support the need to update and extend such CME activities to ensure that HCPs are well-equipped to understand and address the role of microbiota in patient care.

Introduction

As a chronic condition, eosinophilic oesophagitis (EoE) requires lifelong therapeutic management and multidisciplinary care. Reports suggest clinicians managing EoE have gaps in knowledge and competence, which may lead to suboptimal patient outcomes. We aimed to assess whether a purpose-specific curriculum comprising a series of continuing medical education (CME) activities addressed these gaps.

Aims & Methods

Four faculty-led, CME-accredited activities on EoE were hosted on two free-to-access online medical education websites. Each activity provided 30–60 minutes of education in short videos and addressed learning objectives based on a review of published literature and expert insights. Educational outcomes were assessed using Moore’s expanded outcomes framework Levels 1–4 (participation, satisfaction, knowledge, and competence, respectively). Intent to change practice and need for further education were also assessed. Level 1 data were captured using Google Analytics; Level 2–4 data were captured using pre- and post-activity questionnaires administered by an independent third party and analysed by the authors. Across the curriculum 21,032 participants engaged with the content, with a sample size of 800 available for the Level 2–4 analysis; the margin of error was calculated as ~3% based on a standard confidence interval of 95%.

Results

Within 12 weeks of launch, a mean of 5,258 participants engaged with each curriculum activity (Moore’s Level 1). Mean satisfaction (Moore’s Level 2) was high (87.3%) across the curriculum. From baseline to follow-up, significant average increases in declarative knowledge (24%, p=0.012), procedural knowledge (18%, p<0.001), and competence (16%, p=0.004) were observed (Moore’s Levels 3a, 3b, and 4, respectively) (Table). Gastroenterologists had the highest proportion of correct answers at follow-up across all activities (86–95%). Allergists/immunologists had the largest increase in knowledge from baseline to follow-up (51%, activity 1); the smallest increase was seen for gastroenterologists (7%, activity 2). For all specialities, the lowest proportion of correct answers at follow-up was for questions on pathophysiology/causes of EoE (Table). Overall, 64% of learners would change their practice following participation in ≥1 curriculum activity and ~20% indicated further education would be beneficial.

Average proportion of clinicians answering questions correctly across the curriculum by Moore’s level (%)			Baseline	Follow-up	P-value
	Level 3a (declarative knowledge)		63	87	0.012
	Level 3b (procedural knowledge)		74	92	<0.001
	Level 4 (competence)		75	91	0.004
Average proportion of clinicians answering questions correctly across the curriculum by speciality and question theme (%)	Pathophysiology of EoE	Immunologists/allergists	56	85	0.011
		Gastroenterologists	61	86
	Chronic nature of EoE / need for long-term management	Immunologists/allergists	92	94
		Gastroenterologists	87	97
	Biologic treatments	Immunologists/allergists	79	92
		Gastroenterologists	77	95

Conclusion

This expert-led, CME curriculum led to significant improvements in clinician knowledge and competence surrounding the latest research and best practices in the pathophysiology, diagnosis, and management of EoE, which may lead to improvements in patient care and outcomes. Findings support further development of online, multiformat educational activities to address clinical knowledge and competence gaps. Future programs should focus on the underlying pathophysiology of EoE and how this may inform practice.

References

None

Disclosure

Stuart Carr discloses: Consulting fees/advisory board: Sanofi. Honoraria (speakers bureau): Sanofi, Biologix.
Evan S. Dellon discloses: Research funding: Adare/Ellodi, Allakos, Arena, AstraZeneca, GSK, Meritage, Miraca, Nutricia, Celgene/Receptos/BMS, Regeneron, Revolo, Shire/Takeda. Consultant: Abbott, Abbvie, Adare/ Ellodi, Aimmune, Akesobio, Alfasigma, ALK, Allakos, Amgen, Aqilion, Arena/Pfizer, Aslan, AstraZeneca, Avir, Biorasi, Calypso, Celgene/Receptos/BMS, Celldex, Eli Lilly, EsoCap, Eupraxia, Ferring, GSK, Gossamer Bio, Holoclara, Invea, Landos, LucidDx, Morphic, Nexstone Immunology, Nutricia, Parexel/Calyx, Phathom, Regeneron, Revolo, Robarts/Alimentiv, Salix, Sanofi, Shire/Takeda, Target RWE, Upstream Bio. Educational grant: Allakos, Holoclara, Invea
Nirmala Gonsalves discloses: Consultant: Allakos, Astra-Zeneca, Regeneron-Sanofi, BMS, Knopp. Speaking: Regeneron-Sanofi. Royalties: Up To Date.
Salvatore Oliva discloses: Consulting fees from Sanofi.
Jonathan M. Spergel discloses: Consultant: Regeneron and Sanofi-Genzyme, Novartis, Allakos. Grants/Research Support: NIH, FARE, Regeneron, Novartis, Sanofi, Celgene. Speaker’s Bureau: Medscape.
Mário C. Vieira: No conflicts of interest associated with the submitted work to declare.
Katie Bickford, Kathy Day, Alex Noble, Anne Nunn and Alison Scott: No financial relationships to disclose.

Introduction

Irritable bowel syndrome (IBS) is a common disorder of gut-brain interaction affecting 5 to 10% of the population, combining chronic abdominal pain and altered bowel transit. Its varied and complex mechanisms make management difficult and can be responsible for impaired quality of life. Patient education is recommended for managing chronic diseases. As part of a patient education program, the first step is to assess patients' knowledge and needs by conducting a shared educational assessment. Experiments conducted in various countries have shown that therapeutic patient education (TPE) can be effective, reducing severity, improving quality of life, and reducing care seeking. These studies have also shown that patients often have a lack of knowledge and/or misconceptions about IBS (1).

Aims & Methods

This study aimed to assess the baseline knowledge level of patients enrolled in a patient education program. Patients with IBS were selected for participation in a TPE program following a multidisciplinary day hospital for IBS. All patients had to have seen a general practitioner and/or a gastroenterologist outside the team without sufficient improvement in their condition. The TPE was based on a document developed in collaboration with a patient organisation (APSSII). This program was divided into five 1-hour sessions (training and discussion time) conducted by different professionals (neurogastroenterologists, clinical psychologist, dietitian) covering the following points:
1) understanding my illness (epidemiology, diagnosis, mechanisms),
2) talking about my illness and expressing my needs (interaction with loved ones, work, doctor, school, rights and support);
3) organizing my daily life, improving my quality of life (impact of IBS on QoL, work, exercise, intimate life);
4) taking advantage of different treatments and care options (placebo, adverse effects, symptomatic and long-term treatment, alternative treatments);
5) the role of eating and diets (balanced diet, lactose-free, gluten-free, low-FODMAP, food allergies, risks of diets). Before the start of each session, questionnaires testing participants' knowledge on the session topic were completed.

Results

From November 2023 to September 2024, 135 questionnaires completed by 43 patients with IBS were included. 70% were women, mean age 45 ± 18 years, subtypes based on IBS transit: IBS-C 55%, IBS-D 33%, IBS-M 12%, with a mean severity (IBS-SSS) of 331 ± 72 points, EQ5D health score of 50 ± 21. Among the most common misconceptions, 25% believed that a diagnosis by endoscopy was possible, 48% believed the disease could be complicated by IBD, and 13% by colon cancer. Regarding treatments, 11% of patients believed that the placebo effect only concerned medications, 58% believed that faecal microbiota transplantation could currently be offered in clinical routine for IBS care, 78% believed that hypnotherapy was only effective if you believe in it, and 68% believed that multi-strain probiotics were more effective than single-strain ones.

Conclusion

This study, conducted in France on patients with moderate or severe forms of IBS, shows a highly variable level of knowledge about their disease depending on the questions, with some significant misconceptions that need to be addressed. These results justify the implementation of therapeutic education for these patients. A study is underway to verify the improvement in patients' knowledge and the existence of a positive impact of this strategy on symptom severity and quality of life.

References

(1) Halpert et al. What Patients Know About Irritable Bowel Syndrome (IBS) and What They Would Like to Know. National Survey on Patient Educational Needs in IBS and Development and Validation of the Patient Educational Needs Questionnaire (PEQ). Am J Gastroenterol 2007; 102:1972-82.

Disclosure

Nothing to disclose

Introduction

Fecal Microbiota Transplantation (FMT) stands as a promising therapeutic approach for gastrointestinal disorders, notably recurrent Clostridioides difficile infection. Despite its potential, the awareness and perceptions surrounding FMT among stakeholders in low and middle-income countries, such as Armenia, remain relatively unexplored.

Aims & Methods

This study aimed to assess awareness and attitudes towards FMT among 4th to 6th-year medical students of Yerevan State Medical University (YSMU), healthcare professionals at Mikayelyan University Hospital, and patients of the same hospital in Armenia. The primary aim is to evaluate awareness and attitudes towards FMT among these groups and, as a conclusion, to increase awareness among the Armenian population, both patients and physicians, and to promote the integration of microbiota-based researches and therapeutic methods in Armenia. Methods: A questionnaire-based study was conducted among 143 medical students from YSMU (Yerevan State Medical University), 56 healthcare professionals (including gastroenterologists, infectious disease specialists, internists, and endoscopists) at Mikayelyan University Hospital, and 82 patients undergoing outpatient and inpatient treatment at the same hospital. Participants were surveyed to gauge their awareness level, perceptions, and willingness regarding FMT.

Results

This study explores the intricate landscape of awareness and attitudes towards Fecal Microbiota Transplantation (FMT) among medical students, healthcare professionals, and hospital patients in Armenia. Delving into their perspectives, this research offers nuanced insights into the reception and readiness for FMT adoption. Among surveyed medical students, university education emerged as the predominant source of knowledge (47.5%), while 43.4% recognized FMT's efficacy in treating Clostridium difficile infection, with notable percentages acknowledging its potential for inflammatory bowel disease (37.3%) and irritable bowel syndrome (12.0%). Among healthcare professionals, insights revealed that conferences/seminars (41.4%) and scientific journals/publications (37.5%) played pivotal roles in information dissemination, with a striking 72.1% recognizing FMT's effectiveness against Clostridium difficile infection. However, challenges such as the lack of clear guidelines (40.3%) and limited donor material availability (25.8%) underscored existing barriers to FMT application. Patient perspectives offered invaluable insights, with 12.5% exhibiting prior awareness of FMT, prompting further exploration into their readiness and reservations. Post-information dissemination, 33.8% expressed a newfound readiness for FMT application, highlighting the pivotal role of education in shaping patient attitudes. Noteworthy concerns among patients included apprehensions regarding the procedure's unpleasantness (52.2%) and the perceived lack of evidence (13.0%). Furthermore, preferred delivery methods, such as oral capsules (70.6%) and colonoscopy (23.5%), shed light on patient preferences and comfort levels.

Conclusion

The study highlights a significant knowledge gap regarding Fecal Microbiota Transplantation (FMT) among medical students, doctors, and patients in Armenia. Specifically, 44.1% of students, 21.4% of doctors, and 83.3% of patients had never heard of FMT. Despite this initial lack of awareness, 33.8% of patients expressed willingness to undergo FMT after receiving explanations. This underscores the potential for education and awareness-raising initiatives to positively impact attitudes towards FMT adoption in Armenia.

Introduction

The use of a gluten-free diet (GFD) in healthy people has been steadily increasing worldwide based upon the unproven belief that avoiding gluten enhances overall wellness. In contrast, evidence indicates that voluntary GFD has an impact on living costs, psychosocial profile and may cause malnutrition in the long-term^1,2. Since dietary changes may significantly affect gut microbiota composition³, we tested whether a 30-day unnecessary GFD in healthy subjects has an impact on diversity and richness of gut microbiota.

Aims & Methods

116 fecal samples were collected from 30 thoroughly examined healthy subjects (21 females, 9 males; 34±14 years) recruited at St. Anna University Hospital in Ferrara, Italy. All subjects had no demonstrable metabolic, cardiovascular, respiratory, rheumatic and neurological illnesses and were asymptomatic for gastrointestinal symptom (established by Gastrointestinal Symptom Rating Scale, GSRS). Stool samples, collected at day 0, and 3, 7, 30 days from GFD were sequenced via shotgun metagenomic and computationally profiled (bioBAkery 3). Data were analyzed on MetaPhlAn 4.0 and HUMAnN 3.0 for taxonomic and functional profiling, respectively and relative abundance transformed via arcsin-sqrt. Only species present at any time point in at least 5 subjects were considered (600 species). Statistical analysis was performed using a linear mixed model and Friedman’s ANOVA. P values were combined and corrected for multiple hypothesis testing (q value).

Results

Species alpha-diversity did not significantly change during 30 days of GFD (p >0.05). However, during the GFD, 14 species significantly decreased (q < 0.05) in relative abundance. Most of the decreased bacteria belonged to Bifidobacterium genus (e.g. Bifidobacterium longum p=0.000000003; q=0.000001) or those involved in complex carbohydrate metabolism.

Conclusion

In healthy subjects, a 30-day GFD did not significantly affect gut eubiosis. However, consistent changes in the relative abundance of gut microbiota species showed a reduction of Bifidobacterium genus thus potentially affecting intestinal and immunological homeostasis and health status⁴.

References

1. Cardo, A. et al. Nutritional Imbalances in Adult Celiac Patients Following a Gluten-Free Diet. Nutrients 13, 2877 (2021).
2. Dennis, M., Lee, A. R. & McCarthy, T. Nutritional Considerations of the Gluten-Free Diet. Gastroenterology Clinics of North America 48, 53–72 (2019).
3. Caio, G. et al. Effect of Gluten-Free Diet on Gut Microbiota Composition in Patients with Celiac Disease and Non-Celiac Gluten/Wheat Sensitivity. Nutrients 12, 1832 (2020).
4. Tojo, R. et al. Intestinal microbiota in health and disease: Role of bifidobacteria in gut homeostasis. World J Gastroenterol 20, 15163–15176 (2014).