Global Training in Inflammatory Bowel Disease: Addressing Growing Challenges in IBD

Abstract

Inflammatory Bowel Disease (IBD) is increasing in incidence globally, with low- and middle-income countries (LMICs) facing a rapid surge in disease burden. However, the availability of structured training programs for IBD care remains highly unequal. This review evaluates the current global landscape of IBD workforce training, with an emphasis on identifying gaps and proposing solutions to enhance multidisciplinary preparedness. The IBD care team extends beyond gastroenterologists and includes surgeons, radiologists, pathologists, IBD nurses, dietitians, and mental health professionals. Yet, structured training pathways and credentialing mechanisms are scarce outside of high-income countries. Key barriers include limited access, financial constraints, inadequate infrastructure, and lack of standardized curricula. Emerging digital platforms, simulation-based education, and role-specific training frameworks offer promising strategies. Developing globally harmonized curricula, enhancing funding models, and fostering international collaborations are essential to build a resilient and equitable IBD workforce. Addressing these disparities is critical to improving global IBD outcomes.

Introduction

Inflammatory bowel disease (IBD) is a chronic immune-mediated disorder primarily affecting the gastrointestinal tract, leading to significant morbidity, disability, and economic burden [1]. Once considered a disease of Western Europe and North America, the global incidence and prevalence of IBD have been rising, with newly industrialized and low- and middle-income countries (LMICs) experiencing a particularly rapid increase in disease burden over the past three decades [2, 3]. The resulting strain on healthcare systems in these regions has exposed gaps in workforce capacity, infrastructure, and access to high-quality care [3–5].

IBD is a heterogenous disease, and its management is complex requiring expertise in early diagnosis, therapy optimization, monitoring complications, and addressing comorbidities. Advances in treatment, including biologics and small-molecule therapies, have significantly improved outcomes, but access to these remains highly variable across different healthcare systems. In LMICs, barriers such as high treatment costs, inadequate access to advanced imaging, endoscopy, and histopathology, and a lack of multidisciplinary team (MDT) structures contribute to diagnostic delays and early appropriate treatments. Additionally, differentiating IBD from highly prevalent infectious mimics, such as gastrointestinal tuberculosis, remains a major challenge in many LMICs [6, 7].

This manuscript aimed to provide a structured review of the current state of global IBD training, define the scope of the IBD care workforce, highlight barriers to effective training, and propose practical solutions and innovations to strengthen the global IBD care across disciplines.

Training in the IBD Multidisciplinary Workforce

The rising global burden of IBD has not been matched by adequate training of the specialized workforce required to manage it. This workforce includes gastroenterologists, colorectal surgeons, radiologists, pathologists, nurses, dietitians, and other allied health professionals, each of whom plays a critical role within the IBD multidisciplinary team (MDT) [8–13]. The “5C Concept” emphasizes comprehensive care, collaboration, communication, clinical nurse specialists, and care pathways. Originating from the Chronic Care Model, it has been effectively applied in managing chronic diseases such as diabetes, cardiovascular disease, COPD, asthma, and multimorbidity [14–16]. While integrated training in these clinics has been linked to reduced healthcare utilization and cost savings, some debate its broader economic impact [9, 17]. Emerging models such as the “360 IBD Care” framework advocate for holistic, patient-centered approaches that embed behavioral health specialists, dietitians, clinical pharmacists, and social workers alongside medical providers [18]. These integrated care structures have demonstrated improvements in adherence, quality of life, and reduction in symptom burden, particularly when addressing sleep, pain, and social determinants of health [19–23]. Moreover, these programs address mental health and nutritional needs, ensuring holistic support [24]. For example, the integration of IBD nurses facilitates faster access to investigations and medication adjustments, reducing emergency department visits and hospitalizations [9]. While the gastroenterologist (GI) typically leads care coordination, optimal outcomes depend on the IBD-specific competencies of all MDT members. Structured training efforts, however, remain disproportionately focused on GI, with formal IBD fellowships largely limited to North America and Western Europe [25]. The lack of institutionalized MDT structures in many health systems especially in LMICs, limits interdisciplinary collaboration and perpetuates care variability [26–28]. A global IBD training agenda must therefore extend beyond GI-IBD training to systematically upskill all members of the MDT, with role-specific curricula and credentialing mechanisms that support team-based, value-driven care [29, 30].

Current Landscape of IBD Training

Structured IBD fellowship programs remain limited and unevenly distributed. In the United States and Canada, over 40 adult and pediatric positions are available annually across more than 30 institutions. Europe hosts 15 + institutional fellowships and up to 30 annual placements through UEG and ECCO programs​. In contrast, fewer than 5 programs have been identified in Africa and South America, and approximately 6 in Australia, most of which are embedded within general gastroenterology training. Most offer only one position per year with variable curricula or credentialing (Fig. 1).

Fig. 1.

Geographic disparities in IBD fellowship availability: a color-density representation

The lack of a dedicated curriculum and training in advanced therapies and specific surgical techniques for IBD (e.g., ileocecal resections, colectomies, pouch constructions, or seton placements for fistulizing Crohn’s disease) raises concerns about provider readiness. Barriers especially in LMICs include limited training positions, financial constraints, preference for endoscopy training, and faculty position pressures, with limited research infrastructure and opportunities further compounding these barriers [31]. Additionally, physician emigration from LMICs to high-income countries and ongoing workforce shortages further widen disparities in IBD care [32, 33].

Despite the complexity of IBD care, many gastroenterologists report limited exposure during general GI fellowship. Only 53% rated their training as “excellent,” and fewer than 30% had substantial inpatient experience. Physicians who completed advanced IBD fellowships felt significantly more confident managing pregnancy-related IBD, complicated cases, and perioperative scenarios. Yet, the uptake of such training is hindered by perceived lack of necessity (45%), desire for early faculty roles (42%), and financial barriers (23%). These findings underscore the value of advanced training and the need to expand access, particularly in under-resourced regions [34].

Credentialing and competency frameworks for IBD training remain heterogeneous across regions. In the United States, the Crohn’s & Colitis Foundation (CCF) and American College of Gastroenterology (ACG) have developed Entrustable Professional Activities (EPAs) to define core competencies for advanced IBD fellowship training, with recent proposals to integrate IBD-specific EPAs into general GI fellowships [25, 35]. For pediatric training, surveys from North America have identified gaps in managing pouch and ostomy complications, guiding targeted educational initiatives [36].

In Europe, the variability in training is shaped by economic disparity. The VIPER survey revealed that high-GDP countries are more likely to have IBD units, dedicated MDTs, and access to IBD nurses, psychologists, and dietitians [37]. In the UK, competency-based endoscopy credentialing is in place through the British Society of Gastroenterology, including validated assessment tools for certification [38]. Despite these advancements, global standardization remains limited and uneven, with marked heterogeneity in healthcare systems, training, and access to biologics across Europe [39].

Colorectal surgical training and credentialing frameworks vary significantly across regions. In the United States, colorectal surgeons complete ACGME-accredited fellowships and are certified by the American Board of Colon and Rectal Surgery. While EPAs are being piloted for general surgery residents, they are not yet widely implemented for colorectal surgical training [40, 41]. Europe uses the European Board of Surgical Qualification in coloproctology to standardize colorectal surgery training, though national variability persists [42]. In the UK, competency-based assessments and summative evaluations including those for endoscopy are implemented through the Joint Advisory Group [43]. In contrast, training in LMICs is less standardized, often broad-based due to resource constraints, with limited formal certification or access to advanced technologies [44–46]. LMICs increasingly rely on international collaborations and task-shifting strategies to compensate for surgical workforce shortages [45, 47–50].

Beyond physician training, opportunities for nurses and other allied professionals remain sparse. ECCO offers a structured curriculum and certification pathway for IBD nurses in Europe, while similar role-specific programs are rare elsewhere [51]. For dietitians, mental health professionals, and pharmacists, dedicated IBD-focused education is limited and often informal.

Patients with IBD are at high risk for malnutrition and require tailored nutritional strategies based on disease activity and complications. Dietitians play a critical role in managing enteral/parenteral nutrition, diets tailored for patients with IBD flare including exclusive enteral nutrition, perioperative optimization, and preventing nutrient deficiencies [21, 52]. Specialized training ensures safe, evidence-based care, particularly for high-risk groups such as those with complicated Crohn’s disease, pediatric patients, and hospitalized or perioperative individuals [53].

Structured programs such as those by the Dietitians Committee of European Colitis and Crohns Organization (D-ECCO), the BDA (British Dietetic Association) IBD Group, and EFAD (The European Federation of the Associations of Dietitians) ESDN Gastroenterology (European Specialist Dietetic Network for Gastroenterology) offer targeted education through webinars, case studies, and guidelines [54]. The European Society of parenteral and enteral nutrition (ESPEN) clinical nutrition guidelines further support standardized, high-quality care globally. Expanding access to such avenues of training is essential for incorporating dietitians into the multidisciplinary IBD workforce [55]. The Colitis and Crohns Foundation of India (CCFI) also offers a webinar based training in Diet in IBD through case-based learning.

Moreover, the presence of national IBD societies varies widely. While most high-income countries have established IBD associations that support education and advocacy, many LMICs lack such structures, further limiting access to continuous professional development. This fragmented global landscape highlights the urgent need for coordinated efforts to expand, standardize, and scale IBD training across all MDT roles.

Barriers for IBD Training

The implementation of IBD training programs globally faces several challenges [26–28]. A shortage of trained professionals, compounded by limited opportunities for continuing medical education, further exacerbates the issue. Inadequate infrastructure, including restricted endoscopic capacity and a lack of qualified diagnostic pathologists, complicates accurate diagnosis, especially in regions where gastrointestinal infections mimic IBD. Financial disincentives in endoscopy stem from lower reimbursement rates and increased procedure times in academic settings due to fellow involvement, reducing per-hour revenue, private practice, with more efficient procedures, generates higher earnings. This financial gap discourages private practitioners from engaging in IBD training and strains academic centers [56]. Variability in training programs across different regions results in disparities, with high-income countries having more structured programs and access to multidisciplinary care [37]. Cultural and attitudinal barriers, such as stereotypes and resistance to interprofessional education, also hinder effective training implementation [57]. Additionally, logistical challenges, including scheduling conflicts and geographic constraints, create obstacles for interprofessional education and collaboration [58]. Finally, limited awareness and training on patient-centered care approaches among clinicians restrict the adoption of best practices [59]. Overcoming these barriers requires increased funding, expanded training opportunities, infrastructure improvements, and a commitment to fostering interprofessional collaboration and continuous education.

Proposed Strategies/Solutions for Enhancing IBD Training

Increasing Access to Training

IBD training opportunities can be broadly categorized into two pathways: formal fellowships and virtual/online education. Fellowships offer immersive clinical and procedural experience in high-volume IBD centers. To maximize their impact, these programs should include structured objectives such as post-fellowship mentorship and support for establishing IBD units in fellows’ home countries through regional workshops and cascading training through train-the-trainer models. Training in LMICs should emphasize resource-conscious treatment strategies, optimal use of available therapies, and the integration of telemedicine to reach underserved populations [60].

In contrast, virtual education offers scalable, accessible learning across geographic and resource-limited settings. Virtual IBD training effectively enhances provider expertise in underserved areas through initiatives like the IBD LIVE series and immersive digital intervention such as the"In Their Shoes"program [61, 62]. Effectiveness is measured by knowledge improvement, competence, interobserver agreement, diagnostic accuracy, practice changes, participant satisfaction, and self-efficacy [63, 64]. Studies show significant gains in Continuing Medical Education scores, clinical decision-making, and diagnostic precision, demonstrating the impact of virtual education in bridging knowledge gaps and improving IBD care globally [65].

Notably, the number of online e-learning resources for IBD has grown substantially in recent years substantially (Table 1), bridging gaps in professional knowledge and patient care. Notable examples include platforms developed by societies such as ECCO (e.g., e-ECCO), the CCF (e.g., Virtual Preceptorship), and the Canadian Association of Gastroenterology (ePortal), each offering curated curricula, interactive modules, and updated, evidence-based guidelines. Other programs, such as University of Pittsburgh’s “IBD LIVE,” SEEMLI, and Mentoring in IBD, deliver accredited courses, recorded seminars, and peer-reviewed best practices adaptable to individual learning needs. Independent sites (e.g., Imedex, MyCME) provide additional diverse content, while patient-focused portals (e.g., You and IBD) highlight the increasing use of the internet for health information. Collectively, these resources foster broader awareness, promote interdisciplinary collaboration, and help clinicians stay current in managing complex IBD, though some may reasonably question whether digital platforms can substitute fully for on-site training or direct mentorship [66, 67]. While these resources support flexible, self-paced learning and complement formal fellowships and conferences, they should be integrated with hands-on mentorship and structured clinical exposure to ensure comprehensive IBD training. Emerging technologies such as artificial intelligence–driven virtual radiology and pathology tools also offer novel avenues for enhancing diagnostic accuracy and training, particularly in resource-limited settings [68]. To maximize their impact, these virtual initiatives must be actively promoted through national gastroenterological societies, as underutilization often stems from a lack of awareness rather than limited availability.

Table 1.

IBD online education resources

Resource name	Website Link	Description	Availability	Free or paid
IBD-EII inflammatory bowel disease by Beatriz Gros	https://ibd-eii.com/	This platform is intended to help share evidence-based data regarding inflammatory bowel disease in a summarized way	Global	Free
MILESTONE IBD	NA	A program for advanced IBD fellows focusing on standardized training, networking, and implementation of Entrustable Professional Activities (EPAs)	USA and Canada	Free but only by selection from the steering committee and very competitive
MILESTONE-APP	NA	A longitudinal program designed for advanced practice professionals focusing on IBD patient care	USA and Canada	Free
Mentoring in IBD	https://mentoringinibd.com/	Provides accredited educational materials, publications, and videos by experts in IBD	Global	Free
The IBD Project by Takeda	https://www.theibdproject.com/education/	Offers educational resources and on-demand learning modules on IBD management strategies	Global	Free
IBDIQ Educational Modules	https://www.ibdiq.com/local/staticpage/view.php?page=modules	On-demand education created with IBD specialists to enhance professional knowledge	Global	Free
Visiting Inflammatory Bowel Disease Observership Program	https://www.crohnscolitisfoundation.org/science-and-professionals/education-resources/visiting-ibd-fellow-program	A one-month observership at specialty IBD centers for gastroenterology fellows	USA	Free
Crohn's & Colitis Foundation Online Education Modules	https://www.crohnscolitisfoundation.org/science-and-professionals/education-resources/online-education-modules	Provides cutting-edge educational resources on Crohn's disease and ulcerative colitis	USA	Free
VUMEDI	https://www.vumedi.com/term/inflammatory-bowel-disease/	The knowledge of thousands of esteemed medical educators, improving patient care for all	Global	Free
USA IBD Fellowships List (Crohn’s & Colitis Foundation)	https://www.crohnscolitisfoundation.org/science-and-professionals/education-resources/ibd-careers	Comprehensive list of IBD fellowship opportunities across the USA	USA	Free
ReachMD	https://www.reachmd.com/	Offers educational programs on IBD and other medical fields	Global	Free
E-Mentoring in IBD (Canada)	https://mentoringinibd.com/e-mentoring/	Scientific newsletter series focused on best practices in IBD	Canada	Free
IOIBD Travel Grant	https://www.ioibd.org/	International travel grant supporting IBD research and training	Global	Free
Monday Night IBD	@MondayNightIBD	Educational program featuring discussions and case reviews for IBD specialists on X (Twitter)	Global	Free
Cleveland Clinic Continuing Education	https://www.clevelandclinicmeded.com/	Continuing medical education resources for IBD and gastroenterology	Global	Free
CME outfitters	https://www.cmeoutfitters.com/
You and IBD	http://www.youandibd.com/en-ibd/home	Animations, slide shows, quiz	Global	Free
MyCME	http://www.mycme.com/	Videos, CME	Global	Free
GastroCE	https://cme.healio.com/gastroce/	Articles, lectures, videos, case studies, CME	Global	Free
IBD CME Learning Center -Medscape	https://www.medscape.com/resource/ibd	News, videos, CME	Global	Free
Gastroenterology	https://www.medpagetoday.com/gastroenterology	News, videos	Global	Free
RCGP eLearning, Inflammatory Bowel Disease Toolkit	https://elearning.rcgp.org.uk/course/view.php?id=702	Comprehensive toolkit for IBD management and patient education	Global	Free
Literature Guide in IBD	http://amedeo.com/medicine/ibd.htm	Journal scan email	Global	Free
APAGE Training Fellowship	https://apage.org/fellowships.html	Fellowship program for advanced IBD training in the Asia–Pacific region	Asia–Pacific	Free
National University Hospital Singapore—Honorary Clinical Fellowship and Observership	https://www.nuh.com.sg/research-and-education/honorary-clinical-fellowship-and-clinical-observership	Clinical observership and fellowship opportunities	Asia	Free
Singapore General Hospital—IBD Fellowship	https://www.sgh.com.sg/pgmi/fellowship_attachments/Pages/Local-Advanced-Fellowship-in-Inflammatory-Bowel-Disease.aspx	Advanced local IBD fellowship program	Asia	Free
ECCO e-Learning Platform	https://e-learning.ecco-ibd.eu/	Offers advanced IBD education accessible worldwide	Global	Paid
ACG’s Virtual IBD School	https://gi.org/education/acgs-virtual-ibd-school/	On-demand access to recorded lectures covering various aspects of IBD management	USA	Paid
AGA Education	http://www.gastro.org/education	Accredited courses, CME, MOC	Global	Paid
ESPEN Academy	https://www.espen.org/	Offers structured education and webinars on clinical nutrition, including IBD-relevant modules	Global	Paid
Crohn’s & Colitis UK -Dietitian Resources	https://crohnsandcolitis.org.uk/about-inflammatory-bowel-disease/publications	Educational materials and toolkits for dietitians working with IBD patients	UK/Global	Free

While numerous online platforms support gastroenterology education, dedicated IBD-focused training programs for allied health professionals such as dietitians, nurses, pharmacists, and mental health specialists remain limited

In parallel, fostering a research-oriented culture among IBD specialists in LMICs can improve disease understanding, support context-specific diagnostic and therapeutic strategies, build professional capacity, reduce health disparities, enhance global collaboration, and inform policy and resource allocation [69].

Improving Quality and Educational Outcomes

Enhancing IBD training requires a multifaceted approach, incorporating EPAs to define core competencies, Objective Structured Clinical Examinations (OSCEs) to assess clinical skills, and expanded didactic sessions to improve confidence in complex case management [25, 70, 71]. To standardize education across gastroenterology fellowships, Malter et al. proposed incorporating eight clinically focused EPAs into general training, ensuring consistent IBD education [35]. Simulation-based learning, including virtual reality and endoscopic simulators, fosters procedural mastery through deliberate practice and hands-on training [72, 73]. Clinical decision support tools enhance knowledge and decision-making, while training in endoscopic scoring systems improves diagnostic consistency [63, 65]. Integrating health maintenance education ensures adherence to preventive care [70].

Standardizing Credentialing and Certification

Despite growing interest in IBD training, formal certification mechanisms remain inconsistent. EPAs for advanced IBD fellowship training have been implemented in the U.S., while European programs like the EBSQ (European Board of Surgical Qualification) in coloproctology and the UK’s JAG framework for endoscopic certification provide structured assessment for colorectal surgeons. For allied health professionals, ECCO’s curriculum and certification pathway for IBD nurses offers a replicable model, though similar programs are rare elsewhere. Similarly, D-ECCO, the Dietitians of ECCO, represents a growing community that offers structured educational content tailored to dietitians involved in IBD care. Standardized international credentialing frameworks are needed to unify training benchmarks and ensure consistent competency across regions. Policy interventions are needed to fund training programs and sustain IBD specialist development without financial loss. These strategies collectively bridge training gaps and optimize IBD care delivery. The challenges of IBD training, including limited access to expert mentorship and multidisciplinary care, require targeted solutions to improve global training infrastructure. In parallel, international gastroenterology and IBD societies particularly in Europe and North America could consider offering structured virtual mentorship programs in collaboration with national societies to identify and support emerging IBD specialists, especially in underrepresent regions. Figure 2 provides a visual summary of key barriers and potential strategies to enhance IBD education worldwide.

Fig. 2.

Challenges and Solutions in IBD training: bridging the gaps for global advancement

Expanding Access to Intestinal Ultrasound Training

Intestinal ultrasound (IUS) is a growing non-invasive tool for IBD monitoring, particularly valuable in settings with limited access to endoscopy or MRI. Training programs such as IBUS (International Bowel Ultrasound Group) and GENIUS (Gastrointestinal and ENdointestinal Ultrasound) offer structured education, certification, and hands-on workshops [74, 75]. Including IUS training in IBD curricula, especially in LMICs, can enhance diagnostic accuracy and real-time clinical decision-making at lower cost.

Leveraging Cross-Specialty Training Models: Lessons from Chronic Diseases and Surgery

Several global training models from diabetes, oncology, and surgery offer scalable solutions relevant to IBD education. In diabetes care, initiatives like the ADEPT program in Tanzania have integrated stepwise training for nurses and clinicians using web-based platforms, while Project ECHO® has built virtual communities of practice to mentor primary care providers in under-resourced settings [76, 77]. These models emphasize task-shifting, local empowerment, and virtual mentorship.

In oncology, context-specific fellowships such as the Gynecologic Oncology Fellowship in Ghana and POETIC in Sub-Saharan Africa demonstrate the value of in-country training combined with international academic partnerships [78, 79]. Virtual training platforms like the Global Online Fellowship in Head and Neck Oncology have expanded access to specialist education globally [80].

Surgical education has adopted similar innovations. The West African College of Surgeons (WACS) Surgical Oncology Fellowship developed with Queen’s University, and St. Jude global’s pediatric oncology curriculum, exemplify structured, regionally anchored training [81, 82]. Remote procedural mentoring has also proven effective: in Uganda and Peru, telementored laparoscopic and endoscopic procedures significantly improved provider skills and patient outcomes without requiring relocation [83]. Augmented reality and wearable tele proctoring technologies, piloted in Paraguay and Brazil, have enabled local surgeons to safely adopt advanced techniques [84, 85].

These multidisciplinary and technology-enabled models from other chronic diseases collectively highlight the importance of decentralization, remote mentorship, and tailored credentialing, offering relevant lessons for IBD training.

Conclusion

The rising global burden of IBD calls for concerted efforts to expand and refine training programs, particularly in LMICs. A multifaceted strategy that integrates comprehensive fellowship curricula, virtual learning tools, and multidisciplinary team frameworks has the potential to improve diagnostic accuracy, patient outcomes, and cost-effectiveness. Future research should focus on measuring the long-term impact of these interventions in diverse healthcare environments. Although some may question the feasibility of widespread programmatic change, mobilizing professional societies, policymakers, and educators to invest in standardized and equitable training remains essential to safeguarding the next generation of IBD care. Equitable training frameworks must include non-physician roles. Collaborative efforts between GI societies and allied health care professional societies such as ECCO and EFAD should aim to develop accredited, regionally adaptable allied healthcare education programs for all professionals (e.g., dietitians) involved in IBD care.

Key stakeholders such as ECCO, IOIBD, national GI societies of each country, and ministries of health should collaborate to develop and scale accredited multidisciplinary training frameworks. Priorities should include expanding IBD fellowships, supporting nurse and allied health curricula, and leveraging digital platforms for global access.

Progress should be tracked through indicators such as the number of new fellowship positions, the geographic spread of MDT programs, completion rates of virtual training modules, and longitudinal patient care metrics (e.g., hospitalization rates, guideline adherence). With collective investment in training, capacity building, and international collaboration, we can create a future in which every healthcare provider is equipped to deliver high-quality, equitable IBD care regardless of location.

Abbreviations

ACG

American College of Gastroenterology

ACGME

Accreditation Council for Graduate Medical Education

ADEPT

Action to Develop and Evaluate Patient-focused Training

AGA

American Gastroenterological Association

AHUS

Akershus University Hospital

CCF

Crohn’s & Colitis Foundation

CCM

Chronic Care Model

COPD

Chronic Obstructive Pulmonary Disease

CORI

Clinical Outcomes Research Initiative

D-ECCO

Dietitians of ECCO

EBSQ

European Board of Surgical Qualification

ECCO

European Crohn’s and Colitis Organization

ECHO

Extension for Community Healthcare Outcomes (Project ECHO)

ESPEN

European Society for Clinical Nutrition and Metabolism

EFAD

European Federation of the Associations of Dietitians

ESDN

European Specialist Dietetic Network

GENIUS

Gastrointestinal and ENdointestinal UltraSound

IBUS

International Bowel Ultrasound Group

IBD

Inflammatory Bowel Disease

IOIBD

International Organization for the Study of Inflammatory Bowel Disease

JAG

Joint Advisory Group

LMICs

Low- and Middle-Income Countries

MDT

Multidisciplinary Team

N-ECCO

Nurses of ECCO

OSCE

Objective Structured Clinical Examination

POETIC

Program for Enhanced Training in Cancer

SEEMLI

Standardizing the Evaluation and Education of Mucosal Lesions in IBD

UCLA

University of California, Los Angeles

UEG

United European Gastroenterology

VIPER

Variability in IBD Practice across Europe survey

WACS

West African College of Surgeons

Author Contributions

JD and AJ contributed equally as co-first authors to conceptualizing the manuscript, conducting the literature review, drafting the initial outline, and writing the first draft. AC and RL supported data collection, contributed content on LMIC contexts, and helped refine the structure and references. ICS provided critical revisions related to European training disparities and policy frameworks. VS and SS jointly supervised the project, offered intellectual guidance, and critically reviewed all sections for content and coherence. All authors reviewed and approved the final manuscript.

Funding

No funding was obtained for this project.

Data Availability

No datasets were generated or analysed during the current study.

Declarations

Competing interests

The authors declare no competing interests.