Identifying gaps in gastroenterology advanced practice provider onboarding: results from a national survey and early outcomes from a pilot inpatient training curriculum

Abstract

Background and Aims

Advanced practice providers (APPs) play an essential role in gastroenterology (GE), yet structured onboarding practices remain highly variable across practice settings. Limited specialty-specific training may affect provider confidence, clinical readiness, and patient care quality. This study aimed to characterize national GE APP onboarding experiences and evaluate the early outcomes of a pilot inpatient GE training curriculum designed to address identified gaps.

Methods

A 13-item national electronic survey was distributed through the American Gastroenterological Association (AGA) APP listserv to assess onboarding duration, confidence in managing routine GE cases, and desired training topics. Descriptive statistics, the Wilcoxon signed-rank test and McNemar test were used to analyze survey responses. On the basis of key findings, a 4-week competency-based inpatient GE curriculum was implemented at the University of Colorado (Aurora, Colorado, USA). Knowledge acquisition was measured through pretest and post-test assessments, and attending physicians evaluated APP readiness using Accreditation Council for Graduate Medical Education–aligned competency domains.

Results

The survey was distributed to 289 APPs via the AGA APP listserv, with 69 responses received (67 complete; 23% response rate). Before any onboarding, 46.9% reported “not at all” or “slightly confident.” After onboarding (which was <3 months for >80% of respondents), only 39.4% felt “very” or “extremely confident” in managing routine GE cases. In the pilot curriculum, 4 APP participants with prior outpatient GE experience improved their mean knowledge scores from 9.5 out of 13 to 12 out of 13. All participants reported increased confidence, improved team integration, and greater readiness for inpatient care. Attending evaluations reflected progression from developing competence in week 1 to meeting or exceeding expectations by week 4.

Conclusions

National data demonstrate substantial variability and gaps in GE APP onboarding, underscoring the need for structured, competency-based education. The pilot inpatient curriculum significantly improved knowledge, confidence, and observed clinical readiness, suggesting that short, focused training may be an effective model to enhance APP integration and support high-quality GE care.