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      Effective teaching of endoscopy: a qualitative study of the perceptions of gastroenterology fellows and attending gastroenterologists

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          Abstract

          Background: There is little information describing the perceptions of gastroenterology fellows and attending gastroenterologists of what constitutes effective teaching of endoscopy. We sought to identify common themes regarding endoscopy training methods and their impact among fellows and attendings.

          Methods: Focus group exercises and surveys were conducted among fellows, about educational resources, teaching techniques and ways of improving the teaching of endoscopy. The fellows identified the ‘best' teachers of endoscopy, who were interviewed regarding their training in endoscopy, their teaching methods, key points of information, and opinions on endoscopy curriculum.

          Results: Nineteen fellows (68%) had attended the American Society for Gastrointestinal Endoscopy First Year Fellows’ Endoscopy course and found it very helpful. Thirteen fellows(46%) had exposure to an endoscopy simulator, but their median duration of use was only 1 hour. Only two out of five fellowship programs used a formal endoscopic skill assessment tool and none of the programs had an endoscopy curriculum of which the fellows were aware. Fellows reported that they learned endoscopy best by performing procedures. They also volunteered that attending gastroenterologists used variable teaching methods, and might benefit from instruction on how to teach endoscopy. Ten attending gastroenterologists (77%) had received training in advanced procedures; none received formal training on teaching endoscopy: they all felt that such training would be beneficial.

          Conclusions: A standardized endoscopy curriculum may be beneficial to fellows, who prefer to learn endoscopy by performing procedures—but they want explicit and specific instruction. Both those attending and the fellows thought that formal instruction for attending gastroenterologists on how to teach endoscopy would be beneficial, indicating a role for a ‘teach-the-teacher' curriculum.

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          Most cited references7

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          Training to competency in colonoscopy: assessing and defining competency standards.

          How to define competency in colonoscopy, how to assess it, and how much training is required are questions that experts in endoscopy have grappled with since the advent of the procedure. To describe methods to assess core endoscopy skills in trainees and learning curves for these parameters and to define competency thresholds for these skills. A prospective descriptive assessment of trainee colonoscopy performance. Mayo Clinic, Rochester, Minnesota. Gastroenterology fellows undergoing endoscopy training. From July 2007 through June 2010, fellows' core cognitive and motor colonoscopy skills were assessed by using the Mayo Colonoscopy Skills Assessment Tool (MCSAT). Average MCSAT item scores and learning curves are described. Minimal competence thresholds for each MSCAT item are established by using the contrasting groups method. Forty-one GI fellows performed 6635 colonoscopies; 4103 procedures (62%) were assessed by using the MCSAT. Average scores of 3.5 set the competency bar for each of the core skills and were reached by 275 procedures on average. Independent cecal intubation rates of 85% and cecal intubation times of 16 minutes or less were also achieved at 275 procedures on average. Limited to a single center. Learning curves for core colonoscopy skills are described. MCSAT scores of 3.5, cecal intubation rates of 85%, and intubation times of less than 16 minutes are recommended as minimal competency criteria. It takes on average 275 procedures to achieve competence in colonoscopy. This is more than previous gastroenterology training recommendations and far more than current training requirements in other specialties. Copyright © 2011 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
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            An adequate level of training for technical competence in screening and diagnostic colonoscopy: a prospective multicenter evaluation of the learning curve.

            Various training programs in colonoscopy recommend that trainees should perform at least 100 to 200 procedures to be considered technically competent at diagnostic colonoscopy. Our purpose was to determine the adequate level of training for technical competence in screening and diagnostic colonoscopy. A prospective multicenter trial. Fifteen tertiary care academic medical centers. Over 8 months we prospectively evaluated the procedures of 24 first-year GI fellows in 15 tertiary care academic medical centers. A total of 4351 colonoscopies were assessed prospectively with variable clinical factors. Cecal intubation was documented by photographing the identified cecal landmarks, including the appendiceal orifice and the ileocecal valve. Acquisition of competence (success rate) was evaluated for colonoscopic training on the basis of 2 objective criteria: (1) adjusted completion rate (>90%) and (2) cecal intubation time (<20 minutes). The overall success rate was 83.5% (3635/4351). The mean cecal intubation time was 9.23 +/- 4.63 minutes. The success rate significantly improved and reached the requisite standard of competence after 150 procedures (71.5%, 82.6%, 91.3%, 94.4%, 98.4%, and 98.7%, respectively, for every 50 consecutive blocks). The polyp detection rate did not improve significantly during the 8 months and was not correlated with the learning curve. In addition, mean time to cecal intubation decreased significantly, from 11.16 to 8.39 minutes, after 150 procedures. Logistic regression analysis found that prolonged cecal intubation was caused by the following factors: elderly patients, female sex, low body mass index, poor bowel preparation, poor American Society of Anesthesiologists status, abdominal pain as an indication, instructor's supervision, and low case volume. We did not record final pathologic reports of detected polyps and withdrawal time. Competence in technically efficient screening and diagnostic colonoscopy generally requires experience with more than 150 cases. Also, factors associated with prolonged cecal intubation for typical trainees did not differ from those for experienced colonoscopists.
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              ASGE's assessment of competency in endoscopy evaluation tools for colonoscopy and EGD.

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                Author and article information

                Journal
                Gastroenterol Rep (Oxf)
                Gastroenterol Rep (Oxf)
                gastro
                gastro
                Gastroenterology Report
                Oxford University Press
                2052-0034
                May 2016
                22 March 2016
                : 4
                : 2
                : 125-130
                Affiliations
                Boston University Medical Center, Boston, MA, USA
                Author notes
                * Corresponding author. 36 East Springfield Street, Apartment 3, Boston, MA 02118, USA. Tel: +1-315-430-4095; Email: Samuel.a.schueler@ 123456gmail.com

                The authors wish it to be known that, in their opinion, the first two authors should be regarded as co-first-authors.

                Article
                gow003
                10.1093/gastro/gow003
                4863192
                27005761
                ed8eaab8-5b00-4d66-a0bd-586db09067cc
                © The Author(s) 2016. Published by Oxford University Press and Sixth Affiliated Hospital of Sun Yat-Sen University.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 05 December 2015
                : 04 January 2016
                : 11 January 2016
                Page count
                Pages: 6
                Categories
                Original Articles

                endoscopy curriculum,teaching endoscopy,gastroenterology fellowship training

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