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Gupta A, Wlodarczyk J, Cologne KG. Barriers to Implementation of Advanced Endoscopic Procedures. Clin Colon Rectal Surg 2024; 37:340-345. [PMID: 39132199 PMCID: PMC11309790 DOI: 10.1055/s-0043-1770948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Advanced endoscopy has been shown to be useful in the diagnosis and treatment of both benign and low-grade malignant colorectal lesions. In fact, advanced endoscopic procedures are being adopted as standard approaches to these lesions in many places around the world; however, their implementation in the United States has not been as widespread. We ascribe the difficulty in implementation to two reasons: (1) lack of advanced endoscopic training and (2) failure in reimbursement models as they relate to endoscopy. In this article, we hope to describe these barriers and inspire colorectal surgeons to try and overcome them. As surgical specialists with a mastery of endoscopic techniques, colorectal surgeons would be able to maximize benefit for their patients and minimize health care costs in the long run.
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Affiliation(s)
- Abhinav Gupta
- Division of Colorectal Surgery, Keck School of Medicine, University of Southern California Norris Cancer Center, Los Angeles, California
| | - Jordan Wlodarczyk
- Division of Colorectal Surgery, Keck School of Medicine, University of Southern California Norris Cancer Center, Los Angeles, California
| | - Kyle G. Cologne
- Division of Colorectal Surgery, Keck School of Medicine, University of Southern California Norris Cancer Center, Los Angeles, California
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Sohail AH, Martinez C, Martinez K, Nguyen H, Flesner S, Khan A, Quazi MA, Rasheed W, Ali H, Dahiya DS, Gangwani MK, Aziz M, Goyal A. Can my surgeon scope? Trends in endoscopy training volume and experience among general surgery residents in the United States: a nationwide analysis. Surg Endosc 2024; 38:1491-1498. [PMID: 38242988 DOI: 10.1007/s00464-024-10690-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/03/2024] [Indexed: 01/21/2024]
Abstract
INTRODUCTION Endoscopy is a major part of surgical training. Accreditation Council for Graduate Medical Education (ACGME) has set standards regarding the minimum volume of endoscopy cases required for graduation. However, there is paucity of high-quality data on the number of cases that most surgical graduates perform. METHODS We conducted a retrospective analysis of operative case logs of all general surgery residents graduating from ACGME-accredited programs from 2010 to 2023. Data on mean number of endoscopy cases, including mean in each subcategory, were retrieved. Mann-Kendall trend test was used to investigate trends in endoscopy experience. RESULTS Between 2010 and 2023, the mean overall endoscopy procedures per resident remained stable, with 129.5 in 2010 and 132.1 in 2023 (t = 0.429; p-value = 0.037). The majority of these cases were performed as surgeon junior (76.6% in 2010; 80.9% in 2023), while the remaining cases were logged as surgeon chief. The most substantial contribution to the overall volume was from flexible colonoscopy (mean: 64.1 in 2010 and 67.2 in 2023). The volume for colonoscopy remained fairly stable (t = 0.429; p-value = 0.036). This was followed by esophagogastroduodenoscopy (mean: 35.3 in 2010 and 35.5 in 2023), which saw a significant increase in volume (t = 0.890; p-value ≤ 0.001). There was a significant increase in the number of overall upper endoscopic procedures (t = 0.791; p-value ≤ 0.001), while lower endoscopic procedures did not change significantly (t = 0.319; p-value = 0.125). The procedural volume for endoscopic retrograde cholangiography, sigmoidoscopy, cystoscopy/ureteroscopy, laryngoscopy, and bronchoscopy decreased significantly (p-value < 0.05 for all). CONCLUSION The overall endoscopy volume for general surgery residents has largely remained stable, with a minor increase in esophagogastroduodenoscopy and no change in colonoscopy. Future research should investigate whether simulation-based exercises can bridge the gap between procedural volume and learning curve requirements for endoscopy.
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Affiliation(s)
- Amir Humza Sohail
- University of New Mexico School of Medicine, 1209 Dartmouth Dr NE, Albuquerque, NM, 87106, USA
| | - Christian Martinez
- College of Arts and Sciences, University of New Mexico, Albuquerque, USA
| | - Kevin Martinez
- University of New Mexico School of Medicine, 1209 Dartmouth Dr NE, Albuquerque, NM, 87106, USA.
| | - Hoang Nguyen
- University of New Mexico School of Medicine, 1209 Dartmouth Dr NE, Albuquerque, NM, 87106, USA
| | - Samuel Flesner
- University of New Mexico School of Medicine, 1209 Dartmouth Dr NE, Albuquerque, NM, 87106, USA
| | | | - Mohammed A Quazi
- University of New Mexico School of Medicine, 1209 Dartmouth Dr NE, Albuquerque, NM, 87106, USA
| | - Waqas Rasheed
- Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | - Hassam Ali
- Department of Medicine, East Carolina University, Greenville, NC, USA
| | - Dushyant Singh Dahiya
- Division of Gastroenterology, Hepatology and Motility, The University of Kansas School of Medicine, Kansas City, KS, USA
| | | | - Muhammad Aziz
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Aman Goyal
- Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India
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Antonelli G, Voiosu AM, Pawlak KM, Gonçalves TC, Le N, Bronswijk M, Hollenbach M, Elshaarawy O, Beilenhoff U, Mascagni P, Voiosu T, Pellisé M, Dinis-Ribeiro M, Triantafyllou K, Arvanitakis M, Bisschops R, Hassan C, Messmann H, Gralnek IM. Training in basic gastrointestinal endoscopic procedures: a European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement. Endoscopy 2024; 56:131-150. [PMID: 38040025 DOI: 10.1055/a-2205-2613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
This ESGE Position Statement provides structured and evidence-based guidance on the essential requirements and processes involved in training in basic gastrointestinal (GI) endoscopic procedures. The document outlines definitions; competencies required, and means to their assessment and maintenance; the structure and requirements of training programs; patient safety and medicolegal issues. 1: ESGE and ESGENA define basic endoscopic procedures as those procedures that are commonly indicated, generally accessible, and expected to be mastered (technically and cognitively) by the end of any core training program in gastrointestinal endoscopy. 2: ESGE and ESGENA consider the following as basic endoscopic procedures: diagnostic upper and lower GI endoscopy, as well as a limited range of interventions such as: tissue acquisition via cold biopsy forceps, polypectomy for lesions ≤ 10 mm, hemostasis techniques, enteral feeding tube placement, foreign body retrieval, dilation of simple esophageal strictures, and India ink tattooing of lesion location. 3: ESGE and ESGENA recommend that training in GI endoscopy should be subject to stringent formal requirements that ensure all ESGE key performance indicators (KPIs) are met. 4: Training in basic endoscopic procedures is a complex process and includes the development and acquisition of cognitive, technical/motor, and integrative skills. Therefore, ESGE and ESGENA recommend the use of validated tools to track the development of skills and assess competence. 5: ESGE and ESGENA recommend incorporating a multimodal approach to evaluating competence in basic GI endoscopic procedures, including procedural thresholds and the measurement and documentation of established ESGE KPIs. 7: ESGE and ESGENA recommend the continuous monitoring of ESGE KPIs during GI endoscopy training to ensure the trainee's maintenance of competence. 9: ESGE and ESGENA recommend that GI endoscopy training units fulfil the ESGE KPIs for endoscopy units and, furthermore, be capable of providing the dedicated personnel, infrastructure, and sufficient case volume required for successful training within a structured training program. 10: ESGE and ESGENA recommend that trainers in basic GI endoscopic procedures should be endoscopists with formal educational training in the teaching of endoscopy, which allows them to successfully and safely teach trainees.
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Affiliation(s)
- Giulio Antonelli
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome, Italy
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
| | - Andrei M Voiosu
- Department of Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Katarzyna M Pawlak
- Endoscopy Unit, Gastroenterology Department, Hospital of the Ministry of Interior and Administration, Szczecin, Poland
- The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Tiago Cúrdia Gonçalves
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Nha Le
- Gastroenterology Division, Internal Medicine and Hematology Department, Semmelweis University, Budapest, Hungary
| | - Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
- Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium
| | - Marcus Hollenbach
- Division of Gastroenterology, Medical Department II, University of Leipzig Medical Center, Leipzig, Germany
| | - Omar Elshaarawy
- Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Menoufia, Egypt
| | | | - Pietro Mascagni
- IHU Strasbourg, Strasbourg, France
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Theodor Voiosu
- Department of Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Maria Pellisé
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Mário Dinis-Ribeiro
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
- MEDCIDS/Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Marianna Arvanitakis
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, Leuven, Belgium
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, Leuven, Belgium
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Helmut Messmann
- Department of Gastroenterology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Ian M Gralnek
- Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine Technion Israel Institute of Technology, Haifa, Israel
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Finocchiaro M, Banfi T, Donaire S, Arezzo A, Guarner-Argente C, Menciassi A, Casals A, Ciuti G, Hernansanz A. A Framework for the Evaluation of Human Machine Interfaces of Robot-Assisted Colonoscopy. IEEE Trans Biomed Eng 2024; 71:410-422. [PMID: 37535479 DOI: 10.1109/tbme.2023.3301741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
The Human Machine Interface (HMI) of intraluminal robots has a crucial impact on the clinician's performance. It increases or decreases the difficulty of the tasks, and is connected to the users' physical and mental stress. OBJECTIVE This article presents a framework to compare and evaluate different HMIs for robotic colonoscopy, with the objective of identifying the optimal HMI that minimises the clinician's effort and maximises the clinical outcomes. METHODS The framework comprises a 1) a virtual simulator (clinically validated), 2) wearable sensors measuring the cognitive load, 3) a data collection unit of metrics correlated to the clinical performance, and 4) questionnaires exploring the users' impressions and perceived stress. The framework was tested with 42 clinicians investigating the optimal device for tele-operated control of robotic colonoscopes. Two control devices were selected and compared: a haptic serial-kinematic device and a standard videogame joypad. RESULTS The haptic device was preferred by the endoscopists, but the joypad enabled better clinical performance and reduced cognitive and physical load. CONCLUSION The framework can be used to evaluate different aspects of a HMI, both hardware and software, and determine the optimal HMI that can reduce the burden on clinicians while improving the clinical outcome. SIGNIFICANCE The findings of this study, and of future studies performed with this framework, can inform the design and development of HMIs for intraluminal robots, leading to improved clinical performance, reduced physical and mental stress for clinicians, and ultimately better patient outcomes.
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Arimoto J, Chiba H, Yamada K, Nishiguchi T, Kobayashi M, Okada N, Suto T, Niikura T, Kuwabara H, Nakaoka M, Ida T. Cold snare defect protrusion and incomplete polyp resection after forced cold snare polypectomy: a prospective observational study. Endoscopy 2024; 56:14-21. [PMID: 37769690 DOI: 10.1055/a-2183-5505] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
BACKGROUND Cold snare defect protrusions (CSDPs) that occur after cold snare polypectomy (CSP) are considered indicators of incomplete polyp resection (IPR). We have sometimes experienced difficulty resecting polyps with snaring alone; in such cases, a forcible pull on the snare by the endoscopist is necessary. We call this procedure "forced CSP (FCSP)." However, no previous studies have evaluated this procedure. METHODS This was a prospective observational study. From November 2020 to June 2021, the frequency, safety, and validity of FCSP were evaluated at our hospital. We distinguished CSP with snaring alone performed by the assistant as conventional CSP, and CSP requiring a forcible pull on the snare by the endoscopist as FCSP. RESULTS Of 1315 polyps removed, 105 underwent FCSP (8%). The perforation rate was 0% in both groups. The rate of CSDP after the procedure was 96.2% (101/105) with FCSP and 6.4% (77/1210) with conventional CSP (P<0.001). The rate of IPR was 12.5% (13/104) with FCSP and 6.2% (75/1208) with conventional CSP (P=0.02). Multivariable analysis identified polyps located in the cecum (risk ratio [RR], 1.13; 95%CI 1.050-1.179; P=0.003) and polyps ≥6mm in diameter (RR, 2.37; 95%CI 2.146-2.542; P<0.001) as independent risk factors for FCSP. CONCLUSIONS FCSP was performed on 105 polyps (8%) in this study. FCSP may be associated with the occurrence of CSDP and IPR. Further studies are necessary to confirm our results.
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Affiliation(s)
- Jun Arimoto
- Gastroenterology, Omori Red Cross Hospital, Ota-ku, Japan
| | - Hideyuki Chiba
- Gastroenterology, Omori Red Cross Hospital, Ota-ku, Japan
| | - Keiji Yamada
- Gastroenterology, Omori Red Cross Hospital, Ota-ku, Japan
| | | | | | - Naoya Okada
- Gastroenterology, Omori Red Cross Hospital, Ota-ku, Japan
| | - Takuma Suto
- Gastroenterology, Omori Red Cross Hospital, Ota-ku, Japan
| | | | | | | | - Tomonori Ida
- Gastroenterology, Omori Red Cross Hospital, Ota-ku, Japan
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Yao L, Li X, Wu Z, Wang J, Luo C, Chen B, Luo R, Zhang L, Zhang C, Tan X, Lu Z, Zhu C, Huang Y, Tan T, Liu Z, Li Y, Li S, Yu H. Effect of artificial intelligence on novice-performed colonoscopy: a multicenter randomized controlled tandem study. Gastrointest Endosc 2024; 99:91-99.e9. [PMID: 37536635 DOI: 10.1016/j.gie.2023.07.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/21/2023] [Accepted: 07/22/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND AND AIMS The efficacy and safety of colonoscopy performed by artificial intelligence (AI)-assisted novices remain unknown. The aim of this study was to compare the lesion detection capability of novices, AI-assisted novices, and experts. METHODS This multicenter, randomized, noninferiority tandem study was conducted across 3 hospitals in China from May 1, 2022, to November 11, 2022. Eligible patients were randomized into 1 of 3 groups: the CN group (control novice group, withdrawal performed by a novice independently), the AN group (AI-assisted novice group, withdrawal performed by a novice with AI assistance), or the CE group (control expert group, withdrawal performed by an expert independently). Participants underwent a repeat colonoscopy conducted by an AI-assisted expert to evaluate the lesion miss rate and ensure lesion detection. The primary outcome was the adenoma miss rate (AMR). RESULTS A total of 685 eligible patients were analyzed: 229 in the CN group, 227 in the AN group, and 229 in the CE group. Both AMR and polyp miss rate were lower in the AN group than in the CN group (18.82% vs 43.69% [P < .001] and 21.23% vs 35.38% [P < .001], respectively). The noninferiority margin was met between the AN and CE groups of both AMR and polyp miss rate (18.82% vs 26.97% [P = .202] and 21.23% vs 24.10% [P < .249]). CONCLUSIONS AI-assisted colonoscopy lowered the AMR of novices, making them noninferior to experts. The withdrawal technique of new endoscopists can be enhanced by AI-assisted colonoscopy. (Clinical trial registration number: NCT05323279.).
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Affiliation(s)
- Liwen Yao
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China; Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China; Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xun Li
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China; Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China; Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhifeng Wu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China; Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China; Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jing Wang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China; Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China; Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chaijie Luo
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China; Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China; Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Boru Chen
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China; Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China; Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Renquan Luo
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China; Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China; Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lihui Zhang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China; Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China; Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chenxia Zhang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China; Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China; Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xia Tan
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China; Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China; Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zihua Lu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China; Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China; Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ci Zhu
- Digestive Endoscopy Center, Wuhan Eighth Hospital, Wuhan, China
| | - Yuan Huang
- Digestive Endoscopy Center, Wuhan Eighth Hospital, Wuhan, China
| | - Tao Tan
- Department of Endoscopy, The Third People's Hospital of Hubei Province, Wuhan, China
| | - Zhifeng Liu
- Department of Endoscopy, The Third People's Hospital of Hubei Province, Wuhan, China
| | - Ying Li
- Digestive Endoscopy Center, Wuhan Eighth Hospital, Wuhan, China
| | - Shuyu Li
- Department of Endoscopy, The Third People's Hospital of Hubei Province, Wuhan, China
| | - Honggang Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China; Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China; Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China.
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Bohler F, Garden A. Issues of informed consent for non-specialists conducting colorectal cancer screenings. J Osteopath Med 2024; 124:39-42. [PMID: 37691518 DOI: 10.1515/jom-2023-0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/24/2023] [Indexed: 09/12/2023]
Abstract
The United States is currently facing a physician shortage crisis including a lack of specialist providers. Due to this shortage of specialists, some primary care providers offer colorectal cancer screenings in communities with few gastroenterologists, especially in under-resourced areas such as rural regions of the United States. However, discrepancies in training and procedural outcomes raise concerns regarding informed consent for patients. Because osteopathic physicians play a critical role in addressing the physician shortage in these under-resourced communities, this commentary may be especially useful because they are likely to encounter these ethical complexities in their day-to-day practice.
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Affiliation(s)
- Forrest Bohler
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Allison Garden
- Edward Via College of Osteopathic Medicine - Carolinas Campus, Spartanburg, SC, USA
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8
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Tayal A, Pahwa B, Chaurasia B, Gendle C, Sahoo SK, Singh A, Gupta SK, Dhandapani S. The Call for Neuroendoscopy Cadaveric Workshops in Lower-Middle Income Countries. World Neurosurg 2023; 180:e537-e549. [PMID: 37778622 DOI: 10.1016/j.wneu.2023.09.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE This study aims to assess the impact of the workshops organized during Neuroendocon 23 on the perspective and confidence of neurosurgeons toward endoscopy in a lower-middle income country. METHODS Neuroendocon 23 had cranial and spinal endoscopy cadaveric workshops with 30 delegates each. A pre and postworkshop survey was disseminated among the delegates, and statistical analysis was performed with SPSS (version 26) using P < 0.05. RESULTS A total of 24 delegates (40%) consented to participate in the study, with only 1 female respondent (4.17%). After the cranial endoscopy workshop, there was an increase in the level of confidence of delegates in cranial endoscopic approaches (P < 0.001). Similarly, after the spine endoscopy workshop, the respondents had increased confidence in managing spine conditions with the endoscopic approach (P = 0.040), to the extent that they preferred the endoscopic over the microsurgical technique (P < 0.001). All respondents (n = 24, 100%) believed that endoscopy should be promoted in lower-middle income countries and integrated into residency curricula. CONCLUSIONS Cranial and spinal endoscopy cadaveric workshops could be the first step in stimulating the interest of neurosurgeons in endoscopy.
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Affiliation(s)
- Anish Tayal
- Medical Student, University College of Medical Sciences and G.T.B. Hospital, Delhi, India
| | - Bhavya Pahwa
- Medical Student, University College of Medical Sciences and G.T.B. Hospital, Delhi, India
| | - Bipin Chaurasia
- Consultant Neurosurgeon, Neurosurgery Clinic, Birgunj, Nepal
| | | | | | | | - Sunil K Gupta
- Department of Neurosurgery, PGIMER, Chandigarh, India
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9
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Scarallo L, Russo G, Renzo S, Lionetti P, Oliva S. A journey towards pediatric gastrointestinal endoscopy and its training: a narrative review. Front Pediatr 2023; 11:1201593. [PMID: 37576143 PMCID: PMC10416625 DOI: 10.3389/fped.2023.1201593] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023] Open
Abstract
Background and aims Gastrointestinal (GI) endoscopy in pediatric setting has unique features and, therefore, requires an approach that is tailored to pediatric practice. There is still heterogeneity between training programs worldwide in terms of duration, number of procedures and assessment during and at the end of the training process. Methods We conducted a narrative review aiming to describe and summarize the existing literature on the various training methods for pediatric GI endoscopy to highlight the significance of specific pediatric endoscopy training. Results Simulation-based tools have been implemented in several training programs, providing a safer learning environment for trainees, especially in their earlier stages of training. Assessment of competence is gradually shifting from the sole evaluation of procedural numbers towards the development of more reliable and valid tools that can accurately measure technical competence. Despite such seismic shift, there is still a need for a standardized and comprehensive pediatric-oriented endoscopy curriculum that incorporates acquisition of procedural skills education and is built on the current competency-based model of training. All the above must sink their roots in trainees and to ensure that the endoscopists of tomorrow are capable of delivering high quality of care for children undergoing endoscopy. Conclusion It is crucial to parallelly focus on the way trainers teach trainees. In this context, the implementation of "train the trainers" courses has improved important quality meters in GI endoscopy. Future research should put the focus on the potential subsequent favorable benefits of these changes on child health.
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Affiliation(s)
- Luca Scarallo
- Gastroenterology and Nutrition Unit, Meyer Children Hospital IRCCS, Florence, Italy
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Giusy Russo
- Pediatric Gastroenterology and Liver Unit, Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Sara Renzo
- Gastroenterology and Nutrition Unit, Meyer Children Hospital IRCCS, Florence, Italy
| | - Paolo Lionetti
- Gastroenterology and Nutrition Unit, Meyer Children Hospital IRCCS, Florence, Italy
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
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Keating E, Leyden J, O'Connor DB, Lahiff C. Unlocking quality in endoscopic mucosal resection. World J Gastrointest Endosc 2023; 15:338-353. [PMID: 37274555 PMCID: PMC10236981 DOI: 10.4253/wjge.v15.i5.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/24/2023] [Accepted: 04/12/2023] [Indexed: 05/16/2023] Open
Abstract
A review of the development of the key performance metrics of endoscopic mucosal resection (EMR), learning from the experience of the establishment of widespread colonoscopy quality measurements. Potential future performance markers for both colonoscopy and EMR are also evaluated to ensure continued high quality performance is maintained with a focus service framework and predictors of patient outcome.
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Affiliation(s)
- Eoin Keating
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Jan Leyden
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Donal B O'Connor
- Department of Surgery, Tallaght University Hospital, Dublin 24, Ireland
- School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Conor Lahiff
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
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11
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Wang K, Xu WT, Kou WJ, Qi XS. Factors affecting cecal intubation time during colonoscopy. Shijie Huaren Xiaohua Zazhi 2023; 31:105-112. [DOI: 10.11569/wcjd.v31.i3.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
In recent years, the morbidity and mortality of colorectal cancer (CRC) have increased significantly in China, and it has become one of the major malignancies that threaten the health of residents. Colonoscopy is the gold standard for the diagnosis of CRC. High-quality colonoscopy can effectively reduce the mortality of CRC. Cecal intubation time (CIT) is one of the indicators to reflect the quality of colonoscopy. Studies have found that many factors can affect CIT. This paper reviews the literature to identify the factors that affect CIT, such as those related to doctors, patients, assistive technologies, and equipment, in order to improve the quality of colonoscopy performed by endoscopists.
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Affiliation(s)
- Ke Wang
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China,Postgraduate College, China Medical University, Shenyang 110122, Liaoning Province, China
| | - Wen-Tao Xu
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China,Postgraduate College, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning Province, China
| | - Wen-Jing Kou
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Xing-Shun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
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12
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Siau K, Pelitari S, Green S, McKaig B, Rajendran A, Feeney M, Thoufeeq M, Anderson J, Ravindran V, Hagan P, Cripps N, Beales ILP, Church K, Church NI, Ratcliffe E, Din S, Pullan RD, Powell S, Regan C, Ngu WS, Wood E, Mills S, Hawkes N, Dunckley P, Iacucci M, Thomas-Gibson S, Wells C, Murugananthan A. JAG consensus statements for training and certification in colonoscopy. Frontline Gastroenterol 2023; 14:201-221. [PMID: 37056319 PMCID: PMC10086724 DOI: 10.1136/flgastro-2022-102260] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/04/2022] [Indexed: 01/28/2023] Open
Abstract
IntroductionIn the UK, endoscopy certification is awarded when trainees attain minimum competency standards for independent practice. A national evidence-based review was undertaken to update and develop standards and recommendations for colonoscopy training and certification.MethodsUnder the oversight of the Joint Advisory Group (JAG), a modified Delphi process was conducted between 2019 and 2020 with multisociety expert representation. Following literature review and Grading of Recommendations, Assessment, Development and Evaluations appraisal, recommendation statements on colonoscopy training and certification were formulated and subjected to anonymous voting to obtain consensus. Accepted statements were peer reviewed by JAG and relevant stakeholders for incorporation into the updated colonoscopy certification pathway.ResultsIn total, 45 recommendation statements were generated under the domains of: definition of competence (13), acquisition of competence (20), assessment of competence (8) and postcertification support (4). The consensus process led to revised criteria for colonoscopy certification, comprising: (1) achieving key performance indicators defined within British Society of Gastroenterology standards (ie, unassisted caecal intubation rate >90%, rectal retroversion >90%, polyp detection rate >15%+, polyp retrieval rate >90%, patient comfort <10% with moderate–severe discomfort); (2) minimum procedure count 280+; (3) performing 15+ procedures over the preceding 3 months; (4) attendance of the JAG Basic Skills in Colonoscopy course; (5) terminal ileal intubation rates of 60%+ in inflammatory bowel disease; (6) satisfying requirements for formative direct observation of procedure skills (DOPS) and direct observation of polypectomy skills (Size, Morphology, Site, Access (SMSA) level 2); (7) evidence of reflective practice as documented on the JAG Endoscopy Training System reflection tool; (8) successful performance in summative DOPS.ConclusionThe UK standards for training and certification in colonoscopy have been updated, culminating in a single-stage certification process with emphasis on polypectomy competency (SMSA Level 2+). These standards are intended to support training, improve standards of colonoscopy and polypectomy, and provide support to the newly independent practitioner.
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Affiliation(s)
- Keith Siau
- Department of Gastroenterology, Royal Cornwall Hospitals NHS Trust, Truro, Cornwall, UK
- University of Birmingham College of Medical and Dental Sciences, Birmingham, Birmingham, UK
| | - Stavroula Pelitari
- Department of Gastroenterology, Royal Free London NHS Foundation Trust, London, London, UK
| | - Susi Green
- Department of Gastroenterology, University Hospitals Sussex NHS Foundation Trust, Worthing, West Sussex, UK
| | - Brian McKaig
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, Wolverhampton, UK
| | - Arun Rajendran
- Department of Gastroenterology, Hillingdon Hospitals NHS Foundation Trust, Uxbridge, Greater London, UK
| | - Mark Feeney
- Department of Gastroenterology, Torbay and South Devon NHS Foundation Trust, Torquay, Torbay, UK
| | - Mo Thoufeeq
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, Sheffield, UK
| | - John Anderson
- Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, Gloucestershire, UK
| | - Vathsan Ravindran
- Gastroenterology, St Mark's Hospital and Academic Institute Wolfson Unit for Endoscopy, Harrow, London, UK
| | - Paul Hagan
- Endoscopy, Royal Derby Hospital, Derby, UK
| | - Neil Cripps
- Colorectal Surgery, University Hospitals Sussex NHS Foundation Trust, Worthing, West Sussex, UK
| | - Ian L P Beales
- Department of Gastroenterology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
- University of East Anglia, Norwich, Norfolk, UK
| | | | - Nicholas I Church
- Department of Gastroenterology, NHS Lothian, Edinburgh, Edinburgh, UK
| | - Elizabeth Ratcliffe
- Faculty of Medical and Human Sciences, The University of Manchester, Manchester, Manchester, UK
- Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, Wigan, UK
| | - Said Din
- Department of Gastroenterology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Rupert D Pullan
- Colorectal Surgery, Torbay and South Devon NHS Foundation Trust, Torquay, Torbay, UK
| | - Sharon Powell
- Endoscopy, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, Wolverhampton, UK
| | - Catherine Regan
- Endoscopy, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, Wolverhampton, UK
| | - Wee Sing Ngu
- Colorectal Surgery, City Hospitals Sunderland NHS Foundation Trust, South Shields, Tyne and Wear, UK
| | - Eleanor Wood
- Department of Gastroenterology, Homerton University Hospital NHS Foundation Trust, London, London, UK
| | - Sarah Mills
- Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
- Imperial College London, London, UK
| | - Neil Hawkes
- Department of Gastroenterology, Royal Glamorgan Hospital, Llantrisant, UK
| | - Paul Dunckley
- Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, Gloucestershire, UK
| | - Marietta Iacucci
- University of Birmingham College of Medical and Dental Sciences, Birmingham, Birmingham, UK
- Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK
| | - Siwan Thomas-Gibson
- Imperial College London, London, UK
- St Mark's Hospital and Academic Institute Wolfson Unit for Endoscopy, Harrow, London, UK
| | - Christopher Wells
- Department of Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Hartlepool, Hartlepool, UK
| | - Aravinth Murugananthan
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, Wolverhampton, UK
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
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13
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Madhoun MF, Bader N, Ali I, Yohannan B, Grossen A, Nadeem M, Corredine TJ, Harty R. Factors Associated with Difficulty Maintaining Insufflation of the Colon During Endoscopy. Dig Dis Sci 2023; 68:202-207. [PMID: 35759158 DOI: 10.1007/s10620-022-07592-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/24/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Insufflation of the colon allows for adequate visualization of the mucosal tissue and advancement of the endoscope during colonoscopy. Most colonoscopies are performed with sedation to mitigate discomfort and enhance the colonoscopy experience for both the patient and the endoscopist. AIM We aimed to evaluate factors associated with difficulty maintaining insufflation. METHODS A cross-sectional study of individuals undergoing colonoscopy at the Oklahoma City Veterans Affairs Medical Center was performed. Experiencing difficulty maintaining air insufflation during colonoscopy was assessed with a questionnaire completed by the performing endoscopist at the end of procedure. Information regarding procedure times, sedation used, demographics, comorbidities, surgical history, and medications used was extracted from the medical record. A multivariate regression analysis was performed to identify factors associated with difficulty maintaining air insufflation. A P value < 0.05 was considered significant. RESULTS 996 Patients were included for the analysis. Difficulty with insufflation was reported in 240 (24%) colonoscopies; mean age of 63.8 ± 10.4 years old and 13% were female. Fellow trainees were involved in 669 (67%) colonoscopies. Older age (OR 1.02, P 0.03, CI [1.00-1.04]), diabetes (OR 1.5, 95% CI [1.03, 2.05]), fellow's involvement (OR 2.6. (95% CI [1.68, 4.09]), total procedure time (OR 1.02, 95% CI [1.00, 1.03]), mean number of adenomas (OR 1.05, 95% CI [1.00, 1.09]), and MAC use (OR 2.6, 95% CI [1.80, 3.85]) were independent predictors for difficulty in maintaining air insufflation. CONCLUSION Our findings suggest that endoscopists should be cognizant of colon insufflation issues in older, diabetic patients undergoing colonoscopies under deep sedation, particularly if prolonged procedure is anticipated or encountered.
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Affiliation(s)
- Mohammad F Madhoun
- Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Veterans Affairs Medical Center, Oklahoma City, OK, USA.,Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Nimrah Bader
- Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Ijlal Ali
- Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Veterans Affairs Medical Center, Oklahoma City, OK, USA.,Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Bryce Yohannan
- Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Alyssa Grossen
- Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Mahum Nadeem
- Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Thomas J Corredine
- Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Veterans Affairs Medical Center, Oklahoma City, OK, USA.,Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Richard Harty
- Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Veterans Affairs Medical Center, Oklahoma City, OK, USA.,Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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14
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Iqbal U, Diehl DL. Do surgery residents and gastroenterology fellows learn colonoscopy at different rates? Gastrointest Endosc 2022; 96:308-309. [PMID: 35715238 DOI: 10.1016/j.gie.2022.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 04/21/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Umair Iqbal
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - David L Diehl
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA
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15
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Geographic distribution of colonoscopy providers in the United States: An analysis of medicare claims data. Surg Endosc 2022; 36:7673-7678. [PMID: 35729404 DOI: 10.1007/s00464-022-09083-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 01/25/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Screening colonoscopy is one of the few procedures that can prevent cancer. While the majority of colonoscopies in the USA are performed by gastroenterologists, general surgeons play a key role in at-risk, rural populations. The aim of this study was to examine geographic practice patterns in colonoscopy using a nationwide Medicare claims database. METHODS AND PROCEDURES The 2017 Medicare Provider Utilization and Payment database was used to identify physicians performing colonoscopy. Providers were classified as gastroenterologists, surgeons, ambulatory surgical centers (ASCs), or other. Rural-Urban Commuting Area classification at the zip code level was used to determine whether the practice location for an individual provider was in a rural area/small town (< 10,000 people), micropolitan area (10-50,000 people), or metropolitan area (> 50,000 people). RESULTS Claims data from 3,861,187 colonoscopy procedures on Medicare patients were included. The majority of procedures were performed by gastroenterologists (57.2%) and ASCs (32.1%). Surgeons performed 6.8% of cases overall. When examined at a zip code level, surgeons performed 51.6% of procedures in small towns/rural areas and 21.7% of procedures in micropolitan areas. Individual surgeons performed fewer annual procedures as compared to gastroenterologists (median 51 vs. 187, p < 0.001). CONCLUSIONS Surgeons perform the majority of colonoscopies in rural zip codes on Medicare patients. High-quality, surgical training in endoscopy is essential to ensure access to colonoscopy for patients outside of major metropolitan areas.
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16
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Barducci L, Scaglioni B, Martin J, Obstein KL, Valdastri P. Active Stabilization of Interventional Tasks Utilizing a Magnetically Manipulated Endoscope. Front Robot AI 2022; 9:854081. [PMID: 35494547 PMCID: PMC9047764 DOI: 10.3389/frobt.2022.854081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/17/2022] [Indexed: 01/16/2023] Open
Abstract
Magnetically actuated robots have become increasingly popular in medical endoscopy over the past decade. Despite the significant improvements in autonomy and control methods, progress within the field of medical magnetic endoscopes has mainly been in the domain of enhanced navigation. Interventional tasks such as biopsy, polyp removal, and clip placement are a major procedural component of endoscopy. Little advancement has been done in this area due to the problem of adequately controlling and stabilizing magnetically actuated endoscopes for interventional tasks. In the present paper we discuss a novel model-based Linear Parameter Varying (LPV) control approach to provide stability during interventional maneuvers. This method linearizes the non-linear dynamic interaction between the external actuation system and the endoscope in a set of equilibria, associated to different distances between the magnetic source and the endoscope, and computes different controllers for each equilibrium. This approach provides the global stability of the overall system and robustness against external disturbances. The performance of the LPV approach is compared to an intelligent teleoperation control method (based on a Proportional Integral Derivative (PID) controller), on the Magnetic Flexible Endoscope (MFE) platform. Four biopsies in different regions of the colon and at two different system equilibria are performed. Both controllers are asked to stabilize the endoscope in the presence of external disturbances (i.e. the introduction of the biopsy forceps through the working channel of the endoscope). The experiments, performed in a benchtop colon simulator, show a maximum reduction of the mean orientation error of the endoscope of 45.8% with the LPV control compared to the PID controller.
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Affiliation(s)
- Lavinia Barducci
- STORM Lab United Kingdom, Institute of Robotics, Autonomous Systems and Sensing, School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom
| | - Bruno Scaglioni
- STORM Lab United Kingdom, Institute of Robotics, Autonomous Systems and Sensing, School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom
| | - James Martin
- STORM Lab United Kingdom, Institute of Robotics, Autonomous Systems and Sensing, School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom
| | - Keith L. Obstein
- STORM Lab United States, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Pietro Valdastri
- STORM Lab United Kingdom, Institute of Robotics, Autonomous Systems and Sensing, School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom
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17
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Van Berkel N, Opie J, Ahmad OF, Lovat L, Stoyanov D, Blandford A. Initial Responses to False Positives in AI-Supported Continuous Interactions: A Colonoscopy Case Study. ACM T INTERACT INTEL 2022. [DOI: 10.1145/3480247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The use of artificial intelligence (AI) in clinical support systems is increasing. In this article, we focus on AI support for continuous interaction scenarios. A thorough understanding of end-user behaviour during these continuous human-AI interactions, in which user input is sustained over time and during which AI suggestions can appear at any time, is still missing. We present a controlled lab study involving 21 endoscopists and an AI colonoscopy support system. Using a custom-developed application and an off-the-shelf videogame controller, we record participants’ navigation behaviour and clinical assessment across 14 endoscopic videos. Each video is manually annotated to mimic an AI recommendation, being either true positive or false positive in nature. We find that time between AI recommendation and clinical assessment is significantly longer for incorrect assessments. Further, the type of medical content displayed significantly affects decision time. Finally, we discover that the participant’s clinical role plays a large part in the perception of clinical AI support systems. Our study presents a realistic assessment of the effects of imperfect and continuous AI support in a clinical scenario.
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Affiliation(s)
- Niels Van Berkel
- Aalborg University, Denmark and University College London, London, United Kingdom
| | - Jeremy Opie
- University College London, London, United Kingdom
| | | | - Laurence Lovat
- University College London Hospitals, London, United Kingdom
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18
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Abstract
Background: The COVID-19 pandemic has had a negative impact on the training process for resident physicians. The objective of this study was to evaluate the impact of the COVID-19 pandemic on professional training, and also the subjective perception of the levels of stress, anxiety, and depression among resident doctors specializing in gastroenterology in Romania. Methods: We conducted an observational cross-sectional study, for a period of two months, among 180 resident doctors specializing in gastroenterology, working in university hospitals in Romania. A questionnaire consisting of 29 questions distributed through social media platforms was completed in Google Forms. Statistical analyses were performed using IBM SPSS software v.20. Results: A linear relationship was identified between the number of daily hospitalizations in the gastroenterology department and the rate of SARS-CoV-2 infection among resident physicians. In total, 80% of the participants reported an increase in the levels of stress, anxiety, and depression during the COVID-19 pandemic, and 88.3% stated that they were unsatisfied by online courses. Conclusions: The COVID-19 pandemic has had negative effects on both professional training and levesl of stress, anxiety and depression of resident doctors specializing in gastroenterology. In the specialty of gastroenterology there may be certain peculiarities, due to the interventional aspects that this medical specialty involves, for example, endoscopic procedures. Thus, the necessity to acquire practical skills in addition to theoretical knowledge increases the negative impact on gastroenterology internship.
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19
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Ten Cate O, Taylor DR. The recommended description of an entrustable professional activity: AMEE Guide No. 140. MEDICAL TEACHER 2021; 43:1106-1114. [PMID: 33167763 DOI: 10.1080/0142159x.2020.1838465] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Entrustable professional activities (EPAs) have received much attention in the literature since they were first proposed in 2005. Useful guidelines, workshops, courses, and conferences have supported faculty in developing programs and designing assessment procedures using EPAs and entrustment decision-making. Yet, the need for clarification remains, particularly as more programs make the step from design to implementation.Well-written EPAs provide a natural construct to establish the outcome of training. To be useful, EPAs require more than a suitable title. This AMEE Guide elaborates eight sections of a full EPA description, and provides explanations and justifications for each. These sections are: title; specification and limitations; risks in case of failure; most relevant competency domains; knowledge, skills, attitudes and experiences; information sources to assess progress and support summative entrustment; entrustment/supervision level expected at which stage of training; and time period to expiration if not practiced.Constructing fully elaborated EPAs creates a shared mental model amongst learners and programs, informs competency-based curriculum design, directs ad-hoc and formal entrustment decision-making, and provides standards for certifying bodies and boundaries for scope of practice. The framework intends to support curricular leaders looking to adopt new EPAs, or revise and define established EPAs for competency-based education.
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Affiliation(s)
- Olle Ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | - David R Taylor
- Department of Medicine, Queen's University, Kingston, Canada
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20
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Paleti S, Sobani ZA, McCarty TR, Gutta A, Gremida A, Shah R, Nutalapati V, Bazerbachi F, Jesudoss R, Amin S, Okwara C, Kathi PR, Ahmed A, Gessel L, Hung K, Masoud A, Yu J, Mony S, Akshintala V, Jamil L, Nasereddin T, Kochhar G, Vyas N, Saligram S, Garg R, Sandhu D, Benrajab K, Konjeti R, Agnihotri A, Trivedi H, Grunwald M, Mayer I, Mohanty A, Rustagi T. Impact of COVID-19 on gastroenterology fellowship training: a multicenter analysis of endoscopy volumes. Endosc Int Open 2021; 9:E1572-E1578. [PMID: 34540553 PMCID: PMC8445682 DOI: 10.1055/a-1526-1419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/19/2021] [Indexed: 12/02/2022] Open
Abstract
Background and study aims The COVID-19 pandemic has had a profound impact on gastroenterology training programs. We aimed to objectively evaluate procedural training volume and impact of COVID-19 on gastroenterology fellowship programs in the United States. Methods This was a retrospective, multicenter study. Procedure volume data on upper and lower endoscopies performed by gastroenterology fellows was abstracted directly from the electronic medical record. The study period was stratified into 2 time periods: Study Period 1, SP1 (03/15/2020 to 06/30/2020) and Study Period 2, SP2 (07/01/2020 to 12/15/2020). Procedure volumes during SP1 and SP2 were compared to Historic Period 1 (HP1) (03/15/2019 to 06/30/2019) and Historic Period 2 (HP2) (07/01/2019 to 12/15/2019) as historical reference. Results Data from 23 gastroenterology fellowship programs (total procedures = 127,958) with a median of 284 fellows (range 273-289; representing 17.8 % of all trainees in the United States) were collected. Compared to HP1, fellows performed 53.6 % less procedures in SP1 (total volume: 28,808 vs 13,378; mean 105.52 ± 71.94 vs 47.61 ± 41.43 per fellow; P < 0.0001). This reduction was significant across all three training years and for both lower and upper endoscopies ( P < 0.0001). However, the reduction in volume was more pronounced for lower endoscopy compared to upper endoscopy [59.03 % (95 % CI: 58.2-59.86) vs 48.75 % (95 % CI: 47.96-49.54); P < 0.0001]. The procedure volume in SP2 returned to near baseline of HP2 (total volume: 42,497 vs 43,275; mean 147.05 ± 96.36 vs 150.78 ± 99.67; P = 0.65). Conclusions Although there was a significant reduction in fellows' endoscopy volume in the initial stages of the pandemic, adaptive mechanisms have resulted in a return of procedure volume to near baseline without ongoing impact on endoscopy training.
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Affiliation(s)
- Swathi Paleti
- Division of Gastroenterology and Hepatology University of New Mexico, Albuquerque, NM
| | - Zain A. Sobani
- Division of Gastroenterology and Hepatology University of New Mexico, Albuquerque, NM
| | - Thomas R. McCarty
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School. Boston, Massachusetts, United States
| | - Aditya Gutta
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Anas Gremida
- Division of Gastroenterology and Hepatology, Washington University School of Medicine, St Louis, Missouri, United States
| | - Raj Shah
- Division of Gastroenterology and Hepatology, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Venkat Nutalapati
- Division of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Fateh Bazerbachi
- Division of Gastroenterology and Hepatology, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Randhir Jesudoss
- Division of Gastroenterology and Hepatology, University of Iowa, Iowa City, Iowa, United States
| | - Shreya Amin
- Division of Gastroenterology and Hepatology, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Chinemerem Okwara
- Division of Gastroenterology and Hepatology, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Pradeep Reddy Kathi
- Division of Gastroenterology and Hepatology, University of Arizona School of Medicine, Tuscon, Arizona, United States
| | - Ali Ahmed
- Division of Gastroenterology and Hepatology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
| | - Luke Gessel
- Division of Gastroenterology and Hepatology, University of Utah, Salt Lake City, Utah, United States
| | - Kenneth Hung
- Division of Gastroenterology and Hepatology, Yale School of Medicine, New Haven, Connecticut, United States
| | - Amir Masoud
- Division of Gastroenterology and Hepatology, Yale School of Medicine, New Haven, Connecticut, United States
| | - Jessica Yu
- Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, Oregon, United States
| | - Shruti Mony
- Division of Gastroenterology and Hepatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Venkata Akshintala
- Division of Gastroenterology and Hepatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Laith Jamil
- Division of Gastroenterology and Hepatology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, United States
| | - Thayer Nasereddin
- Division of Gastroenterology and Hepatology, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
| | - Gursimran Kochhar
- Division of Gastroenterology and Hepatology, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
| | - Neil Vyas
- Division of Gastroenterology and Hepatology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
| | - Shreyas Saligram
- Division of Gastroenterology and Hepatology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
| | - Rajat Garg
- Division of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio, United States
| | - Dalbir Sandhu
- Division of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio, United States
| | - Karim Benrajab
- Division of Gastroenterology and Hepatology, University of Kentucky, Lexington, Kentucky, United States
| | - Rajesh Konjeti
- Division of Gastroenterology and Hepatology, University of Kentucky, Lexington, Kentucky, United States
| | - Abhishek Agnihotri
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Hirsh Trivedi
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Matthew Grunwald
- Division of Gastroenterology and Hepatology, Maimonides Medical Center, New York, New York, United States
| | - Ira Mayer
- Division of Gastroenterology and Hepatology, Maimonides Medical Center, New York, New York, United States
| | - Arpan Mohanty
- Division of Gastroenterology and Hepatology, Boston University School of Medicine, Boston, Massachusetts, United States
| | - Tarun Rustagi
- Division of Gastroenterology and Hepatology University of New Mexico, Albuquerque, NM
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21
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Dong Z, Sun H, Li B, Zhang Q, Sun K, Wang Z, Qian X, Wang J, Zhan T, Jiang Y, Chen Y, Xu S. Comprehensive evaluation of the learning curve to achieve satisfactory adenoma detection rate. J Gastroenterol Hepatol 2021; 36:1649-1655. [PMID: 33105040 DOI: 10.1111/jgh.15314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/08/2020] [Accepted: 10/17/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM The number of colonoscopies required to reach satisfactory adenoma detection rate (ADR) is not well established. The aim of this study was to identify the appropriate number of procedures required to attain satisfactory ADR for those well-trained endoscopists who have a cecal intubation rate (CIR) ≥ 90% and start to perform colonoscopy independently. METHODS All endoscopists with compelete independent colonoscopy data during career in our database were enrolled. The number of procedures required to achieve ADR ≥ 20% was identified by cumulative summation (Cusum), learning curve Cusum (LC-Cusum), and moving average method. Mixed effect logistic regression model was developed to determine the relationship between endoscopist as well as patient-related factors and adenoma detection. RESULTS A total of 24 943 procedures and 14 endoscopists were enrolled. By Cusum analysis, the interest point was at 207 procedures. By LC-Cusum analysis, 71% (10/14) and 86% (12/14) of endoscopists had attained satisfactory ADR after 200 and 300 procedures, respectively. By moving average method, endoscopists reached a mean ADR of 20% at 216 and 261 procedures over blocks of 50 and 100 procedures, respectively. The total number of procedures, number of daily procedures, patient age and gender, bowel preparation, sedation, and diverticulosis were significantly associated with adenoma detection. CONCLUSIONS This is the first study to investigate the learning curve of ADR for those well-trained endoscopists who have a CIR ≥ 90% and start to perform colonoscopy independently. Two hundred procedures might be an optimal number required to reach an ADR ≥ 20%.
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Affiliation(s)
- Zhiyu Dong
- Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Huihui Sun
- Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Bo Li
- Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qiongmei Zhang
- Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Kejing Sun
- Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhenxiang Wang
- Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xue Qian
- Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Junwen Wang
- Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tingting Zhan
- Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuanxi Jiang
- Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ying Chen
- Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shuchang Xu
- Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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22
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Rajendran A, Thomas-Gibson S, Bassett P, Dunckley P, Rameshshanker R, Sevdalis N, Haycock A. Lower gastrointestinal polypectomy competencies in the United Kingdom: a retrospective analysis of Directly Observed Polypectomy Skills (DOPyS). Endoscopy 2021; 53:629-635. [PMID: 32767282 DOI: 10.1055/a-1234-8233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Polypectomy is often the most hazardous part of colonoscopy. There is significant variability in polypectomy training and assessment internationally. DOPyS (Directly Observed Polypectomy Skills) is a validated assessment tool and is used to demonstrate polypectomy competency in the UK. This study aimed to describe the learning curve for polypectomy competency in UK trainees. METHODS Retrospective DOPyS data (January 2009 to September 2015) were obtained from the UK Joint Advisory Group (JAG) for intestinal endoscopy training system (JETS) national database. The number of lower gastrointestinal (LGI) procedures, overall cecal intubation rate (CIR), procedure intensity, and time in days to the first DOPyS assessment were recorded, and time to JAG certification was calculated. RESULTS 4965 DOPyS assessments from 336 trainees were analyzed. Within the study period, 124 and 53 trainees achieved provisional and full colonoscopy certification, respectively. Trainees started formative assessment of polypectomy after > 130 LGI procedures and with a CIR of > 70 %. Within 3 years from the first DOPyS assessment, 94 % of trainees achieved provisional certification, and 50 % full certification. Higher procedure intensity at baseline DOPyS assessment was associated with a higher likelihood of obtaining certification sooner. CONCLUSION There is a significant variation in time to competency, and this potentially reflects the time necessary to acquire polypectomy skills. There is a need to start polypectomy training earlier, once sufficient skills, such as tip control, have been achieved to shorten the time to competency. Overall, the CIR could be used as a guide for such technical skills. Increasing exposure to training lists also potentially reduces the time to polypectomy competency.
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Affiliation(s)
- Arun Rajendran
- Department of Gastroenterology, Hillingdon Hospitals NHS Foundation Trust, Uxbridge, London, UK.,The Wolfson Unit of Endoscopy, St Mark's Hospital and Academic Institute, Harrow, London, UK.,Centre for Implementation Science, Kings College London, London, UK
| | - Siwan Thomas-Gibson
- The Wolfson Unit of Endoscopy, St Mark's Hospital and Academic Institute, Harrow, London, UK.,Imperial College London, London, UK
| | | | - Paul Dunckley
- Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Rajaratnam Rameshshanker
- Department of Gastroenterology, Hillingdon Hospitals NHS Foundation Trust, Uxbridge, London, UK.,The Wolfson Unit of Endoscopy, St Mark's Hospital and Academic Institute, Harrow, London, UK.,Imperial College London, London, UK
| | - Nick Sevdalis
- Centre for Implementation Science, Kings College London, London, UK
| | - Adam Haycock
- The Wolfson Unit of Endoscopy, St Mark's Hospital and Academic Institute, Harrow, London, UK.,Imperial College London, London, UK
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23
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Brydges R, Boyd VA, Tavares W, Ginsburg S, Kuper A, Anderson M, Stroud L. Assumptions About Competency-Based Medical Education and the State of the Underlying Evidence: A Critical Narrative Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:296-306. [PMID: 33031117 DOI: 10.1097/acm.0000000000003781] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE As educators have implemented competency-based medical education (CBME) as a framework for training and assessment, they have made decisions based on available evidence and on the medical education community's assumptions about CBME. This critical narrative review aimed to collect, synthesize, and judge the existing evidence underpinning assumptions the community has made about CBME. METHOD The authors searched Ovid MEDLINE to identify empirical studies published January 2000 to February 2019 reporting on competence, competency, and CBME. The knowledge synthesis focused on "core" assumptions about CBME, selected via a survey of stakeholders who judged 31 previously identified assumptions. The authors judged, independently and in pairs, whether evidence from included studies supported, did not support, or was mixed related to each of the core assumptions. Assumptions were also analyzed to categorize their shared or contrasting purposes and foci. RESULTS From 8,086 unique articles, the authors reviewed 709 full-text articles and included 189 studies reporting evidence related to 15 core assumptions. Most studies (80%; n = 152) used a quantitative design. Many focused on procedural skills (48%; n = 90) and assessed behavior in clinical settings (37%; n = 69). On aggregate, the studies produced a mixed evidence base, reporting 362 data points related to the core assumptions (169 supportive, 138 not supportive, and 55 mixed). The 31 assumptions were organized into 3 categories: aspirations, conceptualizations, and assessment practices. CONCLUSIONS The reviewed evidence base is significant but mixed, with limited diversity in research designs and the types of competencies studied. This review pinpoints tensions to resolve (where evidence is mixed) and research questions to ask (where evidence is absent). The findings will help the community make explicit its assumptions about CBME, consider the value of those assumptions, and generate timely research questions to produce evidence about how and why CBME functions (or not).
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Affiliation(s)
- Ryan Brydges
- R. Brydges is research director, a scientist, and professor of technology-enabled education, Allan Waters Family Simulation Centre, St. Michael's Hospital, and associate professor, Department of Medicine and Wilson Centre for Research in Education, University of Toronto and University Health Network, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0001-5203-7049
| | - Victoria A Boyd
- V.A. Boyd is a PhD student, Institute of Health Policy, Management and Evaluation, University of Toronto, and a research fellow, Wilson Centre for Research in Education, University of Toronto and University Health Network, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0003-3602-8964
| | - Walter Tavares
- W. Tavares is a scientist, Wilson Centre for Research in Education, University of Toronto and University Health Network, and assistant professor, Post MD Education, Department of Medicine, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0001-8267-9448
| | - Shiphra Ginsburg
- S. Ginsburg is professor, Department of Medicine, University of Toronto, a scientist, Wilson Centre for Research in Education, University of Toronto and University Health Network, and Canada Research Chair in Health Professions Education, Mt Sinai Hospital, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0002-4595-6650
| | - Ayelet Kuper
- A. Kuper is associate professor and faculty co-lead, Person-Centred Care Education, Department of Medicine, University of Toronto, a scientist and associate director, Wilson Centre for Research in Education, University of Toronto and University Health Network, and a staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0001-6399-6958
| | - Melanie Anderson
- M. Anderson is an information specialist, University Health Network, Toronto, Ontario, Canada
| | - Lynfa Stroud
- L. Stroud is associate professor, Department of Medicine, University of Toronto, a Centre researcher, Wilson Centre for Research in Education, University of Toronto and University Health Network, and a staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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24
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Mamunes AP, Campisano F, Martin J, Scaglioni B, Mazomenos E, Valdastri P, Obstein KL. Magnetic flexible endoscope for colonoscopy: an initial learning curve analysis. Endosc Int Open 2021; 9:E171-E180. [PMID: 33532555 PMCID: PMC7834699 DOI: 10.1055/a-1314-9860] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 10/13/2020] [Indexed: 12/19/2022] Open
Abstract
Background and study aims Colonoscopy is a technically challenging procedure that requires extensive training to minimize discomfort and avoid trauma due to its drive mechanism. Our academic team developed a magnetic flexible endoscope (MFE) actuated by magnetic coupling under supervisory robotic control to enable a front-pull maneuvering mechanism, with a motion controller user interface, to minimize colon wall stress and potentially reduce the learning curve. We aimed to evaluate this learning curve and understand the user experience. Methods Five novices (no endoscopy experience), five experienced endoscopists, and five experienced MFE users each performed 40 trials on a model colon using 1:1 block randomization between a pediatric colonoscope (PCF) and the MFE. Cecal intubation (CI) success, time to cecum, and user experience (NASA task load index) were measured. Learning curves were determined by the number of trials needed to reach minimum and average proficiency-defined as the slowest average CI time by an experienced user and the average CI time by all experienced users, respectively. Results MFE minimum proficiency was achieved by all five novices (median 3.92 trials) and five experienced endoscopists (median 2.65 trials). MFE average proficiency was achieved by four novices (median 14.21 trials) and four experienced endoscopists (median 7.00 trials). PCF minimum and average proficiency levels were achieved by only one novice. Novices' perceived workload with the MFE significantly improved after obtaining minimum proficiency. Conclusions The MFE has a short learning curve for users with no prior experience-requiring relatively few attempts to reach proficiency and at a reduced perceived workload.
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Affiliation(s)
- Alexander P. Mamunes
- Division of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Federico Campisano
- Mechanical Engineering Department, Vanderbilt University, Nashville, Tennessee, United States
| | - James Martin
- STORM Lab UK, School of Electronic and Electrical Engineering, University of Leeds, Leeds, UK
| | - Bruno Scaglioni
- STORM Lab UK, School of Electronic and Electrical Engineering, University of Leeds, Leeds, UK
| | - Evangelos Mazomenos
- STORM Lab UK, School of Electronic and Electrical Engineering, University of Leeds, Leeds, UK
| | - Pietro Valdastri
- STORM Lab UK, School of Electronic and Electrical Engineering, University of Leeds, Leeds, UK
| | - Keith L. Obstein
- Mechanical Engineering Department, Vanderbilt University, Nashville, Tennessee, United States
- Division of Gastroenterology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
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25
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Huang C, Hopkins R, Huang K, Demers L, Wasan S. Standardizing Endoscopy Training: A Workshop for Endoscopy Educators. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:11015. [PMID: 33204839 PMCID: PMC7666836 DOI: 10.15766/mep_2374-8265.11015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 06/17/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Endoscopy education in the US traditionally follows the apprenticeship model, in which educators often have little formal training in education, and the acquisition of procedural skills by trainees relies heavily on procedure volume and learning by doing. A growing appreciation of the need to formally educate endoscopy trainers has led to the development of mandatory training curricula in other countries, but the implementation of such courses in the US has been limited. This 1-hour workshop aimed to provide educators the rationale and skills to offer a more standardized approach to procedural training. METHODS We implemented a 1-hour interactive workshop designed for both gastroenterology faculty and trainees. The four sections of the workshop focused on: (1) rationale for standardized approach, (2) verbal and physical preparation for training, (3) training using standardized language and avoidance of cognitive overload, and (4) providing feedback. Four interactive video cases followed by large-group discussion were included. RESULTS A total of 13 gastroenterology faculty and trainees attended the workshop. Eight additional members of the gastroenterology faculty watched an online video of the workshop. Survey data revealed that the workshop was effective in helping faculty set goals with trainees (Mpre = 2.4, Mpost = 3.6), identify standardized language to use during endoscopy (Mpre = 3.1, Mpost = 3.8), and give feedback after sessions (Mpre = 3.4, Mpost = 4.1). DISCUSSION A 1-hour lecture-based interactive workshop with video cases was an engaging and effective introduction to formal endoscopy education techniques. The format was easy to incorporate into faculty conferences and can help bridge the current gap in formal endoscopy faculty training.
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Affiliation(s)
- Christopher Huang
- Director of Endoscopy, Clinical Associate Professor, Section of Gastroenterology, Department of Medicine, Boston University School of Medicine
| | - Reid Hopkins
- Fellow in Gastroenterology, Department of Medicine, Boston University School of Medicine
| | - Kevin Huang
- Resident, Department of Medicine, Boston University School of Medicine
| | - Lindsay Demers
- Assistant Professor, Department of Medicine, Boston University School of Medicine
| | - Sharmeel Wasan
- Fellowship Program Director, Assistant Professor, Section of Gastroenterology, Department of Gastroenterology, Boston University School of Medicine
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26
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Martin JW, Scaglioni B, Norton JC, Subramanian V, Arezzo A, Obstein KL, Valdastri P. Enabling the future of colonoscopy with intelligent and autonomous magnetic manipulation. NAT MACH INTELL 2020; 2:595-606. [PMID: 33089071 PMCID: PMC7571595 DOI: 10.1038/s42256-020-00231-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/01/2020] [Indexed: 12/24/2022]
Abstract
Early diagnosis of colorectal cancer significantly improves survival. However, over half of cases are diagnosed late due to demand exceeding the capacity for colonoscopy - the "gold standard" for screening. Colonoscopy is limited by the outdated design of conventional endoscopes, associated with high complexity of use, cost and pain. Magnetic endoscopes represent a promising alternative, overcoming drawbacks of pain and cost, but struggle to reach the translational stage as magnetic manipulation is complex and unintuitive. In this work, we use machine vision to develop intelligent and autonomous control of a magnetic endoscope, for the first time enabling non-expert users to effectively perform magnetic colonoscopy in-vivo. We combine the use of robotics, computer vision and advanced control to offer an intuitive and effective endoscopic system. Moreover, we define the characteristics required to achieve autonomy in robotic endoscopy. The paradigm described here can be adopted in a variety of applications where navigation in unstructured environments is required, such as catheters, pancreatic endoscopy, bronchoscopy, and gastroscopy. This work brings alternative endoscopic technologies closer to the translational stage, increasing availability of early-stage cancer treatments.
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Affiliation(s)
| | | | | | | | - Alberto Arezzo
- Department of Surgical Science, University of Torino, Corso Dogliotti, Turin, Italy
| | - Keith L. Obstein
- STORM Lab USA, Vanderbilt University, Nashville, USA
- Vanderbilt University Medical Centre, Nashville, TN, USA
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27
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Frimberger E, Klare P, Haller B, Elnegouly M, Bajbouj M, Schmid RM, von Delius S, Abdelhafez M. Preliminary assessment of two novel mechanical colonoscopic polypectomy simulators: Description, evaluation and validation. Endosc Int Open 2020; 8:E1522-E1529. [PMID: 33043124 PMCID: PMC7541194 DOI: 10.1055/a-1186-8420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 03/02/2020] [Indexed: 12/15/2022] Open
Abstract
Background and study aims Colonoscopic polypectomy is an essential endoscopic skill. The simulators available for training are limited and based on raw porcine colons. Animal intestines are inconvenient and offer limited advantages for polypectomy training. These limitations are avoided by two novel mechanical simulators - the magnetic system based simulator (MSPS) and the simulator for polypectomy with high frequency current (HFPS) - described here. They are equipped to demonstrate self-repair of polyps after making a cut and hybrid polyps. The aim of this study was to describe and establish face, content, and construct validity of the two simulators and to assess their perceived utility as training and assessment tools. Methods Ten novice, seven intermediate, and 10 advanced endoscopists participated in this study. Each one performed two polypectomies in MSPS and then one polypectomy and polyp retrieval in HFPS. The median times were compared among the three groups to preliminarily assess construct validity as a primary outcome. To establish face validity, the novices and intermediates completed a questionnaire about the credibility of each simulator after finishing the tasks. For content validity, the experts completed a questionnaire grading different aspects of the simulators' realism and their usefulness for training. Results All 27 participants completed the modules. Median times needed to complete the tasks in both simulators differed significantly between the participants with different levels of experience ( P < 0.05). Both MSPS and HFPS received favorable scores regarding face and content validity. No technical problems were encountered. Conclusion This study provides preliminary validation for MSPS and HFPS as useful training tools in a preclinical setting as well as during colonoscopy training. Moreover, we demonstrated the construct validity of both simulators, which confirms their use as a skill assessment tool during a colonoscopy training program.
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Affiliation(s)
| | - Peter Klare
- Klinik und Poliklinik für Innere Medizin, Munich, Germany
| | - Bernhard Haller
- Institut für Medizinische Statistik und Epidemiologie, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Mayada Elnegouly
- Klinik und Poliklinik für Innere Medizin, Munich, Germany,Department of infectious diseases and endemic Hepatology and Gastroenterology, Kasr Alainy Hospital, Cairo University, Cairo, Egypt
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28
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Ou A, Shin CM, Goodman AJ, Poles MA, Popov VB. Endoscopic part-task training box scores correlate with endoscopic outcomes. Surg Endosc 2020; 35:3592-3599. [PMID: 32720176 DOI: 10.1007/s00464-020-07830-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 07/15/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Competency in endoscopy has traditionally been based on number of procedures performed. With movement towards milestone-based accreditation, new standards of establishing competency are required. The Thompson Endoscopic Skills Trainer (TEST) is a training device previously shown to differentiate between novice and expert endoscopists. This study aims to correlate TEST scores to other markers of performance in endoscopy. METHODS Trainees of a gastroenterology fellowship program were guided through the TEST. Their scores and sub-scores were correlated to their endoscopic metrics of performance, including adenoma detection rate, cecal intubation rate, cecal intubation time, withdrawal time, fentanyl usage, midazolam usage, pain score, overall procedure time, and performance on the ASGE Assessment of Competency in Endoscopy Tool (ACE Tool). RESULTS The Overall Score positively correlated with the ACE Tool Total Score (r = 0.707, p = 0.010) and sub-scores (Cognitive Skills Score: r = 0.624, p = 0.030; Motor Skills Score: r = 0.756, p = 0.004), and negatively correlated with cecal intubation time (r = - 0.591, p = 0.043). The Gross Motor Score positively correlated with cecal intubation rate (r = 0.593, p = 0.042), ACE Tool Total Score (r = 0.594, p = 0.042) and Motor Skills Score (r = 0.623, p = 0.031), and negatively correlated with cecal intubation time (r = - 0.695, p = 0.012). The Fine Motor Score positively correlated with the ACE Tool Polypectomy Score (r = 0.601, p = 0.039), and negatively correlated with procedure time (r = - 0.640, p = 0.025), cecal intubation time (r = - 0.645, p = 0.024), and withdrawal time (r = - 0.629, p = 0.028). CONCLUSION This study demonstrates that performance on the TEST correlate to endoscopic measures. Given these results, the TEST may be used in conjunction with existing assessment tools for demonstrating competency in endoscopy.
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Affiliation(s)
- Amy Ou
- Department of Medicine, NYU Grossman School of Medicine, 550 First Ave, NBV 16N30, New York, NY, 10016, USA.
| | - Claire M Shin
- Department of Internal Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Adam J Goodman
- Division of Gastroenterology & Hepatology, NYU Grossman School of Medicine, New York, NY, USA
| | - Michael A Poles
- Division of Gastroenterology & Hepatology, NYU Grossman School of Medicine, New York, NY, USA
| | - Violeta B Popov
- Division of Gastroenterology & Hepatology, NYU Grossman School of Medicine, New York, NY, USA
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29
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Sewell JL, Bowen JL, Cate OT, O'Sullivan PS, Shah B, Boscardin CK. Learning Challenges, Teaching Strategies, and Cognitive Load: Insights From the Experience of Seasoned Endoscopy Teachers. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:794-802. [PMID: 31425188 DOI: 10.1097/acm.0000000000002946] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Learners of medical procedures must develop, refine, and apply schemas for both cognitive and psychomotor constructs, which may strain working memory capacity. Procedures with limitations in visual and tactile information may add risk of cognitive overload. The authors sought to elucidate how experienced procedural teachers perceived learners' challenges and their own teaching strategies in the exemplar setting of gastrointestinal endoscopy. METHOD The authors interviewed 22 experienced endoscopy teachers in the United States, Canada, and the Netherlands between May 2016 and March 2019 and performed thematic analysis using template analysis method. Interviews addressed learner challenges and teaching strategies from the teacher participants' perspectives. Cognitive load theory informed data interpretation and analysis. RESULTS Participants described taking steps to "diagnose" trainee ability and identify struggling trainees. They described learning challenges related to trainees (performance over mastery goal orientation, low self-efficacy, lack of awareness), tasks (psychomotor challenges, mental model development, tactile understanding), teachers (teacher-trainee relationship, inadequate teaching, teaching variability), and settings (internal/external distractions, systems issues). Participants described employing strategies that could match intrinsic load to learners' levels (teaching along developmental continuum, motor instruction, technical assistance/takeover), minimize extraneous load (optimize environment, systems solutions, emotional support, define expectations), and optimize germane load (promote mastery, teach schemas, stop and focus). CONCLUSIONS Participants provided insight into possible challenges while learning complex medical procedures with limitations in sensory channels, as well as teaching strategies that may address these challenges at individual and systems levels. Using cognitive load theory, the authors provide recommendations for procedural teachers.
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Affiliation(s)
- Justin L Sewell
- J.L. Sewell is associate professor, Division of Gastroenterology, Department of Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California; ORCID: http://orcid.org/0000-0003-4049-2874. J.L. Bowen is professor, Department of Medical Education and Clinical Sciences, and associate dean for curriculum, Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington. O. ten Cate is professor, Medical Education, University Medical Center Utrecht, Utrecht, The Netherlands, and adjunct professor, Department of Medicine University of California, San Francisco, San Francisco, California; ORCID: http://orcid.org/0000-0002-6379-8780. P.S. O'Sullivan is professor, Department of Medicine, and director of research and development in medical education, Center for Faculty Educators, University of California, San Francisco, San Francisco, California; ORCID: http://orcid.org/0000-0002-8706-4095. B. Shah is associate professor, Division of Gastroenterology, Department of Medicine, Department of Geriatrics and Palliative Medicine, Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York. C.K. Boscardin is associate professor, Department of Medicine, University of California, San Francisco, San Francisco, California
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30
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Han S, Obuch JC, Keswani RN, Hall M, Patel SG, Menard-Katcher P, Simon V, Ezekwe E, Aagaard E, Ahmad A, Alghamdi S, Austin K, Brimhall B, Broy C, Carlin L, Cooley M, Di Palma JA, Duloy AM, Early DS, Ellert S, Gaumnitz EA, Goyal J, Kathpalia P, Day L, El-Nachef N, Kerman D, Lee RH, Lunsford T, Mittal M, Morigeau K, Pietrak S, Piper M, Shah AS, Shapiro AB, Shergill A, Sonnier W, Sorrell C, Vignesh S, Wani S. Effect of individualized feedback on learning curves in EGD and colonoscopy: a cluster randomized controlled trial. Gastrointest Endosc 2020; 91:882-893.e4. [PMID: 31715173 DOI: 10.1016/j.gie.2019.10.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/22/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Gastroenterology fellowships need to ensure that trainees achieve competence in upper endoscopy (EGD) and colonoscopy. Because the impact of structured feedback remains unknown in endoscopy training, this study compared the effect of structured feedback with standard feedback on trainee learning curves for EGD and colonoscopy. METHODS In this multicenter, cluster, randomized controlled trial, trainees received either individualized quarterly learning curves or feedback standard to their fellowship. Assessment was performed in all trainees using the Assessment of Competency in Endoscopy tool on 5 consecutive procedures after every 25 EGDs and colonoscopies. Individual learning curves were created using cumulative sum (CUSUM) analysis. The primary outcome was the mean CUSUM score in overall technical and overall cognitive skills. RESULTS In all, 13 programs including 132 trainees participated. The intervention arm (6 programs, 51 trainees) contributed 558 EGD and 600 colonoscopy assessments. The control arm (7 programs, 81 trainees) provided 305 EGD and 468 colonoscopy assessments. For EGD, the intervention arm (-.7 [standard deviation {SD}, 1.3]) had a superior mean CUSUM score in overall cognitive skills compared with the control arm (1.6 [SD, .8], P = .03) but not in overall technical skills (intervention, -.26 [SD, 1.4]; control, 1.76 [SD, .7]; P = .06). For colonoscopy, no differences were found between the 2 arms in overall cognitive skills (intervention, -.7 [SD, 1.3]; control, .7 [SD, 1.3]; P = .95) or overall technical skills (intervention, .1 [SD, 1.5]; control, -.1 [SD, 1.5]; P = .77). CONCLUSIONS Quarterly feedback in the form of individualized learning curves did not affect learning curves for EGD and colonoscopy in a clinically meaningful manner. (Clinical trial registration number: NCT02891304.).
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Affiliation(s)
- Samuel Han
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Joshua C Obuch
- Division of Gastroenterology, Geisenger Medical Center, Danville, Pennsylvania, USA
| | - Rajesh N Keswani
- Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matt Hall
- Children's Hospital Association, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Swati G Patel
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Paul Menard-Katcher
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Violette Simon
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Eze Ezekwe
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Eva Aagaard
- Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
| | - Asyia Ahmad
- Division of Gastroenterology and Hepatology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Saad Alghamdi
- Division of Gastroenterology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Kerri Austin
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine, Madison, Wisconsin, USA
| | - Bryan Brimhall
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Charles Broy
- Division of Gastroenterology, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
| | - Linda Carlin
- Colorado Clinical and Translational Sciences Institute, University of Colorado Anschutz Medical Center, Aurora, Colorado
| | - Matthew Cooley
- Division of Gastroenterology, Ascension Providence Hospital, Southfield, Michigan, USA
| | - Jack A Di Palma
- Division of Gastroenterology, University of South Alabama, Mobile, Alabama, USA
| | - Anna M Duloy
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Dayna S Early
- Division of Gastroenterology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Swan Ellert
- Colorado Clinical and Translational Sciences Institute, University of Colorado Anschutz Medical Center, Aurora, Colorado
| | - Eric A Gaumnitz
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine, Madison, Wisconsin, USA
| | - Jatinder Goyal
- Division of Gastroenterology, University of Miami, Miami, Florida, USA
| | - Priya Kathpalia
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA
| | - Lukejohn Day
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA
| | - Najwa El-Nachef
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA
| | - David Kerman
- Division of Gastroenterology, University of Miami, Miami, Florida, USA
| | - Robert H Lee
- Division of Gastroenterology, University of California, Irvine, Irvine, California, USA
| | - Tisha Lunsford
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Mohit Mittal
- Division of Gastroenterology, University of California, Irvine, Irvine, California, USA
| | - Kirsten Morigeau
- Division of Gastroenterology, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Stanley Pietrak
- Division of Gastroenterology and Hepatology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Michael Piper
- Division of Gastroenterology, Ascension Providence Hospital, Southfield, Michigan, USA
| | - Anand S Shah
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Alan B Shapiro
- Division of Gastroenterology, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
| | - Amandeep Shergill
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA
| | - William Sonnier
- Division of Gastroenterology, University of South Alabama, Mobile, Alabama, USA
| | - Cari Sorrell
- Division of Gastroenterology, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Shivakumar Vignesh
- Division of Gastroenterology and Hepatology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
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Saxena A, Pauli EM, Haluck RS, Fell B, Moore J. Tubular Locomotion and Positioning Using Tip Eversion for Endoscopy. J Med Device 2020. [DOI: 10.1115/1.4046433] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Abstract
Colonoscopy is a minimally invasive procedure to examine the large intestine using a flexible endoscope. Currently, colonoscopic procedures require physically pushing the endoscope through the large intestine which potentially imparts damaging forces on the intestinal wall, requires a high level of expertise to perform safely, and can require extensive procedure time. This paper presents the use of inverted tubular element locomotion (ITEL) for improved endoscope translation and positioning that works via tip eversion of inverted plastic tubes. Experiments were performed to examine the fluid pressure required for locomotion through a large intestinal model and in both straight and curved paths and determine the optimal tube dimensions for insertion via ITEL. Experiments were then performed to compare intestinal forces during manual and ITEL-based insertion. The experiments established a relationship between the tip eversion pressure and the tube thickness and diameter. In addition, it was found that pressure required for locomotion was only minimally impeded by being enclosed in the intestinal manikin but significantly impacted by the curvature of the turn. Measured insertion forces for ITEL were found to be 10.1% less compared to traditional insertion. These results will aid in the future design and development of ITEL for endoscopic positioning.
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Affiliation(s)
- Ankit Saxena
- Department of Mechanical Engineering, Pennsylvania State University, University Park, PA 16803
| | - Eric M. Pauli
- Department of Surgery, Penn State Hershey Medical Center, Hershey, PA 17033
| | - Randy S. Haluck
- Department of Surgery, Penn State Hershey Medical Center, Hershey, PA 17033
| | - Barry Fell
- Thermoplastic Products Corp., Hummelstown, PA 17036
| | - Jason Moore
- Department of Mechanical Engineering, Pennsylvania State University, University Park, PA 16802
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Han S, Obuch JC, Duloy AM, Keswani RN, Hall M, Simon V, Ezekwe E, Menard-Katcher P, Patel SG, Aagard E, Brimhall B, Ahmad A, Alghamdi S, Brown MD, Broy C, Carlin L, Chugh P, Connolly SE, Cooley DM, Cowley K, Di Palma JA, Early DS, Ellert S, Gaumnitz EA, Ghassemi KA, Lebovics E, Lee RH, Lunsford T, Massaad J, Mittal M, Morigeau K, Pietrak S, Piper M, Shah AS, Shapiro A, Sonnier W, Sorrell C, Vignesh S, Woolard S, Wani S. A Prospective Multicenter Study Evaluating Endoscopy Competence Among Gastroenterology Trainees in the Era of the Next Accreditation System. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:283-292. [PMID: 31335810 DOI: 10.1097/acm.0000000000002885] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE The Next Accreditation System requires training programs to demonstrate competence among trainees. Within gastroenterology (GI), there are limited data describing learning curves and structured assessment of competence in esophagogastroduodenoscopy (EGD) and colonoscopy. In this study, the authors aimed to demonstrate the feasibility of a centralized feedback system to assess endoscopy learning curves among GI trainees in EGD and colonoscopy. METHOD During academic year 2016-2017, the authors performed a prospective multicenter cohort study, inviting participants from multiple GI training programs. Trainee technical and cognitive skills were assessed using a validated competence assessment tool. An integrated, comprehensive data collection and reporting system was created to apply cumulative sum analysis to generate learning curves that were shared with program directors and trainees on a quarterly basis. RESULTS Out of 183 fellowships invited, 129 trainees from 12 GI fellowships participated, with an overall trainee participation rate of 72.1% (93/129); the highest participation level was among first-year trainees (90.9%; 80/88), and the lowest was among third-year trainees (51.2%; 27/53). In all, 1,385 EGDs and 1,293 colonoscopies were assessed. On aggregate learning curve analysis, third-year trainees achieved competence in overall technical and cognitive skills, while first- and second-year trainees demonstrated the need for ongoing supervision and training in the majority of technical and cognitive skills. CONCLUSIONS This study demonstrated the feasibility of using a centralized feedback system for the evaluation and documentation of trainee performance in EGD and colonoscopy. Furthermore, third-year trainees achieved competence in both endoscopic procedures, validating the effectiveness of current training programs.
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Affiliation(s)
- Samuel Han
- S. Han is a fellow, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado. J.C. Obuch is faculty, Division of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania. A.M. Duloy is advanced endoscopy fellow, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado. R.N. Keswani is associate professor, Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Chicago, Illinois. M. Hall is principal biostatistician, Children's Hospital Association, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. V. Simon is professional research assistant, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado. E. Ezekwe is professional research assistant, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado. P. Menard-Katcher is associate fellowship program director and assistant professor, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado. S.G. Patel is assistant professor, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado. E. Aagard is senior associate dean for education and professor of medical education, Washington University School of Medicine in St. Louis, St. Louis, Missouri. B. Brimhall is advanced endoscopy fellow, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina. A. Ahmad is fellowship program director and professor, Division of Gastroenterology and Hepatology, Drexel University College of Medicine, Philadelphia, Pennsylvania. S. Alghamdi is advanced hepatology fellow, Division of Gastroenterology, Washington University School of Medicine in St. Louis, St. Louis, Missouri. M.D. Brown is fellowship program director and professor, Division of Digestive Diseases and Nutrition, Rush Medical College, Chicago, Illinois. C. Broy is fellow, Division of Gastroenterology, Advocate Lutheran General Hospital, Park Ridge, Illinois. L. Carlin is senior professional research assistant, Colorado Clinical and Translational Sciences Institute, University of Colorado Anschutz Medical Center, Aurora, Colorado. P. Chugh is assistant professor, Icahn School of Medicine at Mount Sinai, New York, New York. S.E. Connolly is chief of general gastroenterology and fellowship program director, Division of Gastroenterology, Ochsner Medical Center, New Orleans, Louisiana. D.M. Cooley is gastroenterologist, Community Hospitals and Wellness Center, Archbold, Ohio. K. Cowley is fellow, Division of Gastroenterology, Ochsner Medical Center, New Orleans, Louisiana. J.A. Di Palma is division director, fellowship program director, director, Section of Inflammatory Bowel Diseases, and professor, Division of Gastroenterology, University of South Alabama, Mobile, Alabama. D.S. Early is director of endoscopy, advanced interventional fellowship program director, and professor, Division of Gastroenterology, Washington University School of Medicine in St. Louis, St. Louis, Missouri. S. Ellert is research informaticist, Colorado Clinical and Translational Sciences Institute, University of Colorado Anschutz Medical Center, Aurora, Colorado. E.A. Gaumnitz is fellowship program director and professor, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine, Madison, Wisconsin. K.A. Ghassemi is director of clinical programs, Center for Esophageal Disorders, Division of Gastroenterology, University of California, Los Angeles, Los Angeles, California. E. Lebovics is director of gastroenterology and hepatobiliary diseases, fellowship program director, and professor, Division of Gastroenterology, New York Medical College, Valhalla, New York R.H. Lee is director of gastrointestinal motility, Division of Gastroenterology, University of California, Irvine, Irvine, California. T. Lunsford is associate professor and consultant, Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Arizona. J. Massaad is fellowship program director and assistant professor, Division of Gastroenterology, Emory University School of Medicine, Atlanta, Georgia. M. Mittal is gastroenterologist, Southern California Permanente Medical Group, Woodland Hills, California. K. Morigeau is gastroenterologist, Idaho Gastroenterology Associates, Meridian, Idaho. S. Pietrak is fellow, Division of Gastroenterology and Hepatology, Drexel University College of Medicine, Philadelphia, Pennsylvania. M. Piper is fellowship program director, Division of Gastroenterology, Ascension Providence Hospital, Southfield, Michigan. A.S. Shah is assistant professor, Icahn School of Medicine at Mount Sinai, New York, New York. A. Shapiro is fellowship program director, Division of Gastroenterology, Advocate Lutheran General Hospital, Park Ridge, Illinois. W. Sonnier is fellow, Division of Gastroenterology, University of South Alabama, Mobile, Alabama. C. Sorrell is gastroenterologist, Lubbock Digestive Disease Associates, Lubbock, Texas. S. Vignesh is chief, fellowship program director, and associate professor, Division of Gastroenterology and Hepatology, SUNY Downstate Medical Center, Brooklyn, New York. S. Woolard is gastroenterologist, Division of Gastroenterology, Emory University School of Medicine, Atlanta, Georgia. S. Wani is medical director, Esophageal and Gastric Center, and associate professor, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado
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Abstract
BACKGROUND Incomplete polyp resection (IPR) is recognized as a risk factor for interval colorectal cancer (ICC), and is, therefore, an important issue in polypectomy. Cold snare polypectomy (CSP) is a procedure that does not involve electrocautery and has no burn effect. Therefore, there is the possibility that the risk of ICC associated with IPR is higher in cases undergoing CSP than in those undergoing hot polypectomy. However, little is known about the risk factors for IPR after CSP. PURPOSE Precise identification of the risk factors can lead to prevention of IPR after CSP. Therefore, we performed this observational study for accurate identification of the risk factors for IPR after CSP. METHODS Medical records of a total of 501 patients with 1177 colorectal polyps that were resected at Omori Red Cross Hospital between October 2017 and March 2018 were retrospectively reviewed. The lateral and deep margins of the resected polyps were evaluated to check for the resection completeness. RESULTS Among the 1177 polyp resections, 1163 were included in the final analysis. IPR was detected in 206 (17.7%) cases. Performance of the resection by a trainee (OR (95% CI) 1.87 (1.328-2.632); P < 0.001) was identified as an independent risk factor for IPR in patients undergoing CSP. CONCLUSIONS Performance of the polypectomy by a trainee was identified as a significant risk factor for IPR in patients undergoing CSP. Prospective, randomized studies are necessary in the future to develop effective methods for the prevention/control of IPR after CSP.
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Sewell JL, Young JQ, Boscardin CK, Ten Cate O, O'Sullivan PS. Trainee perception of cognitive load during observed faculty staff teaching of procedural skills. MEDICAL EDUCATION 2019; 53:925-940. [PMID: 31179594 DOI: 10.1111/medu.13914] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/15/2019] [Accepted: 04/25/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Although teachers impact learners' cognitive load, how specific teaching activities affect intrinsic, germane and extraneous load during procedural skills training is unknown. We sought to characterise teaching activities used in the exemplar procedural setting of colonoscopy, and to explore how they were enacted and how learners perceived them as affecting intrinsic, germane and extraneous cognitive load. METHODS We observed 10 colonoscopies performed by eight different gastroenterology fellows and supervised by 10 different attending physicians at two hospitals, and recorded the teaching activities observed, as well as details of when they were used and how they were enacted. After the colonoscopy, each fellow completed the Cognitive Load Inventory for Colonoscopy to quantify intrinsic, germane and extraneous load. We then interviewed each fellow to determine how he or she perceived teaching as affecting cognitive load. Qualitative data were subjected to content analysis. Instances of germane load-promoting activities were correlated with measured germane load. RESULTS We observed 515 instances of teaching activities. The intensity of teaching varied substantially, ranging from 0.7 to 3.3 activities per minute, as did the pattern of teaching activities used by different attending physicians. Little teaching occurred immediately before or after a procedure. Fellows usually perceived teaching as affecting cognitive load in ways that promoted learning, particularly by reducing intrinsic load and increasing germane load. Fellows strongly perceived that the provision of autonomy promoted germane load. Conversely, fellows perceived that excessive teaching increased extraneous load. Instances of germane load-promoting teaching activities correlated moderately with measured germane load. CONCLUSIONS Teaching in the exemplar procedural setting of colonoscopy affected learners' cognitive load in mostly beneficial ways, yet even 'good' teaching activities had detrimental effects when used excessively. Teachers of procedures should consider learner experience, task complexity and environmental factors to modulate the modality, content and intensity of teaching to promote balanced cognitive load and learning. Teaching more reservedly during the procedure and taking advantage of pre- and post-procedure opportunities may help.
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Affiliation(s)
- Justin L Sewell
- Division of Gastroenterology, Department of Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA
| | - John Q Young
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Christy K Boscardin
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Olle Ten Cate
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Department of Medical Education, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Patricia S O'Sullivan
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Cho M, Kim JH, Hong KS, Kim JS, Kong HJ, Kim S. Identification of cecum time-location in a colonoscopy video by deep learning analysis of colonoscope movement. PeerJ 2019; 7:e7256. [PMID: 31392088 PMCID: PMC6673422 DOI: 10.7717/peerj.7256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 06/05/2019] [Indexed: 12/11/2022] Open
Abstract
Background Cecal intubation time is an important component for quality colonoscopy. Cecum is the turning point that determines the insertion and withdrawal phase of the colonoscope. For this reason, obtaining information related with location of the cecum in the endoscopic procedure is very useful. Also, it is necessary to detect the direction of colonoscope's movement and time-location of the cecum. Methods In order to analysis the direction of scope's movement, the Horn-Schunck algorithm was used to compute the pixel's motion change between consecutive frames. Horn-Schunk-algorithm applied images were trained and tested through convolutional neural network deep learning methods, and classified to the insertion, withdrawal and stop movements. Based on the scope's movement, the graph was drawn with a value of +1 for insertion, -1 for withdrawal, and 0 for stop. We regarded the turning point as a cecum candidate point when the total graph area sum in a certain section recorded the lowest. Results A total of 328,927 frame images were obtained from 112 patients. The overall accuracy, drawn from 5-fold cross-validation, was 95.6%. When the value of "t" was 30 s, accuracy of cecum discovery was 96.7%. In order to increase visibility, the movement of the scope was added to summary report of colonoscopy video. Insertion, withdrawal, and stop movements were mapped to each color and expressed with various scale. As the scale increased, the distinction between the insertion phase and the withdrawal phase became clearer. Conclusion Information obtained in this study can be utilized as metadata for proficiency assessment. Since insertion and withdrawal are technically different movements, data of scope's movement and phase can be quantified and utilized to express pattern unique to the colonoscopist and to assess proficiency. Also, we hope that the findings of this study can contribute to the informatics field of medical records so that medical charts can be transmitted graphically and effectively in the field of colonoscopy.
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Affiliation(s)
- Minwoo Cho
- Interdisciplinary Program for Bioengineering, Graduate School, Seoul National University, Seoul, South Korea
| | - Jee Hyun Kim
- Department of Gastroenterology, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Kyoung Sup Hong
- Department of Gastroenterology, Mediplex Sejong Hospital, Incheon, South Korea
| | - Joo Sung Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyoun-Joong Kong
- Department of Biomedical Engineering, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Sungwan Kim
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, South Korea
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Siau K, Hodson J, Valori RM, Ward ST, Dunckley P. Performance indicators in colonoscopy after certification for independent practice: outcomes and predictors of competence. Gastrointest Endosc 2019; 89:482-492.e2. [PMID: 30076842 DOI: 10.1016/j.gie.2018.07.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 07/25/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Robust real-world performance data of newly independent colonoscopists are lacking. In the United Kingdom, provisional colonoscopy certification (PCC) marks the transition from training to newly independent practice. We aimed to assess changes in key performance indicators (KPIs) such as cecal intubation rate (CIR) in the periods pre- and post-PCC, particularly regarding rates and predictors of trainees exhibiting a drop in performance (DIP), defined as CIR <90% in the first 50 procedures post-PCC. METHODS A prospective United Kingdom-wide observational study of Joint Advisory Group on Gastrointestinal Endoscopy Electronic Training System (JETS) e-portfolio colonoscopy entries (257,800) from trainees awarded PCC between July 2011 and 2016 was undertaken. Moving average analyses were used to study KPI trends relative to PCC. Pre-PCC trainee, trainer, and training environment factors were compared between DIP and non-DIP cohorts to identify predictors of DIP. RESULTS Seven hundred thirty-three trainees from 180 centers were awarded PCC after a median of 265 procedures and 3.1 years. Throughout the early post-PCC period, average CIRs surpassed the national 90% standard. Despite this, not all trainees achieved this standard post-PCC, with DIP observed in 18.4%. DIP was not influenced by trainer presence and diminished after 100 additional procedures. On multivariable analysis, pre-PCC CIRs and trainer specialty were predictive of DIP. Trainees with DIP incurred higher post-PCC rates of moderate to severe discomfort despite requiring higher analgesic dosages and were more likely to require trainer assistance in failed procedures. CONCLUSIONS The current PCC requirements are appropriate for diagnostic colonoscopy. It is possible to identify predictors of underperformance in trainees, which may be of value to training leads and could improve the patient experience.
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Affiliation(s)
- Keith Siau
- Joint Advisory Group, Royal College of Physicians, London, United Kingdom; Department of Gastroenterology, Dudley Group Hospitals NHSFT, Dudley, United Kingdom
| | - James Hodson
- Department of Statistics, Institute of Translational Medicine, University Hospital Birmingham NHSFT, Birmingham, United Kingdom
| | - Roland M Valori
- Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, United Kingdom
| | - Stephen T Ward
- Centre for Liver Research & NIHR Birmingham Biomedical Research Unit, University of Birmingham, Birmingham, United Kingdom
| | - Paul Dunckley
- Joint Advisory Group, Royal College of Physicians, London, United Kingdom; Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, United Kingdom
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Mahadev S, Jin Z, Lebwohl B, Rosenberg RM, Garcia-Carrasquillo RJ, Ramirez I, Freedberg DE. Trainee colonoscopy quality is influenced by the independent and unobserved performance characteristics of supervising physicians. Endosc Int Open 2019; 7:E74-E82. [PMID: 30746431 PMCID: PMC6368225 DOI: 10.1055/a-0770-2646] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/30/2018] [Indexed: 12/24/2022] Open
Abstract
Background Endoscopy training remains an apprenticeship, and the characteristics that facilitate transfer of high quality procedural skills from role models to trainees are unknown. We sought to determine whether unobserved supervisor performance influences the quality of colonoscopy performed by trainees, by studying how supervisors perform alone and how trainees perform while under those same supervisors. Methods This was a retrospective cross-sectional study conducted among ambulatory adults ≥ 50 years old who underwent colonoscopy for cancer screening or polyp surveillance from 2006 to 2015 at one academic medical center. The primary exposures were the colonoscopy withdrawal time (WT) and adenoma detection rate (ADR) of supervisors while performing colonoscopies alone. The primary outcomes were the WT and ADR of trainees performing colonoscopies under supervision. Results Data were included from 22 attending gastroenterologist supervisors, 56 gastroenterology fellow trainees, and 2777 adults undergoing 3094 colonoscopy procedures. Among all supervised colonoscopies, mean trainee WT was 12.7 minutes (SD 4.9) and trainee ADR was 33.5 %. The trainee WT was 0.42 minutes longer (standard error = 0.16, P = 0.01) per minute increase in supervisor WT. Similarly, trainee ADR was higher under a high ADR supervisor, and the odds ratio of high compared to low supervisor ADR category was 1.28 (95 %CI 1.01 - 1.62, P = 0.04) after adjusting for other factors. Conclusions The unobserved performance characteristics of supervising endoscopists may influence the quality of colonoscopy performed by trainees.
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Affiliation(s)
- Srihari Mahadev
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York USA,Corresponding author Srihari Mahadev, MD MS 1283 York Ave9th FloorNew YorkNY 10065USA+1-888-247-2593
| | - Zhezhen Jin
- Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Benjamin Lebwohl
- Mailman School of Public Health, Columbia University, New York, New York, USA,Division of Digestive and Liver Disease, Department of Medicine, Columbia University, New York, New York, USA
| | - Richard M. Rosenberg
- Division of Digestive and Liver Disease, Department of Medicine, Columbia University, New York, New York, USA
| | | | - Ivonne Ramirez
- Division of Digestive and Liver Disease, Department of Medicine, Columbia University, New York, New York, USA
| | - Daniel E. Freedberg
- Division of Digestive and Liver Disease, Department of Medicine, Columbia University, New York, New York, USA
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Placek SB, Franklin BR, Ritter EM. Simulation in Surgical Endoscopy. COMPREHENSIVE HEALTHCARE SIMULATION: SURGERY AND SURGICAL SUBSPECIALTIES 2019. [DOI: 10.1007/978-3-319-98276-2_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Bitar H, Zia H, Bashir M, Parava P, Hanafi M, Tierney W, Madhoun M. Impact of fellowship training level on colonoscopy quality and efficiency metrics. Gastrointest Endosc 2018; 88:378-387. [PMID: 29679692 DOI: 10.1016/j.gie.2018.04.2338] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 04/10/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Previous studies have described variable effects of fellow involvement on the adenoma detection rate (ADR), but few have stratified this effect by level of training. We aimed to evaluate the "fellow effect" on multiple procedural metrics including a newly defined adenoma management efficiency index, which may have a role in documenting colonoscopy proficiency for trainees. We also describe the impact of level of training on moderate sedation use. METHODS We performed a retrospective review of 2024 patients (mean age, 60.9 ± 10 years; 94% men) who underwent outpatient colonoscopy between June 2012 and December 2014 at our Veterans Affairs Medical Center. Colonoscopies were divided into 5 groups. The first 2 groups were first-year fellows in the first 6 months and last 6 months of the training year. Second- and third-year fellows and attending-only procedures accounted for 1 group each. We collected data on doses of sedatives used, frequency of adjunctive agent use, procedural times, and location, size, and histology of polyps. We defined the adenoma management efficiency index as average time required per adenoma resected during withdrawal. RESULTS Of the colonoscopies performed, 1675 involved a fellow and 349 were performed by the attending alone. There was no difference in ADR between fellows according to level of training (P = .8) or between fellows compared with attending-only procedures (P = .67). Procedural times decreased consistently during training and declined further for attending-only procedures. This translated into improvement in the adenoma management efficiency index (fellow groups by ascending level of training: 23.5 minutes vs 18.3 minutes vs 13.7 minutes vs 13.4 minutes vs attending group 11.7 minutes; P < .001). There was no difference in the average doses of midazolam and fentanyl used among fellow groups (P = .16 and P = .1, respectively). Compared with attending-only procedures, fellow involvement was associated with higher doses of fentanyl and midazolam and more frequent use of diphenhydramine and glucagon (P < .0001, P = .0002, P < .0001, and P = .01, respectively). CONCLUSIONS ADR was similar at different stages of fellowship training and comparable with the attending group. Efficiency of detecting and resecting polyps improved throughout training without reaching the attending level. Fellow involvement led to a greater use of moderate sedation, which may relate to a longer procedure duration and an evolving experience in endoscopic technique.
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Affiliation(s)
- Hussein Bitar
- Section of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Section of Digestive Diseases and Nutrition, Veterans Affairs Medical Center, Oklahoma City, Oklahoma, USA
| | - Hassaan Zia
- Section of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Section of Digestive Diseases and Nutrition, Veterans Affairs Medical Center, Oklahoma City, Oklahoma, USA
| | - Muhammad Bashir
- Section of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Section of Digestive Diseases and Nutrition, Veterans Affairs Medical Center, Oklahoma City, Oklahoma, USA
| | - Pratyusha Parava
- Section of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Section of Digestive Diseases and Nutrition, Veterans Affairs Medical Center, Oklahoma City, Oklahoma, USA
| | - Muhammad Hanafi
- Section of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Section of Digestive Diseases and Nutrition, Veterans Affairs Medical Center, Oklahoma City, Oklahoma, USA
| | - William Tierney
- Section of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Section of Digestive Diseases and Nutrition, Veterans Affairs Medical Center, Oklahoma City, Oklahoma, USA
| | - Mohammad Madhoun
- Section of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Section of Digestive Diseases and Nutrition, Veterans Affairs Medical Center, Oklahoma City, Oklahoma, USA
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Turner JS, Henry D, Chase A, Kpodzo D, Flood MC, Clark CE. Adenoma Detection Rate in Colonoscopy: Does the Participation of a Resident Matter? Am Surg 2018. [DOI: 10.1177/000313481808400667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Presently, endoscopic procedures are a requirement for training competency for completion of a general surgery residency. There are no studies to date that have assessed whether having a resident perform a colonoscopy impacts quality indicators such as adenoma detection rate (ADR). To retrospectively review ADR in adult patients, who undergo screening colonoscopy at a single institution with (ColFacR) and without (ColFac) the participation of a general surgery resident. A total of 792 patients were identified in the database screening colonoscopies between the ages of 45 and 80 from July 2013 to June 2015. Of those, 501 were reviewed after exclusion criteria. When comparing the ColFac group (n = 316) to the ColFacR group (n = 185), there were no differences between age, gender, body mass index, American Society of Anesthesiologists score, or quality of bowel preparation. The mean number of total polyps, hyperplastic polyps, and adenomatous polyps retrieved were similar between the two groups. There was no difference in the ADR for the ColFac cases and ColFacR cases (25.95% vs 27.03%, respectively, P = 0.834). ADR is similar in elective colonoscopies that were performed with or without a general surgery resident. The participation of a general surgery resident in routine colonoscopies should not impact reported quality indicators.
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Affiliation(s)
- Jacquelyn S. Turner
- Department of Surgery, Division of Colon and Rectal Surgery, Morehouse School of Medicine, Atlanta, Georgia
| | - Desmond Henry
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia
| | - Ayana Chase
- Department of Surgery, Division of Colon and Rectal Surgery, Morehouse School of Medicine, Atlanta, Georgia
| | - Dzifa Kpodzo
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia
| | - Michael C. Flood
- Department of Medicine, Division of Gastroenterology, Morehouse School of Medicine, Atlanta, Georgia
| | - Clarence E. Clark
- Department of Surgery, Division of Colon and Rectal Surgery, Morehouse School of Medicine, Atlanta, Georgia
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Lam J, Wilkinson J, Brassett C, Brown J. Difference in real-time magnetic image analysis of colonic looping patterns between males and females undergoing diagnostic colonoscopy. Endosc Int Open 2018; 6:E575-E581. [PMID: 29756015 PMCID: PMC5943688 DOI: 10.1055/a-0574-2478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/08/2017] [Indexed: 11/21/2022] Open
Abstract
Abstract
Background and study aim Magnetic imaging technology is of proven benefit to trainees in colonoscopy, but few studies have examined its benefits in experienced hands. There is evidence that colonoscopy is more difficult in women. We set out to investigate (i) associations between the looping configurations in the proximal and distal colon and (ii) differences in the looping prevalence between the sexes. We have examined their significance in terms of segmental intubation times and position changes required for the completion of colonoscopy.
Patients and methods We analyzed 103 consecutive synchronized luminal and magnetic image videos of diagnostic colonoscopies with normal anatomy undertaken by a single experienced operator.
Results Deep transverse loops and sigmoid N-loops were more common in females. A deep transverse loop was more likely to be present if a sigmoid alpha-loop or N-loop had formed previously. Patients with sigmoid N-loops were turned more frequently from left lateral to supine before the sigmoid-descending junction was reached, but there was no statistical correlation between completion time and looping pattern.
Conclusions This study has reexamined the prevalence of the common looping patterns encountered during colonoscopy and has identified differences between the sexes. This finding may offer an explanation as to why colonoscopy has been shown to be more difficult in females. Although a deep transverse loop following a resolved sigmoid alpha-loop was the most commonly encountered pattern, no statistical correlation between completion time and looping pattern could be shown. It is the first study to examine segmental completion times using a magnetic imager in expert hands.
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Affiliation(s)
- Jacob Lam
- The University of Cambridge School of Clinical Medicine,Corresponding author Jacob Lam Jesus CollegeCambridgeCB5 8BL07758 228567
| | | | - Cecilia Brassett
- Human Anatomy Teaching Group, Department of Physiology, Development and Neuroscience, University of Cambridge
| | - Jonathan Brown
- Human Anatomy Teaching Group, Department of Physiology, Development and Neuroscience, University of Cambridge,Gloucestershire Hospitals NHS Foundation Trust, Gloucester
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Preisler L, Svendsen MBS, Svendsen LB, Konge L. Methods for certification in colonoscopy - a systematic review. Scand J Gastroenterol 2018; 53:350-358. [PMID: 29361859 DOI: 10.1080/00365521.2018.1428767] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Reliable, valid, and feasible assessment tools are essential to ensure competence in colonoscopy. This study aims to provide an overview of the existing assessment methods and the validity evidence that supports them. METHODS A systematic search was conducted in October 2016. Pubmed, EMBASE, and PsycINFO were searched for studies evaluating assessment methods to ensure competency in colonoscopy. Outcome variables were described and evidence of validity was explored using a contemporary framework. RESULTS Twenty-five observational studies were included in the systematic review. Most studies were based on small sample sizes. The studies were categorized after outcome measures into five groups: Clinical process related outcome metrics (n = 2), direct observational colonoscopy assessment (n = 8), simulator based metrics (n = 11), automatic computerized metrics (n = 2), and self-assessment (n = 1). Validity score varied among the studies and only five studies presented sufficient evidence to recommend the tool for clinical assessment. CONCLUSIONS The objectives vary throughout the presented tools. Some tools are global tools where others focus on procedural technical skill assessment or even part-task skills. There is a tendency in the most recent studies towards more specific assessment of technical skills. The majority of assessment methods lack sufficient validity evidence.
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Affiliation(s)
- Louise Preisler
- a Department of Surgical Gastroenterology and Transplantation C , Rigshospitalet, University of Copenhagen and the Capital Region of Denmark , Copenhagen , Denmark.,b Copenhagen Academy for Medical Education and Simulation , University of Copenhagen and the Capital Region of Denmark , Copenhagen , Denmark
| | - Morten Bo Søndergaard Svendsen
- b Copenhagen Academy for Medical Education and Simulation , University of Copenhagen and the Capital Region of Denmark , Copenhagen , Denmark
| | - Lars Bo Svendsen
- a Department of Surgical Gastroenterology and Transplantation C , Rigshospitalet, University of Copenhagen and the Capital Region of Denmark , Copenhagen , Denmark
| | - Lars Konge
- b Copenhagen Academy for Medical Education and Simulation , University of Copenhagen and the Capital Region of Denmark , Copenhagen , Denmark
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El-Halabi MM, Barrett PR, Martinez Mateo M, Fayad NF. Should We Measure Adenoma Detection Rate for Gastroenterology Fellows in Training? Gastroenterology Res 2018; 11:290-294. [PMID: 30116428 PMCID: PMC6089585 DOI: 10.14740/gr1043w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 05/29/2018] [Indexed: 02/06/2023] Open
Abstract
Background Adenoma detection rate (ADR) is a proven quality metric for colonoscopy. The value of ADR for the evaluation of gastroenterology fellows is not well established. The aim of this study is to calculate and evaluate the utility of ADR as a measure of competency for gastroenterology fellows. Methods Colonoscopies for the purposes of screening and surveillance, on which gastroenterology fellows participated at the Richard L. Roudebush VAMC (one of the primary training sites at Indiana University), during a 9-month period, were included. ADR, cecal intubation rate, and indirect withdrawal time were measured. These metrics were compared between the levels of training. Results A total of 591 screening and surveillance colonoscopies were performed by 14 fellows. This included six, four and four fellows, in the first, second and third year of clinical training, respectively. Fellows were on rotation at the VAMC for a mean of 1.9 months (range 1 to 3 months) during the study period. The average ADR was 68.8% (95% CI 65.37 - 72.24). The average withdrawal time was 27.59 min (95% CI 23.45 - 31.73). The average cecal intubation rate was 99% (95% CI 98-100%). There was no significant difference between ADRs, cecal intubation rates, and withdrawal times at different levels of training; however, a trend toward swifter withdrawal times with advancing training was noted. Conclusions ADR appears not to be a useful measure of competency for gastroenterology fellows. Consideration should be given to alternative metrics that could avoid bias and confounders.
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Affiliation(s)
- Mustapha M El-Halabi
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Patrick R Barrett
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Melissa Martinez Mateo
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nabil F Fayad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.,Section of Gastroenterology and Hepatology, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
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Qayed E, Vora R, Levy S, Bostick RM. Colonoscopy procedural volume increases adenoma and polyp detection rates in gastroenterologytrainees. World J Gastrointest Endosc 2017; 9:540-551. [PMID: 29184610 PMCID: PMC5696606 DOI: 10.4253/wjge.v9.i11.540] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/20/2017] [Accepted: 08/15/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate changes in polyp detection throughout fellowship training, and estimate colonoscopy volume required to achieve the adenoma detection rate (ADRs) and polyp detection rate (PDRs) of attending gastroenterologists.
METHODS We reviewed colonoscopies from July 1, 2009 to June 30, 2014. Fellows’ procedural logs were used to retrieve colonoscopy procedural volumes, and these were treated as the time variable. Findings from screening colonoscopies were used to calculate colonoscopy outcomes for each fellow for the prior 50 colonoscopies at each time point. ADR and PDR were plotted against colonoscopy procedural volumes to produce individual longitudinal graphs. Repeated measures linear mixed effects models were used to study the change of ADR and PDR with increasing procedural volume.
RESULTS During the study period, 12 fellows completed full three years of training and were included in the analysis. The average ADR and PDR were, respectively, 31.5% and 41.9% for all fellows, and 28.9% and 38.2% for attendings alone. There was a statistically significant increase in ADR with increasing procedural volume (1.8%/100 colonoscopies, P = 0.002). Similarly, PDR increased 2.8%/100 colonoscopies (P = 0.0001), while there was no significant change in advanced ADR (0.04%/100 colonoscopies, P = 0.92). The ADR increase was limited to the right side of the colon, while the PDR increased in both the right and left colon. The adenoma per colon and polyp per colon also increased throughout training. Fellows reached the attendings’ ADR and PDR after 265 and 292 colonoscopies, respectively.
CONCLUSION We found that the ADR and PDR increase with increasing colonoscopy volume throughout fellowship. Our findings support recent recommendations of ≥ 275 colonoscopies for colonoscopy credentialing.
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Affiliation(s)
- Emad Qayed
- Department of Medicine, Division of Digestive diseases, Emory University School of Medicine, Atlanta, GA 30303, United States
- Grady Memorial Hospital, Atlanta, GA 30303, United States
| | - Ravi Vora
- Department of Medicine, Division of Digestive diseases, Emory University School of Medicine, Atlanta, GA 30303, United States
| | - Sara Levy
- Department of Medicine, Division of Digestive diseases, Emory University School of Medicine, Atlanta, GA 30303, United States
| | - Roberd M Bostick
- Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, GA 30303, United States
- Emory University, Winship Cancer Institute Atlanta, GA 30303, United States
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Eberth JM, Josey MJ, Mobley LR, Nicholas DO, Jeffe DB, Odahowski C, Probst JC, Schootman M. Who Performs Colonoscopy? Workforce Trends Over Space and Time. J Rural Health 2017; 34:138-147. [PMID: 29143383 DOI: 10.1111/jrh.12286] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/01/2017] [Accepted: 10/16/2017] [Indexed: 01/18/2023]
Abstract
PURPOSE With the increased availability of colonoscopy to average risk persons due to insurance coverage benefit changes, we sought to identify changes in the colonoscopy workforce. We used outpatient discharge records from South Carolina between 2001 and 2010 to examine shifts over time and in urban versus rural areas in the types of medical providers who perform colonoscopy, and the practice settings in which they occur, and to explore variation in colonoscopy volume across facility and provider types. METHODS Using an all-payer outpatient discharge records database from South Carolina, we conducted a retrospective analysis of all colonoscopy procedures performed between 2001 and 2010. FINDINGS We identified a major shift in the type of facilities performing colonoscopy in South Carolina since 2001, with substantial gains in ambulatory surgery settings (2001: 15, 2010: 34, +127%) versus hospitals (2001: 58, 2010: 59, +2%), particularly in urban areas (2001: 12, 2010: 27, +125%). The number of internists (2001: 46, 2010: 76) and family physicians (2001: 34, 2010: 106) performing colonoscopies also increased (+65% and +212%, respectively), while their annual procedures volumes stayed fairly constant. Significant variation in annual colonoscopy volume was observed across medical specialties (P < .001), with nongastroenterologists having lower volumes versus gastroenterologists and colon and rectal surgeons. CONCLUSIONS There have been substantial changes over time in the number of facilities and physicians performing colonoscopy in South Carolina since 2001, particularly in urban counties. Findings suggest nongastroenterologists are meeting a need for colonoscopies in rural areas.
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Affiliation(s)
- Jan M Eberth
- Department of Epidemiology and Biostatistics, Statewide Cancer Prevention and Control Program, and South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Michele J Josey
- Department of Epidemiology and Biostatistics, Statewide Cancer Prevention and Control Program, and South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Lee R Mobley
- Department of Health Management and Policy, School of Public Health, Georgia State University, Atlanta, Georgia
| | - Davidson O Nicholas
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri.,Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri
| | - Donna B Jeffe
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Cassie Odahowski
- Department of Epidemiology and Biostatistics, Statewide Cancer Prevention and Control Program, and South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Janice C Probst
- Department of Health Services Policy and Management and South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Mario Schootman
- Department of Epidemiology, College for Public Health and Social Justice, St. Louis University, St. Louis, Missouri
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Sewell JL, Boscardin CK, Young JQ, Ten Cate O, O'Sullivan PS. Learner, Patient, and Supervisor Features Are Associated With Different Types of Cognitive Load During Procedural Skills Training: Implications for Teaching and Instructional Design. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:1622-1631. [PMID: 28445213 DOI: 10.1097/acm.0000000000001690] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Cognitive load theory, focusing on limits of the working memory, is relevant to medical education; however, factors associated with cognitive load during procedural skills training are not well characterized. The authors sought to determine how features of learners, patients/tasks, settings, and supervisors were associated with three types of cognitive load among learners performing a specific procedure, colonoscopy, to identify implications for procedural teaching. METHOD Data were collected through an electronically administered survey sent to 1,061 U.S. gastroenterology fellows during the 2014-2015 academic year; 477 (45.0%) participated. Participants completed the survey immediately following a colonoscopy. Using multivariable linear regression analyses, the authors identified sets of features associated with intrinsic, extraneous, and germane loads. RESULTS Features associated with intrinsic load included learners (prior experience and year in training negatively associated, fatigue positively associated) and patient/tasks (procedural complexity positively associated, better patient tolerance negatively associated). Features associated with extraneous load included learners (fatigue positively associated), setting (queue order positively associated), and supervisors (supervisor engagement and confidence negatively associated). Only one feature, supervisor engagement, was (positively) associated with germane load. CONCLUSIONS These data support practical recommendations for teaching procedural skills through the lens of cognitive load theory. To optimize intrinsic load, level of experience and competence of learners should be balanced with procedural complexity; part-task approaches and scaffolding may be beneficial. To reduce extraneous load, teachers should remain engaged, and factors within the procedural setting that may interfere with learning should be minimized. To optimize germane load, teachers should remain engaged.
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Affiliation(s)
- Justin L Sewell
- J.L. Sewell is assistant professor of medicine, Department of Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California. C.K. Boscardin is associate professor of medicine, Department of Medicine, University of California, San Francisco, San Francisco, California. J.Q. Young is professor and vice chair for education, Department of Psychiatry, Hofstra Northwell School of Medicine, Glen Oaks, New York. O. ten Cate is professor of medical education and director, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands, and adjunct professor of medicine, Department of Medicine, University of California, San Francisco, San Francisco, California. P.S. O'Sullivan is professor of medicine, Department of Medicine, and director of research and development in medical education, Center for Faculty Educators, University of California, San Francisco, San Francisco, California
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Chan DKH, Wong RKM, Yeoh KG, Tan KK. Accredited residents perform colonoscopy to the same high standards as consultants. Surg Endosc 2017; 32:1377-1381. [PMID: 28812156 DOI: 10.1007/s00464-017-5818-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 08/03/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Endoscopy remains a critical component of General Surgery and Gastroenterology training. Whilst residents need to gain experience, the quality of endoscopy which patients receive cannot be compromised. We conducted this study to compare quality indicators between consultants and residents with regards to colonoscopy. METHODS A review of colonoscopies from a prospectively collected database was performed from September 2011 to February 2016. Quality indicators such as caecum intubation rate, adenoma detection rate, adherence to a 6-min withdrawal rule, mean number of polyps detected per colonoscope, and complications were collected and compared between the two groups. RESULTS In total, out of 25,749 colonoscopies that were performed, 14,168 (55.0%) were performed by Consultants. Consultants achieved a better caecum intubation rate compared with residents (96.0% vs 94.9%, p < 0.001), and were more compliant to the 6-min withdrawal rule (74.7% vs 68.6%, p < 0.001). There were, however, no statistically significant differences in the adenoma detection rate (33.5% vs 34.5%, p = 0.098). Bleeding was a rare complication that was encountered more frequently in colonoscopies performed by consultants than for residents (0.002% vs 0.00008%, p < 0.001). There were only three (%) perforations in the entire series, and all were from colonoscopies performed by Consultants. CONCLUSION Given the proper training, residents are able to perform colonoscopy with the same level of competence as consultants. Whilst colonoscopic related complications are often tied to the difficulty of the procedures, the adherence to the 6-min withdrawal rule must be reinforced and continually educated to both residents and consultants.
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Affiliation(s)
- Dedrick Kok Hong Chan
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | | | - Khay Guan Yeoh
- Department of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, University Medical Cluster, National University Health System, Singapore, Singapore
| | - Ker-Kan Tan
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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Riek S, Hill A, Plooy AM, Horswill MS, Cresp ASG, Marinovic W, Christofidis MJ, Burgess-Limerick R, Wallis GM, Watson MO, Hewett DG. A novel training device for tip control in colonoscopy: preliminary validation and efficacy as a training tool. Surg Endosc 2017; 31:5364-5371. [PMID: 28593418 PMCID: PMC5715030 DOI: 10.1007/s00464-017-5617-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 05/16/2017] [Indexed: 12/13/2022]
Abstract
Background Effective control of the colonoscope tip is one of the most fundamental components of colonoscopy skill. Mastering fine tip control can be problematic for novice trainees, yet no validated training regimes exist for developing this specific skill component in isolation. We aimed to conduct a preliminary validation of a novel training device for colonoscopic tip control, and to assess its efficacy as a training tool. Methods In study 1 (validation), 13 experienced colonoscopists and 16 novices used a colonoscope to accurately track 28 targets on each of four concave “training surfaces” as quickly as possible, and we compared their performance. In study 2 (pre–post-training study), another 16 novices were tested before and after a six-session training program. In both studies, the main outcome measurements were completion time (measured automatically by the device) and variability of individual performance (the SD of each individual’s completion times across trials). Results Compared with novices, experienced colonoscopists were faster (P < 0.0001) and their performances less variable (P < 0.0001). With training, novices became faster (P < 0.0001) and more consistent (P = 0.003), and these improvements also generalized to novel training surfaces (P’s < 0.01). After training, the novices’ tip control performance was indistinguishable from that of the experienced colonoscopists (P’s > 0.05). The composite measures of completion time used in both studies all had acceptable to excellent internal consistency reliability (α’s ranged from 0.72 to 0.93). Conclusions We found that performance measures derived from using the device to assess skill can discriminate between experienced colonoscopists and novices in terms of their ability to control and guide the colonoscope tip precisely, providing preliminary evidence to support the construct validity of the metrics. The device is also an effective training tool for this fundamental component of colonoscopy skill.
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Affiliation(s)
- Stephan Riek
- School of Human Movement Studies, The University of Queensland, Brisbane, Australia
| | - Andrew Hill
- Clinical Skills Development Service, Metro North Hospital and Health Service, Brisbane, Australia. .,School of Psychology, The University of Queensland, Brisbane, Australia.
| | - Annaliese M Plooy
- School of Human Movement Studies, The University of Queensland, Brisbane, Australia
| | - Mark S Horswill
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Alanna St G Cresp
- School of Human Movement Studies, The University of Queensland, Brisbane, Australia
| | - Welber Marinovic
- School of Human Movement Studies, The University of Queensland, Brisbane, Australia
| | | | | | - Guy M Wallis
- School of Human Movement Studies, The University of Queensland, Brisbane, Australia
| | - Marcus O Watson
- Clinical Skills Development Service, Metro North Hospital and Health Service, Brisbane, Australia.,School of Psychology, The University of Queensland, Brisbane, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia
| | - David G Hewett
- Clinical Skills Development Service, Metro North Hospital and Health Service, Brisbane, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia
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Sunada K, Shinozaki S, Yano T, Hayashi Y, Sakamoto H, Lefor AK, Yamamoto H. Double-Balloon Colonoscopy Has a Higher Cecal Intubation Rate Than Conventional Colonoscopy Using a Colon Simulator. Dig Dis Sci 2017; 62:979-983. [PMID: 28194595 DOI: 10.1007/s10620-017-4477-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 01/25/2017] [Indexed: 12/09/2022]
Abstract
BACKGROUND/AIM Cecal intubation using conventional colonoscopy (CC) requires substantial training. We hypothesized that double-balloon colonoscopy (DBC) facilitates cecal intubation by endoscopy naïve operators. The aim of this study is to evaluate the cecal intubation rate and learning curve of DBC compared with CC. METHODS Eighteen endoscopy naïve medical students were allocated to two groups and attempted cecal intubation within 20 min using a colon simulator. In group A, CC was performed ten times and then DBC ten times. In group B, the reverse was carried out. We evaluated the cecal intubation rate and learning curve. RESULTS The overall success rate for cecal intubation using DBC was significantly superior to CC [132/180 (73%) vs. 12/180 (7%), p < 0.001]. To evaluate the success rate overtime, we divided the ten repetitions of the procedure into three time periods: first (1-3), second (4-6), and third (7-10). The success rate using CC is <20%, even during the third time period, in both groups, and one perforation occurred. The success rate using DBC is over 30% in the first period and increased to nearly 80% in the third period in both groups. Finally, we evaluated the time needed for cecal intubation using DBC. The mean cecal intubation time in the first period is 14 min and decreased to 11 min in the third period. CONCLUSIONS DBC has a higher cecal intubation rate than CC performed by endoscopy naïve medical students using a colon simulator in this randomized-controlled, cross-over study.
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Affiliation(s)
- Keijiro Sunada
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Satoshi Shinozaki
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.,Shinozaki Medical Clinic, Tochigi, Japan
| | - Tomonori Yano
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Yoshikazu Hayashi
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Hirotsugu Sakamoto
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | | | - Hironori Yamamoto
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
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