Training mid-career internists to perform high-quality colonoscopy: a pilot training programme to meet increasing demands for colonoscopy

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

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.

You are not lab rats at teaching hospitals: A systematic review of resident and fellow participation leads to improved colonoscopy

BACKGROUND

Participation in colonoscopies is an essential aspect of endoscopic training. The purpose of this study was to explore the impact of fellow/trainee participation on colonoscopy outcomes.

METHODS

This meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO). From database inception to July 2022, studies investigating fellow involvement and colonoscopy outcomes were searched across Cochrane library, PubMed, and other databases. The random-effects model was applied to generate more conservative estimates. Sensitive analysis was conducted to explore whether the result would depend on a particular study. Egger's test and Begg's test were used to estimate the potential for publication bias.

RESULTS

Seventeen studies including 30,062 participants were included. We found that fellow/trainee involvement enhanced the overall rates of adenoma detection and polyp detection (OR = 1.26, 95% CI = 1.14-1.40, p < 0.001; OR = 1.29, 95% CI = 1.02-1.63, p = 0.020, respectively). The mean number of adenoma/polyps per colonoscopy was also higher with fellow/trainee participation (MD = 0.12, 95% CI = 0.08-0.17, p < 0.001; MD = 0.15, 95% CI = 0.02-0.28, p = 0.020, respectively).

CONCLUSION

In addition to its educational purpose, fellow or trainee involvement is associated with beneficial effects on colonoscopy outcomes.

Synthesis of Existent Oncology Curricula for Primary Care Providers: A Scoping Review With a Global Equity Lens

PURPOSE

Global increases in cancer, coupled with a shortage of cancer specialists, has led to an increasing role for primary care providers (PCP) in cancer care. This review aimed to examine all extant cancer curricula for PCPs and to analyze the motivations for curriculum development.

METHODS

A comprehensive literature search was conducted from inception to October 13, 2021, with no language restrictions. The initial search yielded 11,162 articles and 10,902 articles underwent title and abstract review. After full-text review, 139 articles were included. Numeric and thematic analyses were conducted and education programs were evaluated using Bloom's taxonomy.

RESULTS

Most curricula were developed in high-income countries (HICs), with 58% in the United States. Cancer-specific curricula focused on HIC priority cancers, such as skin/melanoma, and did not represent the global cancer burden. Most (80%) curricula were developed for staff physicians and 73% focused on cancer screening. More than half (57%) of programs were delivered in person, with a shift toward online delivery over time. Less than half (46%) of programs were codeveloped with PCPs and 34% did not involve PCPs in the program design and development. Curricula were primarily developed to improve cancer knowledge, and 72 studies assessed multiple outcome measures. No studies included the top two levels of Bloom's taxonomy of learning (evaluating; creating).

CONCLUSION

To our knowledge, this is the first review to assess the current state of cancer curricula for PCPs with a global focus. This review shows that extant curricula are primarily developed in HICs, do not represent the global cancer burden, and focus on cancer screening. This review lays a foundation to advance the cocreation of curricula that are aligned to the global cancer burden.

Effect of fellow involvement on colonoscopy outcomes: A systematic review and meta-analysis

BACKGROUND AND AIMS

The effect of fellow involvement on colonoscopy outcomes is controversial. Thus, we evaluated this effect on adenoma detection rate (ADR) and on other colonoscopy quality indicators.

METHODS

MEDLINE and Cochrane central register of controlled trials were searched up to September 2018 for studies evaluating fellow-involved colonoscopies vs. attending physicians-only examinations in terms of colonoscopy outcomes. Primary outcome was ADR, while advanced ADR (AADR), mean number of adenomas per colonoscopy (MAC), cecum intubation rate (CIR) and adverse events rate comprised the secondary outcomes. The effect size on study outcomes was calculated using random-effects model and it is presented as Odds Ratio (OR) or Mean Difference (MD) with 95% confidence interval (CI).

RESULTS

Nineteen observational studies involving 34,059 patients (fellow-involved 16,875, attending physician-only 17,184) were included. Compared to the attending physician-only group, fellow involvement marginally increased ADR [OR (95%CI) = 1.12 (1.00-1.26); p = 0.06, I² = 76%]. Attending physicians with low-to-moderate ADR (<35%) benefited most from fellow's participation [OR (95%CI): 1.26 (1.13-1.40) vs. 1.12 (1.00-1.26); p = 0.03 when ADR < 35% and OR (95%CI): 1.29 (1.13-1.46) vs. 0.95 (0.78-1.16); p = 0.01 when ADR < 30%, respectively]. Moreover, fellow-involved group had higher MAC compared to attending-only group [MD (95%CI) = 0.12 (0.04-0.20); p = 0.002, I² = 53%]. No benefit from fellow involvement was detected either for AADR, CIR or adverse events rate.

CONCLUSIONS

Fellow involvement during colonoscopy is associated with more adenomas detected per procedure and with higher ADR when the attending physician-only group ADR is less than 35%.

A novel summary report of colonoscopy: timeline visualization providing meaningful colonoscopy video information

PURPOSE

The colonoscopy adenoma detection rate depends largely on physician experience and skill, and overlooked colorectal adenomas could develop into cancer. This study assessed a system that detects polyps and summarizes meaningful information from colonoscopy videos.

METHODS

One hundred thirteen consecutive patients had colonoscopy videos prospectively recorded at the Seoul National University Hospital. Informative video frames were extracted using a MATLAB support vector machine (SVM) model and classified as bleeding, polypectomy, tool, residue, thin wrinkle, folded wrinkle, or common. Thin wrinkle, folded wrinkle, and common frames were reanalyzed using SVM for polyp detection. The SVM model was applied hierarchically for effective classification and optimization of the SVM.

RESULTS

The mean classification accuracy according to type was over 93%; sensitivity was over 87%. The mean sensitivity for polyp detection was 82.1%, and the positive predicted value (PPV) was 39.3%. Polyps detected using the system were larger (6.3 ± 6.4 vs. 4.9 ± 2.5 mm; P = 0.003) with a more pedunculated morphology (Yamada type III, 10.2 vs. 0%; P < 0.001; Yamada type IV, 2.8 vs. 0%; P < 0.001) than polyps missed by the system. There were no statistically significant differences in polyp distribution or histology between the groups. Informative frames and suspected polyps were presented on a timeline. This summary was evaluated using the system usability scale questionnaire; 89.3% of participants expressed positive opinions.

CONCLUSIONS

We developed and verified a system to extract meaningful information from colonoscopy videos. Although further improvement and validation of the system is needed, the proposed system is useful for physicians and patients.