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Wei LK, Chan W, Asokkumar R. Response. Gastrointest Endosc 2023; 98:142-143. [PMID: 37331772 DOI: 10.1016/j.gie.2023.03.003] [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: 02/28/2023] [Revised: 03/02/2023] [Accepted: 03/02/2023] [Indexed: 06/20/2023]
Affiliation(s)
- Lim Kim Wei
- Department of Gastroenterology and Hepatology, Singapore General Hospital; Duke-NUS Graduate Medical School, Singapore
| | - Webber Chan
- Department of Gastroenterology and Hepatology, Singapore General Hospital; Duke-NUS Graduate Medical School, Singapore
| | - Ravishankar Asokkumar
- Department of Gastroenterology and Hepatology, Singapore General Hospital; Duke-NUS Graduate Medical School, Singapore
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Hands-On Training in a Digital World: A Novel Simulation-Based Virtual Training Program for Placement and Removal of the Subdermal Contraceptive Implant. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:1167-1173. [PMID: 36087921 PMCID: PMC9451933 DOI: 10.1016/j.jogc.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/16/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The COVID-19 pandemic necessitated a shift from traditional in-person instruction for learning new technical skills to virtual delivery of medical education training. The objectives of this study were to develop and evaluate a virtual simulation-based training program for Canadian health care professionals (HCPs) on the insertion, localization, and removal of the etonogestrel subdermal contraceptive implant. METHODS A scientific committee of Canadian family planning experts developed a 2-part virtual training program during the COVID-19 pandemic. Core educational content (part 1) was provided in an asynchronous, self-directed, online format. Part 2 consisted of synchronous, simulation-based training using web conferencing. The HCPs were provided with model arms and placebo applicators; the trainers demonstrated implant insertion and removal techniques, and trainees received individual feedback. All trainees were asked to complete an online evaluation upon completion of the program. RESULTS Between September 22, 2020, and December 31, 2021, 83 trainers conducted 565 virtual training sessions. A total of 3162 HCPs completed part 1 of the training program, of whom 2740 had completed part 2 by December 31, 2021. Participants reported high levels of satisfaction with virtual simulation-based training; 96.5% of respondents (1570/1627) agreed that the virtual format was effective. Additional training prior to inserting the implant in clinical practice was requested by 4.5% of respondents (75/1671). CONCLUSION Virtual simulation-based learning provides effective education and technique training for etonogestrel implant insertion and removal. Online training for implant use can be scaled, as needed, to reach professionals in remote or underserved locations. This virtual training approach may be appropriate for other technical or minor surgical procedures.
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Fouhy F, Sheehy B, Hannon MJ, Sweeney AM, Kennedy MP. Remote Simulation Training in the COVID-19 Era: A Novel Approach to Ultrasound-guided Diagnostic Thoracentesis. J Bronchology Interv Pulmonol 2022; 29:e60-e63. [PMID: 35822742 DOI: 10.1097/lbr.0000000000000827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Fergal Fouhy
- Department of Medicine, Bantry General Hospital, Bantry
| | - Brian Sheehy
- Department of Medicine, Bantry General Hospital, Bantry
| | - Mark J Hannon
- Department of Medicine, Bantry General Hospital, Bantry
| | - Anne M Sweeney
- Department of Respiratory Medicine, Cork University Hospital
| | - Marcus P Kennedy
- Department of Respiratory Medicine, Cork University Hospital
- ASSERT Centre
- College of Medicine and Health, University College Cork, Cork, Ireland
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Maulahela H, Annisa NG, Konstantin T, Syam AF, Soetikno R. Simulation-based mastery learning in gastrointestinal endoscopy training. World J Gastrointest Endosc 2022; 14:512-523. [PMID: 36186944 PMCID: PMC9516469 DOI: 10.4253/wjge.v14.i9.512] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/03/2022] [Accepted: 08/16/2022] [Indexed: 02/05/2023] Open
Abstract
Simulation-based mastery learning (SBML) is an emerging form of competency-based training that has been proposed as the next standard method for procedural task training, including that in gastrointestinal endoscopy. Current basic gastrointestinal endoscopy training relies on the number of procedures performed, and it has been criticized for its lack of objective standards that result in variable skills among trainees and its association with patient safety risk. Thus, incorporating simulators into a competency-based curriculum seems ideal for gastrointestinal endoscopy training. The curriculum for SBML in gastrointestinal endoscopy is currently being developed and has promising potential to translate into the clinical performance. Unlike the present apprenticeship model of “see one, do one, teach one,” SBML integrates a competency-based curriculum with specific learning objectives alongside simulation-based training. This allows trainees to practice essential skills repeatedly, receive feedback from experts, and gradually develop their abilities to achieve mastery. Moreover, trainees and trainers need to understand the learning targets of the program so that trainees can focus their learning on the necessary skills and trainers can provide structured feedback based on the expected outcomes. In addition to learning targets, an assessment plan is essential to provide trainees with future directions for their improvement and ensure patient safety by issuing a passing standard. Finally, the SBML program should be planned and managed by a specific team and conducted within a developed and tested curriculum. This review discusses the current state of gastrointestinal endoscopy training and the role of SBML in that field.
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Affiliation(s)
- Hasan Maulahela
- Department of Internal Medicine, Gastroenterology Division, Faculty of Medicine University of Indonesia-Cipto Mangunkusumo General Central National Hospital, Jakarta 10430, Indonesia
| | | | | | - Ari Fahrial Syam
- Department of Internal Medicine, Gastroenterology Division, Faculty of Medicine University of Indonesia-Cipto Mangunkusumo General Central National Hospital, Jakarta 10430, Indonesia
| | - Roy Soetikno
- Department of Internal Medicine, Gastroenterology Division, Faculty of Medicine University of Indonesia-Cipto Mangunkusumo General Central National Hospital, Jakarta 10430, Indonesia
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Keswani RN. Pump Up the Volume? The Complex Relationship of Specialty and Colonoscopy Competency. Clin Gastroenterol Hepatol 2022; 20:1925-1926. [PMID: 34756994 DOI: 10.1016/j.cgh.2021.10.034] [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: 10/10/2021] [Accepted: 10/24/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Rajesh N Keswani
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Koo CS, Siah KTH, Koh CJ. Endoscopy training in COVID-19: Challenges and hope for a better age. J Gastroenterol Hepatol 2021; 36:2715-2719. [PMID: 33871079 PMCID: PMC8251278 DOI: 10.1111/jgh.15524] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/04/2021] [Accepted: 04/16/2021] [Indexed: 12/12/2022]
Abstract
The COVID-19 pandemic is a unique challenge that has disrupted endoscopy training. Initial infection control measures aimed at protecting patients and staff meant nonessential endoscopic activity was suspended in many countries. The decrease in elective caseload from the pandemic also reduced training numbers during this period. While hands-on training took a backseat, more efforts were directed to didactic training of cognitive competencies. We review the literature describing the impact of COVID-19 on endoscopy training and summarize key measures aimed at mitigating this effect. These include leveraging on web-based didactic material and video-conferences, increased use of simulation and models to hone technical competencies, and a shift in focus from numbers-based accreditation to competency-based accreditation. While COVID-19 was hoped to be short-lived, it is clear the impact is long-lasting. Hence, it is crucial for training programs to take stock of how endoscopy training is evolving and use this opportunity to implement new paradigms into their endoscopic training curricula. COVID-19 might just be the catalyst that transforms endoscopy training into a new digital era.
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Affiliation(s)
- Chieh Sian Koo
- Division of Gastroenterology and HepatologyNational University HospitalSingapore
| | - Kewin Tien Ho Siah
- Division of Gastroenterology and HepatologyNational University HospitalSingapore,Yong Loo Lin School of MedicineNational University of SingaporeSingapore
| | - Calvin Jianyi Koh
- Division of Gastroenterology and HepatologyNational University HospitalSingapore,Yong Loo Lin School of MedicineNational University of SingaporeSingapore
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Abstract
The coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented disruptions in fellowship training programs worldwide. In gastroenterology, the strain in healthcare service provision and the emphasis on preventing viral transmission has adversely impacted hands-on training opportunities, with trainees facing the constant pressure to meet training requirements under the continuous threat of viral transmission. Emerging evidence highlight the scale of the problem, specifically with regard to endoscopy competence due to cancellation of elective endoscopic procedures, provision of inpatient and outpatient consultative care as well as academic education and the mental well-being of trainees. As such, it has been necessary for trainees, trainers and training programs collectively to adapt to these challenges and incorporate novel and adaptive solutions to circumvent these training barriers. This review aims to summarise data on the global impact of COVID-19 on gastroenterology training and the practical interventions that could be implemented.
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Buddam A, Rao S, Koppala J, Rangray R, Abdussalam A, Mukherjee S, Chandra S. Over-the-scope clip as first-line therapy for ulcers with high-risk bleeding stigmata is efficient compared to standard endoscopic therapy. Endosc Int Open 2021; 9:E1530-E1535. [PMID: 34540546 PMCID: PMC8445675 DOI: 10.1055/a-1526-0754] [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: 02/22/2021] [Accepted: 06/04/2021] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Ulcers with high-risk stigmata have significant rebleeding rates despite standard endoscopic therapy. Data on over-the-scope clip (OTSC) for recurrent bleeding is promising but data on first line therapy is lacking. We report comparative outcomes of OTSC as first-line therapy versus standard endoscopic therapy in ulcers with high-risk stigmata. Patients and methods Consecutive adults who underwent endoscopic therapy for ulcers with high-risk stigmata between July 2019 to September 2020 were included. Patients were grouped into OTSC or standard therapy based on first-line therapy used on index endoscopy. Outcomes measured included: 1) intra-procedural hemostasis based on endoscopic documentation of adequate hemostasis; 2) 7-day rebleeding (> 2 g/dL drop in hemoglobin, hematochezia or hemorrhagic shock); 3) cost of endoscopic interventions; and 4) procedure duration measured as endoscope insertion to removal time. Cost of tools used during the index endoscopy was included. Results Sixty-eight patients were included, 47 were in standard therapy and 21 in the OTSC group. Hemostasis was achieved in 95.2 % in the OTSC group compared to 83.0 % in the standard therapy group ( P = 0.256, number needed to treat [NNT]: 9). Procedure time was shorter in the OTSC group (23 vs. 16 minutes, P = 0.002). Cost of endoscopic interventions were comparable, P = 0.203. Early rebleeding was less often in OTSC group, two (9.5 %) compared to 10 (21.3 %) in standard therapy group, NNT 9. Conclusions Use of OTSCs as first-line treatment for ulcers bleed probably improves hemostasis and decreases early rebleeding. Use of OTSC as first-line therapy shortened procedure duration without increasing the cost of endoscopic interventions.
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Affiliation(s)
- Avanija Buddam
- Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, Nebraska, United States
| | - Sirish Rao
- Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, Nebraska, United States
| | - Jahnavi Koppala
- Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, Nebraska, United States
| | - Rajani Rangray
- Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, Nebraska, United States
| | - Abdullah Abdussalam
- Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, Nebraska, United States
| | - Sandeep Mukherjee
- Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, Nebraska, United States
| | - Subhash Chandra
- Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, Nebraska, United States
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Hock SM, Martin JJ, Stanfield SC, Alcorn TR, Binstadt ES. Novel cricothyrotomy assessment tool for attending physicians: A multicenter study of an error avoidance checklist. AEM EDUCATION AND TRAINING 2021; 5:e10687. [PMID: 34589660 PMCID: PMC8457693 DOI: 10.1002/aet2.10687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/24/2021] [Accepted: 08/03/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND This study used existing literature and expert feedback to develop and pilot a novel error-avoidance checklist tool for cricothyrotomy in attending physicians. Prior literature has not focused on expert cricothyrotomy performance. While published checklists teach a specific procedural method, ideal for novice learners, this may hinder expert learners. OBJECTIVES We endeavored to create a succinct error-avoidance checklist for cricothyrotomy. We hypothesized that such a checklist would prove feasible and acceptable to attending physicians. METHODS This is a multicenter prospective checklist creation, evaluation, and feasibility study. Multiple experts pursued an iterative process to reach consensus on a 7-item error-avoidance checklist. The checklist was trialed for feasibility in pilot sessions at two sites by 45 attending emergency physicians who used the checklist for peer performance assessment and provided feedback. RESULTS During the pilot implementation, 94% of respondents completed the procedure within the allotted 120 s. Greater than 85% of respondents agreed that four of the five procedural errors on the checklist were very or somewhat critical to avoid, including cutting >2 cm from midline, creating a false passage, failing to continuously maintain an object in the trachea, and injuring oneself during the procedure. Only 66% of participants felt severing the cricoid cartilage was critical. Successful breath administration and time under 120 s were critical for 100% and 95% of participants, respectively. The checklist was rated "easy" or "very easy" to use by 93% of participants, and 95% found this checklist reasonable for evaluating attending physicians. CONCLUSIONS We present the multicenter development and implementation of a novel error-avoidance checklist tool for use in expert cricothyrotomy performance. Attending emergency medicine (EM) physicians rated our tool easy to use and agreed that most of the proposed errors were critical. Participants overwhelmingly agreed this tool would be reasonable for evaluation of cricothyrotomy performance among attending EM physicians.
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Affiliation(s)
- Sara M. Hock
- Emergency DepartmentRush University Medical CenterChicagoIllinoisUSA
| | - Jerome J. Martin
- Emergency DepartmentRush University Medical CenterChicagoIllinoisUSA
| | | | - Thomas R. Alcorn
- Emergency DepartmentRush University Medical CenterChicagoIllinoisUSA
| | - Emily S. Binstadt
- Emergency DepartmentRegions HospitalHealth PartnersSt PaulMinnesotaUSA
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Calderwood AH, Calderwood MS, Williams JL, Dominitz JA. Impact of the COVID-19 pandemic on utilization of EGD and colonoscopy in the US: An Analysis of the GIQuIC Registry. ACTA ACUST UNITED AC 2021; 23:313-321. [PMID: 34345871 PMCID: PMC8323550 DOI: 10.1016/j.tige.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background and aims The coronavirus disease 2019 (COVID-19) pandemic has limited the ability to perform endoscopy. The aim of this study was to quantify the impact of the pandemic on endoscopy volumes and indications in the US. Methods We performed a retrospective analysis of data from the GI Quality Improvement Consortium (GIQuIC) registry. We compared volumes of colonoscopy and esophagogastroduodenoscopy (EGD) during the pandemic (March to September 2020) to before the pandemic (January 2019 through February 2020). The primary outcome was change in monthly volumes. Secondary outcomes included changes in the distribution of procedure indications and in procedure volume by region of US, patient characteristics, trainee involvement, and practice setting, as well as colorectal cancer diagnoses. Results Among 451 sites with 3,514 endoscopists, the average monthly volume of colonoscopies and EGDs dropped by 38.5% and 33.4%, respectively. There was regional variation, with the greatest and least decline in procedures in the Northeast and South, respectively. There was a modest shift in procedure indications from prevention to diagnostic, an initial increase in performance in the hospital setting, and a decrease in procedures with trainees. The decline in volume of colonoscopy and EGD during the first seven months of the pandemic was equivalent to approximately 2.7 and 2.4 months of pre-pandemic productivity, respectively. Thirty percent fewer colorectal cancers were diagnosed compared to expected. Conclusions These data on actual endoscopy utilization nationally during the pandemic can help in anticipating impact of delays in care on outcomes and planning for the recovery phase.
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Affiliation(s)
- Audrey H Calderwood
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - Michael S Calderwood
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | | | - Jason A Dominitz
- VA Puget Sound Health Care System, Seattle, Washington, D.C
- University of Washington, Seattle, Washington, D.C
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