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Nehra D, Clements CDM, Bezzaa SL, Tabbakh Y, Walsh CM. Patient-reported outcomes of laparoscopic magnetic sphincter augmentation for gastro-oesophageal reflux disease. Ann R Coll Surg Engl 2024; 106:344-352. [PMID: 37609688 PMCID: PMC10981991 DOI: 10.1308/rcsann.2023.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 08/24/2023] Open
Abstract
INTRODUCTION Gastro-oesophageal reflux disease (GORD) is a chronic progressive disease, associated with substantial clinical and economic burden. Proton pump inhibitors (PPIs) are considered first-line treatment; however, there are concerns around the long-term impact of their usage. Surgical treatment with Nissen fundoplication can be considered but, because of the potential side effects, few patients undergo surgery and there remains a substantial therapeutic gap within the current treatment pathway. Laparoscopic magnetic sphincter augmentation (MSA) using the LINX® device is an alternative surgical approach. METHODS The objective of this study was to investigate patient-reported outcomes following laparoscopic MSA surgery using the LINX® device in a UK setting. A retrospective questionnaire obtained data regarding postoperative symptoms, medication use and patient satisfaction. RESULTS Out of 131 patients surveyed, 97 responses were received, with a minimum follow-up time of 1 year. In those who reported heartburn and regurgitation preoperatively, improvement was reported in 93% (84/90) and 90% (86/96) of patients, respectively. Eighty-eight per cent (73/83) of patients were able to completely stop or reduce their medication by at least 75%. Seventy-seven per cent (73/95) of patients were "very satisfied" or "satisfied". CONCLUSIONS This study is the first to present patient-reported outcomes of MSA using the LINX® device for patients with GORD in the UK. It demonstrates that the device has favourable outcomes and could effectively bridge the current therapeutic gap that exists between PPI medication and Nissen fundoplication.
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Affiliation(s)
- D Nehra
- Epsom and St Helier University Hospitals NHS Trust, UK
| | - CDM Clements
- Epsom and St Helier University Hospitals NHS Trust, UK
| | - SL Bezzaa
- Epsom and St Helier University Hospitals NHS Trust, UK
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Liu K, Elmunzer BJ, Wani S, Taft T, Walsh CM, Arain MA, Berzin TM, Buxbaum J, DiMaio C, Fehmi SMA, Gupta N, Jonnalagadda S, Kushnir V, Maple JT, Muthusamy R, Rastogi A, Shah JN, Chak A, Faulx A, Forbes N, Keswani RN. The Bethesda ERCP Skills Assessment Tool (BESAT) can reliably differentiate endoscopists of different experience levels. Endosc Int Open 2024; 12:E324-E331. [PMID: 38420150 PMCID: PMC10901650 DOI: 10.1055/a-2161-1982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/22/2023] [Indexed: 03/02/2024] Open
Abstract
Background and study aims The Bethesda ERCP Skill Assessment Tool (BESAT) is a video-based assessment tool of technical endoscopic retrograde cholangiopancreatography (ERCP) skill with previously established validity evidence. We aimed to assess the discriminative validity of the BESAT in differentiating ERCP skill levels. Methods Twelve experienced ERCP practitioners from tertiary academic centers were asked to blindly rate 43 ERCP videos using the BESAT. ERCP videos consisted of native biliary cannulation and sphincterotomy and were recorded from 10 unique endoscopists of various ERCP experience (from advanced endoscopy fellow to > 10 years of ERCP experience). Inter-rater reliability, discriminative validity, and internal structure validity were subsequently assessed. Results The BESAT was found to reliably differentiate between endoscopists of varying levels of ERCP experience with experienced ERCPists scoring higher than novice ERCPists in 11 of 13 (85%) instrument items. Inter-rater reliability for BESAT items ranged from good to excellent (intraclass correlation range: 0.86 to 0.93). Internal structure validity was assessed with item-total correlations ranging from 0.53 to 0.83. Conclusions Study findings demonstrate that the BESAT, a video-based ERCP skill assessment tool, has high inter-rater reliability and has discriminative validity in differentiating novice from expert ERCP skill. Further investigations are needed to determine the role of video-based assessment in improving trainee learning curves and patient outcomes.
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Affiliation(s)
- Kevin Liu
- Gastroenterology, Banner - University Medical Center Phoenix, Phoenix, United States
| | - B. Joseph Elmunzer
- Division of Gastroenterology, Medical University of South Carolina, Charleston, United States
| | - Sachin Wani
- Gastroenterology, University of Colorado and Veterans Affairs Medical Center, Aurora, United States
| | - Tiffany Taft
- Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, United States
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology, and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto Faculty of Medicine, Toronto, Canada
- The Wilson Centre, University of Toronto, Toronto, Canada
| | - Mustafa A Arain
- Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
| | - Tyler M. Berzin
- Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, United States
| | - James Buxbaum
- Medicine/Gastroenterology, University of California, San Francisco, San Francisco, United States
| | - Christopher DiMaio
- Gastroenterology, Catholic Health St Francis Hospital & Heart Center, Roslyn, United States
| | | | - Neil Gupta
- Gastroenterology, Loyola University Medical Center, Chicago, United States
| | | | - Vladimir Kushnir
- Gastroenterology, Washington University, St Louis, United States
| | - John T. Maple
- Internal Medicine, University of Oklahoma, Oklahoma City, United States
| | - Raman Muthusamy
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles, United States
| | - Amit Rastogi
- Gastroenterology, Kansas University Medical Center, Kansas City, United States
- Gastroenterology, Veterans Affairs Medical Center, Kansas City, United States
| | - Janak N Shah
- Gastroenterology, Ochsner Medical Center - New Orleans, New Orleans, United States
| | - Amitabh Chak
- Gastroenterology, UH Cleveland Medical Center, Cleveland, United States
| | - Ashley Faulx
- Gastroenterology, UH Cleveland Medical Center, Cleveland, United States
| | | | - Rajesh N Keswani
- Medicine, Northwestern University Feinberg School of Medicine, Chicago, United States
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Tenedero CB, O'Brien KT, Patel BP, Strom M, Deveci AC, Chu L, Jayawardena S, Noseworthy R, McPherson AC, Walsh CM, Hamilton JK. Medical students' perceived comfort and competence performing physical examinations on patients with obesity: A mixed-methods needs assessment. Clin Obes 2024; 14:e12617. [PMID: 37559427 DOI: 10.1111/cob.12617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/16/2023] [Accepted: 07/26/2023] [Indexed: 08/11/2023]
Abstract
Physicians are unsatisfied with their training in the care of patients with obesity. Physical examination is a key component of care, and modifications to techniques are often necessary for patients with obesity. To determine learning needs, we examined medical students' perceived comfort and competency in conducting physical examinations on patients with obesity. This mixed-methods study of Canadian medical students used a questionnaire and semi-structured focus groups to assess medical students' perceived comfort and competence in examining patients with obesity. Participants included 175 Canadian medical students. A minority of medical students felt comfortable (42%) or competent (14%) examining patients with obesity. Physical exam challenges included modifying exam manoeuvres, interpreting findings and communicating sensitively around weight. Lack of early exposure to patients with obesity, minimal instruction by preceptors and a lack of curricular focus on obesity were felt to be barriers to improving these skills. Students perceived their lack of confidence as negatively impacting their ability to manage patients with obesity and more training in this area was desired to prevent disparities in care. Medical students feel that adequate training on how to perform an obesity-specific physical examination is lacking. Developing curricula and including formal teaching around these key competencies within medical education is essential.
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Affiliation(s)
- Christine B Tenedero
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | - Barkha P Patel
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Michele Strom
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Arin C Deveci
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lisa Chu
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | - Rebecca Noseworthy
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Amy C McPherson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Catharine M Walsh
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- SickKids Research and Learning Institutes, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jill K Hamilton
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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Grover SC, Walsh CM. Integrating artificial intelligence into endoscopy training: opportunities, challenges, and strategies. Lancet Gastroenterol Hepatol 2024; 9:11-13. [PMID: 37832570 DOI: 10.1016/s2468-1253(23)00309-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 10/15/2023]
Affiliation(s)
- Samir C Grover
- Division of Gastroenterology and Hepatology and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition, Sickkids Research Institute, and Sickkids Learning Institute, The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1X8, Canada.
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5
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Khan R, Samnani S, Vaska M, Grover SC, Walsh CM, Mosko J, Bourke M, Heitman SJ, Forbes N. Effectiveness and safety of thin vs. thick cold snare polypectomy of small colorectal polyps: Systematic review and meta-analysis. Endosc Int Open 2024; 12:E99-E107. [PMID: 38250163 PMCID: PMC10798846 DOI: 10.1055/a-2221-7792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/28/2023] [Indexed: 01/23/2024] Open
Abstract
Background and study aims Cold-snare polypectomy (CSP) is considered the standard of care for resection of colorectal polyps ≤10 mm. Data on the efficacy of CSP performed with thin-wire snares compared0 with thick-wire snares are conflicting. We performed a meta-analysis comparing complete resection (CR) and adverse event rates of CSP using thin-wire and thick-wire snares. Patients and methods Comparative studies of adult patients with ≧1 colorectal polyp(s) ≦10 mm who underwent CSP with thin-wire or thick-wire snares were included. We collected data on study, patient, polyp, and snare characteristics. The primary outcome was CR rate. Secondary outcomes were polyp retrieval rate, intraprocedural bleeding, delayed post-polypectomy bleeding, deep mural injury or perforation, patient discomfort, total sedation, and procedure time. We used random-effects models to calculate risk ratios for outcomes. We performed risk of bias assessments, rated the certainty of evidence, and assessed publication bias for all studies. Results We included four randomized controlled trials (RCTs) and two observational studies including 1316 patients with 1679 polyps (826 thin-wire CSPs and 853 thick-wire CSPs). There was no significant difference between thin-wire CSP (92.1%) and thick-wire CSP (87.7%) for RCTs (risk ratio [RR] 1.05, 95% confidence interval [CI] 0.94-1.16) or observational studies (78.1% versus 79.6%, RR 1.03, 95% CI 0.99-1.08). There were no significant differences in polyp retrieval rate or intraprocedural bleeding. There were no cases of delayed bleeding or perforation. Conclusions We found no differences in CR rates for CSP between thin-wire and thick-wire snares. CSP, regardless of snare type, is safe and effective for resection of small colorectal polyps.
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Affiliation(s)
- Rishad Khan
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Sunil Samnani
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Marcus Vaska
- Knowledge Resource Service, Tom Baker Cancer Centre, Calgary, Canada
| | - Samir C Grover
- Department of Medicine, University of Toronto, Toronto, Canada
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Canada
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology, and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto Faculty of Medicine, Toronto, Canada
- The Wilson Centre, University of Toronto, Toronto, Canada
| | - Jeffrey Mosko
- Gastroenterology, St Michael's Hospital, Toronto, Canada
| | | | - Steven J Heitman
- Division of Gastroenterology, University of Calgary, Calgary, Canada
| | - Nauzer Forbes
- Division of Gastroenterology, University of Calgary, Calgary, Canada
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Mahoney LB, Huang JS, Lightdale JR, Walsh CM. Pediatric endoscopy: how can we improve patient outcomes and ensure best practices? Expert Rev Gastroenterol Hepatol 2024; 18:89-102. [PMID: 38465446 DOI: 10.1080/17474124.2024.2328229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/05/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Strategies to promote high-quality endoscopy in children require consensus around pediatric-specific quality standards and indicators. Using a rigorous guideline development process, the international Pediatric Endoscopy Quality Improvement Network (PEnQuIN) was developed to support continuous quality improvement efforts within and across pediatric endoscopy services. AREAS COVERED This review presents a framework, informed by the PEnQuIN guidelines, for assessing endoscopist competence, granting procedural privileges, audit and feedback, and for skill remediation, when required. As is critical for promoting quality, PEnQuIN indicators can be benchmarked at the individual endoscopist, endoscopy facility, and endoscopy community levels. Furthermore, efforts to incorporate technologies, including electronic medical records and artificial intelligence, into endoscopic quality improvement processes can aid in creation of large-scale networks to facilitate comparison and standardization of quality indicator reporting across sites. EXPERT OPINION PEnQuIN quality standards and indicators provide a framework for continuous quality improvement in pediatric endoscopy, benefiting individual endoscopists, endoscopy facilities, and the broader endoscopy community. Routine and reliable measurement of data, facilitated by technology, is required to identify and drive improvements in care. Engaging all stakeholders in endoscopy quality improvement processes is crucial to enhancing patient outcomes and establishing best practices for safe, efficient, and effective pediatric endoscopic care.
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Affiliation(s)
- Lisa B Mahoney
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Jeannie S Huang
- Rady Children's Hospital, San Diego, CA and University of California San Diego, La Jolla, CA, USA
| | - Jenifer R Lightdale
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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7
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Grover SC, Ong A, Bollipo S, Dilly CK, Siau K, Walsh CM. Approach to Remediating the Underperforming Endoscopic Trainee. Gastroenterology 2023; 165:1323-1327. [PMID: 37832593 DOI: 10.1053/j.gastro.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Affiliation(s)
- Samir C Grover
- Division of Gastroenterology and Hepatology, and Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada.
| | - Andrew Ong
- Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore
| | - Steven Bollipo
- Department of Gastroenterology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Christen K Dilly
- Division of Gastroenterology, Hepatology, and Nutrition, Indiana University School of Medicine, Indianapolis, Indiana; Roudebush VA Medical Center, Indianapolis, Indiana
| | - Keith Siau
- Royal Cornwall Hospital NHS Trust, Truro, United Kingdom
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, Department of Pediatrics and the Wilson Center, University of Toronto, Toronto, Ontario, Canada
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Zhao AY, Gimpaya N, Angeli Fujiyoshi MR, Fujiyoshi Y, Khan R, Lisondra J, Walsh CM, Grover SC. How to make cost-effective polyp simulators for high-fidelity simulation-based training in postpolypectomy bleeding management and EMR. VideoGIE 2023; 8:520-526. [PMID: 38155828 PMCID: PMC10751457 DOI: 10.1016/j.vgie.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
Video 1Demonstration of manufacturing instructions and features of the postpolypectomy bleeding and conventional and underwater EMR simulators.
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Affiliation(s)
- Ally Y Zhao
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Nikko Gimpaya
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Yusuke Fujiyoshi
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Rishad Khan
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - James Lisondra
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology, and Nutrition and the Research and Learning Institutes, Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Samir C Grover
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Mahoney LB, Walsh CM, Lightdale JR. Promoting Research that Supports High-Quality Gastrointestinal Endoscopy in Children. Curr Gastroenterol Rep 2023; 25:333-343. [PMID: 37782450 DOI: 10.1007/s11894-023-00897-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE OF REVIEW Defining and measuring the quality of endoscopic care is a key component of performing gastrointestinal endoscopy in children. The purpose of this review is to discuss quality metrics for pediatric gastrointestinal endoscopy and identify where additional research is needed. RECENT FINDINGS Pediatric-specific standards and indicators were recently defined by the international Pediatric Endoscopy Quality Improvement Network (PEnQuIN) working group through a rigorous guideline consensus process. Although the aim of these guidelines is to facilitate best practices for safe and high-quality gastrointestinal endoscopy in children, they highlight the pressing need to expand upon the body of evidence supporting these standards and indicators as predictors of clinically relevant outcomes. In this review, we propose and discuss ideas for several high-yield research topics to engage pediatric endoscopists and promote best practices in pediatric endoscopy.
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Affiliation(s)
- Lisa B Mahoney
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jenifer R Lightdale
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
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Khan R, Homsi H, Gimpaya N, Lisondra J, Sabrie N, Gholami R, Bansal R, Scaffidi MA, Lightfoot D, James PD, Siau K, Forbes N, Wani S, Keswani RN, Walsh CM, Grover SC. Validity evidence for observational ERCP competency assessment tools: a systematic review. Endoscopy 2023; 55:847-856. [PMID: 36822219 DOI: 10.1055/a-2041-7546] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND : Assessment of competence in endoscopic retrograde cholangiopancreatography (ERCP) is critical for supporting learning and documenting attainment of skill. Validity evidence supporting ERCP observational assessment tools has not been systematically evaluated. METHODS : We conducted a systematic search using electronic databases and hand-searching from inception until August 2021 for studies evaluating observational assessment tools of ERCP performance. We used a unified validity framework to characterize validity evidence from five sources: content, response process, internal structure, relations to other variables, and consequences. Each domain was assigned a score of 0-3 (maximum score 15). We assessed educational utility and methodological quality using the Accreditation Council for Graduate Medical Education framework and the Medical Education Research Quality Instrument, respectively. RESULTS : From 2769 records, we included 17 studies evaluating 7 assessment tools. Five tools were studied for clinical ERCP, one for simulated ERCP, and one for simulated and clinical ERCP. Validity evidence scores ranged from 2 to 12. The Bethesda ERCP Skills Assessment Tool (BESAT), ERCP Direct Observation of Procedural Skills Tool (ERCP DOPS), and The Endoscopic Ultrasound (EUS) and ERCP Skills Assessment Tool (TEESAT) had the strongest validity evidence, with scores of 10, 12, and 11, respectively. Regarding educational utility, most tools were easy to use and interpret, and required minimal additional resources. Overall methodological quality (maximum score 13.5) was strong, with scores ranging from 10 to 12.5. CONCLUSIONS : The BESAT, ERCP DOPS, and TEESAT had strong validity evidence compared with other assessments. Integrating tools into training may help drive learners' development and support competency decision making.
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Affiliation(s)
- Rishad Khan
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Hoomam Homsi
- Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Nikko Gimpaya
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Canada
| | - James Lisondra
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Canada
| | | | - Reza Gholami
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Toronto, Toronto, Canada
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Canada
| | - Rishi Bansal
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | | | - David Lightfoot
- Health Science Library, Unity Health Toronto, St. Michael's Hospital, Toronto, Canada
| | - Paul D James
- Division of Gastroenterology, University Health Network, Toronto, Canada
| | - Keith Siau
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, United Kingdom
- Immunology and Immunotherapy, University of Birmingham College of Medical and Dental Sciences, Birmingham, United Kingdom
| | - Nauzer Forbes
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rajesh N Keswani
- Division of Gastroenterology, Department of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Catharine M Walsh
- The Wilson Centre, University of Toronto, Toronto, Canada
- SickKids Research and Learning Institute, The Hospital for Sick Children, Toronto, Canada
- Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Samir C Grover
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Toronto, Toronto, Canada
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, Toronto, Canada
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11
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Lieberman L, Hajjaj OI, Walsh CM, Lin Y. Transfusion medicine curricular content for general pediatricians and pediatric subspecialists: A national multi-specialty Delphi consensus study. Transfusion 2023; 63:1571-1579. [PMID: 37309566 DOI: 10.1111/trf.17453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/13/2023] [Accepted: 05/10/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Although pediatric residents frequently order blood products, transfusion medicine (TM) education is both limited and unstandardized during postgraduate training. Using Delphi methodology, this study aimed to identify and prioritize which pediatric TM curricular topics are most important to inform postgraduate training in TM for general pediatricians and pediatric subspecialists. METHODS A national panel of experts iteratively rated potential curricular topics, on a 5-point scale, to determine their priority for inclusion within a TM curriculum. After each round, responses were analyzed. Topics receiving a mean rating <3/5 were removed from subsequent rounds and remaining topics were resent to the panel for further ratings until consensus was achieved, defined as Cronbach α ≥ 0.95. At conclusion of the Delphi process, topics rated ≥4/5 were considered core curricular topics, while topics rated ≥3 to <4 were considered extended topics. RESULTS Forty-five TM experts from 17 Canadian institutions and 12 subspecialties completed the first Delphi round and 31 completed the second. Fifty-seven potential curricular topics were generated from a systematic literature review and Delphi panelists. Two survey rounds were completed before consensus was achieved. Seventy-three topics in six domains reached consensus: 31 core curricular topics and 42 extended topics. There were no significant differences in ratings between TM and non-TM specialists. DISCUSSION A multispecialty Delphi panel reached consensus in identification of curricular topics for pediatric resident physicians. These results set the stage to develop a pediatric TM curriculum that will be foundational for pediatric trainees to enhance learning and improve transfusion safety.
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Affiliation(s)
- Lani Lieberman
- Department of Clinical Pathology, University Health Network, Toronto, Ontario, Canada
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Omar I Hajjaj
- Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology, and Nutrition and the SickKids Research and Learning Institutes, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics and the Wilson Centre, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Yulia Lin
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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12
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Pattni C, Scaffidi M, Li J, Genis S, Gimpaya N, Khan R, Bansal R, Torabi N, Walsh CM, Grover SC. Video-based interventions to improve self-assessment accuracy among physicians: A systematic review. PLoS One 2023; 18:e0288474. [PMID: 37440486 DOI: 10.1371/journal.pone.0288474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
PURPOSE Self-assessment of a physician's performance in both procedure and non-procedural activities can be used to identify their deficiencies to allow for appropriate corrective measures. Physicians are inaccurate in their self-assessments, which may compromise opportunities for self- development. To improve this accuracy, video-based interventions of physicians watching their own performance, an experts' performance or both, have been proposed to inform their self-assessment. We conducted a systematic review of the effectiveness of video-based interventions targeting improved self-assessment accuracy among physicians. MATERIALS AND METHODS The authors performed a systematic search of MEDLINE, Embase, EBM reviews, and Scopus databases from inception to August 23, 2022, using combinations of terms for "self-assessment", "video-recording", and "physician". Eligible studies were empirical investigations assessing the effect of video-based interventions on physicians' self-assessment accuracy with a comparison of self-assessment accuracy pre- and post- video intervention. We defined self-assessment accuracy as a "direct comparison between an external evaluator and self-assessment that was quantified using formal statistical analysis". Two reviewers independently screened records, extracted data, assessed risk of bias, and evaluated quality of evidence. A narrative synthesis was conducted, as variable outcomes precluded a meta-analysis. RESULTS A total of 2,376 papers were initially retrieved. Of these, 22 papers were selected for full-text review; a final 9 studies met inclusion criteria for data extraction. Across studies, 240 participants from 5 specialties were represented. Video-based interventions included self-video review (8/9), benchmark video review (3/9), and/or a combination of both types (1/9). Five out of nine studies reported that participants had inaccurate self-assessment at baseline. After the intervention, 5 of 9 studies found a statistically significant improvement in self-assessment accuracy. CONCLUSIONS Overall, current data suggests video-based interventions can improve self-assessment accuracy. Benchmark video review may enable physicians to improve self-assessment accuracy, especially for those with limited experience performing a particular clinical skill. In contrast, self-video review may be able to provide improvement in self-assessment accuracy for more experience physicians. Future research should use standardized methods of comparison for self-assessment accuracy, such as the Bland-Altman analysis, to facilitate meta-analytic summation.
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Affiliation(s)
- Chandni Pattni
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Michael Scaffidi
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada
- Department of Medicine, Queen's University, Kingston, Canada
| | - Juana Li
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Shai Genis
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Nikko Gimpaya
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Rishad Khan
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Rishi Bansal
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Nazi Torabi
- Gerstein Science Information Centre, University of Toronto, Toronto, Canada
| | - Catharine M Walsh
- Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
- Department of Medicine, Hospital for Sick Children, University of Toronto, Toronto, Canada
- The Wilson Centre, University of Toronto, Toronto, Canada
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Samir C Grover
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, Toronto, Canada
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13
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Giuliano J, Krishna A, Napolitano N, Panisello J, Shenoi A, Sanders RC, Rehder K, Al-Subu A, Brown C, Edwards L, Wright L, Pinto M, Harwayne-Gidansky I, Parsons S, Romer A, Laverriere E, Shults J, Yamada NK, Walsh CM, Nadkarni V, Nishisaki A. Implementation of Video Laryngoscope-Assisted Coaching Reduces Adverse Tracheal Intubation-Associated Events in the PICU. Crit Care Med 2023; 51:936-947. [PMID: 37058348 DOI: 10.1097/ccm.0000000000005847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
OBJECTIVES To evaluate implementation of a video laryngoscope (VL) as a coaching device to reduce adverse tracheal intubation associated events (TIAEs). DESIGN Prospective multicenter interventional quality improvement study. SETTING Ten PICUs in North America. PATIENTS Patients undergoing tracheal intubation in the PICU. INTERVENTIONS VLs were implemented as coaching devices with standardized coaching language between 2016 and 2020. Laryngoscopists were encouraged to perform direct laryngoscopy with video images only available in real-time for experienced supervising clinician-coaches. MEASUREMENTS AND MAIN RESULTS The primary outcome was TIAEs. Secondary outcomes included severe TIAEs, severe hypoxemia (oxygen saturation < 80%), and first attempt success. Of 5,060 tracheal intubations, a VL was used in 3,580 (71%). VL use increased from baseline (29.7%) to implementation phase (89.4%; p < 0.001). VL use was associated with lower TIAEs (VL 336/3,580 [9.4%] vs standard laryngoscope [SL] 215/1,480 [14.5%]; absolute difference, 5.1%; 95% CI, 3.1-7.2%; p < 0.001). VL use was associated with lower severe TIAE rate (VL 3.9% vs SL 5.3%; p = 0.024), but not associated with a reduction in severe hypoxemia (VL 15.7% vs SL 16.4%; p = 0.58). VL use was associated with higher first attempt success (VL 71.8% vs SL 66.6%; p < 0.001). In the primary analysis after adjusting for site clustering, VL use was associated with lower adverse TIAEs (odds ratio [OR], 0.61; 95% CI, 0.46-0.81; p = 0.001). In secondary analyses, VL use was not significantly associated with severe TIAEs (OR, 0.72; 95% CI, 0.44-1.19; p = 0.20), severe hypoxemia (OR, 0.95; 95% CI, 0.73-1.25; p = 0.734), or first attempt success (OR, 1.28; 95% CI, 0.98-1.67; p = 0.073). After further controlling for patient and provider characteristics, VL use was independently associated with a lower TIAE rate (adjusted OR, 0.65; 95% CI, 0.49-0.86; p = 0.003). CONCLUSIONS Implementation of VL-assisted coaching achieved a high level of adherence across the PICUs. VL use was associated with reduced adverse TIAEs.
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Affiliation(s)
- John Giuliano
- Department of Pediatrics, Section of Pediatric Critical Care Medicine, Yale University School of Medicine, New Haven, CT
| | - Ashwin Krishna
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Kentucky College of Medicine, Lexington, KY
| | - Natalie Napolitano
- Respiratory Therapy Department, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Josep Panisello
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Asha Shenoi
- Department of Pediatrics and Critical Care Medicine, University of Kentucky College of Medicine, Kentucky Children's Hospital, Lexington, KY
| | - Ronald C Sanders
- Section of Critical Care, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Kyle Rehder
- Division of Pediatric Critical Care, Duke Children's Hospital, Durham, NC
| | - Awni Al-Subu
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, UW Health American Family Children's Hospital, University of Wisconsin-Madison, Madison, WI
| | - Calvin Brown
- Department of Emergency Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Lauren Edwards
- Section of Critical Care, Department of Pediatrics, Arkansas Children's Hospital, Little Rock, AR
| | - Lisa Wright
- Department of Pediatrics and Critical Care Medicine, University of Kentucky College of Medicine, Kentucky Children's Hospital, Lexington, KY
| | - Matthew Pinto
- Pediatric Critical Care Medicine, Department of Pediatrics, Maria Fareri Children's Hospital, Valhalla, NY
| | - Ilana Harwayne-Gidansky
- Department of Pediatrics, Bernard and Millie Duker Children's Hospital at Albany Medical Center, Albany, NY
| | - Simon Parsons
- Division of Critical Care, Alberta Children's Hospital, Calgary, AB, Canada
| | - Amy Romer
- Division of Cardiac Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Elizabeth Laverriere
- Division of Critical Care Medicine and Division of General Anesthesiology at Children's Hospital of Philadelphia, Philadelphia, PA
| | - Justine Shults
- Division of Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Nicole K Yamada
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto, Toronto, ON, Canada
| | - Vinay Nadkarni
- Department of Anesthesiology, Critical Care, and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Akira Nishisaki
- Department of Anesthesiology, Critical Care, and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Matava CT, Alam F, Kealey A, Bahrey LA, McCreath GA, Walsh CM. The influence of resident and faculty gender on assessments in anesthesia competency-based medical education. Can J Anaesth 2023; 70:978-987. [PMID: 37165126 PMCID: PMC10171726 DOI: 10.1007/s12630-023-02454-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 05/12/2023] Open
Abstract
PURPOSE Competency-based medical education (CBME) relies on frequent workplace-based assessments of trainees, providing opportunities for conscious and implicit biases to reflect in these assessments. We aimed to examine the influence of resident and faculty gender on performance ratings of residents within a CBME system. METHODS This retrospective cohort study took place from August 2017 to January 2021 using resident assessment data from two workplace-based assessments: the Anesthesia Clinical Encounter Assessment (ACEA) and Entrustable Professional Activities (EPAs). Self-reported gender data were also extracted. The primary outcome-gender-based differences in entrustment ratings of residents on the ACEA and EPAs-was evaluated using mixed-effects logistic regression, with differences reported through odds ratios and confidence intervals (α = 0.01). Gender-based differences in the receipt of free-text comments on the ACEA and EPAs were also explored. RESULTS In total, 14,376 ACEA and 4,467 EPA assessments were analyzed. There were no significant differences in entrustment ratings on either assessment tool between men and women residents. Regardless of whether assessments were completed by men or women faculty, entrustment rates between men and women residents were not significantly different for any postgraduate year level. Additionally, men and women residents received strengths-related and actions-related comments on both assessments at comparable frequencies, irrespective of faculty gender. CONCLUSION We found no gender-based differences in entrustment ratings for both the ACEA and EPAs, which suggests an absence of resident gender bias within this CBME system. Given considerable heterogeneity in rater leniency, future work would be strengthened by using rater leniency-adjusted scores rather than raw scores.
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Affiliation(s)
- Clyde T Matava
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Fahad Alam
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Alayne Kealey
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lisa A Bahrey
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, University Health Network-Toronto General Hospital, Toronto, ON, Canada
| | - Graham A McCreath
- SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Catharine M Walsh
- SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- The Wilson Centre, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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15
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Huang JS, Walsh CM. Electronic Medical Records: Use as Tools for Improving Quality in Pediatric Endoscopy. Gastrointest Endosc Clin N Am 2023; 33:267-290. [PMID: 36948746 DOI: 10.1016/j.giec.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Quality indicators and standards for pediatric endoscopy have recently been developed by the inaugural working group of the international Pediatric Endoscopy Quality Improvement Network (PEnQuIN). Currently available electronic medical record (EMR) functionalities can enable real-time capture of quality indicators to support continuous quality measurement and improvement within pediatric endoscopy facilities. Ultimately, EMR interoperability and cross-institutional data sharing can serve to validate PEnQuIN standards of care and permit benchmarking across endoscopy services, in the pursuit of elevating the quality of endoscopic care for children everywhere.
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Affiliation(s)
- Jeannie S Huang
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, MC 0984, La Jolla, CA 92093, USA; Division of Pediatric Gastroenterology, Rady Children's Hospital San Diego, 3020 Children's Way, San Diego, CA, USA.
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology, and Nutrition, and the SickKids Research and Learning Institutes, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics and The Wilson Centre, University of Toronto, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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16
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Walsh CM. Pediatric Endoscopy. Gastrointest Endosc Clin N Am 2023; 33:xv-xvi. [PMID: 36948758 DOI: 10.1016/j.giec.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Affiliation(s)
- Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition, SickKids Research and Learning Institutes, The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, Temerty Faculty of Medicine, University of Toronto, Toronto M5G 1X8, Canada.
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17
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Abstract
Pediatric endoscopists are at risk of work-related injuries from overuse and repetitive motions during endoscopy. Recently, there has been increasing appreciation for the importance of ergonomics education and training to help build long-term habits that prevent injury. This article reviews the epidemiology of endoscopy-related injuries in pediatric practice, describes methods for controlling exposures in the workplace, discusses key ergonomic principles that can be used to mitigate injury risk, and outlines tips for integrating education on endoscopy ergonomics during training.
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Affiliation(s)
- Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the SickKids Research and Learning Institutes, The Hospital for Sick Children, Department of Paediatrics and The Wilson Centre, Temerty Faculty of Medicine, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
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18
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Khan R, Faggen A, Shergill A, Grover SC, Walsh CM. Integrating Ergonomics into Endoscopy Training: A Guide for Faculty and Fellows. Clin Gastroenterol Hepatol 2023; 21:868-872. [PMID: 36804733 DOI: 10.1016/j.cgh.2022.12.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 02/23/2023]
Affiliation(s)
- Rishad Khan
- Division of Gastroenterology and Hepatology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alec Faggen
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California
| | - Amandeep Shergill
- Division of Gastroenterology and Hepatology, San Francisco Veterans Affairs Medical Center, San Francisco, California; Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California
| | - Samir C Grover
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Gastroenterology and Hepatology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology, and Nutrition, SickKids Research and Learning Institutes, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Paediatrics and The Wilson Centre, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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19
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Dhaliwal J, Walsh CM. Artificial Intelligence in Pediatric Endoscopy: Current Status and Future Applications. Gastrointest Endosc Clin N Am 2023; 33:291-308. [PMID: 36948747 DOI: 10.1016/j.giec.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
The application of artificial intelligence (AI) has great promise for improving pediatric endoscopy. The majority of preclinical studies have been undertaken in adults, with the greatest progress being made in the context of colorectal cancer screening and surveillance. This development has only been possible with advances in deep learning, like the convolutional neural network model, which has enabled real-time detection of pathology. Comparatively, the majority of deep learning systems developed in inflammatory bowel disease have focused on predicting disease severity and were developed using still images rather than videos. The application of AI to pediatric endoscopy is in its infancy, thus providing an opportunity to develop clinically meaningful and fair systems that do not perpetuate societal biases. In this review, we provide an overview of AI, summarize the advances of AI in endoscopy, and describe its potential application to pediatric endoscopic practice and education.
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Affiliation(s)
- Jasbir Dhaliwal
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medictal Center, University of Cincinnati, OH, USA.
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology, and Nutrition, and the SickKids Research and Learning Institutes, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics and The Wilson Centre, University of Toronto, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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20
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Gould MJ, Marcon MA, Nguyen GC, Benchimol EI, Moineddin R, Swayze S, Kopp A, Ratcliffe EM, Merritt N, Davidson J, Langer JC, Mistry N, Lorenzo AJ, Temple M, Walsh CM. Impact of antegrade enema initiation on healthcare utilization in pediatric patients: A population-based cohort study. Neurogastroenterol Motil 2023; 35:e14495. [PMID: 36377812 DOI: 10.1111/nmo.14495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 10/24/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND When constipation is refractory to first-line interventions, antegrade enema use may be considered. We aimed to assess the impact of this intervention on healthcare utilization. METHODS We conducted a population-based, quasi-experimental study with pre-post comparison of the intervention group and a non-equivalent control group using linked clinical and health administrative data from Ontario, Canada. Subjects included children (0-18 years) who underwent antegrade enema initiation from 2007 to 2020 and matched controls (4:1) from the general population. To assess the change in healthcare utilization following antegrade enema initiation, we used negative binomial generalized estimating equations with covariates selected a priori. KEY RESULTS One hundred thirty-eight subjects met eligibility criteria (appendicostomy = 55 (39.9%); cecostomy tube = 83 (60.1%)) and were matched to 550 controls. There was no significant difference in the change in the rate of hospitalizations (rate ratio (RR) 1.05, 95% confidence interval (CI) 0.35-1.75), outpatient visits (RR 1.05, 95% CI 0.91-1.18), or same-day surgical procedures (RR 1.51, 95% CI 0.60-2.43) across cases in 2 years following antegrade enema initiation compared with controls. Cases had an increased rate of emergency department (ED) visits, which was not observed in controls (RR 1.52, 95% CI 1.11-1.79), driven in part by device-related complications. CONCLUSIONS AND INFERENCES Understanding healthcare utilization patterns following antegrade enema initiation allows for effective health system planning and aids medical decision-making. The observed increase in ED visits for device-related complications speaks to the need to improve preventive management to help mitigate emergency care after initiation of antegrade enemas.
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Affiliation(s)
- Michelle J Gould
- Division of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Margaret A Marcon
- Division of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Geoffrey C Nguyen
- Division of Gastroenterology, Mount Sinai Hospital, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,ICES, Toronto, Canada
| | - Eric I Benchimol
- Division of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada.,ICES, Toronto, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, Division of Biostatistics, University of Toronto, Toronto, Canada
| | | | | | - Elyanne M Ratcliffe
- Division of Pediatric Gastroenterology and Nutrition, McMaster Children's Hospital, Hamilton, Canada.,Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Neil Merritt
- Division of Pediatric Surgery, London Health Sciences Center, London, Canada
| | - Jacob Davidson
- Division of Pediatric Surgery, London Health Sciences Center, London, Canada
| | - Jacob C Langer
- Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| | - Niraj Mistry
- Department of Paediatrics, University of Toronto, Toronto, Canada.,Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Canada
| | - Armando J Lorenzo
- Department of Surgery, University of Toronto, Toronto, Canada.,Division of Urology, Hospital for Sick Children, Toronto, Canada
| | - Michael Temple
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada.,SickKids Research and Learning Institutes, Toronto, Canada
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21
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Scaffidi MA, Li J, Genis S, Tipton E, Khan R, Pattni C, Gimpaya N, Bradley-Ridout G, Walsh CM, Grover SC. Accuracy of self-assessment in gastrointestinal endoscopy: a systematic review and meta-analysis. Endoscopy 2023; 55:176-185. [PMID: 36162425 DOI: 10.1055/a-1929-1318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Assessment is necessary to ensure both attainment and maintenance of competency in gastrointestinal (GI) endoscopy, and this can be accomplished through self-assessment. We conducted a systematic review with meta-analysis to evaluate the accuracy of self-assessment among GI endoscopists. METHODS This was an individual participant data meta-analysis of studies that investigated self-assessment of endoscopic competency. We performed a systematic search of the following databases: Ovid MEDLINE, Ovid EMBASE, Wiley Cochrane CENTRAL, and ProQuest Education Resources Information Center. We included studies if they were primary investigations of self-assessment accuracy in GI endoscopy that used statistical analyses to determine accuracy. We conducted a meta-analysis of studies using a limits of agreement (LoA) approach to meta-analysis of Bland-Altman studies. RESULTS After removing duplicate entries, we screened 7138 records. After full-text review, we included 16 studies for qualitative analysis and three for meta-analysis. In the meta-analysis, we found that the LoA were wide (-41.0 % to 34.0 %) and beyond the clinically acceptable difference. Subgroup analyses found that both novice and intermediate endoscopists had wide LoA (-45.0 % to 35.1 % and -54.7 % to 46.5 %, respectively) and expert endoscopists had narrow LoA (-14.2 % to 21.4 %). CONCLUSIONS GI endoscopists are inaccurate in self-assessment of their endoscopic competency. Subgroup analyses demonstrated that novice and intermediate endoscopists were inaccurate, while expert endoscopists have accurate self-assessment. While we advise against the sole use of self-assessment among novice and intermediate endoscopists, expert endoscopists may wish to integrate it into their practice.
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Affiliation(s)
- Michael A Scaffidi
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada.,Faculty of Health Sciences, School of Medicine, Queen's University, Toronto, Canada
| | - Juana Li
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Shai Genis
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Elizabeth Tipton
- Department of Statistics and Institute for Policy Research, Northwestern University, Evanston, Illinois, USA
| | - Rishad Khan
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Chandni Pattni
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Nikko Gimpaya
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | | | - Catharine M Walsh
- Department of Paediatrics, University of Toronto, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Samir C Grover
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute, Toronto, Canada
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22
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Pritchard L, Bright KS, Walsh CM, Samuel S, Li QKW, Wollny K, Twilt M, Tomfohr-Madsen L, Pires L, Dimitropoulos G. "Walking on both sides of the fence": A qualitative exploration of the challenges and opportunities facing emergent clinician-scientists in child health. J Eval Clin Pract 2023; 29:59-68. [PMID: 35700054 DOI: 10.1111/jep.13719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/13/2022] [Accepted: 05/25/2022] [Indexed: 01/18/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES While paediatric clinician-scientists are ideally positioned to generate clinically relevant research and translate research evidence into practice, they face challenges in this dual role. The authors sought to explore the unique contributions, opportunities, and challenges of paediatric clinician-scientists, including issues related to training and ongoing support needs to ensure their success. METHOD The authors used a qualitative descriptive approach with thematic analysis to explore the experiences of clinician-scientist stakeholders in child health (n = 39). Semi-structured interviews (60 min) were conducted virtually and recorded. Thematic analysis was conducted according to the phases outlined by Braun and Clarke (2006). RESULTS The analysis resulted in the creation of three themes: (1) "Walking on both sides of the fence": unique positioning of clinician-scientists for advancing clinical practice and research; (2) the clinician-scientist: a specialized role with significant challenges; and (3) beyond the basics of clinical and research training programmes: essential skill sets and knowledge for future clinician-scientists. CONCLUSIONS While clinician-scientists can make unique contributions to the advancement of evidence-based practice, they face significant barriers straddling their dual roles including divergent institutional cultures in healthcare and academia and a lack of infrastructure to effectively support clinician-scientist positions. Training programmes can play an important role in mentoring and supporting early-career clinician-scientists.
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Affiliation(s)
- Lesley Pritchard
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Katherine S Bright
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada.,SickKids Research and Learning Institutes, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics and the Wilson Centre, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Susan Samuel
- Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Queenie K W Li
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Krista Wollny
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.,Canadian Child Health Clinician Scientist Program (PILLAR), Toronto, Ontario, Canada
| | - Marinka Twilt
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lianne Tomfohr-Madsen
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Departments of Educational and Counselling Psychology and Special Education (ECPS), University of British Columbia, Vancouver, British Columbia, Canada
| | - Linda Pires
- Canadian Child Health Clinician Scientist Training Program (CCHCSP), Toronto, Ontario, Canada
| | - Gina Dimitropoulos
- Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, Alberta, Canada.,Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
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Ruan W, Walsh CM, Pawa S, D'Souza SL, Banerjee P, Kothari S, McCreath GA, Fishman DS. Musculoskeletal injury and ergonomics in pediatric gastrointestinal endoscopic practice. Surg Endosc 2023; 37:248-254. [PMID: 35920909 DOI: 10.1007/s00464-022-09455-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 07/06/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND AIMS Endoscopy-related musculoskeletal injuries (ERI) are increasingly prevalent in adult endoscopists; however, there are no studies that have evaluated ERI and ergonomic practices among pediatric gastroenterologists and trainees. We aimed to examine the prevalence, nature, and impact of musculoskeletal injuries in pediatric endoscopic practice and assess attitudes towards ergonomic training needs. METHODS Pediatric gastroenterologists and trainees were surveyed to collect information on endoscopist and practice characteristics, the prevalence, nature, and impacts of ERI, ergonomics strategies employed in practice, previous ergonomics training, and perceptions of ergonomics training (elicited using a 1 (strongly disagree) to 5 (strongly agree) Likert scale). Responses were analyzed using descriptive statistics, and bivariate analyses were conducted to explore correlates of ERI. RESULTS Among 146 survey respondents, 50 (34.2%) were trainees and 96 (65.8%) were practicing endoscopists with a mean duration of endoscopic practice of 9.7 ± 9.4 years. Overall, 55.6% (n = 80/144) reported experiencing a musculoskeletal injury, with 34.7% (n = 50/144) reporting an injury attributable to endoscopy. Among those with ERI, the most common sites were the neck/upper back (44.0%), thumb (42.0%), hand/finger (38.0%), and lower back (36.0%). Women were more likely to experience ERI compared to men (43.4% vs. 23.4%; p = 0.013). Only 20.9% of participants had formal training in ergonomics. Respondents reported being motivated to implement practice changes to prevent ERI (4.41 ± 0.95) and perceived ergonomics training as important (4.37 ± 0.96). CONCLUSIONS Pediatric endoscopists, and particularly women, experience significant ERI; however, formal endoscopy ergonomics training is rare. Improved ergonomics training is needed for both practicing pediatric gastroenterologists and trainees.
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Affiliation(s)
- Wenly Ruan
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, D1010.18, Houston, TX, 77030, USA.
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology, and Nutrition, and the Research and Learning Institutes, Hospital for Sick Children,, Department of Paediatrics and the Wilson Centre, University of Toronto, Toronto, ON, Canada
| | - Swati Pawa
- Section of Gastroenterology and Hepatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.,Bill Hefner VA Healthcare System, Salisbury, NC, USA
| | | | - Promila Banerjee
- Loyola Stritch School of Medicine and Edward Hines Jr Veterans Administration Hospital, Hines, IL, USA
| | | | - Graham A McCreath
- The Hospital for Sick Children, SickKids Research Institute, Toronto, ON, Canada
| | - Douglas S Fishman
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, D1010.18, Houston, TX, 77030, USA
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24
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Science M, Caldeira-Kulbakas M, Parekh RS, Maguire BR, Carroll S, Anthony SJ, Bitnun A, Bourns LE, Campbell DM, Cohen E, Dodds A, Dubey V, Friedman JN, Greenwood JL, Hopkins JP, Imgrund R, Korczak DJ, Looi T, Louca E, Mertz D, Nashid J, Panzera G, Schneiderman JE, Schwartz KL, Streitenberger L, Vuppal S, Walsh CM, Jüni P, Matava CT, Allen U, Alvares AD, Birken CS, Brown A, Carbone VL, Christie A, Cividino ME, Cohen-Silver JH, Cohn RD, Crosbie J, da Costa BR, Dharmaraj B, Freeman SJ, Gaebe K, Hajjaj O, Huang L, Khan S, Lee E, Logeman C, Manteghi S, Moore C, Morris SK, Orkin J, Pelger SD, Pickel L, Salman S, Shouldice A, Solomon R, Thampi N, Thorpe K, Wasiak A, Xie J. Effect of Wearing a Face Mask on Hand-to-Face Contact by Children in a Simulated School Environment: The Back-to-School COVID-19 Simulation Randomized Clinical Trial. JAMA Pediatr 2022; 176:1169-1175. [PMID: 36279142 PMCID: PMC9593317 DOI: 10.1001/jamapediatrics.2022.3833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
IMPORTANCE Wearing a face mask in school can reduce SARS-CoV-2 transmission but it may also lead to increased hand-to-face contact, which in turn could increase infection risk through self-inoculation. OBJECTIVE To evaluate the effect of wearing a face mask on hand-to-face contact by children while at school. DESIGN, SETTING, AND PARTICIPANTS This prospective randomized clinical trial randomized students from junior kindergarten to grade 12 at 2 schools in Toronto, Ontario, Canada, during August 2020 in a 1:1 ratio to either a mask or control class during a 2-day school simulation. Classes were video recorded from 4 angles to accurately capture outcomes. INTERVENTIONS Participants in the mask arm were instructed to bring their own mask and wear it at all times. Students assigned to control classes were not required to mask at any time (grade 4 and lower) or in the classroom where physical distancing could be maintained (grade 5 and up). MAIN OUTCOMES AND MEASURES The primary outcome was the number of hand-to-face contacts per student per hour on day 2 of the simulation. Secondary outcomes included hand-to-mucosa contacts and hand-to-nonmucosa contacts. A mixed Poisson regression model was used to derive rate ratios (RRs), adjusted for age and sex with a random intercept for class with bootstrapped 95% CIs. RESULTS A total of 174 students underwent randomization and 171 students (mask group, 50.6% male; control group, 52.4% male) attended school on day 2. The rate of hand-to-face contacts did not differ significantly between the mask and the control groups (88.2 vs 88.7 events per student per hour; RR, 1.00; 95% CI, 0.78-1.28; P = >.99). When compared with the control group, the rate of hand-to-mucosa contacts was significantly lower in the mask group (RR, 0.12; 95% CI, 0.07-0.21), while the rate of hand-to-nonmucosa contacts was higher (RR, 1.40; 95% CI, 1.08-1.82). CONCLUSIONS AND RELEVANCE In this clinical trial of simulated school attendance, hand-to-face contacts did not differ among students required to wear face masks vs students not required to wear face masks; however, hand-to-mucosa contracts were lower in the face mask group. This suggests that mask wearing is unlikely to increase infection risk through self-inoculation. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04531254.
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Affiliation(s)
- Michelle Science
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada,Public Health Ontario, Toronto, Ontario, Canada,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Monica Caldeira-Kulbakas
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rulan S. Parekh
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Division of Nephrology, Department of Pediatrics and Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Bryan R. Maguire
- Biostatistics Design and Analysis Unit, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stacie Carroll
- Child and Family Centred Care, The Hospital for Sick Children, Toronto, Ontario, Canada,Education and Community Partnership Program, Toronto District School Board, Toronto, Ontario, Canada
| | - Samantha J. Anthony
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Ari Bitnun
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Douglas M. Campbell
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Neonatal Intensive Care Unit, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada,Allan Waters Family Simulation Program, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada,Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
| | - Eyal Cohen
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Complex Care Program, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada,Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
| | - Alison Dodds
- SimKids Simulation Program, The Learning Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vinita Dubey
- Communicable Disease Control, Toronto Public Health, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jeremy N. Friedman
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jodi L. Greenwood
- Child and Family Centred Care, The Hospital for Sick Children, Toronto, Ontario, Canada,Education and Community Partnership Program, Toronto District School Board, Toronto, Ontario, Canada
| | - Jessica P. Hopkins
- Public Health Ontario, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ryan Imgrund
- Biostatistics, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Daphne J. Korczak
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Looi
- Department of Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada,The Wilfred and Joyce Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Emily Louca
- SimKids Simulation Program, The Learning Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Dominik Mertz
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada,Department of Infection Prevention and Control, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - John Nashid
- Corporate Strategy, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Giovanna Panzera
- Child and Family Centred Care, The Hospital for Sick Children, Toronto, Ontario, Canada,Education and Community Partnership Program, Toronto District School Board, Toronto, Ontario, Canada
| | - Jane E. Schneiderman
- Division of Respiratory Medicine, Clinical Research Services, The Hospital for Sick Children, Toronto, Ontario, Canada,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Kevin L. Schwartz
- Public Health Ontario, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Division of Infectious Diseases, Department of Medicine, Unity Health Toronto, Toronto, Ontario, Canada
| | - Laurie Streitenberger
- Infection Prevention & Control (IPAC) Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sunayna Vuppal
- SimKids Simulation Program, The Learning Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Catharine M. Walsh
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada,SimKids Simulation Program, The Learning Institute, The Hospital for Sick Children, Toronto, Ontario, Canada,Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter Jüni
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada,Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Clyde T. Matava
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Upton Allen
- for the Back-to-School COVID-19 School Study Group
| | | | | | - Ahuva Brown
- for the Back-to-School COVID-19 School Study Group
| | | | | | | | | | | | | | | | | | | | | | - Omar Hajjaj
- for the Back-to-School COVID-19 School Study Group
| | - Lennox Huang
- for the Back-to-School COVID-19 School Study Group
| | - Sarah Khan
- for the Back-to-School COVID-19 School Study Group
| | - Eon Lee
- for the Back-to-School COVID-19 School Study Group
| | | | | | - Clara Moore
- for the Back-to-School COVID-19 School Study Group
| | | | - Julia Orkin
- for the Back-to-School COVID-19 School Study Group
| | | | | | - Soha Salman
- for the Back-to-School COVID-19 School Study Group
| | | | | | - Nisha Thampi
- for the Back-to-School COVID-19 School Study Group
| | - Kevin Thorpe
- for the Back-to-School COVID-19 School Study Group
| | - Anna Wasiak
- for the Back-to-School COVID-19 School Study Group
| | - Jiayin Xie
- for the Back-to-School COVID-19 School Study Group
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Walsh CM, Jones NL, McCreath GA, Connan V, Pires L, Abuloghod L, Buchanan F, Macarthur C. Codevelopment and usability testing of Patient Engagement 101: a Patient-Oriented Research Curriculum in Child Health e-learning module for health care professionals, researchers and trainees. CMAJ Open 2022; 10:E872-E881. [PMID: 36195343 PMCID: PMC9544233 DOI: 10.9778/cmajo.20210336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Patient and family engagement is thought to improve the quality and relevance of child health research. We developed and evaluated the usability of Patient Engagement 101, an e-learning module designed to strengthen the patient-oriented research readiness of health care professionals, researchers, trainees and other stakeholders. METHODS The development of Patient Engagement 101 was co-led by a parent and a researcher and overseen by a diverse multistake-holder steering committee. The module was refined and evaluated using a mixed-methods usability testing approach with 2 iterative cycles of semistructured interviews, observations and questionnaires. We collected module feedback by way of semistructured interviews, the validated System Usability Scale, and satisfaction, knowledge and confidence questionnaires. Thematic coding of transcripts and field notes, informed by team discussions, guided the module revisions. RESULTS Thirty end-users completed usability testing (15 per cycle). In each cycle, we modified the module with respect to its content, learner experience, learner-centred design and aesthetic design. Participants were highly satisfied, and System Usability Scale scores indicated the module had the best imaginable usability. Substantial increases in the participants' knowledge test scores and the confidence to engage in patient-oriented research, but not self-rated knowledge, were observed after module completion. INTERPRETATION Codevelopment with patients and caregivers, and refinement through comprehensive end-user testing, resulted in a training resource with exceptional usability that improved knowledge and confidence to engage in patient-oriented research in child health. Patient Engagement 101 is openly available online, and the methods used to develop and evaluate it may facilitate the creation and evaluation of similar capacity-building resources.
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Affiliation(s)
- Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition (Walsh, Jones), Department of Clinical Dietetics (Connan), SickKids Learning Institute (Walsh), SickKids Research Institute (Walsh, Jones, McCreath, Abuloghod, Macarthur) and Canadian Child Health Clinician Scientist Program (Pires), The Hospital for Sick Children (Walsh, Jones, McCreath, Abuloghod, Buchanan, Macarthur); Departments of Paediatrics (Walsh, Jones, Macarthur) and Physiology (Jones), and The Wilson Centre for Research in Education (Walsh), Temerty Faculty of Medicine (Walsh, Jones, Macarthur); Institute of Health Policy, Management, and Evaluation (Walsh, Buchanan), University of Toronto, Toronto, Ont.
| | - Nicola L Jones
- Division of Gastroenterology, Hepatology and Nutrition (Walsh, Jones), Department of Clinical Dietetics (Connan), SickKids Learning Institute (Walsh), SickKids Research Institute (Walsh, Jones, McCreath, Abuloghod, Macarthur) and Canadian Child Health Clinician Scientist Program (Pires), The Hospital for Sick Children (Walsh, Jones, McCreath, Abuloghod, Buchanan, Macarthur); Departments of Paediatrics (Walsh, Jones, Macarthur) and Physiology (Jones), and The Wilson Centre for Research in Education (Walsh), Temerty Faculty of Medicine (Walsh, Jones, Macarthur); Institute of Health Policy, Management, and Evaluation (Walsh, Buchanan), University of Toronto, Toronto, Ont
| | - Graham A McCreath
- Division of Gastroenterology, Hepatology and Nutrition (Walsh, Jones), Department of Clinical Dietetics (Connan), SickKids Learning Institute (Walsh), SickKids Research Institute (Walsh, Jones, McCreath, Abuloghod, Macarthur) and Canadian Child Health Clinician Scientist Program (Pires), The Hospital for Sick Children (Walsh, Jones, McCreath, Abuloghod, Buchanan, Macarthur); Departments of Paediatrics (Walsh, Jones, Macarthur) and Physiology (Jones), and The Wilson Centre for Research in Education (Walsh), Temerty Faculty of Medicine (Walsh, Jones, Macarthur); Institute of Health Policy, Management, and Evaluation (Walsh, Buchanan), University of Toronto, Toronto, Ont
| | - Veronik Connan
- Division of Gastroenterology, Hepatology and Nutrition (Walsh, Jones), Department of Clinical Dietetics (Connan), SickKids Learning Institute (Walsh), SickKids Research Institute (Walsh, Jones, McCreath, Abuloghod, Macarthur) and Canadian Child Health Clinician Scientist Program (Pires), The Hospital for Sick Children (Walsh, Jones, McCreath, Abuloghod, Buchanan, Macarthur); Departments of Paediatrics (Walsh, Jones, Macarthur) and Physiology (Jones), and The Wilson Centre for Research in Education (Walsh), Temerty Faculty of Medicine (Walsh, Jones, Macarthur); Institute of Health Policy, Management, and Evaluation (Walsh, Buchanan), University of Toronto, Toronto, Ont
| | - Linda Pires
- Division of Gastroenterology, Hepatology and Nutrition (Walsh, Jones), Department of Clinical Dietetics (Connan), SickKids Learning Institute (Walsh), SickKids Research Institute (Walsh, Jones, McCreath, Abuloghod, Macarthur) and Canadian Child Health Clinician Scientist Program (Pires), The Hospital for Sick Children (Walsh, Jones, McCreath, Abuloghod, Buchanan, Macarthur); Departments of Paediatrics (Walsh, Jones, Macarthur) and Physiology (Jones), and The Wilson Centre for Research in Education (Walsh), Temerty Faculty of Medicine (Walsh, Jones, Macarthur); Institute of Health Policy, Management, and Evaluation (Walsh, Buchanan), University of Toronto, Toronto, Ont
| | - Lama Abuloghod
- Division of Gastroenterology, Hepatology and Nutrition (Walsh, Jones), Department of Clinical Dietetics (Connan), SickKids Learning Institute (Walsh), SickKids Research Institute (Walsh, Jones, McCreath, Abuloghod, Macarthur) and Canadian Child Health Clinician Scientist Program (Pires), The Hospital for Sick Children (Walsh, Jones, McCreath, Abuloghod, Buchanan, Macarthur); Departments of Paediatrics (Walsh, Jones, Macarthur) and Physiology (Jones), and The Wilson Centre for Research in Education (Walsh), Temerty Faculty of Medicine (Walsh, Jones, Macarthur); Institute of Health Policy, Management, and Evaluation (Walsh, Buchanan), University of Toronto, Toronto, Ont
| | - Francine Buchanan
- Division of Gastroenterology, Hepatology and Nutrition (Walsh, Jones), Department of Clinical Dietetics (Connan), SickKids Learning Institute (Walsh), SickKids Research Institute (Walsh, Jones, McCreath, Abuloghod, Macarthur) and Canadian Child Health Clinician Scientist Program (Pires), The Hospital for Sick Children (Walsh, Jones, McCreath, Abuloghod, Buchanan, Macarthur); Departments of Paediatrics (Walsh, Jones, Macarthur) and Physiology (Jones), and The Wilson Centre for Research in Education (Walsh), Temerty Faculty of Medicine (Walsh, Jones, Macarthur); Institute of Health Policy, Management, and Evaluation (Walsh, Buchanan), University of Toronto, Toronto, Ont
| | - Colin Macarthur
- Division of Gastroenterology, Hepatology and Nutrition (Walsh, Jones), Department of Clinical Dietetics (Connan), SickKids Learning Institute (Walsh), SickKids Research Institute (Walsh, Jones, McCreath, Abuloghod, Macarthur) and Canadian Child Health Clinician Scientist Program (Pires), The Hospital for Sick Children (Walsh, Jones, McCreath, Abuloghod, Buchanan, Macarthur); Departments of Paediatrics (Walsh, Jones, Macarthur) and Physiology (Jones), and The Wilson Centre for Research in Education (Walsh), Temerty Faculty of Medicine (Walsh, Jones, Macarthur); Institute of Health Policy, Management, and Evaluation (Walsh, Buchanan), University of Toronto, Toronto, Ont
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26
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Walsh CM, Lightdale JR. Pediatric Endoscopy Quality Improvement Network (PEnQuIN) quality standards and indicators for pediatric endoscopy: an ASGE-endorsed guideline. Gastrointest Endosc 2022; 96:593-602. [PMID: 36028336 DOI: 10.1016/j.gie.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 06/08/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Current endoscopy quality guidelines largely focus on cancer screening-related metrics that are not applicable to pediatric populations. Through an international Pediatric Endoscopy Quality Improvement Network (PEnQuIN), quality standards and indicators for pediatric endoscopic procedures were developed and endorsed by the American Society for Gastrointestinal Endoscopy (ASGE). METHODS The Appraisal of Guidelines for REsearch and Evaluation II instrument guided PEnQuIN members, from 31 centers representing 11 countries, in generating and refining proposed quality standards and indicators. Quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development, and Evaluation approach. Consensus on reporting elements was sought with an iterative online Delphi process. RESULTS Forty-nine quality standards and 47 indicators, encompassing pediatric endoscopy facilities, procedures, and endoscopists, as well as 30 reporting elements essential for inclusion within a pediatric endoscopy report reached consensus. Minimal acceptable standards were defined for 3 key indicators related to pediatric lower endoscopy: terminal ileal intubation rate ≥85%, cecal intubation rate ≥90%, and rate of adequate bowel preparation ≥80%. There was strong consensus that terminal ileal intubation, rather than cecal intubation, is integral to ensuring high-quality endoscopic care in children. CONCLUSIONS The PEnQuIN guidelines establish international agreement on clinically meaningful metrics tailored to pediatric endoscopy that can be used to promote safe, high-quality, patient- and family-centered endoscopic care. Moving forward, it is recommended that all providers and facilities involved in endoscopy service for children adopt the PEnQuIN standards, indicators, and key reporting elements outlined in these ASGE-endorsed guidelines.
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Affiliation(s)
- Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jenifer R Lightdale
- Division of Gastroenterology and Nutrition, UMass Memorial Children's Medical Center, Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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27
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Li QKW, Wollny K, Twilt M, Walsh CM, Bright K, Dimitropoulos G, Pires L, Pritchard L, Samuel S, Tomfohr-Madsen L. Curricula, Teaching Methods, and Success Metrics of Clinician-Scientist Training Programs: A Scoping Review. Acad Med 2022; 97:1403-1412. [PMID: 36098782 DOI: 10.1097/acm.0000000000004764] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE To describe the literature on clinician-scientist training programs to inform the development of contemporary and inclusive training models. METHOD The authors conducted a scoping review, searching the PubMed/MEDLINE, CINAHL, and Embase databases from database inception until May 25, 2020. Studies presenting primary research that described and evaluated clinician-scientist training programs were identified for data abstraction. On the basis of deductive and inductive methods, information about program characteristics, curricula, teaching strategies, and success metrics was extracted. The extracted variables were analyzed using descriptive statistics. RESULTS From the initial 7,544 citations retrieved and 4,974 unique abstracts screened, 81 studies were included. Of the 81 included studies, 65 (80.2%) were published between 2011 and 2020, 54 (66.7%) were conducted in the United States, and 64 (79.0%) described programs that provided broad clinician-scientist training. Few programs provided funding or protected research time or specifically addressed needs of trainees from underrepresented minority groups. Curricula emphasized research methods and knowledge dissemination, whereas patient-oriented research competencies were not described. Most programs incorporated aspects of mentorship and used multiple teaching strategies, such as direct and interactive instruction. Extrinsic metrics of success (e.g., research output) were dominant in reported program outcomes compared with markers of intrinsic success (e.g., career fulfillment). CONCLUSIONS Although programs are providing clinician-scientists with practical skills training, opportunities exist for curricular and pedagogic optimization that may better support this complex career path. Training programs for clinician-scientists can address contemporary issues of wellness and equity by reconsidering metrics of program success and evolving the core tenets of their education models to include equity, diversity, and inclusion principles and patient-oriented research competencies.
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Affiliation(s)
- Queenie K W Li
- Q.K.W. Li is a clinical research coordinator, Department of Psychology, University of Calgary, Calgary, Alberta, Canada; ORCID: https://orcid.org/0000-0001-7318-1701
| | - Krista Wollny
- K. Wollny is instructor, Faculty of Nursing, University of Calgary, and at the time of writing was a PhD candidate, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and trainee, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Marinka Twilt
- M. Twilt is a pediatric rheumatologist and associate professor, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Catharine M Walsh
- C.M. Walsh is staff gastroenterologist, Division of Gastroenterology, Hepatology, and Nutrition, an educational researcher, SickKids Learning Institute, a scientist, Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children (SickKids), a cross-appointed scientist, Wilson Centre for Research in Education, and associate professor of paediatrics, University of Toronto, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0003-3928-703X
| | - Katherine Bright
- K. Bright is Health System Impact Postdoctoral Fellow, Canadian Institutes for Health Research, Addictions and Mental Health Strategic Clinical Network, Alberta Health Services and Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Gina Dimitropoulos
- G. Dimitropoulos is a social worker and associate professor, Faculty of Social Work and Department of Psychiatry and Pediatrics, University of Calgary, Calgary, Alberta, Canada; ORCID: https://orcid.org/0000-0001-9487-0290
| | - Linda Pires
- L. Pires is research operations manager, Canadian Child Health Clinician Scientist Program, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Lesley Pritchard
- L. Pritchard is pediatric physical therapist and associate professor, Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada; ORCID: https://orcid.org/0000-0002-6684-376X
| | - Susan Samuel
- S. Samuel is pediatric nephrologist and professor, Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lianne Tomfohr-Madsen
- L. Tomfohr-Madsen is a clinical psychologist and associate professor, Department of Psychology, University of Calgary, Calgary, Alberta, Canada
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Dimitropoulos G, Bright KS, Li QKW, Wollny K, Twilt M, Walsh CM, Pires L, Tomfohr-Madsen L, Samuel S, Pritchard L. Equity, diversity and inclusion of pediatric clinician-scientists in Canada: a thematic analysis. CMAJ Open 2022; 10:E911-E921. [PMID: 36257684 PMCID: PMC9616604 DOI: 10.9778/cmajo.20220134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Underrepresented voices and perspectives are missing from academic and clinical health sciences. We aimed to define the unique opportunities and challenges of pediatric clinician-scientists related to equity, diversity and inclusion; and to identify key components of training needed to support people from equity-seeking groups as emerging and early-career pediatric clinician-scientists to generate diverse health research leaders in knowledge generation, implementation and translation. METHODS Using a qualitative descriptive approach, we examined the experiences of clinician stakeholders. Semistructured interviews were conducted with pediatric clinician-scientist stakeholders. Thematic analysis was performed. RESULTS We interviewed a total of 39 individuals. Our analysis resulted in 4 interrelated themes: the pervasiveness and invisibility of sexism; the invisibility and visibility of racism; proposed individual-level solutions to the sexism and racism; and proposed institutional and system-level changes to address the porous and leaky pipeline. These themes acknowledged that, ultimately, system change is required for addressing equity, diversity and inclusion in clinical and academic training environments. INTERPRETATION These findings highlight the importance of addressing systemic biases that limit the inclusion of women and racialized individuals in pediatric clinician-scientist careers. Further research is needed to explore the problem of exclusion, which will, in turn, inform education of pediatric clinician-scientists and inform better ways to promote equity, diversity and inclusivity; these steps are needed to foster systemic change in the cultures that perpetuate exclusivity in both academic and clinical communities.
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Affiliation(s)
- Gina Dimitropoulos
- Faculty of Social Work (Dimitropoulos), University of Calgary; Mathison Centre for Mental Health Research and Education (Dimitropoulos), Alberta Children's Hospital Research Institute (Tomfohr-Madsen, Twilt, Wollny, Dimitropoulos); Faculty of Nursing (Wollny, Bright), University of Calgary; Department of Community Health Sciences (Samuel, Wollny, Bright), Cumming School of Medicine, University of Calgary; Department of Psychology (Tomfohr-Madsen, Li), University of Calgary; Department of Pediatrics (Tomfohr-Madsen, Twilt), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Gastroenterology, Hepatology and Nutrition and SickKids Research Institute and SickKids Learning Institute (Walsh), The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto; Canadian Child Health Clinician Scientist Program (Pires), The Hospital for Sick Children, Toronto, Ont.; Department of Physical Therapy, Faculty of Rehabilitation (Pritchard), University of Alberta, Edmonton, Alta.
| | - Katherine S Bright
- Faculty of Social Work (Dimitropoulos), University of Calgary; Mathison Centre for Mental Health Research and Education (Dimitropoulos), Alberta Children's Hospital Research Institute (Tomfohr-Madsen, Twilt, Wollny, Dimitropoulos); Faculty of Nursing (Wollny, Bright), University of Calgary; Department of Community Health Sciences (Samuel, Wollny, Bright), Cumming School of Medicine, University of Calgary; Department of Psychology (Tomfohr-Madsen, Li), University of Calgary; Department of Pediatrics (Tomfohr-Madsen, Twilt), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Gastroenterology, Hepatology and Nutrition and SickKids Research Institute and SickKids Learning Institute (Walsh), The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto; Canadian Child Health Clinician Scientist Program (Pires), The Hospital for Sick Children, Toronto, Ont.; Department of Physical Therapy, Faculty of Rehabilitation (Pritchard), University of Alberta, Edmonton, Alta
| | - Queenie K W Li
- Faculty of Social Work (Dimitropoulos), University of Calgary; Mathison Centre for Mental Health Research and Education (Dimitropoulos), Alberta Children's Hospital Research Institute (Tomfohr-Madsen, Twilt, Wollny, Dimitropoulos); Faculty of Nursing (Wollny, Bright), University of Calgary; Department of Community Health Sciences (Samuel, Wollny, Bright), Cumming School of Medicine, University of Calgary; Department of Psychology (Tomfohr-Madsen, Li), University of Calgary; Department of Pediatrics (Tomfohr-Madsen, Twilt), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Gastroenterology, Hepatology and Nutrition and SickKids Research Institute and SickKids Learning Institute (Walsh), The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto; Canadian Child Health Clinician Scientist Program (Pires), The Hospital for Sick Children, Toronto, Ont.; Department of Physical Therapy, Faculty of Rehabilitation (Pritchard), University of Alberta, Edmonton, Alta
| | - Krista Wollny
- Faculty of Social Work (Dimitropoulos), University of Calgary; Mathison Centre for Mental Health Research and Education (Dimitropoulos), Alberta Children's Hospital Research Institute (Tomfohr-Madsen, Twilt, Wollny, Dimitropoulos); Faculty of Nursing (Wollny, Bright), University of Calgary; Department of Community Health Sciences (Samuel, Wollny, Bright), Cumming School of Medicine, University of Calgary; Department of Psychology (Tomfohr-Madsen, Li), University of Calgary; Department of Pediatrics (Tomfohr-Madsen, Twilt), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Gastroenterology, Hepatology and Nutrition and SickKids Research Institute and SickKids Learning Institute (Walsh), The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto; Canadian Child Health Clinician Scientist Program (Pires), The Hospital for Sick Children, Toronto, Ont.; Department of Physical Therapy, Faculty of Rehabilitation (Pritchard), University of Alberta, Edmonton, Alta
| | - Marinka Twilt
- Faculty of Social Work (Dimitropoulos), University of Calgary; Mathison Centre for Mental Health Research and Education (Dimitropoulos), Alberta Children's Hospital Research Institute (Tomfohr-Madsen, Twilt, Wollny, Dimitropoulos); Faculty of Nursing (Wollny, Bright), University of Calgary; Department of Community Health Sciences (Samuel, Wollny, Bright), Cumming School of Medicine, University of Calgary; Department of Psychology (Tomfohr-Madsen, Li), University of Calgary; Department of Pediatrics (Tomfohr-Madsen, Twilt), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Gastroenterology, Hepatology and Nutrition and SickKids Research Institute and SickKids Learning Institute (Walsh), The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto; Canadian Child Health Clinician Scientist Program (Pires), The Hospital for Sick Children, Toronto, Ont.; Department of Physical Therapy, Faculty of Rehabilitation (Pritchard), University of Alberta, Edmonton, Alta
| | - Catharine M Walsh
- Faculty of Social Work (Dimitropoulos), University of Calgary; Mathison Centre for Mental Health Research and Education (Dimitropoulos), Alberta Children's Hospital Research Institute (Tomfohr-Madsen, Twilt, Wollny, Dimitropoulos); Faculty of Nursing (Wollny, Bright), University of Calgary; Department of Community Health Sciences (Samuel, Wollny, Bright), Cumming School of Medicine, University of Calgary; Department of Psychology (Tomfohr-Madsen, Li), University of Calgary; Department of Pediatrics (Tomfohr-Madsen, Twilt), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Gastroenterology, Hepatology and Nutrition and SickKids Research Institute and SickKids Learning Institute (Walsh), The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto; Canadian Child Health Clinician Scientist Program (Pires), The Hospital for Sick Children, Toronto, Ont.; Department of Physical Therapy, Faculty of Rehabilitation (Pritchard), University of Alberta, Edmonton, Alta
| | - Linda Pires
- Faculty of Social Work (Dimitropoulos), University of Calgary; Mathison Centre for Mental Health Research and Education (Dimitropoulos), Alberta Children's Hospital Research Institute (Tomfohr-Madsen, Twilt, Wollny, Dimitropoulos); Faculty of Nursing (Wollny, Bright), University of Calgary; Department of Community Health Sciences (Samuel, Wollny, Bright), Cumming School of Medicine, University of Calgary; Department of Psychology (Tomfohr-Madsen, Li), University of Calgary; Department of Pediatrics (Tomfohr-Madsen, Twilt), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Gastroenterology, Hepatology and Nutrition and SickKids Research Institute and SickKids Learning Institute (Walsh), The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto; Canadian Child Health Clinician Scientist Program (Pires), The Hospital for Sick Children, Toronto, Ont.; Department of Physical Therapy, Faculty of Rehabilitation (Pritchard), University of Alberta, Edmonton, Alta
| | - Lianne Tomfohr-Madsen
- Faculty of Social Work (Dimitropoulos), University of Calgary; Mathison Centre for Mental Health Research and Education (Dimitropoulos), Alberta Children's Hospital Research Institute (Tomfohr-Madsen, Twilt, Wollny, Dimitropoulos); Faculty of Nursing (Wollny, Bright), University of Calgary; Department of Community Health Sciences (Samuel, Wollny, Bright), Cumming School of Medicine, University of Calgary; Department of Psychology (Tomfohr-Madsen, Li), University of Calgary; Department of Pediatrics (Tomfohr-Madsen, Twilt), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Gastroenterology, Hepatology and Nutrition and SickKids Research Institute and SickKids Learning Institute (Walsh), The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto; Canadian Child Health Clinician Scientist Program (Pires), The Hospital for Sick Children, Toronto, Ont.; Department of Physical Therapy, Faculty of Rehabilitation (Pritchard), University of Alberta, Edmonton, Alta
| | - Susan Samuel
- Faculty of Social Work (Dimitropoulos), University of Calgary; Mathison Centre for Mental Health Research and Education (Dimitropoulos), Alberta Children's Hospital Research Institute (Tomfohr-Madsen, Twilt, Wollny, Dimitropoulos); Faculty of Nursing (Wollny, Bright), University of Calgary; Department of Community Health Sciences (Samuel, Wollny, Bright), Cumming School of Medicine, University of Calgary; Department of Psychology (Tomfohr-Madsen, Li), University of Calgary; Department of Pediatrics (Tomfohr-Madsen, Twilt), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Gastroenterology, Hepatology and Nutrition and SickKids Research Institute and SickKids Learning Institute (Walsh), The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto; Canadian Child Health Clinician Scientist Program (Pires), The Hospital for Sick Children, Toronto, Ont.; Department of Physical Therapy, Faculty of Rehabilitation (Pritchard), University of Alberta, Edmonton, Alta
| | - Lesley Pritchard
- Faculty of Social Work (Dimitropoulos), University of Calgary; Mathison Centre for Mental Health Research and Education (Dimitropoulos), Alberta Children's Hospital Research Institute (Tomfohr-Madsen, Twilt, Wollny, Dimitropoulos); Faculty of Nursing (Wollny, Bright), University of Calgary; Department of Community Health Sciences (Samuel, Wollny, Bright), Cumming School of Medicine, University of Calgary; Department of Psychology (Tomfohr-Madsen, Li), University of Calgary; Department of Pediatrics (Tomfohr-Madsen, Twilt), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Gastroenterology, Hepatology and Nutrition and SickKids Research Institute and SickKids Learning Institute (Walsh), The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto; Canadian Child Health Clinician Scientist Program (Pires), The Hospital for Sick Children, Toronto, Ont.; Department of Physical Therapy, Faculty of Rehabilitation (Pritchard), University of Alberta, Edmonton, Alta
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Laverriere E, Fiadjoe JE, McGowan N, Bruins BB, Napolitano N, Watanabe I, Yamada NK, Walsh CM, Berg RA, Nadkarni VM, Nishisaki A. A prospective observational study of video laryngoscopy-guided coaching in the pediatric intensive care unit. Paediatr Anaesth 2022; 32:1015-1023. [PMID: 35656910 PMCID: PMC9357165 DOI: 10.1111/pan.14505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 05/05/2022] [Accepted: 05/30/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND There are limited data on the use of video laryngoscopy for pediatric patients outside of the operating room. AIM Our primary aim was to evaluate whether implementation of video laryngoscopy-guided coaching for tracheal intubation is feasible with a high level of compliance and associated with a reduction in adverse tracheal intubation-associated events. METHODS This is a pre-post observational study of video laryngoscopy implementation with standardized coaching language for tracheal intubation in a single-center, pediatric intensive care unit. The use of video laryngoscopy as a coaching device with standardized coaching language was implemented as a part of practice improvement. All patients in the pediatric intensive care unit were included between January 2016 and December 2017 who underwent primary tracheal intubation with either video laryngoscopy or direct laryngoscopy. The uptake of the implementation, sustained compliance, tracheal intubation outcomes including all adverse tracheal intubation-associated events, oxygen desaturations (<80% SpO2), and first attempt success were measured. RESULTS Among 580 tracheal intubations, 284 (49%) were performed during the preimplementation phase, and 296 (51%) postimplementation. Compliance for the use of video laryngoscopy with standardized coaching language was high (74% postimplementation) and sustained. There were no statistically significant differences in adverse tracheal intubation-associated events between the two phases (pre- 9% vs. post- 5%, absolute difference -3%, CI95 : -8% to 1%, p = .11), oxygen desaturations <80% (pre- 13% vs. post- 13%, absolute difference 1%, CI95 : -6% to 5%, p = .75), or first attempt success (pre- 73% vs. post- 76%, absolute difference 4%, CI95 : -3% to 11%, p = .29). Supervisors were more likely to use the standardized coaching language when video laryngoscopy was used for tracheal intubation than with standard direct laryngoscopy (80% vs. 43%, absolute difference 37%, CI95 : 23% to 51%, p < .001). CONCLUSIONS Implementation of video laryngoscopy as a supervising device with standardized coaching language was feasible with high level of adherence, yet not associated with an increased occurrence of any adverse tracheal intubation-associated events and oxygen desaturation.
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Affiliation(s)
- Elizabeth Laverriere
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
- Division of General Anesthesiology, Department of Anesthesiology and Critical Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - John E. Fiadjoe
- Division of General Anesthesiology, Department of Anesthesiology and Critical Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Nancy McGowan
- Department of Respiratory Care, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Benjamin B. Bruins
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
- Division of General Anesthesiology, Department of Anesthesiology and Critical Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Natalie Napolitano
- Department of Respiratory Care, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Ichiro Watanabe
- Division of Critical Care Medicine, Department of Emergency and Critical Care Medicine, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan
| | - Nicole K. Yamada
- Division of Neonatal and Perinatal Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Catharine M. Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto, Toronto, Ontario, Canada
| | - Robert A. Berg
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Vinay M. Nadkarni
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Akira Nishisaki
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
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Lerner DG, Mencin A, Novak I, Huang C, Ng K, Lirio RA, Khlevner J, Utterson EC, Harris BR, Pitman RT, Mir S, Gugig R, Walsh CM, Fishman D. Advances in Pediatric Diagnostic Endoscopy: A State-of-the-Art Review. JPGN Rep 2022; 3:e224. [PMID: 37168622 PMCID: PMC10158303 DOI: 10.1097/pg9.0000000000000224] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/20/2022] [Indexed: 05/13/2023]
Abstract
Pediatric endoscopy has revolutionized the way we diagnose and treat gastrointestinal disorders in children. Technological advances in computer processing and imaging continue to affect endoscopic equipment and advance diagnostic tools for pediatric endoscopy. Although commonly used by adult gastroenterologists, modalities, such as endomicroscopy, image-enhanced endoscopy, and impedance planimetry, are not routinely used in pediatric gastroenterology. This state-of-the-art review describes advances in diagnostic modalities, including image-enhanced endoscopy, confocal laser endomicroscopy, optical coherence tomography, endo functional luminal imaging probes, wireless motility/pH capsule, wireless colon capsule endoscopy, endoscopic ultrasound, and discusses the basic principles of each technology, including adult indications and pediatric applications, safety cost, and training data.
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Affiliation(s)
- Diana G. Lerner
- From the Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, Milwaukee, WI
| | - Ali Mencin
- Division of Pediatric Gastroenterology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Inna Novak
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Hospital at Montefiore, Bronx, NY
| | - Clifton Huang
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cook Children’s Medical Center, Fort Worth, TX
| | - Kenneth Ng
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Richard A. Lirio
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, UMASS Memorial Children’s Medical Center/UMASS Medical School, Worcester, MA
| | - Julie Khlevner
- Division of Pediatric Gastroenterology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Elizabeth C. Utterson
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, MO
| | - Brendan R. Harris
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, MO
| | - Ryan T. Pitman
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, MO
| | - Sabina Mir
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, UNC School of Medicine, Chapel Hill, NC
| | - Roberto Gugig
- Lucile Packard Children’s Hospital at Stanford, Palo Alto, CA
| | - Catharine M. Walsh
- Department of Paediatrics and the Wilson Centre, Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Doug Fishman
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Houston, TX
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Jeyalingam T, Walsh CM, Tavares W, Mylopoulos M, Hodwitz K, Liu LWC, Heitman SJ, Brydges R. Variable or Fixed? Exploring Entrustment Decision Making in Workplace- and Simulation-Based Assessments. Acad Med 2022; 97:1057-1064. [PMID: 35263307 DOI: 10.1097/acm.0000000000004661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Many models of competency-based medical education (CBME) emphasize assessing entrustable professional activities (EPAs). Despite the centrality of EPAs, researchers have not compared rater entrustment decisions for the same EPA across workplace- and simulation-based assessments. This study aimed to explore rater entrustment decision making across these 2 assessment settings. METHOD An interview-based study using a constructivist grounded theory approach was conducted. Gastroenterology faculty at the University of Toronto and the University of Calgary completed EPA assessments of trainees' endoscopic polypectomy performance in both workplace and simulation settings between November 2019 and January 2021. After each assessment, raters were interviewed to explore how and why they made entrustment decisions within and across settings. Transcribed interview data were coded iteratively using constant comparison to generate themes. RESULTS Analysis of 20 interviews with 10 raters found that participants (1) held multiple meanings of entrustment and expressed variability in how they justified their entrustment decisions and scoring, (2) held personal caveats for making entrustment decisions "comfortably" (i.e., authenticity, task-related variability, opportunity to assess trainee responses to adverse events, and the opportunity to observe multiple performances over time), (3) experienced cognitive tensions between formative and summative purposes when assessing EPAs, and (4) experienced relative freedom when using simulation to formatively assess EPAs but constraint when using only simulation-based assessments for entrustment decision making. CONCLUSIONS Participants spoke about and defined entrustment variably, which appeared to produce variability in how they judged entrustment across participants and within and across assessment settings. These rater idiosyncrasies suggest that programs implementing CBME must consider how such variability affects the aggregation of EPA assessments, especially those collected in different settings. Program leaders might also consider how to fulfill raters' criteria for comfortably making entrustment decisions by ensuring clear definitions and purposes when designing and integrating workplace- and simulation-based assessments.
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Affiliation(s)
- Thurarshen Jeyalingam
- T. Jeyalingam is an advanced fellow in luminal therapeutic endoscopy, University of Calgary, Calgary, Alberta, Canada; ORCID: http://orcid.org/0000-0002-7254-9639
| | - Catharine M Walsh
- C.M. Walsh is a staff gastroenterologist, Division of Gastroenterology, Hepatology and Nutrition, educational researcher, SickKids Learning Institute, scientist, Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, scientist, Wilson Centre, and associate professor of paediatrics, University of Toronto, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0003-3928-703X
| | - Walter Tavares
- W. Tavares is assistant professor and scientist, Wilson Centre and Temerty Faculty of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0001-8267-9448
| | - Maria Mylopoulos
- M. Mylopoulos is associate professor, Department of Paediatrics, and scientist and associate director, Wilson Centre, University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0003-0012-5375
| | - Kathryn Hodwitz
- K. Hodwitz is a clinical research specialist, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0003-3099-1709
| | - Louis W C Liu
- L.W.C. Liu is associate professor, Department of Medicine, University of Toronto, and head, Division of Gastroenterology and Hepatology, University Health Network and Sinai Health, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0001-6899-7941
| | - Steven J Heitman
- S.J. Heitman is associate professor, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, holds the N.B. Hershfield Chair in Therapeutic Endoscopy, University of Calgary, is medical director, Forzani & MacPhail Colon Cancer Screening Centre, and scientific director, Digestive Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada; ORCID: http://orcid.org/0000-0002-4952-779X
| | - Ryan Brydges
- R. Brydges is a scientist and holds the Professorship in Technology-Enabled Education, St. Michael's Hospital, Unity Health Toronto, and is associate professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0001-5203-7049
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Jeyalingam T, Brydges R, Ginsburg S, McCreath GA, Walsh CM. How Clinical Supervisors Conceptualize Procedural Entrustment: An Interview-Based Study of Entrustment Decision Making in Endoscopic Training. Acad Med 2022; 97:586-592. [PMID: 34935727 DOI: 10.1097/acm.0000000000004566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Entrustment is central to assessment in competency-based medical education (CBME). To date, little research has addressed how clinical supervisors conceptualize entrustment, including factors they consider in making entrustment decisions. The aim of this study was to characterize supervisors' decision making related to procedural entrustment, using gastrointestinal endoscopy as a test case. METHOD Using methods from constructivist grounded theory, the authors interviewed 29 endoscopy supervisors in the United States and Canada across multiple specialties (adult and pediatric gastroenterology, surgery, and family medicine). Semistructured interviews, conducted between April and November 2019, focused on how supervisors conceptualize procedural entrustment, how they make entrustment decisions, and what factors they consider. Transcripts were analyzed using constant comparison to generate an explanatory framework and themes. RESULTS Three themes were identified from the analysis of interview transcripts: (1) entrustment occurs in varying degrees and fluctuates over time; (2) entrustment decisions can transfer within and across procedural and nonprocedural contexts; (3a) persistent static factors (e.g., supervisor competence, institutional culture, legal considerations) influence entrustment decisions, as do (3b) fluctuating, situated dynamic factors (e.g., trainee skills, patient acuity, time constraints), which tend to change from one training encounter to the next. CONCLUSIONS In the process of making procedural entrustment decisions, clinical supervisors appear to synthesize multiple dynamic factors against a background of static factors, culminating in a decision of whether to entrust. Entrustment decisions appear to fluctuate over time, and assessors may transfer decisions about specific trainees across settings. Understanding which factors supervisors perceive as influencing their decision making has the potential to inform faculty development, as well as competency committees seeking to aggregate faculty judgments about trainee unsupervised practice. Those leading CBME programs may wish to invest in optimizing the observed static factors, such that these foundational factors are tuned to facilitate trainee learning and achievement of entrustment.
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Affiliation(s)
- Thurarshen Jeyalingam
- T. Jeyalingam is an advanced fellow in luminal therapeutic endoscopy, University of Calgary, Calgary, Alberta, Canada; ORCID: http://orcid.org/0000-0002-7254-9639
| | - Ryan Brydges
- R. Brydges is a scientist and holds the Professorship in Technology-Enabled Education, St. Michael's Hospital, Unity Health Toronto, and is associate professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shiphra Ginsburg
- S. Ginsburg is professor of medicine, Department of Medicine, Sinai Health System and Faculty of Medicine, a scientist, Wilson Centre for Research in Education, and Canada Research Chair in Health Professions Education, University of Toronto, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0002-4595-6650
| | - Graham A McCreath
- G.A. McCreath is clinical research project coordinator, SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0002-9312-8665
| | - Catharine M Walsh
- C.M. Walsh is staff gastroenterologist, Division of Gastroenterology, Hepatology, and Nutrition, educational researcher, SickKids Learning Institute, scientist, Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, scientist, Wilson Centre for Research in Education, and associate professor of paediatrics, University of Toronto, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0003-3928-703X
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Lightdale JR, Walsh CM, Oliva S, Jacobson K, Huynh HQ, Homan M, Hojsak I, Gillett PM, Furlano RI, Fishman DS, Croft NM, Brill H, Bontems P, Amil-Dias J, Utterson EC, Tavares M, Rosh JR, Riley MR, Narula P, Mamula P, Mack DR, Liu QY, Lerner DG, Leibowitz IH, Otley AR, Kramer RE, Ambartsumyan L, Connan V, McCreath GA, Thomson MA. Pediatric Endoscopy Quality Improvement Network Quality Standards and Indicators for Pediatric Endoscopic Procedures: A Joint NASPGHAN/ESPGHAN Guideline. J Pediatr Gastroenterol Nutr 2022; 74:S30-S43. [PMID: 34402486 DOI: 10.1097/mpg.0000000000003264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION High-quality pediatric gastrointestinal procedures are performed when clinically indicated and defined by their successful performance by skilled providers in a safe, comfortable, child-oriented, and expeditious manner. The process of pediatric endoscopy begins when a plan to perform the procedure is first made and ends when all appropriate patient follow-up has occurred. Procedure-related standards and indicators developed to date for endoscopy in adults emphasize cancer screening and are thus unsuitable for pediatric medicine. METHODS With support from the North American and European Societies of Pediatric Gastroenterology Hepatology and Nutrition (NASPGHAN and ESPGHAN), an international working group of the Pediatric Endoscopy Quality Improvement Network (PEnQuIN) used the methodological strategy of the Appraisal of Guidelines for REsearch and Evaluation (AGREE) II instrument to develop standards and indicators relevant for assessing the quality of endoscopic procedures. Consensus was sought via an iterative online Delphi process and finalized at an in-person conference. The quality of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development, and Evaluation) approach. RESULTS The PEnQuIN working group achieved consensus on 14 standards for pediatric endoscopic procedures, as well as 30 indicators that can be used to identify high-quality procedures. These were subcategorized into three subdomains: Preprocedural (3 standards, 7 indicators), Intraprocedural (8 standards, 18 indicators), and Postprocedural (3 standards, 5 indicators). A minimum target for the key indicator, "rate of adequate bowel preparation," was set at ≥80%. DISCUSSION It is recommended that all facilities and individual providers performing pediatric endoscopy worldwide initiate and engage with the procedure-related standards and indicators developed by PEnQuIN to identify gaps in quality and drive improvement.
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Affiliation(s)
- Jenifer R Lightdale
- Department of Pediatrics, Division of Gastroenterology and Nutrition, UMass Memorial Children's Medical Center, University of Massachusetts Medical School, Worcester, MA, United States
| | - Catharine M Walsh
- Department of Paediatrics and the Wilson Centre, Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Umberto I - University Hospital, Sapienza - University of Rome, Rome, Italy
| | - Kevan Jacobson
- Division of Gastroenterology, Hepatology and Nutrition, British Columbia's Children's Hospital and British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hien Q Huynh
- Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Matjaž Homan
- Department of Gastroenterology, Faculty of Medicine, Hepatology and Nutrition, University Children's Hospital, University of Ljubljana, Ljubljana, Slovenia
| | - Iva Hojsak
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, University of Zagreb Medical School, Zagreb, University J.J. Strossmayer Medical School, Osijek, Croatia
| | - Peter M Gillett
- Paediatric Gastroenterology, Hepatology and Nutrition Department, Royal Hospital for Sick Children, Edinburgh, Scotland, United Kingdom
| | - Raoul I Furlano
- Pediatric Gastroenterology & Nutrition, Department of Pediatrics, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Douglas S Fishman
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Nicholas M Croft
- Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Herbert Brill
- Department of Pediatrics, Division of Gastroenterology & Nutrition, McMaster Children's Hospital, McMaster University, William Osler Health System, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Bontems
- Division of Pediatrics, Department of Pediatric Gastroenterology, Queen Fabiola Children's University Hospital, ICBAS - Université Libre de Bruxelles, Brussels, Belgium
| | - Jorge Amil-Dias
- Pediatric Gastroenterology, Department of Pediatrics, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Elizabeth C Utterson
- Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, MO, United States
| | - Marta Tavares
- Division of Pediatrics, Pediatric Gastroenterology Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Joel R Rosh
- Division of Pediatric Gastroenterology, Department of Pediatrics, Goryeb Children's Hospital, Icahn School of Medicine at Mount Sinai, Morristown, NJ, United States
| | - Matthew R Riley
- Department of Pediatric Gastroenterology, Providence St. Vincent's Medical Center, Portland, OR, United States
| | - Priya Narula
- Department of Paediatric Gastroenterology, Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
| | - Petar Mamula
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - David R Mack
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Quin Y Liu
- Division of Gastroenterology and Hepatology, Medicine and Pediatrics, Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Diana G Lerner
- Division of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition, Children's of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Ian H Leibowitz
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Children's National Medical Center, George Washington University, Washington, DC, United States
| | - Anthony R Otley
- Gastroenterology & Nutrition, Department of Pediatrics, IWK Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robert E Kramer
- Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Colorado, University of Colorado, Aurora, CO, United States
| | - Lusine Ambartsumyan
- Department of Pediatrics, Division of Gastroenterology and Hepatology, Seattle Children's Hospital, University of Washington, Seattle, WA, United States
| | - Veronik Connan
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Graham A McCreath
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mike A Thomson
- Department of Paediatric Gastroenterology, Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
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Walsh CM, Lightdale JR, Mack DR, Amil-Dias J, Bontems P, Brill H, Croft NM, Fishman DS, Furlano RI, Gillett PM, Hojsak I, Homan M, Huynh HQ, Jacobson K, Leibowitz IH, Lerner DG, Liu QY, Mamula P, Narula P, Oliva S, Riley MR, Rosh JR, Tavares M, Utterson EC, Ambartsumyan L, Otley AR, Kramer RE, Connan V, McCreath GA, Thomson MA. Overview of the Pediatric Endoscopy Quality Improvement Network Quality Standards and Indicators for Pediatric Endoscopy: A Joint NASPGHAN/ESPGHAN Guideline. J Pediatr Gastroenterol Nutr 2022; 74:S3-S15. [PMID: 34402484 DOI: 10.1097/mpg.0000000000003262] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Pediatric-specific quality standards for endoscopy are needed to define best practices, while measurement of associated indicators is critical to guide quality improvement. The international Pediatric Endoscopy Quality Improvement Network (PEnQuIN) working group was assembled to develop and define quality standards and indicators for pediatric gastrointestinal endoscopic procedures through a rigorous guideline consensus process. METHODS The Appraisal of Guidelines for REsearch and Evaluation (AGREE) II instrument guided PEnQuIN members, recruited from 31 centers of various practice types representing 11 countries, in generating and refining proposed quality standards and indicators. Consensus was sought via an iterative online Delphi process, and finalized at an in-person conference. Quality of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development, and Evaluation) approach. RESULTS Forty-nine quality standards and 47 indicators reached consensus, encompassing pediatric endoscopy facilities, procedures, endoscopists, and the patient experience. The evidence base for PEnQuIN standards and indicators was largely adult-based and observational, and downgraded for indirectness, imprecision, and study limitations to "very low" quality, resulting in "conditional" recommendations for most standards (45/49). CONCLUSIONS The PEnQuIN guideline development process establishes international agreement on clinically meaningful metrics that can be used to promote safety and quality in endoscopic care for children. Through PEnQuIN, pediatric endoscopists and endoscopy services now have a framework for auditing, providing feedback, and ultimately, benchmarking performance. Expansion of evidence and prospective validation of PEnQuIN standards and indicators as predictors of clinically relevant outcomes and high-quality pediatric endoscopic care is now a research priority.
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Affiliation(s)
- Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jenifer R Lightdale
- Division of Gastroenterology and Nutrition, UMass Memorial Children's Medical Center, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, United States
| | - David R Mack
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Jorge Amil-Dias
- Pediatric Gastroenterology, Department of Pediatrics, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Patrick Bontems
- Division of Pediatrics, Department of Pediatric Gastroenterology, Queen Fabiola Children's University Hospital, ICBAS - Université Libre de Bruxelles, Brussels, Belgium
| | - Herbert Brill
- Division of Gastroenterology & Nutrition, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Department of Paediatrics, William Osler Health System, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas M Croft
- Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Douglas S Fishman
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Raoul I Furlano
- Pediatric Gastroenterology & Nutrition, Department of Pediatrics, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Peter M Gillett
- Paediatric Gastroenterology, Hepatology and Nutrition Department, Royal Hospital for Sick Children, Edinburgh, Scotland, United Kingdom
| | - Iva Hojsak
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, University of Zagreb Medical School, Zagreb, University J.J. Strossmayer Medical School, Osijek, Croatia
| | - Matjaž Homan
- Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Hien Q Huynh
- Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Kevan Jacobson
- Division of Gastroenterology, Hepatology and Nutrition, British Columbia's Children's Hospital and British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ian H Leibowitz
- Division of Gastroenterology, Hepatology and Nutrition, Children's National Medical Center, Department of Pediatrics, George Washington University, Washington, DC, United States
| | - Diana G Lerner
- Division of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition, Children's of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Quin Y Liu
- Division of Gastroenterology and Hepatology, Medicine and Pediatrics, Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Petar Mamula
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Priya Narula
- Department of Paediatric Gastroenterology, Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
| | - Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Umberto I - University Hospital, Sapienza - University of Rome, Rome, Italy
| | - Matthew R Riley
- Department of Pediatric Gastroenterology, Providence St. Vincent's Medical Center, Portland, OR, United States
| | - Joel R Rosh
- Division of Pediatric Gastroenterology, Department of Pediatrics, Goryeb Children's Hospital, Icahn School of Medicine at Mount Sinai, Morristown, NJ, United States
| | - Marta Tavares
- Division of Pediatrics, Pediatric Gastroenterology Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Elizabeth C Utterson
- Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, MO, United States
| | - Lusine Ambartsumyan
- Division of Gastroenterology and Hepatology, Seattle Children's Hospital, Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Anthony R Otley
- Gastroenterology & Nutrition, Department of Pediatrics, IWK Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robert E Kramer
- Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Colorado, University of Colorado, Aurora, CO, United States
| | - Veronik Connan
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Graham A McCreath
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mike A Thomson
- Department of Paediatric Gastroenterology, Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
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Walsh CM, Lightdale JR, Fishman DS, Furlano RI, Mamula P, Gillett PM, Narula P, Hojsak I, Oliva S, Homan M, Riley MR, Huynh HQ, Rosh JR, Jacobson K, Tavares M, Leibowitz IH, Utterson EC, Croft NM, Mack DR, Brill H, Liu QY, Bontems P, Lerner DG, Amil-Dias J, Kramer RE, Otley AR, Ambartsumyan L, Connan V, McCreath GA, Thomson MA. Pediatric Endoscopy Quality Improvement Network Pediatric Endoscopy Reporting Elements: A Joint NASPGHAN/ESPGHAN Guideline. J Pediatr Gastroenterol Nutr 2022; 74:S53-S62. [PMID: 34402488 DOI: 10.1097/mpg.0000000000003266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION High-quality procedure reports are a cornerstone of high-quality pediatric endoscopy as they ensure the clear communication of procedural events and outcomes, guide patient care and facilitate continuous quality improvement. The aim of this document is to outline standardized reporting elements that achieved international consensus as requirements for high-quality pediatric endoscopy procedure reports. METHODS With support from the North American and European Societies of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN and ESPGHAN), an international working group of the Pediatric Endoscopy Quality Improvement Network (PEnQuIN) used Delphi methodology to identify key elements that should be found in all pediatric endoscopy reports. Item reduction was attained through iterative rounds of anonymized online voting using a 6-point scale. Responses were analyzed after each round and items were excluded from subsequent rounds if ≤50% of panelists rated them as 5 ("agree moderately") or 6 ("agree strongly"). Reporting elements that ≥70% of panelists rated as "agree moderately" or "agree strongly" were considered to have achieved consensus. RESULTS Twenty-six PEnQuIN group members from 25 centers internationally rated 63 potential reporting elements that were generated from a systematic literature review and the Delphi panelists. The response rates were 100% for all three survey rounds. Thirty reporting elements reached consensus as essential for inclusion within a pediatric endoscopy report. DISCUSSION It is recommended that the PEnQuIN Reporting Elements for pediatric endoscopy be universally employed across all endoscopists, procedures and facilities as a foundational means of ensuring high-quality endoscopy services, while facilitating quality improvement activities in pediatric endoscopy.
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Affiliation(s)
- Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jenifer R Lightdale
- Division of Gastroenterology and Nutrition, UMass Memorial Children's Medical Center, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, United States
| | - Douglas S Fishman
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Raoul I Furlano
- Pediatric Gastroenterology & Nutrition, Department of Pediatrics, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Petar Mamula
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Peter M Gillett
- Paediatric Gastroenterology, Hepatology and Nutrition Department, Royal Hospital for Sick Children, Edinburgh, Scotland, United Kingdom
| | - Priya Narula
- Department of Paediatric Gastroenterology, Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
| | - Iva Hojsak
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, University of Zagreb Medical School, Zagreb, University J.J. Strossmayer Medical School, Osijek, Croatia
| | - Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Umberto I - University Hospital, Sapienza - University of Rome, Rome, Italy
| | - Matjaž Homan
- Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Matthew R Riley
- Department of Pediatric Gastroenterology, Providence St. Vincent's Medical Center, Portland, OR, United States
| | - Hien Q Huynh
- Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Joel R Rosh
- Division of Pediatric Gastroenterology, Department of Pediatrics, Goryeb Children's Hospital, Icahn School of Medicine at Mount Sinai, Morristown, NJ, United States
| | - Kevan Jacobson
- Division of Gastroenterology, Hepatology and Nutrition, British Columbia's Children's Hospital and British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marta Tavares
- Division of Pediatrics, Pediatric Gastroenterology Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Ian H Leibowitz
- Division of Gastroenterology, Hepatology and Nutrition, Children's National Medical Center, Department of Pediatrics, George Washington University, Washington, DC, United States
| | - Elizabeth C Utterson
- Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, MO, United States
| | - Nicholas M Croft
- Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - David R Mack
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Herbert Brill
- Division of Gastroenterology & Nutrition, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Department of Paediatrics, William Osler Health System, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Quin Y Liu
- Division of Gastroenterology and Hepatology, Medicine and Pediatrics, Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Patrick Bontems
- Division of Pediatrics, Department of Pediatric Gastroenterology, Queen Fabiola Children's University Hospital, ICBAS - Université Libre de Bruxelles, Brussels, Belgium
| | - Diana G Lerner
- Division of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition, Children's of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jorge Amil-Dias
- Pediatric Gastroenterology, Department of Pediatrics, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Robert E Kramer
- Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Colorado, University of Colorado, Aurora, CO, United States
| | - Anthony R Otley
- Gastroenterology & Nutrition, Department of Pediatrics, IWK Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lusine Ambartsumyan
- Division of Gastroenterology and Hepatology, Seattle Children's Hospital, Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Veronik Connan
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Graham A McCreath
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mike A Thomson
- Department of Paediatric Gastroenterology, Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
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Walsh CM, Lightdale JR, Leibowitz IH, Lerner DG, Liu QY, Mack DR, Mamula P, Narula P, Oliva S, Riley MR, Rosh JR, Tavares M, Utterson EC, Amil-Dias J, Bontems P, Brill H, Croft NM, Fishman DS, Furlano RI, Gillett PM, Hojsak I, Homan M, Huynh HQ, Jacobson K, Ambartsumyan L, Otley AR, Kramer RE, McCreath GA, Connan V, Thomson MA. Pediatric Endoscopy Quality Improvement Network Quality Standards and Indicators for Pediatric Endoscopists and Endoscopists in Training: A Joint NASPGHAN/ESPGHAN Guideline. J Pediatr Gastroenterol Nutr 2022; 74:S44-S52. [PMID: 34402487 DOI: 10.1097/mpg.0000000000003265] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION High-quality pediatric endoscopy requires reliable performance of procedures by competent individual providers who consistently uphold all standards determined to assure optimal patient outcomes. Establishing consensus expectations for ongoing monitoring and assessment of individual pediatric endoscopists is a method for confirming the highest possible quality of care for such procedures worldwide. We aim to provide guidance to define and measure quality of endoscopic care for children. METHODS With support from the North American and European Societies of Pediatric Gastroenterology Hepatology and Nutrition (NASPGHAN and ESPGHAN), an international working group of the Pediatric Endoscopy Quality Improvement Network (PEnQuIN) used the methodological strategy of the Appraisal of Guidelines for REsearch and Evaluation (AGREE) II instrument to develop standards and indicators relevant for assessing the quality of endoscopists. Consensus was sought via an iterative online Delphi process and finalized at an in-person conference. The quality of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development, and Evaluation) approach. RESULTS The PEnQuIN working group achieved consensus on 6 standards that all providers who perform pediatric endoscopy should uphold and 2 standards for pediatric endoscopists in training, with 7 corresponding indicators that can be used to identify high-quality endoscopists. Additionally, these can inform continuous quality improvement at the provider level. Minimum targets for defining high-quality pediatric ileocolonoscopy were set for 2 key indicators: cecal intubation rate (≥90%) and terminal ileal intubation rate (≥85%). DISCUSSION It is recommended that all individual providers performing or training to perform pediatric endoscopy initiate and engage with these international endoscopist-related standards and indicators developed by PEnQuIN.
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Affiliation(s)
- Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jenifer R Lightdale
- Division of Gastroenterology and Nutrition, UMass Memorial Children's Medical Center, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, United States
| | - Ian H Leibowitz
- Division of Gastroenterology, Hepatology and Nutrition, Children's National Medical Center, Department of Pediatrics, George Washington University, Washington, DC, United States
| | - Diana G Lerner
- Division of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition, Children's of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Quin Y Liu
- Division of Gastroenterology and Hepatology, Medicine and Pediatrics, Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - David R Mack
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Petar Mamula
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Priya Narula
- Department of Paediatric Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
| | - Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Umberto I - University Hospital, Sapienza - University of Rome, Rome, Italy
| | - Matthew R Riley
- Department of Pediatric Gastroenterology, Providence St. Vincent's Medical Center, Portland, OR, United States
| | - Joel R Rosh
- Division of Pediatric Gastroenterology, Department of Pediatrics, Goryeb Children's Hospital, Icahn School of Medicine at Mount Sinai, Morristown, NJ, United States
| | - Marta Tavares
- Division of Pediatrics, Pediatric Gastroenterology Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Elizabeth C Utterson
- Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, MO, United States
| | - Jorge Amil-Dias
- Pediatric Gastroenterology, Department of Pediatrics, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Patrick Bontems
- Division of Pediatrics, Department of Pediatric Gastroenterology, Queen Fabiola Children's University Hospital, ICBAS - Université Libre de Bruxelles, Brussels, Belgium
| | - Herbert Brill
- Division of Gastroenterology & Nutrition, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Department of Paediatrics, William Osler Health System, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas M Croft
- Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Douglas S Fishman
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Raoul I Furlano
- Pediatric Gastroenterology & Nutrition, Department of Pediatrics, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Peter M Gillett
- Paediatric Gastroenterology, Hepatology and Nutrition Department, Royal Hospital for Sick Children, Edinburgh, Scotland, United Kingdom
| | - Iva Hojsak
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, University of Zagreb Medical School, Zagreb, University J.J. Strossmayer Medical School, Osijek, Croatia
| | - Matjaž Homan
- Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Hien Q Huynh
- Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Kevan Jacobson
- Division of Gastroenterology, Hepatology and Nutrition, British Columbia's Children's Hospital and British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lusine Ambartsumyan
- Division of Gastroenterology and Hepatology, Seattle Children's Hospital, Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Anthony R Otley
- Gastroenterology & Nutrition, Department of Pediatrics, IWK Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robert E Kramer
- Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Colorado, University of Colorado, Aurora, CO, United States
| | - Graham A McCreath
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Veronik Connan
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mike A Thomson
- Department of Paediatric Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
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Lightdale JR, Walsh CM, Narula P, Utterson EC, Tavares M, Rosh JR, Riley MR, Oliva S, Mamula P, Mack DR, Liu QY, Lerner DG, Leibowitz IH, Jacobson K, Huynh HQ, Homan M, Hojsak I, Gillett PM, Furlano RI, Fishman DS, Croft NM, Brill H, Bontems P, Amil-Dias J, Kramer RE, Ambartsumyan L, Otley AR, McCreath GA, Connan V, Thomson MA. Pediatric Endoscopy Quality Improvement Network Quality Standards and Indicators for Pediatric Endoscopy Facilities: A Joint NASPGHAN/ESPGHAN Guideline. J Pediatr Gastroenterol Nutr 2022; 74:S16-S29. [PMID: 34402485 DOI: 10.1097/mpg.0000000000003263] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION There is increasing international recognition of the impact of variability in endoscopy facilities on procedural quality and outcomes. There is also growing precedent for assessing the quality of endoscopy facilities at regional and national levels by using standardized rating scales to identify opportunities for improvement. METHODS With support from the North American and European Societies of Pediatric Gastroenterology Hepatology and Nutrition (NASPGHAN and ESPGHAN), an international working group of the Pediatric Endoscopy Quality Improvement Network (PEnQuIN) used the methodological strategy of the Appraisal of Guidelines for REsearch and Evaluation (AGREE) II instrument to develop standards and indicators relevant for assessing the quality of facilities where endoscopic care is provided to children. Consensus was reached via an iterative online Delphi process and subsequent in-person meeting. The quality of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development and Evaluation) approach. RESULTS The PEnQuIN working group achieved consensus on 27 standards for facilities supporting pediatric endoscopy, as well 10 indicators that can be used to identify high-quality endoscopic care in children. These standards were subcategorized into three subdomains: Quality of Clinical Operations (15 standards, 5 indicators); Patient and Caregiver Experience (9 standards, 5 indicators); and Workforce (3 standards). DISCUSSION The rigorous PEnQuIN process successfully yielded standards and indicators that can be used to universally guide and measure high-quality facilities for procedures around the world where endoscopy is performed in children. It also underscores the current paucity of evidence for pediatric endoscopic care processes, and the need for research into this clinical area.
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Affiliation(s)
- Jenifer R Lightdale
- Department of Pediatrics, Division of Gastroenterology and Nutrition, UMass Memorial Children's Medical Center, University of Massachusetts Medical School, Worcester, MA, United States
| | - Catharine M Walsh
- Department of Paediatrics and the Wilson Centre, Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Priya Narula
- Department of Paediatric Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
| | - Elizabeth C Utterson
- Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, MO, United States
| | - Marta Tavares
- Pediatric Gastroenterology Department, Division of Pediatrics, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Joel R Rosh
- Division of Pediatric Gastroenterology, Department of Pediatrics, Goryeb Children's Hospital, Icahn School of Medicine at Mount Sinai, Morristown, NJ, United States
| | - Matthew R Riley
- Department of Pediatric Gastroenterology, Providence St. Vincent's Medical Center, Portland, OR, United States
| | - Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Umberto I - University Hospital, Sapienza - University of Rome, Rome, Italy
| | - Petar Mamula
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - David R Mack
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Quin Y Liu
- Division of Gastroenterology and Hepatology, Medicine and Pediatrics, Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Diana G Lerner
- Division of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition, Children's of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Ian H Leibowitz
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Children's National Medical Center, George Washington University, Washington, DC, United States
| | - Kevan Jacobson
- Division of Gastroenterology, Hepatology and Nutrition, British Columbia's Children's Hospital and British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hien Q Huynh
- Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Matjaž Homan
- Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Iva Hojsak
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, University of Zagreb Medical School, Zagreb, University J.J. Strossmayer Medical School, Osijek, Croatia
| | - Peter M Gillett
- Paediatric Gastroenterology, Hepatology and Nutrition Department, Royal Hospital for Sick Children, Edinburgh, Scotland, United Kingdom
| | - Raoul I Furlano
- Pediatric Gastroenterology & Nutrition, Department of Pediatrics, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Douglas S Fishman
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Nicholas M Croft
- Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Herbert Brill
- Division of Gastroenterology & Nutrition, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Department of Paediatrics, William Osler Health System, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Bontems
- Division of Pediatrics, Department of Pediatric Gastroenterology, Queen Fabiola Children's University Hospital, ICBAS - Université Libre de Bruxelles, Brussels, Belgium
| | - Jorge Amil-Dias
- Pediatric Gastroenterology, Department of Pediatrics, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Robert E Kramer
- Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Colorado, University of Colorado, Aurora, CO, United States
| | - Lusine Ambartsumyan
- Division of Gastroenterology and Hepatology, Seattle Children's Hospital, Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Anthony R Otley
- Gastroenterology & Nutrition, Department of Pediatrics, IWK Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Graham A McCreath
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Veronik Connan
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mike A Thomson
- Department of Paediatric Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
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Lightdale JR, Thomson MA, Walsh CM. The Pediatric Endoscopy Quality Improvement Network Joint NASPGHAN/ESPGHAN Guidelines: A Global Path to Quality for Pediatric Endoscopy. J Pediatr Gastroenterol Nutr 2022; 74:S1-S2. [PMID: 34402483 DOI: 10.1097/mpg.0000000000003261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Jenifer R Lightdale
- Division of Gastroenterology and Nutrition, UMass Memorial Children's Medical Center, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, United States
| | - Mike A Thomson
- Department of Paediatric Gastroenterology, Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto, Toronto, Ontario, Canada
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Walsh CM, Jones NL, McCreath GA, Connan V, Pires L, Chen AQH, Karoly A, Macarthur C. Co-development and Usability Testing of Research 101: A Patient-Oriented Research Curriculum in Child Health (PORCCH) E-Learning Module for Patients and Families. Front Pediatr 2022; 10:849959. [PMID: 35874594 PMCID: PMC9297034 DOI: 10.3389/fped.2022.849959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Engaging patients and families as research partners increases the relevance, quality, and impact of child health research. However, those interested in research engagement may feel underequipped to meaningfully partner. We sought to co-develop an online learning (e-learning) module, "Research 101," to support capacity-development in patient-oriented child health research amongst patients and families. METHODS Module co-development was co-led by a parent and researcher, with guidance from a diverse, multi-stakeholder steering committee. A mixed-methods usability testing approach, with three iterative cycles of semi-structured interviews, observations, and questionnaires, was used to refine and evaluate the e-learning module. Module feedback was collected during testing and a post-module interview, and with the validated System Usability Scale (SUS), and satisfaction, knowledge, and self-efficacy questionnaires. Transcripts and field notes were analyzed through team discussion and thematic coding to inform module revisions. RESULTS Thirty participants fully tested Research 101, and another 15 completed confirmatory usability testing (32 caregivers, 6 patients, and 7 clinician-researchers). Module modifications pertaining to learner-centered design, content, aesthetic design, and learner experience were made in each cycle. SUS scores indicated the overall usability of the final version was "excellent." Participants' knowledge of patient-oriented research and self-efficacy to engage in research improved significantly after completing Research 101 (p < 0.01). CONCLUSIONS Co-development and usability testing facilitated the creation of an engaging and effective resource to support the scaling up of patient-oriented child health research capacity. The methods and findings of this study may help guide the integration of co-development and usability testing in creating similar resources.
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Affiliation(s)
- Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the SickKids Research and Learning Institutes, The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nicola L Jones
- Division of Gastroenterology, Hepatology and Nutrition and the SickKids Research Institute, The Hospital for Sick Children, Department of Paediatrics and Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Graham A McCreath
- SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Veronik Connan
- Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Linda Pires
- Canadian Child Health Clinician Scientist Program, Toronto, ON, Canada
| | - Autumn Q H Chen
- SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Aliza Karoly
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Colin Macarthur
- SickKids Research Institute, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
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Shi JY, Orkin J, Walsh CM, Chu S, Keilty K, McKay S, Mocanu C, Qazi A, Ambreen M, Amin R. Pediatric Chronic Tracheostomy Care: An Evaluation of an Innovative Competency-Based Education Program for Community Health Care Providers. Front Pediatr 2022; 10:885405. [PMID: 35757113 PMCID: PMC9220937 DOI: 10.3389/fped.2022.885405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/05/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To evaluate the immediate and sustained knowledge retention and sense of self-efficacy of homecare nurses following completion of a standardized competency-based tracheostomy education course. Safe discharge of children requiring tracheostomy with or without ventilation relies on the competence of homecare nurses. STUDY DESIGN Pragmatic, randomized controlled trial of 44 homecare nurses. Participants were randomized into the intervention group (n = 21), which received the tracheostomy course, or the control group (n = 23), which received an enterostomy and vascular access course. Multiple-choice question (MCQ) knowledge assessments and self-efficacy questionnaires were administered to both groups pre-course and post-course at 6 week, 3 month, 6 month, and 12 month follow-ups. RESULTS Twenty participants in the intervention group and 19 in the control group were included. Four withdrew from the study and two crossed over from the control into the intervention arm. The change in mean self-efficacy scores (total score = 100) was significantly higher in the intervention group than in the control group at 6 weeks (intervention (mean ± SD): 18.6 ± 14.5; control: 6.6 ± 20.4; p = 0.04) and 3 months (intervention: 19.6 ± 14.2; control: 5.2 ± 17.0; p = 0.007), and trended higher at 6 months (intervention: 18.0 ± 14.5; control: 6.9 ± 24.1; p = 0.1). The change in mean MCQ assessment scores (total score = 20) trended higher in the intervention group than in the control group at 6 weeks (intervention (mean ± SD): 1.8 ± 2.2; control: 1.6, ± 2.9; p = 0.8). CONCLUSIONS Homecare nurses who attended the tracheostomy course demonstrated a higher sense of self-efficacy at long-term follow-up. CLINICAL TRIAL REGISTRATION www.ClinicalTrials.gov, identifier: NCT04559932.
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Affiliation(s)
- Jenny Y Shi
- Paediatric Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Julia Orkin
- Complex Care Program, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics and the SickKids Research and Learning Institutes, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Stephanie Chu
- Connected Care, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Krista Keilty
- Connected Care, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Cora Mocanu
- Paediatric Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Adam Qazi
- Paediatric Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Munazzah Ambreen
- Paediatric Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Reshma Amin
- Paediatric Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Khan R, Zheng E, Wani SB, Scaffidi MA, Jeyalingam T, Gimpaya N, Anderson JT, Grover SC, McCreath G, Walsh CM. Colonoscopy competence assessment tools: a systematic review of validity evidence. Endoscopy 2021; 53:1235-1245. [PMID: 33440438 DOI: 10.1055/a-1352-7293] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Assessment tools are essential for endoscopy training, being required to support feedback provision, optimize learner capabilities, and document competence. We aimed to evaluate the strength of validity evidence that supports the available colonoscopy direct observation assessment tools using the unified framework of validity. METHODS We systematically searched five databases for studies investigating colonoscopy direct observation assessment tools from inception until 8 April 2020. We extracted data outlining validity evidence (content, response process, internal structure, relations to other variables, and consequences) from the five sources and graded the degree of evidence, with a maximum score of 15. We assessed educational utility using an Accreditation Council for Graduate Medical Education framework and methodological quality using the Medical Education Research Quality Instrument (MERSQI). RESULTS From 10 841 records, we identified 27 studies representing 13 assessment tools (10 adult, 2 pediatric, 1 both). All tools assessed technical skills, while 10 each assessed cognitive and integrative skills. Validity evidence scores ranged from 1-15. The Assessment of Competency in Endoscopy (ACE) tool, the Direct Observation of Procedural Skills (DOPS) tool, and the Gastrointestinal Endoscopy Competency Assessment Tool (GiECAT) had the strongest validity evidence, with scores of 13, 15, and 14, respectively. Most tools were easy to use and interpret, and required minimal resources. MERSQI scores ranged from 9.5-11.5 (maximum score 14.5). CONCLUSIONS The ACE, DOPS, and GiECAT have strong validity evidence compared with other assessments. Future studies should identify barriers to widespread implementation and report on the use of these tools in credentialing examinations.
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Affiliation(s)
- Rishad Khan
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Eric Zheng
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sachin B Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michael A Scaffidi
- Faculty of Medicine, Queen's University, Kingston, Canada.,Division of Gastroenterology, St. Michael's Hospital, Toronto, Canada
| | - Thurarshen Jeyalingam
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada.,The Wilson Centre, University of Toronto, Toronto, Canada
| | - Nikko Gimpaya
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Canada
| | - John T Anderson
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK.,Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, UK
| | - Samir C Grover
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Gastroenterology, St. Michael's Hospital, Toronto, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Graham McCreath
- SickKids Research and Lerning Institutes, The Hospital for Sick Children, Toronto, Canada
| | - Catharine M Walsh
- The Wilson Centre, University of Toronto, Toronto, Canada.,SickKids Research and Lerning Institutes, The Hospital for Sick Children, Toronto, Canada.,Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
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Tam SS, Picoraro JA, Gupta SK, Oliva S, Furlano RI, Walsh CM. Changes to Pediatric Gastroenterology Practice During the COVID-19 Pandemic and Lessons Learned: An International Survey of Division and Group Heads. Gastroenterology 2021; 161:1052-1055. [PMID: 33675745 PMCID: PMC8093127 DOI: 10.1053/j.gastro.2021.02.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/24/2021] [Accepted: 02/28/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Sharon S Tam
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Joseph A Picoraro
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Medical Center, New York, New York
| | - Sandeep K Gupta
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Illinois, University of Illinois, Peoria, Illinois
| | - Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Umberto I-University Hospital, Sapienza-University of Rome, Rome, Italy
| | - Raoul I Furlano
- Pediatric Gastroenterology and Nutrition, Department of Pediatrics, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto, Toronto, Ontario, Canada.
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Abstract
BACKGROUND Endoscopists use self-assessment to monitor the development and maintenance of their skills. The accuracy of these self-assessments, which reflects how closely one's own rating corresponds to an external rating, is unclear. METHODS In this narrative review, we critically examine the current literature on self-assessment in gastrointestinal endoscopy with the aim of informing training and practice and identifying opportunities to improve the methodological rigor of future studies. RESULTS In the seven included studies, the evidence regarding self-assessment accuracy was mixed. When stratified by experience level, however, novice endoscopists were least accurate in their self-assessments and tended to overestimate their performance. Studies examining the utility of video-based interventions using observation of expert benchmark performances show promise as a mechanism to improve self-assessment accuracy among novices. CONCLUSIONS Based on the results of this review, we highlight problematic areas, identify opportunities to improve the methodological rigor of future studies on endoscopic self-assessment and outline potential avenues for further exploration.
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Affiliation(s)
- Michael A Scaffidi
- School of Medicine, Faculty of Health Sciences, Queen’s University, Kingston, Canada
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Rishad Khan
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Samir C Grover
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Nikko Gimpaya
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology, and Nutrition and the Research and Learning Institutes, Hospital for Sick Children, University of Toronto, Toronto, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
- The Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, Canada
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Walsh CM, Qayed E, Aihara H, Anand GS, Byrne K, Chahal P, Dacha S, James TW, Kowalski TE, Repaka A, Saadi M, Sheth SG, Taylor JR, Williams RL, Wagh MS. Core curriculum for ergonomics in endoscopy. Gastrointest Endosc 2021; 93:1222-1227. [PMID: 33820648 DOI: 10.1016/j.gie.2021.01.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto, Toronto, Ontario, Canada
| | - Emad Qayed
- Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Hiroyuki Aihara
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gobind S Anand
- Division of Gastroenterology, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Kathryn Byrne
- Division of Gastroenterology, Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Prabhleen Chahal
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sunil Dacha
- Division of Gastroenterology, Underwood Center for Digestive Disorders, Houston Methodist Hospital, Houston, Texas, USA
| | - Theodore W James
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Thomas E Kowalski
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Aparna Repaka
- Division of Gastroenterology, VA Boston Healthcare System and Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Mohammed Saadi
- Department of Gastroenterology, Hepatology, and Nutrition, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Sunil G Sheth
- Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Jason R Taylor
- Division of Gastroenterology and Hepatology, St Louis University, St Louis, Missouri, USA
| | - Renee L Williams
- Division of Gastroenterology and Hepatology, Department of Medicine, NYU Langone Health, New York, New York, USA
| | - Mihir S Wagh
- Division of Gastroenterology, University of Colorado-Denver School of Medicine, Aurora, Colorado, USA
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Macarthur C, Walsh CM, Buchanan F, Karoly A, Pires L, McCreath G, Jones NL. Development of the patient-oriented research curriculum in child health (PORCCH). Res Involv Engagem 2021; 7:27. [PMID: 33971980 PMCID: PMC8111753 DOI: 10.1186/s40900-021-00276-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/20/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The Canadian Institutes for Health Research launched a national 'Strategy for Patient-Oriented Research' (SPOR) in 2011. Patient-oriented research is defined as a continuum of research that engages patients as partners, focuses on patient-identified priorities, and improves patient outcomes. Capacity development is a core element of SPOR. Barriers to patient-oriented research include unfamiliarity with the research process for patients and families and unfamiliarity with the methods of patient and family engagement for researchers. METHODS The aim of the Patient-Oriented Research Curriculum in Child Health (PORCCH) is to build capacity in patient-oriented research in child health among patients and families, researchers, healthcare professionals, decision-makers, and trainees through a curriculum delivered via a series of interactive online modules (e-learning). A multi-disciplinary, multi-stakeholder steering committee, which included patients and families, guided the development of the curriculum and provided feedback on individual modules. The content, design, and development of each module were co-led by a parent and researcher in an equal partnership. RESULTS PORCCH consists of a series of five modules. All modules are interactive and include video vignettes and knowledge comprehension questions. Access to the modules is free and each module takes approximately 30 min to complete. The five modules are: Research 101 (an Introduction to Patient-Oriented Research, parts 1 and 2), Patient Engagement 101 (an Introduction to Patient Engagement in Child Health Research, parts 1 and 2), and Research Ethics 101. CONCLUSIONS PORCCH was developed specifically to overcome recognized barriers to the engagement of patients and families in child health research. The aim of the curriculum is to build capacity in patient-oriented research in child health. The goal is for PORCCH to be a useful resource for all stakeholders involved in patient-oriented research: patients and families, researchers, healthcare professionals, decision-makers, and trainees.
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Affiliation(s)
- Colin Macarthur
- SickKids Research Institute, Hospital for Sick Children, Toronto, Canada.
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Catharine M Walsh
- SickKids Research Institute, Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Canada
- SickKids Learning Institute, Hospital for Sick Children, Toronto, Canada
- The Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Francine Buchanan
- Family Advisor, Hospital for Sick Children, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Aliza Karoly
- Family Advisor, Hospital for Sick Children, Toronto, Canada
| | - Linda Pires
- Canadian Child Health Clinician Scientist Program, Toronto, Canada
| | - Graham McCreath
- SickKids Research Institute, Hospital for Sick Children, Toronto, Canada
| | - Nicola L Jones
- SickKids Research Institute, Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Canada
- SickKids Learning Institute, Hospital for Sick Children, Toronto, Canada
- Department of Physiology, University of Toronto, Toronto, Canada
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Elmunzer BJ, Walsh CM, Guiton G, Serrano J, Chak A, Edmundowicz S, Kwon RS, Mullady D, Papachristou GI, Elta G, Baron TH, Yachimski P, Fogel E, Draganov PV, Taylor J, Scheiman J, Singh V, Varadarajulu S, Willingham FF, Cote G, Cotton PB, Simon V, Spitzer R, Keswani R, Wani S. Development and initial validation of an instrument for video-based assessment of technical skill in ERCP. Gastrointest Endosc 2021; 93:914-923. [PMID: 32739484 PMCID: PMC8961206 DOI: 10.1016/j.gie.2020.07.055] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/24/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The accurate measurement of technical skill in ERCP is essential for endoscopic training, quality assurance, and coaching of this procedure. Hypothesizing that technical skill can be measured by analysis of ERCP videos, we aimed to develop and validate a video-based ERCP skill assessment tool. METHODS Based on review of procedural videos, the task of ERCP was deconstructed into its basic components by an expert panel that developed an initial version of the Bethesda ERCP Skill Assessment Tool (BESAT). Subsequently, 2 modified Delphi panels and 3 validation exercises were conducted with the goal of iteratively refining the tool. Fully crossed generalizability studies investigated the contributions of assessors, ERCP performance, and technical elements to reliability. RESULTS Twenty-nine technical elements were initially generated from task deconstruction. Ultimately, after iterative refinement, the tool comprised 6 technical elements and 11 subelements. The developmental process achieved consistent improvements in the performance characteristics of the tool with every iteration. For the most recent version of the tool, BESAT-v4, the generalizability coefficient (a reliability index) was .67. Most variance in BESAT scores (43.55%) was attributed to differences in endoscopists' skill, indicating that the tool can reliably differentiate between endoscopists based on video analysis. CONCLUSIONS Video-based assessment of ERCP skill appears to be feasible with a novel instrument that demonstrates favorable validity evidence. Future steps include determining whether the tool can discriminate between endoscopists of varying experience levels and predict important outcomes in clinical practice.
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Affiliation(s)
- B. Joseph Elmunzer
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC, USA
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology, and Nutrition, Learning Institute and Research Institute, Hospital for Sick Children, Toronto, Canada
| | - Gretchen Guiton
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jose Serrano
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Amitabh Chak
- Division of Gastroenterology and Liver Disease, Case Western Reserve University, Cleveland, OH, USA
| | - Steven Edmundowicz
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Richard S. Kwon
- Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA
| | - Daniel Mullady
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Georgios I. Papachristou
- Division of Gastroenterology, Hepatology, and Nutrition, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Grace Elta
- Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA
| | - Todd H. Baron
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
| | - Patrick Yachimski
- Division of Gastroenterology, Vanderbilt University, Nashville, TN, USA
| | - Evan Fogel
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN, USA
| | - Peter V. Draganov
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, FL, USA
| | - Jason Taylor
- Division of Gastroenterology and Hepatology, Saint Louis University, Saint Louis, MO, USA
| | - James Scheiman
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA, USA
| | - Vikesh Singh
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | | | | | - Gregory Cote
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC, USA
| | - Peter B. Cotton
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC, USA
| | - Violette Simon
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rebecca Spitzer
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC, USA
| | - Rajesh Keswani
- Division of Gastroenterology, Northwestern University, Chicago, IL, USA
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Huber JF, Davis S, Phan J, Jegathesan T, Campbell DM, Chau R, Walsh CM. Children's Ability to Call 911 in an Emergency: A Simulation Study. Pediatrics 2021; 147:peds.2020-010520. [PMID: 33692162 DOI: 10.1542/peds.2020-010520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Joelene F Huber
- Divisions of Paediatric Medicine, .,Division of Developmental Paediatrics.,Division of Developmental Paediatrics.,Department of Paediatrics.,Faculty of Medicine and
| | - Sarah Davis
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Jean Phan
- Applied Disability Studies, Brock University, St Catharines, Canada; and
| | | | - Douglas M Campbell
- Department of Paediatrics.,The Wilson Centre.,Departments of Child and Youth Studies and
| | | | - Catharine M Walsh
- Gastroenterology, Hepatology, and Nutrition and the Research and Learning Institutes, Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics.,The Wilson Centre.,Department of Paediatrics
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Khan R, Zheng E, Wani SB, Scaffidi MA, Jeyalingam T, Gimpaya N, Anderson J, Grover SC, McCreath G, Walsh CM. A97 TOOLS FOR DIRECT OBSERVATION AND ASSESSMENT OF COLONOSCOPY: A SYSTEMATIC REVIEW OF VALIDITY EVIDENCE. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
An increasing focus on quality and safety in colonoscopy has led to broader implementation of competency-based educational systems that enable documentation of trainees’ achievement of the knowledge, skills, and attitudes needed for independent practice. The meaningful assessment of competence in colonoscopy is critical to this process. While there are many published tools that assess competence in performing colonoscopy, there is a wide range of underlying validity evidence. Tools with strong evidence of validity are required to support feedback provision, optimize learner capabilities, and document competence.
Aims
We aimed to evaluate the strength of validity evidence that supports available colonoscopy direct observation assessment tools using the unified framework of validity.
Methods
We systematically searched five databases for studies investigating colonoscopy direct observation assessment tools from inception until April 8, 2020. We extracted data outlining validity evidence from the five sources (content, response process, internal structure, relations to other variables, and consequences) and graded the degree of evidence, with a maximum score of 15. We assessed educational utility using an Accreditation Council for Graduate Medical Education framework and methodological quality using the Medical Education Research Quality Instrument (MERSQI).
Results
From 10,841 records, we identified 27 studies representing 13 assessment tools (10 adult, 2 pediatric, 1 both). All tools assessed technical skills, while 10 assessed cognitive and integrative skills. Validity evidence scores ranged from 1–15. The Assessment of Competency in Endoscopy (ACE) tool, the Direct Observation of Procedural Skills (DOPS) tool, and the Gastrointestinal Endoscopy Competency Assessment Tool (GiECAT) had the strongest validity evidence, with scores of 13, 15, and 14, respectively. Most tools were easy to use and interpret and required minimal resources. MERSQI scores ranged from 9.5–11.5 (maximum score 14.5).
Conclusions
The ACE, DOPS, and GiECAT have strong validity evidence compared to other assessments. Future studies should identify barriers to widespread implementation and report on use of these tools in credentialing purposes.
Funding Agencies
None
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Affiliation(s)
- R Khan
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - E Zheng
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - S B Wani
- University of Colorado Anschutz Medical Campus, Aurora, CO
| | - M A Scaffidi
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - N Gimpaya
- St. Michael’s Hospital, Toronto, ON, Canada
| | - J Anderson
- Dept. of Gastroenterology, Cheltenham Hospital, Cheltenham, United Kingdom
| | - S C Grover
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - G McCreath
- The Hospital for Sick Children, Toronto, ON, Canada
| | - C M Walsh
- The Hospital for Sick Children, Toronto, ON, Canada
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Jeyalingam T, Walsh CM, Tavares W, Mylopoulos M, Hodwitz K, Liu LW, Brydges R. A95 HOW ENDOSCOPY TEACHERS MAKE POLYPECTOMY ENTRUSTMENT DECISIONS IN CLINICAL AND SIMULATION-BASED SETTINGS. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Entrustment, a central construct in competency-based medical education (CBME), represents the point at which clinical supervisors trust a trainee to perform a task independently. Many implementations of CBME involve assessing entrustment through observation of entrustable professional activities (EPAs). While EPAs are frequently assessed in both clinical and simulation-based settings, research has yet to clarify how faculty who teach endoscopy form judgments of entrustment across these two contexts.
Aims
We aimed to explore the features that endoscopy teachers report as influencing their entrustment decisions regarding polypectomy across clinical and simulation-based assessment settings.
Methods
We designed an interview-based, constructivist grounded theory-informed study involving endoscopy teachers and trainees in the University of Toronto gastroenterology residency program. Teachers completed separate EPA assessments of each trainee’s performance of an endoscopic polypectomy (colonic polyps < 1cm, Paris 0-Is or 0-Ip in morphology) in both settings. Teachers were interviewed after each assessment to explore how they made their entrustment decision within and across settings. Transcribed interview data were coded iteratively using constant comparison to generate themes.
Results
Based on 14 interviews with 7 endoscopy teachers, we found that they: (1) held multiple meanings of entrustment for polypectomy, both within and across participants, (2) expressed variability in how they justified their entrustment decisions, the related narrative, and numerical scoring, (3) held unique personal criteria for making decisions ‘comfortably,’ including authenticity of the task, variability in terms of polyp shape, location, and morphology, as well as the ability to assess trainee response to procedural complications (e.g., post-polypectomy bleeding), and (4) perceived a relative freedom when using simulation to make entrustment decisions due to the absence of a real patient.
Conclusions
We found that faculty who teach endoscopy defined polypectomy entrustment in a variety of ways, leading to variability in how they judged entrustment within and across trainees and assessment settings. The observed idiosyncrasies suggest gastroenterology competence committees cannot assume equivalence of EPA data obtained from different settings. Furthermore, educators designing faculty development for CBME will need to attend to the criteria that endoscopy teachers report they need to comfortably make entrustment decisions.
Funding Agencies
Royal College of Physicians and Surgeons of Canada
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Affiliation(s)
| | - C M Walsh
- Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children and The Wilson Centre, Toronto, ON, Canada
| | - W Tavares
- The Wilson Centre, Toronto, ON, Canada
| | | | - K Hodwitz
- St Michael’s Hospital Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - L W Liu
- University Health Network, Toronto, ON, Canada
| | - R Brydges
- The Wilson Centre, Toronto, ON, Canada
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50
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Dacha S, Aihara H, Anand GS, Byrne KR, Chahal P, James T, Kowalski TE, Qayed E, Repaka A, Saadi M, Sheth SG, Taylor JR, Walsh CM, Williams RL, Wagh MS. Core curriculum for peroral endoscopic myotomy (POEM). Gastrointest Endosc 2021; 93:539-543. [PMID: 33422284 DOI: 10.1016/j.gie.2020.10.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Sunil Dacha
- Division of Gastroenterology, Underwood Center for Digestive Disorders, Houston Methodist Hospital, Houston, Texas, USA
| | - Hiroyuki Aihara
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gobind S Anand
- Division of Gastroenterology, University of California San Diego, San Diego, California, USA
| | - Kathryn R Byrne
- Division of Gastroenterology, University of Utah, Salt Lake City, Utah, USA
| | - Prabhleen Chahal
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Theodore James
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Thomas E Kowalski
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Emad Qayed
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Aparna Repaka
- Division of Gastroenterology, VA Boston Healthcare system, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Mohammed Saadi
- Division of Gastroenterology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Sunil G Sheth
- Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Jason R Taylor
- Division of Gastroenterology and Hepatology, St Louis University, St Louis, Missouri, USA
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto, Toronto, Ontario, Canada
| | - Renee L Williams
- Division of Gastroenterology and Hepatology, NYU Langone Health, New York, New York, USA
| | - Mihir S Wagh
- Division of Gastroenterology, University of Colorado-Denver School of Medicine, Aurora, Colorado, USA
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