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Studies explore endoscopy training issues, trends to improve patient safety

Joshua B. Satchwell, MD
Joshua B. Satchwell, MD

A series of presentations covered several recent studies focusing on ways to enhance and improve endoscopy training — and ultimately improve patient safety — for both the trainer and trainee during an ASGE session on Saturday Training Tips in Endoscopy for the Student and the Teacher.

Joshua B. Satchwell, MD, of St. Michael’s Hospital, Toronto, Ontario, discussed the results of a randomized trial looking at a game-based learning intervention for novice endoscopists and its impact on the performance of simulated and live colonoscopies, compared to a conventional simulation-based training (SBT) curriculum.

“Gamification, which is the application of game-design elements, such as competition, rankings and rewards, has been used to enhance procedural learning in health care, but no studies have investigated the effects of a comprehensive gamification curriculum on the acquisition of endoscopic skills amongst novice endoscopists,” Dr. Satchwell said. “In this study, we found that an SBT curriculum using gamification for colonoscopy was associated with significantly improved global performance among novice endoscopists, and believe it is an instructional strategy with potential to enhance learning.”

Karen Dickinson, MD, of Houston Methodist Institute for Technology, Innovation & Education, TX, followed with the results of a study designed to improve training in colonic endoscopic submucosal dissection (cESD) by deconstructing cESD into
its essential steps.

In conjunction with nine national and international subject matter experts, Dr. Dickinson and her colleagues identified and described the following 10 steps for performing standard cESD:

  1. Access lesion and plan resection strategy.
  2. Visualize/evaluate lesion.
  3. Delineate planned resection margin.
  4. Submucosal injection.
  5. Initial incision to access submucosal plane.
  6. Alternate extension of partial marginal incision and submucosal dissection to include majority of circumference.
  7. Complete en bloc resection.
  8. Retrieve specimen.
  9. Inspect resection bed and tattoo area if indicated.
  10. Proper management of specimen.

“These steps should be incorporated into a cESD training curriculum or used as the basis for creating an ESD simulator or cESD assessment tool,” Dr. Dickinson said. “Ongoing work from our group is doing just that.”

Ronak Vashi Patel, MD, of Northwestern University Feinberg School of Medicine, Chicago, IL, presented the results of a study demonstrating that simulation-based mastery learning (SBML) improves polypectomy competency among experienced endoscopists.

“Ultimately, holding faculty to the rigorous mastery standard would require more training than current direct observation of polypectomy skills (DOPyS) competency standards,” Dr. Patel said. “While validation of these findings in clinical practice is needed, SBML in polypectomy should be considered to improve skills for practicing gastroenterologists.”

Sara Cerrone, MD, of Zucker School of Medicine at Hofstra/Northwell, East Garden City, NY, discussed the results of a study that explored the use of remote video auditing (RVA) to improve time-out compliance in the endoscopy suite

“Patient and procedure verification, or the time out process (TOP), is considered one of the most vital components of patient safety, but has had limited attention in the endoscopy literature,” Dr. Cerrone said. “We found that TOP compliance rates significantly improved in our endoscopy unit through the use of RVA and the implementation of specific actionable items.”

In the final presentation, Anna Duloy, MD, of University of Colorado, Boulder, shared the results of a study that examined the association between cannulation time and advanced endoscopy trainee (AET) competence at the end of training.

“We found that there is no association between cannulation times and competence in ERCP among AETs, suggesting that factors beyond allowed cannulation times impact competence,” Dr. Duloy said. “Further studies focusing on trainee and trainer
predictors for competence are needed.

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