S613 Standardized General Endoscopy Lexicon for Learners

Abstract

Introduction: Physicians completing subspecialty training in gastroenterology are expected to develop competence in performing general endoscopic procedures including upper endoscopy, colonoscopy, and flexible sigmoidoscopy. Endoscopy education is often provided through an apprenticeship model where trainees work with various endoscopists and develop skills in real-time procedures. Inherent to this model is heterogeneity in the education provided. Recent research exploring essential teaching competencies for those involved in endoscopic education suggests usage of succinct standardized language when teaching endoscopy, but to date no one has examined the breadth of terms used or developed consensus around specific language to be used in this aspect of medical training. In this study we surveyed terminology used worldwide by expert teachers of endoscopy and, through a Delphi process, developed a standardized lexicon for general endoscopic education. Methods: We invited 26 physicians identified as expert endoscopy educators from various countries around the world to participate in this Delphi process. A total of 20 physicians participated. Four rounds of surveys were completed. Common terminology was identified in round 1. Rounds 2 through 4 consisted of surveys where participants indicated terms they were most likely to use when instructing learners during endoscopy. A consensus threshold of 70% was defined for term inclusion into the lexicon. Terms that achieved a 70% minimum consensus were included as “recommended terms”. Terms that offered balance to the lexicon but did not reach the threshold consensus were included as “suggested terms”. Results: After 4 rounds of surveys, 36 recommended terms and 5 suggested terms were included in our general endoscopy lexicon (Table). Conclusion: Through this international Delphi project, we constructed a general endoscopy lexicon for learners. The use of standardized language has been shown to have several benefits in other areas of healthcare including improved communication, quality of patient care, and knowledge generation. We expect that adopting a uniform lexicon will improve quality of endoscopic education for learners. In addition, because this study was conducted on an international level, we anticipate this lexicon to be applicable to trainees throughout the world. Future projects exploring standardized language for advanced endoscopic procedural education should be considered. Table 1. - Terms included in general endoscopy lexicon post-survey Endoscopy Instruction Committee Consensus (%) Final Stance Scope Manipulation Rotate (torque)clockwise/counterclockwiseRotate (torque) right/left 100* Recommended Big wheel/dial up 94.42 Recommended Big wheel/dial down 88.9 Recommended Little wheel/dial up 88.9 Recommended Little wheel/dial down 88.89 Recommended Advance scope 77.78 Recommended Pull scope back 100% Recommended Brush Manipulation Put brush out 100%* Recommended Pull brush inWithdraw brushAdvance brush 83.33* Recommended Brush tissues 56.25 Suggested Clip Manipulation Open clip 93.75 Recommended Close clip 81.25 Recommended Rotate clip 87.5 Recommended Deploy clipFire clip 91.67* Recommended Cautery - Monopolar, Bipolar – Manipulation Advance cautery probe 75 Recommended Start cauteryCut/coagulate 58.33* Suggested Forceps Manipulation Open forceps 93.75 Recommended Close forceps 81.25 Recommended Advance forceps 91.67 Recommended Withdraw forceps 100 Recommended Pictures/Video Take a picture/video 77.78 Recommended Air (blue button) Insufflate 72.22 Recommended Water (blue button) Clean your lens 88.89 Recommended Suction (red button) Suction 77.78 Recommended Through the Scope Balloon Dilator Manipulation Advance dilator 56.25 Suggested Inflate balloon 100 Recommended Deflate balloon 56.25 Suggested Bougie Dilator Manipulation Advance wire 81.25 Recommended Advance dilator over wire 87.5 Recommended Net Manipulation Open net 93.75 Recommended Close net 93.75 Recommended Use of Electrocautery Pedals (blue, yellow) Blue pedal 81.25 Recommended Yellow pedal 81.25 Recommended Snare Manipulation Open snare 93.75 Recommended Close snare 93.75 Recommended Cut 56.25 Suggested *The committee consensus to include both terms in the lexicon