The Effects of a One-Day Hands-On Endoscopic Training Course for Practicing Gastroenterologists

Abstract

Purpose: Continuing education for gastroenterologists is required but consists primarily of didactic lectures. Hands-on training rarely plays a role in educational programs and has not been evaluated as an exclusive educational format for promoting endoscopic training. Our aim was to evaluate the effectiveness of a one-day hands-on endoscopic training course for practicing gastroenterologists. Methods: Six hands-on training stations (argon plasma coagulation, Bravo pH probe placement, endoscopic clip deployment, esophageal stent deployment, variceal band ligation, capsule endoscopy) and one demonstration station (endoscopic mucosal resection or EMR) were outfitted with pig models, upper endoscopes, and appropriate equipment. Thirty practicing gastroenterologists (trainees) were separated into groups of 5 and rotated at 35 minute intervals through each station. Trainees were instructed and allowed to independently perform each technique, except EMR. The teacher of each station was a gastroenterologist deemed proficient at performing the technique. After the course, each trainee completed a questionnaire regarding the influences of the program. Results: Twenty-eight questionnaires were completed. The trainees' mean number of years in practice was 16 with a median of 15. Eighty-six percent of trainees were in a group private practice. The most common reason for attending the course was to learn to perform advanced techniques (76%). Level of comfort in independently performing the procedures increased significantly (p≤ 0.001 to p≤ 0.05) after completing all hands-on stations. Level of comfort did not significantly improve in the demonstration-only station (EMR). Most trainees felt they could independently teach any hands-on station after completing the course. This was again not true for EMR. Length of time in practice did not predict the degree of skill improvement or ability to teach the skill. Trainees who performed <1 particular procedure/month were more likely to improve in their skill comfort scores when compared to those who performed ≥1 particular procedure/month. Conclusions: Lectures and endoscopic demonstrations alone have little impact on enhancing the competence of gastroenterologists. Conversely, hands-on endoscopic training is highly effective in improving skill and comfort levels and should be incorporated into educational programs for all gastroenterologists.