Direct Observation Of Procedural Skills Research Articles

Assessing Operative Skill in the Competency-based Education Era: Lessons From the UK and Ireland.

Decisions regarding the operative competence of surgical residents in the United Kingdom and Ireland are informed by operative workplace-based assessments (WBAs) and operative number targets for index procedures. This review seeks to outline the validity evidence of these assessment methods. A review of the MEDLINE (Pubmed), EMBASE and Cochrane Library databases was undertaken in accordance with the Joanna Briggs Institute Protocol for Scoping Reviews (2020). Articles were included if they provided evidence of the validity of procedure-based assessments, direct observation of procedural skills, or indicative operative number targets. The educational impact of each article was evaluated using a modified Kirkpatrick model. Twenty-eight articles outlining validity evidence of WBAs and operative number targets were synthesised by narrative review. Five studies documented users' views on current assessment methods (Kirkpatrick level 1). Two articles recorded changes in attitudes towards current operative assessments (level 2a). Ten studies documented the ability of current assessments to record improvements in operative competence (level 2b). Ten studies measured a change in behaviour as a result of the introduction of these assessments (level 3). One article studied the ability of operative assessments to predict clinical outcomes (level 4b). Operative WBAs are reliable. Scores achieved correlate with both time spent in training and recorded operative experience. Trainers and residents have concerns regarding the subjectivity of these assessments and the opportunistic nature in which they are used. Operative number targets are not criterion-referenced, lack validity evidence, and may be set too low to ensure operative competence.

Introduction of Direct Observation of Procedural Skills as Workplace-Based Assessment Tool in Department of Anesthesiology

Abstract Background: The direct observation of procedural skills (DOPS) was introduced for the workplace-based assessment of procedural skills. It offers an opportunity to provide feedback to trainees. This makes DOPS an authentic measure of clinical competence in anesthesiology training. The goal of this study was to assess the perceptions of both trainees and consultants regarding the use of DOPS and to evaluate the performance of anesthesia postgraduate (PG) trainees over consecutive assessments. Materials and Methods: After approval from the ethical committee and sensitization workshop, two exposures of DOPS per trainee were given for three common anesthesia skills as per their years in training. Thereafter anonymous feedback was collected from faculty and trainees to gather their perception regarding DOPS. Consecutive DOPS scores for trainees were analyzed. Data were presented in terms of percentages, mean, and standard deviation. A P value of <0.05 was considered significant. Results: More than 50% of participants were satisfied with the way DOPS was conducted and thought it was feasible for formative assessment. About 80% of participants were of the view that DOPS is helpful for anesthesia training and improving anesthesia procedural skills. Yet only 40%–50% favored the addition of DOPS to the departmental assessment plan. Significant improvement was observed in DOPS scores of PG trainees. Mean DOPS scores of postgraduate trainee year 1, 2, and 3 (JR 1, JR 2, and JR 3) increased from 2.6 to 4.8, 4 to 5.7, and 5.6 to 7, respectively (P < 0.05). Conclusions: DOPS may be considered as a useful tool for workplace-based assessment for anesthesia PG training.

Higher adenoma detection, sessile serrated lesion detection and proximal sessile serrated lesion detection are associated with physician specialty and performance on Direct Observation of Procedural Skills

ObjectiveAdenoma detection rate (ADR) and sessile serrated lesion detection rate (SSLDR) vary among physicians. We sought to determine physician characteristics associated with ADR and SSLDR in a population-based colon screening...

Comparing the Efficacy of Portfolio and Direct Observation of Procedural Skills (DOPS) Model, on Nursing Students Disposition Toward Critical Thinking

Comparing the Efficacy of Portfolio and Direct Observation of Procedural Skills (DOPS) Model, on Nursing Students Disposition Toward Critical Thinking

Outcome-based student assessment enhances academic performance in basic medical laboratory course

Basic medical laboratory courses (BMLCs) play an important role in medical educational courses helping the student acquire three important skills of surgical operating, collaborative learning, and problem solving. The outcome-based student assessment (OBSA) is a learning evaluation method that establishes specific evaluation points based on performance of students in three aspects: surgical operating, collaborative learning, and problem solving in the BMLC curriculum practices. The purpose of the present randomized controlled trial study is to explore the efficiency of OBSA program in BMLCs. The 233 students attending BMLCs were randomly divided into 2 groups, 118 in the OBSA group and 115 in the control group. We conducted multiple-choice examination questions (MCQs) test and two questionnaires with the method of two-sample t test for statistics. The results of MCQs in total eight BMLC blocks showed that the academic performance of the OBSA group was significantly better than that of the control group (P < 0.05). In addition, the average scores of direct observation of procedural skills (DOPS) and mini-experimental evaluation exercise in OBSA group were significantly higher than those in control group (P < 0.05). The majority of the medical students preferred the OBSA and considered OBSA could effectively improve their surgical operating skills (83.9%), collaborative learning skills (92.1%), and problem-solving skills (91.1%). From the above, OBSA is an effective evaluation method for the implementation of the BMLC curriculum.

Simulator-based Videolaryngoscopy Training for Capacity Building in Intubation during COVID-19 Pandemic

Background: Coronavirus disease 2019 (COVID-19) pandemic has presented the healthcare sector with unique challenges. The use of a videolaryngoscope (VL) for intubation is one of the recommendations. The paucity of availability of VL outside the operation room results in lack of intubation skills with VL among clinicians. This study was undertaken to analyse the effectiveness of fast-tracked simulation-based training in enabling frontline resident doctors with skills of videolaryngoscopy. Material and Methods: Residents already trained in the skills of direct laryngoscopy underwent training on VL using the King Vision™ VL (channeled blade) through structured simulation-based training in batches of &lt;20. Sessions included interactive lecture, demonstration by the instructor and supervised hands-on practice by residents on an airway manikin. Knowledge gained was assessed with multiple-choice questions through a pre-test and post-test. Skills gained were assessed through Objective Structured Clinical Examination (OSCE) and Direct Observation of Procedural Skills (DOPS). Feedback was taken from participants on a 3-point Likert scale. Results: 190 residents were enabled with skills of videolaryngoscopy within 3 months. Overall mean pre-test scores of 6.16 ± 1.79 improved to 7.21 ± 2.02 in post-test scores and improvement in knowledge was found to be statistically significant (P &lt; 0.0001). Skill assessment through DOPS revealed excellent performance by 72% of participants while 3% scored borderline. OSCE results showed overall good performance by residents across various clinical disciplines. 90.4% of participants responded that training gave them the confidence to perform videolaryngoscopy. Conclusion: A well-structured simulation-based training on videolaryngoscopy is effective in imparting indirect airway management skills to residents of various clinical specialties. Simulation-based fast-tracked training is an effective method to train a large number of clinicians within a limited period.

Colonoscopy competence assessment tools: a systematic review of validity evidence.

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. 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). 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). 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.

A97 TOOLS FOR DIRECT OBSERVATION AND ASSESSMENT OF COLONOSCOPY: A SYSTEMATIC REVIEW OF VALIDITY EVIDENCE

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

Introduction of direct observation of procedural skills (DOPS) as a formative assessment tool during postgraduate training in anaesthesiology: Exploration of perceptions.

Background and Aims:Formative assessment of procedural skills of Anaesthesiology postgraduate (PG) students is not conducted conventionally. Direct observation of procedural skills (DOPS) helps to identify gaps in performance and provides structured feedback. The present study was taken to explore perceptions of PG students and faculty about DOPS.Methods:This mixed design interventional study was conducted on 12 PGs and 10 faculty members in Department of Anaesthesiology. After conducting DOPS, a pre-validated questionnaire was given to them about perceptions using 3-point Likert's scale along with open ended questions. Statistical analysis was done using descriptive statistics of perception to calculate percentages and themes were identified for qualitative data.Results:Responses of students were positive about skill improvement (83%), time provided (75%), feedback (100%), interaction (83%), motivation (83%), satisfaction (83%), effectiveness (83%) and opportunity creation (92%). Faculty responded positively regarding change in attitude (100%), effectiveness (100%), scope (90%), feasible application (90%), ease (90%), opportunity creation (80%), gap identification (100%), satisfaction (80%). However, 60% felt training was required, 50% thought more time and commitment was required. Themes identified were DOPS is comprehensive, interactive, student-friendly, good teaching-learning tool, identifies gaps, provides focus for learning, provides systematic constructive feedback, improves skills, prepares for future practice, requires planning, may not reflect competence, has assessor variability and can be included in PG curriculum.Conclusion:DOPS was perceived as an effective assessment and teaching-learning tool by PG students as well as faculty.

Comparison of video-based observation and direct observation for assessing the operative performance of residents undergoing phacoemulsification training.

Purpose:To compare the video observation of procedural skills (VOPS) method with the direct observation of procedural skills (DOPS) method in the assessment of senior residents' performance utilizing the International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric for phacoemulsification (ICO-OSCAR; phaco).Methods:This is a prospective comparative study conducted at a university-affiliated hospital. Six ophthalmology residents of postgraduate year 4 participated. Their performance in phacoemulsification was rated via DOPS and later in a masked manner through VOPS by a single faculty assessor.Results:Seventy-one surgeries were evaluated. There were no statistically significant differences between the scores of VOPS and DOPS regarding all ICO-OSCAR indices except “instrument insertion into the eye” in which DOPS had higher scores (P = 0.035). A significant correlation was observed in total scores of “task-specific” (r = 0.64, P < 0.001) and “global” (r = 0.38, P = 0.003) indices between VOPS and DOPS while some subscales did not show a correlation between the two methods of assessment. The Bland-Altman analysis demonstrated that nearly all data points of total “task-specific” and “global” scores fell within the 95% limits of agreement ([-5.84, 6.87] and [-4.78, 4.86], respectively).Conclusion:This study demonstrated that VOPS holds promise for a general rating of residents' performance.

English

BACKGROUND Basic life support (BLS) although a lifesaving skill, is seldom taught in the first year of traditional Indian undergraduate medical curriculum resulting in lack of competence and confidence. Medical Council of India’s new competency based undergraduate curriculum stresses on early skill acquisition. Basic life support hands-on workshop can be a simple yet effective educational intervention in achieving the goal. The aim of the study is to determine the effectiveness of introduction of BLS training workshop to first year MBBS curriculum as a part of foundation course skills development. METHODS An interventional study in the form of BLS workshop consisting of lecture, demonstration and hands on practice on mannequins was conducted on first MBBS students. Assessment was done by standardized pre- and post-test questionnaire and direct observation of procedural skills (DOPS). Student’s perception was qualitatively explored by conducting focus group discussions (FGD) followed by thematic analysis. RESULTS Analysis of median pre- and post-test scores using Wilcoxon test matched pairs signed rank test revealed highly significant gain in knowledge and confidence (P value = 0.000). Thirty three percent students could perform all the seven steps of cardiopulmonary resuscitation (CPR) correctly, meeting all six quality indicators indicating satisfactory skill acquisition. Six overarching themes emerged from the focus group responses viz. importance of clinical skill acquisition in first year, suggested methods to improve skill training, effectiveness of BLS workshop, usefulness of learning BLS skill, readiness to perform CPR in real life scenario and need for curriculum reformation. CONCLUSIONS Simulation-based hands-on workshop can serve as an effective teaching learning strategy for foundation course BLS skills development under new competencybased first MBBS curriculum by Medical Council of India (MCI). KEYWORDS Basic Life Support, Cardiopulmonary Resuscitation, MBBS, Curriculum, Competency, Qualitative Analysis, Medical Education

The Effect of Repeated Direct Observation of Procedural Skills (R-DOPS) Assessment Method on the Clinical Skills of Anesthesiology Residents.

BackgroundThe ultimate result of patient care is one of the most important outcomes in medical education. Several methods, including the direct observation of procedural skills (DOPS), have been proposed to assess professional competencies in clinical practice.ObjectivesThis study aimed to assess the effects of the Repeated DOPS (R-DOPS) method on the performance of procedural skills in anesthesiology residents.MethodsThe procedural skill performance of anesthesiology residents was assessed using a standard DOPS protocol from May to October 2019. Their scores were then objectively recorded, and the satisfaction rates regarding the 2 DOPS exams were assessed.ResultsWe found a considerable improvement in anesthesiology residents’ procedural skill performance, especially in the anesthesiology residency curriculum’s basic items. Besides, anesthesiology residents’ satisfaction was significantly improved after the 2nd DOPS.ConclusionsR-DOPS leads to improved training outcomes, including assessing the procedural skills, time to feedback to trainees, and trainee satisfaction.

Effects of a mobile phone application for graduate nurses to improve central venous catheter care: A randomized controlled trial.

To develop and test a mobile phone application (app) for graduate nurses on the use and care of central venous catheters. A randomized controlled trial was conducted at a teaching hospital in the central east coast of Taiwan. Recruitment occurred from 1 August 2019 -31 October 2019. All graduates (N=90) attending a 2-week induction program attended a lecture and completed a 10-item questionnaire on central venous catheter assessment and care at the end of Week 1 (Time 1). Volunteers were then randomly allocated to receive a link to the learning app on their mobile phone (n=39 Group A) or control condition (N=40 Group B). One week later, all graduates completed the knowledge assessment (Time 2) and a simulated clinical assessment with a mannequin. Skills were assessed using an 11-item, direct observation of procedural skills form. Only data from consenting participants were analysed. Compared with controls, nurses receiving the intervention reported significantly better knowledge (t=-7.98, p<.001, CI=20.9~34.8) and skill scores (t=2.83, p=.006, CI=1.14~6.61). More frequent use of the mobile phone app was associated with higher knowledge (r=0.39, p=.02, CI=0.11~0.99) and skills (r=0.42, p=.008, CI=0.17~1.03). Mobile app instruction for graduate nurses on central venous catheter care increased specific knowledge and skills compared with conventional methods of instruction. Implementation of mobile phone application technology can be considered a feasible means to proactively provide training and education. Mobile phone apps could be developed for a range of clinical procedures and various settings. Future studies with a larger sample and a longitudinal follow-up are warranted to confirm results.

The effect of direct observation of procedural skills/mini-clinical evaluation exercise on the satisfaction and clinical skills of nursing students in dialysis.

BACKGROUND:Since the purpose of medicine science is health promotion, education of this group is very important. The use of new evaluation methods is one of the first educational needs. Given that many conventional clinical evaluation methods are not able to fully evaluation students in the clinical settings and only evaluate limited information, This study is designed to evaluate the impact of direct observation of procedural skills (DOPS) and mini-clinical evaluation exercise (mini-CEX) on nursing students and their clinical satisfaction skills.MATERIALS AND METHODS:This quasi-experimental study was conducted in 2018 to evaluate the dialysis unit of the 6th semester nursing students of Babol University of Medical Sciences in Iran. Samples were selected by the census method and then random allocation. Data collection was performed using two questionnaires and two checklists to evaluate the clinical skills and satisfaction of the two groups of testing and control. Moreover, the data were analysed with using the SPSS software (version 18, IBM SPSS Inc., Chicago, IL, USA) through the descriptive and analytical statistics (Chi-square test and t-test).RESULTS:The results showed that the intervention group compared with the control evaluation score of 13/73 ± 2/44, 11/74 ± 2/43, P < 0.002, respectively. Furthermore, the mean score of satisfaction of the intervention group with the DOPS method compared to the traditional method of the control group was 72/50 ± 7/31, 63/48 ± 9/31, P < 0.001, respectively. As well as, the mean score of satisfaction with the mini-CEX method of the intervention group compared to the traditional method of the control group was 73/28 ± 7/78, 63/48 ± 9/31, P < 0.002, respectively.CONCLUSIONS:The results of this study showed that students who were evaluated by DOPS and mini-CEX methods had a higher score of clinical performance evaluation and higher level of satisfaction. Nursing professors can improve the learning process and the satisfaction of nursing students by using direct feedback on such evaluation methods.

The Efficacy of a Web-Based Logbook in the Monitoring of Educational Activities of Emergency Medicine Residents

Background: Regularly monitoring of educational activities is of undisputed importance in residency training programs. Various educational and training activities can be recorded in a logbook, including giving a lecture, participating in training courses, morning reports, providing particular procedures and skills. Objectives: The current study aimed to compare a newly launched web-based logbook to a paper-based logbook to identify potential strengths and weaknesses. Methods: Emergency medicine residents of postgraduate year 1 (PGY1) and 2 (PGY2) and faculty members participated in the present study. Electronically collected data from February-April 2014 were compared to those of paper logbooks for the same period in the previous year. Furthermore, to evaluate the perspectives of both students and faculty members on the web-based logbook, a survey was implemented. Results: In total 47 residents recorded their activities in the web-based logbook. For the same period in the previous year, logbooks of 40 residents were available. The frequency of work shifts in paper and web-based logbook was 668 and 1020, respectively (P = 0.4). However, a significant difference was observed concerning the work shifts recorded in the logbook and those confirmed by a faculty member [416 (62.3%) in the paper logbook and 945 (92.7%) in the web-based logbook, P value = 0.05]. Also, the frequency of unconfirmed procedures, review of medical cases, morning reports, rotations, and direct observation of procedural skills were significantly lower in the web-based logbook (P value = 0.0001). Based on the results of the survey, 55.55% of faculty members and 66.66% of residents reported the effectiveness of the web-based logbook. Conclusions: This study demonstrated the potential of web-based logbooks to improve recording activities of residents and assisting faculty members to precisely monitor their activities.

Continuum in the acquisition of competencies for work in family medicine in Croatia

Integration of new scientific knowledge into the medical schools, family medicine specialty training programmes, and achievement of the competencies acquired with the real health needs of the population are the challenges of the medical doctors’ education in the 21st century. It is necessary to ensure well-structured family physicians’ education because this kind of medical professionals is the basis of a well-organized health care system. The aim of this study is to describe the education of family physicians in Croatia and compare it with EU member states. The European Academy of Teachers in General Practice/Family Medicine prepared a minimal core curriculum for family medicine in undergraduate medical education and educational training requirements for family medicine specialty training. In Croatia curricula of all medical schools have the subject Family Medicine. Subject Family Medicine at the School of Medicine in Zagreb entirely includes a minimal core curriculum for family medicine in undergraduate medical education, direct observation of procedural skills, e-portfolio and experience based learning. Subject Family Medicine at the School of Medicine in Split entirely includes a minimal core curriculum for family medicine in undergraduate medical education, and organization of clinical teaching in urban and island teaching family medicine practices. Teaching of family medicine at the School of Medicine in Rijeka includes theoretical and practical teaching and written answers to a selected clinical question based on clinical experiences. Teaching of family medicine at the School of Medicine in Osijek includes a combination of clinical teaching in family medicine and exercises in the skills lab. The four-year competency based family medicine specialty training programme in Croatia implies that the residents spend half time of the specialty training in the mentors’ family medicine office accredited for specialty training.Therefore,education of family physicians in Croatia is in line with European and global recommendations.

Can We Use Peer-Assisted Learning to Teach Basic Surgical Skills?

BackgroundIt is reported that medical students do not receive adequate opportunities to learn surgical skill and are at risk of being unable to perform simple surgical procedures safely. The usefulness of peer-assisted learning (PAL) as a tool to assist in delivering surgical skills training is worth exploring.MethodsThis is a randomised single blinded controlled trial. Fourth-year students from the university’s Surgical Society were asked to volunteer as peer tutors and those in 3rd-year were asked to undertake surgical skills training. A cohort of 35 students were selected and randomised to receive basic surgical skills training conducted either by faculty members or peers. The students’ performance of basic suturing skills was assessed using a checklist, through directly observed procedural skills (DOPS) technique. The assessment was conducted by faculty blinded to the training. Students’ perception to surgical skills training was assessed using a questionnaire survey.ResultsThe suturing and knotting skills of students learned from their peers was comparable to that acquired from faculty. The students’ perceived that their peers could conduct surgical skills training similar to their faculty.ConclusionPAL approach for basic surgical skills training is as effective as faculty-led training. PAL has the potential to optimise the delivery of surgical skills training in undergraduate medical education.

Correction: Curriculum for small-bowel capsule endoscopy and device-assisted enteroscopy training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement.

The European Society of Gastrointestinal Endoscopy (ESGE) has recognized the need to formalize training in small-bowel endoscopy across European centers. The following criteria and framework for training in small-bowel capsule endoscopy (SBCE) and device-assisted enteroscopy (DAE), which aim to provide uniform and high quality training to ensure that small-bowel endoscopists are competent to operate independently, are based on the current literature and experience of experts in the field. Three main areas are covered: skills required prior to commencing training in small-bowel endoscopy; structured training for trainees to become independent endoscopists; and ways of ensuring competence is achieved. 1 Centers providing training in SBCE should perform a minimum of 75 – 100 SBCEs/year. 2 Experience in bidirectional endoscopies is desirable for structured training in SBCE. 3 SBCE courses should consist of at least 50 % hands-on training and cover information on technology, indications and contraindications for SBCE, pathologies that can be encountered on SBCE, and standard terminology that should be used during reporting of SBCE. An SBCE course should be completed prior to achieving competence in SBCE reporting. 4 Competence in SBCE can be assessed by considering a minimum of 30 SBCEs. Direct Observation of Procedural Skills, short SBCE videos, and multiple-choice questions can be useful to assess improvement in the skills of trainees. 5 Centers offering training in DAE should aim to carry out at least 75 DAEs/year, should have direct links with an SBCE service, and should allow regular discussion of cases at a radiology small-bowel MDT. Training centers with lower numbers are encouraged to offer training by “buddying-up” with other centers, or using mentoring systems. 6 DAE trainees must be independent in bidirectional endoscopies and have experience in level 1 polypectomy prior to commencement of training. They should also be competent in reviewing SBCEs. 7 Training in DAE should be structured with a minimum of 75 procedures, including 35 retrograde DAEs, with therapeutic procedures undertaken in at least 50 % of the DAEs performed. Training should cover the indications, contraindications, complications including prevention, and technicalities of the DAE procedure; formal evaluation should follow. DAE trainees must acquire skills to independently manage and advise on small-bowel pathology following DAE procedures. 8 It is highly recommended that international societies develop online modules and courses on DAE, which are currently lacking across Europe.

Curriculum for small-bowel capsule endoscopy and device-assisted enteroscopy training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement.

The European Society of Gastrointestinal Endoscopy (ESGE) has recognized the need to formalize training in small-bowel endoscopy across European centers. The following criteria and framework for training in small-bowel capsule endoscopy (SBCE) and device-assisted enteroscopy (DAE), which aim to provide uniform and high quality training to ensure that small-bowel endoscopists are competent to operate independently, are based on the current literature and experience of experts in the field. Three main areas are covered: skills required prior to commencing training in small-bowel endoscopy; structured training for trainees to become independent endoscopists; and ways of ensuring competence is achieved. 1 : Centers providing training in SBCE should perform a minimum of 75 - 100 SBCEs/year. 2 : Experience in bidirectional endoscopies is desirable for structured training in SBCE. 3 : SBCE courses should consist of at least 50 % hands-on training and cover information on technology, indications and contraindications for SBCE, pathologies that can be encountered on SBCE, and standard terminology that should be used during reporting of SBCE. An SBCE course should be completed prior to achieving competence in SBCE reporting. 4 : Competence in SBCE can be assessed by considering a minimum of 30 SBCEs. Direct Observation of Procedural Skills, short SBCE videos, and multiple-choice questions can be useful to assess improvement in the skills of trainees. 5 : Centers offering training in DAE should aim to carry out at least 75 DAEs/year, should have direct links with an SBCE service, and should allow regular discussion of cases at a radiology small-bowel MDT. Training centers with lower numbers are encouraged to offer training by "buddying-up" with other centers, or using mentoring systems. 6 : DAE trainees must be independent in bidirectional endoscopies and have experience in level 1 polypectomy prior to commencement of training. They should also be competent in reviewing SBCEs. 7 : Training in DAE should be structured with a minimum of 75 procedures, including 35 retrograde DAEs, with therapeutic procedures undertaken in at least 50 % of the DAEs performed. Training should cover the indications, contraindications, complications including prevention, and technicalities of the DAE procedure; formal evaluation should follow. DAE trainees must acquire skills to independently manage and advise on small-bowel pathology following DAE procedures. 8 : It is highly recommended that international societies develop online modules and courses on DAE, which are currently lacking across Europe.

THU0586 ESTABLISHING THE KEY COMPONENTS OF A EULAR PORTFOLIO FOR TRAINING IN RHEUMATOLOGY: A EULAR SCHOOL OF RHEUMATOLOGY INITIATIVE

Background:In clinical training, a portfolio is expected to stimulate learning and encourage critical reflection. Some, but not all, European countries use a portfolio in rheumatology training, and their scope varies widely. A EULAR portfolio for Rheumatology trainees could contribute to improve overall training, raise educational standards, foster the setting of common goals and harmonize rheumatology training across countries.Objectives:Develop key components that should be included in a EULAR portfolio of Rheumatology.Methods:A working group (WG) composed of 9 rheumatologists and 1 educationalist was established. A systematic literature review (SLR) was conducted in November 2018, according to the PIM structure: Population: trainees; Instrument of interest: portfolio; Measurement of properties of interest: content portfolio. A survey was disseminated among the WG group and WG members of the EMerging EUlar NETwork (EMEUNET), inquiring about the content and structure of existing national portfolios. Portfolio materials of selected countries were reviewed. Last, the WG elected the key components of the portfolio.Results:13/2,034 articles were included in the SLR (12 high/1 moderate risk of bias). Information on direct observation of procedural skills (DOPS) (9/13), personal reflections (8/13), learning goals (5/13) and multisource feedback (5/13) were most often included in the portfolio. Twenty-five respondents filled out the survey (response rate ≈ 50%). Reflective writing (n=7), learning goals (n=4) and feedback (n=4) were considered the most useful components of a portfolio. About half indicated that a portfolio was a bureaucratic burden; 4 respondents mentioned lack of feedback by supervisors as a barrier. Portfolio materials of 7 European countries were reviewed. Several portfolios (Germany, Italy, Greece and Spain) were logbooks, i.e. a record of clinical activities. Other portfolios (UK, Denmark, The Netherlands) also included information on workplace-based assessments, learning goals, and personal reflections. The proposed key components of the portfolio are included in Table 1.Table 1.Key components of the EULAR portfolio of Rheumatology.Key componentContentCurriculum vitaePersonal record of achievements, experiences, knowledge and skillsPersonal Development PlanLearning goals and action planClinical workInformation on managing patients (e.g. rheumatoid arthritis)Skills (e.g. joint aspiration)Assessments (summative and formative)Personal reflectionsProfessional behaviourMultisource feedbackPersonal reflectionsEducationContinuing professional development, list of formal and non-formal learning activitiesAssessments (e.g. teaching assessment, evidence based medicine assignment)Personal reflectionsResearchList of abstracts, published articlesInformation on research funding, scholarships, bursaries, academic postsConclusion:This initiative resulted in the establishment of a list of key components to be included in a EULAR portfolio of Rheumatology. Assessment forms for each key portfolio component are currently being developed. Portfolio implementation, particularly in countries that do not use it yet, may contribute significantly to promote a higher standard of patient care across Europe.Disclosure of Interests:Marloes van Onna: None declared, Sofia Ramiro Grant/research support from: MSD, Consultant of: Abbvie, Lilly, Novartis, Sanofi Genzyme, Speakers bureau: Lilly, MSD, Novartis, Catherine Haines: None declared, M. Holland-Fischer: None declared, José Antonio P. da Silva Grant/research support from: Pfizer, Abbvie, Consultant of: Pfizer, AbbVie, Roche, Lilly, Novartis, Jean Dudler: None declared, Christopher Edwards Grant/research support from: Abbvie, Biogen, Roche, Consultant of: Abbvie, Samsung, Speakers bureau: Abbvie, BMS, Biogen, Celgene, Fresenius, Gilead, Janssen, Lilly, Mundipharma, Pfizer, MSD, Novartis, Roche, Samsung, Sanofi, UCB,Alessia Alunno: None declared, Elena Nikiphorou: None declared, L. Falzon: None declared, Francisca Sivera: None declared