Endoscopic Education Research Articles

Meet EBE: The Development of an Evidence-Based Endoscopy Simulator

In the digital era of evidence-based medicine, there is a paucity of video endoscopy teaching platforms that use evidence-based medicine principles, or that allow for cognitive simulation of endoscopic management strategies. We created a guideline-based teaching platform for fellows that incorporates these features, and tested it. A pilot video module with embedded questions was drafted, and after incorporation of feedback from several attending gastroenterologists, an additional 2 modules were created. The embedded questions were designed to simulate cognitive management decisions as if the viewer were doing the endoscopy procedure in the video. A narrator explained the evidence behind the task being performed, and its certainty based on endoscopic guidelines. Quizzes and surveys were developed and administered to a sample of attendings and fellows who completed the video modules to test efficacy, usability, and likeability. Three video modules, named evidence-based endoscopy (EBE), incorporating low fidelity simulation, and utilizing evidence-based medicine principles, were created. Eight fellows and 10 attendings completed the video modules and all quizzes and surveys. Mean test scores improved from before to after completing the video modules (56% to 92%; mean difference= -35%; 95% confidence interval, 27%-47%). Surveys indicated that the product was viewed favorably by participants, and that there is a strong desire for this type of educational product. The EBE simulator is a unique, desirable, and effective educational platform based on evidence-based medicine principles that fills a gap in available tools for endoscopy education. Further studies are needed to assess whether EBE can aid in long-term knowledge retention and increase adherence to guideline recommendations.

Endoscopy Teaching Competencies for Junior Faculty: Outstanding Endoscopy Teaching Is Within Your SCOPE.

1Brigham and Women’s Hospital, Division of Gastroenterology, Boston, Massachusetts, USA; 2Harvard Medical School, Boston, Massachusetts, USA; 3San Francisco General Hospital and Trauma Center, Division of Gastroenterology, San Francisco, California, USA; 4University of California San Francisco, San Francisco, California, USA. Correspondence: Navin L. Kumar, MD. E-mail: [email protected].

A High-Yield Approach to Effective Endoscopy Teaching and Assessment

Endoscopy training is a core component of gastroenterology fellowship education. Most fellowship programs teach endoscopy via the apprenticeship model, in which fellows learn how to perform endoscopic procedures under the direct supervision of an attending gastroenterologist. Whereas this traditional model of learning allows for passage of skills from an experienced attending to a fellow in training, this approach exposes trainees to variable teaching styles that can potentially lead to suboptimal procedural education.

Application and practice of a step-by-step method combined with case-based learning in Chinese otoendoscopy education

BackgroundStandardized training allows more physicians to master otoendoscopic surgery. However, the lecture-based learning (LBL) applied in otoendoscopy teaching may not be conducive to training students in clinical thinking and surgical ability. It is necessary to explore innovative methods for otoendoscopy teaching. This study aimed to determine the effect of a step-by-step (SBS) method combined with case-based learning (CBL) in otoendoscopy teaching.MethodsFifty-nine physicians who participated in otoendoscopy training were selected as the study subjects and randomly divided into two groups (A and B). Group A underwent training with the SBS & CBL method, while Group B underwent training with the LBL & CBL method. The effects of these two methods for otoendoscopy training were compared by evaluation of professional skills and questionnaires before and after the training.ResultsProficiency in otoendoscopic anatomy and grades for both professional knowledge and otoendoscopic skills were significantly higher in Group A than in Group B(P < 0.05). In terms of learning interest, surgical ability, acting capacity during surgery, reducing surgical complications, and satisfaction with learning experience, all responses from Group A were better than those from Group B(P < 0.05).ConclusionsThe SBS & CBL method may help to improve ability in otoendoscopic surgery and clinical thinking and appears suitable for endoscopy teaching.

Standardizing Endoscopy Training: A Workshop for Endoscopy Educators.

IntroductionEndoscopy education in the US traditionally follows the apprenticeship model, in which educators often have little formal training in education, and the acquisition of procedural skills by trainees relies heavily on procedure volume and learning by doing. A growing appreciation of the need to formally educate endoscopy trainers has led to the development of mandatory training curricula in other countries, but the implementation of such courses in the US has been limited. This 1-hour workshop aimed to provide educators the rationale and skills to offer a more standardized approach to procedural training.MethodsWe implemented a 1-hour interactive workshop designed for both gastroenterology faculty and trainees. The four sections of the workshop focused on: (1) rationale for standardized approach, (2) verbal and physical preparation for training, (3) training using standardized language and avoidance of cognitive overload, and (4) providing feedback. Four interactive video cases followed by large-group discussion were included.ResultsA total of 13 gastroenterology faculty and trainees attended the workshop. Eight additional members of the gastroenterology faculty watched an online video of the workshop. Survey data revealed that the workshop was effective in helping faculty set goals with trainees (Mpre = 2.4, Mpost = 3.6), identify standardized language to use during endoscopy (Mpre = 3.1, Mpost = 3.8), and give feedback after sessions (Mpre = 3.4, Mpost = 4.1).DiscussionA 1-hour lecture-based interactive workshop with video cases was an engaging and effective introduction to formal endoscopy education techniques. The format was easy to incorporate into faculty conferences and can help bridge the current gap in formal endoscopy faculty training.

Faculty Development Workshop for Endoscopic Teaching Techniques.

Given the substantial variability in endoscopy teaching that gastroenterology fellows can be expected to encounter over the course of their fellowship, it is important to identify a standard set of behaviors that faculty can adopt to help trainees gain competence in endoscopy at an efficient rate. There remains a scarcity of easily distributed, effective tools for faculty development in regard to teaching endoscopy. Based on a prior qualitative study, we developed a three-part trigger video to be used for discussion during a faculty development session. We utilized three role-play scenarios between a fellow and supervisor managing a gastrointestinal bleed in the endoscopy suite. We summarized the implementation and instructions in a faculty guide. We used a postsession survey to measure effectiveness of the faculty development session. This workshop has been successfully administered twice in 2018 with over 30 gastroenterologists and hepatologists involved in endoscopic teaching. Overall, all faculty have found the workshop useful in learning about endoscopic teaching behaviors and helpful in adjusting their own behaviors in endoscopic teaching. We developed a faculty development workshop specifically for teaching endoscopy to gastroenterology trainees that is widely generalizable to other programs. Overall, we found a high level of satisfaction amongst the participants who have completed it. The tools we created can be easily tailored to complement any existing faculty development session and extrapolated to similar procedural disciplines.

Simulation-Based Mastery Learning With Virtual Coaching: Experience in Training Standardized Upper Endoscopy to Novice Endoscopists

Simulation-Based Mastery Learning With Virtual Coaching: Experience in Training Standardized Upper Endoscopy to Novice Endoscopists

The Impact of COVID-19 on Gastrointestinal Endoscopy Training in the United Kingdom

The Impact of COVID-19 on Gastrointestinal Endoscopy Training in the United Kingdom

Issue Highlights

Issue Highlights

Are you better off than you were 4 years ago? Measuring the impact of the ABS flexible endoscopy curriculum.

In 2014, the ABS introduced the Flexible Endoscopy Curriculum (FEC). The FEC did not alter the minimum defined category case volumes for endoscopy; however, it did introduce specific cognitive and technical milestones for endoscopy training. It also mandated that residents pass the Fundamentals of Endoscopic Skills (FES) exam to qualify for board certification. Although significant research has been published regarding residents' success on the FES exam, very little is known regarding how the FEC has changed the way general surgery programs train their residents in surgical endoscopy. The aim of this study was to quantify changes in flexible endoscopy education at a large academic program in the 4 years since the FEC was published. We classified the impact of FEC into four categories: (a) case volume or distribution, (b) clinical rotations, (c) required didactics or simulation exercises, and (d) FES pass rates. For category (a), we reviewed current and historical case logs for all categorical residents from 2013 to 2018. Mann-Whitney U tests were used to compare endoscopy volumes for each PGY level in 2013-2014 to the respective PGY level in 2017-2018 with p < 0.05 considered significant. For categories (b)-(d), we gathered historical records from the residency coordinator and endoscopy rotation director. Complete data were available for 57 residents in the 2013-2014 academic year and 56 residents in the 2017-2018 academic year. Median total endoscopies performed by PGY2, PGY3, and PGY5 residents all significantly increased during the FEC rollout. Our program's focus on endoscopy also expanded with absolute increases in endoscopy rotations, didactics, and simulation exercises. These changes translated into significantly increased pass rates on the FES exam from 40 to 100%. Implementation of the FEC at a large academic program led to measurable improvements in clinical experience, program structure, educational programing, and performance on high-stakes assessments.

An Inexpensive, Portable Physical Endoscopic Simulator: Description and Initial Evaluation

BackgroundSurgeons and gastroenterologists in training benefit from simulation-based endoscopy education, yet the price of most training endoscopy simulators is prohibitive. We set out to create and evaluate a low-cost endoscopic simulator and box model trainer for learning fundamental endoscopic skills. MethodsAfter adding a wireless network-enabled camera (total cost, $20) to a discarded clinical endoscope, we paired this with an easily constructed box trainer (cost $32) to generate an endoscopic simulator system (YazanoScope) for simulation training. Participants (general surgery interns, research fellows, and medical and college students) used the YazanoScope to train to mastery on 5 FES tasks. Outcomes included skill assessments on a computer simulator and trainees' perceptions comparing the physical model to the computer simulator. ResultsForty trainees participated. The median (range) training time was 110 (60-180) min. Only 10% of trainees were able to reach the cecum at baseline compared to 100% after training. The mean (SD) time was 253 (154) s at baseline (including completers and non-completers) and 249 (89) after training (P = 0.88). On a retention test 2 wk later, 21 of 22 (96%) completed the computer simulator assessment (endoscope tip reached the cecum). Mean time was 214 (67) s (P = 0.32 compared with immediate posttraining). All 40 trainees believed the YazanoScope provided better haptic feedback than the computer simulator. ConclusionsTraining with this inexpensive, portable endoscopic simulator (YazanoScope) was associated with increased procedure completion with no change in procedure time. All participants favored the haptic feedback of the $52 YazanoScope over a computer simulator.

Best Practices in Teaching Endoscopy Based on a Delphi Survey of Gastroenterology Program Directors and Experts in Endoscopy Education

Teaching endoscopy is a key objective of gastroenterology (GI) fellowship programs but the best approach is not known. We sought to characterize which teaching competencies experts considered most critical for endoscopy education. We developed and refined 18 endoscopy teaching competencies based on literature review, personal experience, and interviews with experts. We invited GI fellowship program directors and endoscopy education experts to participate in a Delphi process to rate each proposed competency as essential, important but not essential, or not important using a 70% agreement threshold for consensus. Thirty-four GI fellowship program directors and 2 experts in endoscopy education participated (n= 36). Most survey participants were male (61.8%), associate professors (55.9%), and had performed at least a quarter of procedures with fellows (80.6%). Survey response rates were 94% (34 of 36) for round 1 and 91% (31 of 34) for round 2 (overall 31 of 36; 86.1%). After 2 rounds we achieved the predefined consensus level for most competencies. Fourteen of 18 competencies (77.8%) reached consensus after round 2: 10 (55.6%) were deemed essential and 4 (22.2%) were deemed important but not essential. Essential competencies included the following: discusses patient history and plans for procedure with trainee (100%), assumes control of procedure when trainee is unable to progress or if patient safety concerns arise (100%), maintains attention throughout the case (96.8%), and discusses the next steps in management for the patient (96.8%). In a national Delphi survey of endoscopy education experts, we identified 10 essential endoscopy teaching competencies. These can be used to frame faculty development and standardize GI fellowship programs to promote high-quality endoscopy education.

Tu1031 – Best Practices in Teaching Endoscopy: A Delphi Survey of Gastroenterology Program Directors and Experts in Endoscopy Education

Tu1031 – Best Practices in Teaching Endoscopy: A Delphi Survey of Gastroenterology Program Directors and Experts in Endoscopy Education

Evolving endoscopy teaching in the era of the millennial trainee

Evolving endoscopy teaching in the era of the millennial trainee

Identifying Behaviors and Characteristics of High Quality Endoscopy Educators: Do We Practice What We Preach?

Introduction: Teaching endoscopy requires a structured approach that encompasses cognitive and technical skills. Endoscopy education in the US traditionally follows the apprenticeship model, creating a wide variability in teaching techniques without clear guidance for best practices. Despite a growing appreciation of the need for endoscopy educators (EE) to be formally trained to teach procedures using evidence-based principles, there are limited data on which teaching behaviors are most important. Furthermore, there is no validated, objective way of assessing the quality of endoscopy education. Methods: After a literature review, we compiled a list of nine behaviors and characteristics of EE considered critical for effective teaching. Using Qualtrics, we electronically surveyed EE across the US to rate the importance of these behaviors and estimate how frequently they actually perform these behaviors while teaching. Results: The survey was sent to 258 EE in the US. The overall response rate was 19%. Respondent demographics are listed in Table 1. Educational behaviors were rated in importance on a scale from 1 (not important) to 6 (extremely important). The frequency of performance of behaviors was rated on a scale from 1 (never) to 5 (always). Results and correlation between importance and frequency is displayed in Table 2. All behaviors showed significant correlation between importance and frequency, but four behaviors showed only a medium-sized correlation (correlation coefficient 0.3-0.5). Conclusion: All teaching behaviors identified on our list were rated as at least “moderately important” by the respondents, with the most important behavior using clear, concise verbal instructions when needed. Our survey indicates that respondents “practiced what they preached”, although for 4 behaviors there was only a medium-sized correlation between importance and frequency. A potential area for improvement would be reviewing procedure notes with trainees, a behavior that was rated as at least “very important” by 75.5% of respondents but was done at least “most of the time” by only 48.6%. While our response rate of 19% raises the risk of nonresponse bias, prior studies have shown similar response rates among physician populations. Future directions for research includes developing an instrument to objectively assess endoscopy teaching quality and applying this instrument to measure the impact of interventions aimed at improving endoscopy teaching skills.495_A Figure 1. Respondent characteristics495_B Figure 2. Relative importance and frequency of endoscopy education behaviors

New tools for education in endoscopy: ESGE perspectives

New tools for education in endoscopy: ESGE perspectives

What Makes a Good Endoscopic Teacher: A Qualitative Analysis

Teaching learners to perform endoscopic procedures is challenging, yet effective endoscopy teaching practices are not well-described in the literature, and prior studies have focused on perspectives of supervising physicians rather than learners. We sought to characterize, from the perspective of endoscopy learners, endoscopic teaching behaviors perceived as beneficial and detrimental to learning using qualitative methods. This is a prospective qualitative content analysis. Gastroenterology fellows from 2 tertiary care centers anonymously provided feedback regarding supervising physicians' teaching behaviors during endoscopic training between March 2016 and December 2016. Preprinted cards were completed at the conclusion of procedures to document behaviors that fellows perceived as enhancing or hampering their learning. Two investigators performed content analysis of written comments; each identified behavior was assigned positive or negative valence. Mount Sinai Hospital in New York, New York and University of California San Francisco in San Francisco, California. Both institutions are academic tertiary care centers. A total of 19 gastroenterology fellows at 2 training institutions participated. A total of 239 teaching behaviors were identified by 19 fellows who worked with 31 supervising physicians; 29 unique behaviors were identified and organized into 7 themes: teaching, learning environment, autonomy, communication, coaching, feedback, and professionalism. Of all, 185 (77.4%) behaviors were reported as beneficial, and 54 (22.6%) as detrimental to the learning experience. Behaviors related to teaching were most often perceived as beneficial, while behaviors related to professionalism and communication were most often perceived as detrimental to learning. Specific teaching behaviors may help or hinder learning of endoscopic skills. These behaviors may be useful for efforts related to teaching evaluation, faculty development, and direct teaching.

WEO Newsletter.

WEO Newsletter.

Sa1124 - What Makes a Good Endoscopic Teacher: A Qualitative Analysis

Objective Teaching learners to perform endoscopic procedures is challenging, yet effective endoscopy teaching practices are not well-described in the literature, and prior studies have focused on perspectives of supervising physicians rather than learners. We sought to characterize, from the perspective of endoscopy learners, endoscopic teaching behaviors perceived as beneficial and detrimental to learning using qualitative methods. Design This is a prospective qualitative content analysis. Gastroenterology fellows from 2 tertiary care centers anonymously provided feedback regarding supervising physicians’ teaching behaviors during endoscopic training between March 2016 and December 2016. Preprinted cards were completed at the conclusion of procedures to document behaviors that fellows perceived as enhancing or hampering their learning. Two investigators performed content analysis of written comments; each identified behavior was assigned positive or negative valence. Setting Mount Sinai Hospital in New York, New York and University of California San Francisco in San Francisco, California. Both institutions are academic tertiary care centers. Participants A total of 19 gastroenterology fellows at 2 training institutions participated. Results A total of 239 teaching behaviors were identified by 19 fellows who worked with 31 supervising physicians; 29 unique behaviors were identified and organized into 7 themes: teaching, learning environment, autonomy, communication, coaching, feedback, and professionalism. Of all, 185 (77.4%) behaviors were reported as beneficial, and 54 (22.6%) as detrimental to the learning experience. Behaviors related to teaching were most often perceived as beneficial, while behaviors related to professionalism and communication were most often perceived as detrimental to learning. Conclusions Specific teaching behaviors may help or hinder learning of endoscopic skills. These behaviors may be useful for efforts related to teaching evaluation, faculty development, and direct teaching.

Development and use of a non-biomaterial model for hands-on training of endoscopic procedures.

Endoscopic submucosal dissection (ESD) and peroral endoscopic myotomy (POEM) are recently developed techniques that have the potential to significantly improve clinical outcomes. However, training opportunities on these techniques remain limited. To address this issue, we developed a novel ex-vivo ESD/POEM training model. Our aim in this paper is to describe the model and provide preliminary evidence of promising feasibility to improve access to ESD/POEM training. The model was developed using polyvinyl alcohol hydrogel, which can easily be modified to reproduce the stiffness of the different intestinal layers, namely the mucosa, submucosa, and muscle layer. A training workshop, using our ex-vivo model, was held for 28 residents. Satisfaction and feasibility in using the ex-vivo model for endoscopic training were evaluated by using a self-report questionnaire. All participants were satisfied with their training experience (100% satisfaction rate), with 27 of the 28 participants reporting that the model was feasible in replicating all components of the ESD/POEM technique (96.4% feasibility rate). Based on this feedback, we propose that our non-biomaterial model has the feasibility to provide an effective endoscopy education tool and a satisfactory training experience.