Dr. Cohen’s vast experience in the practice of endoscopy as well as his special expertise in teaching has resulted in his being requested to teach and perform procedures in endoscopy units throughout the world, giving him a first‐hand observation into the types of training and teaching performed in first‐class endoscopy suites in North and South America but also in Europe and Asia. Drawing on his understanding of the State of the Art of Training, Dr. Cohen has been able to gather the very best teaching endoscopists from many countries to share their special knowledge and techniques of training and their approach to problems encountered during gastrointestinal endoscopic procedures. Each author was chosen primarily for their skill in performance of endoscopy while also currently engaged in teaching these skills to students and other accomplished endoscopists. In addition, the authors also had to have demonstrated their ability to express their thoughts in writing as well as being articulate in discussions during live endoscopic cases.
Through years of observations, Dr. Cohen has come to understand that some doctors that are outstanding practitioners of the art are not necessarily the best teachers of endoscopy and that the best teachers may not be the quickest or best practitioners of endoscopy. He has chosen the best teachers for each chapter in this book. Teachers of endoscopy have taken on the enormous responsibility to not only share their knowledge completely and selflessly with the student, but have accepted the task of patient advocate during each case to ensure their safety so that the teaching aspect of the procedure does not infringe upon the ability to provide the best endoscopic examination possible. The endoscopic approach, learned in apprentice fashion at the side of the teacher will be a part of that person’s endoscopic framework every time that they pick up an endoscope.
Dr. Cohen has made it a priority to present all facets of teaching the procedural aspects of gastrointestinal endoscopy, and has done it well. In addition to the detailed written description in each chapter, there is an extensive video section available on the web version of the book, which demonstrates the techniques discussed.
Teaching and learning are not linear experiences, but rather a repeating cycle of cognitive input with each cycle incorporating new data and new material as it evolves. Endoscopy learning embraces an entirely new dimension, the technical aspects of manipulating tubes inside the human body, a skill which can only be learned by repeated handling of an endoscope, and aided by the close tutelage of a mentor. This book is not intended to replace the eye–hand coordination required of bedside endoscopy teaching, but does provide every other aspect required for effective transfer of endoscopic knowledge from teacher to student, and does this from several aspects: the teacher, the student and practitioners who desire to learn the latest material in the field of endoscopy. All three of these separate audiences need to know what is covered in this book on Successful Training in Gastrointestinal Endoscopy.
The World Endoscopy Organization (WEO) is pleased to endorse this book since its goals are clear and well defined: in order to perform endoscopy, one needs proper training. This training is best accomplished under the watchful tutelage of a person who is dedicated, expert, and facile not only in the performance of the procedure, but also in the ability to transfer skills to the next generation of endoscopists. The WEO promotes excellence in endoscopy throughout the entire world and focuses on bringing endoscopy to underserved areas where endoscopy is underutilized.
This second edition of the book, Successful Training in Gastrointestinal Endoscopy will be an invaluable resource to trainees as well as accomplished endoscopists who desire to learn new techniques. All endoscopists who are involved in training must read this book which contains the knowledge needed to successfully teach the techniques of endoscopy.
Jerome D. Waye, MD
Past President: World Endoscopy Organization
Past President: American Society for Gastrointestinal Endoscopy
Past President: American College of Gastroenterology
Professor Emeritus: Icahn School of Medicine at Mount Sinai
Preface
The field of gastrointestinal endoscopy is evolving at a rapid pace. In the 10 years since the publication of the first edition of Successful Training in Endoscopy, several then emerging technologies and techniques have become firmly established and adopted into GI practice. There has been a steady development of new accessories and devices, and adaption of existing tools to new applications. A heightened focus on optimizing quality performance in our procedures necessarily has required a renewed attention on how to ensure that the individuals asked to practice endoscopy are fully trained to achieve the highest possible outcomes. Quality metrics initially developed for major endoscopy procedures like colonoscopy and ERCP have been defined for more specific techniques. These in turn have enabled a transition to competency‐based education, along with the development of validated formative and summative objective assessment tools.
Competing diagnostic and therapeutic modalities threaten to make some of the standard procedures obsolete and challenge the individuals who spend most of their time performing them to adapt. For many individuals caught in this crossroads mid‐career, finding the time and opportunities to retool can be very challenging, irrespective of the personal economic concerns involved in making the commitment to upgrade skills in response to the changing conditions. Innovative new opportunities for retooling and learning new skills mid‐career have been developed in the last decade.
Resources for training in major GI endoscopy procedures and in specific advanced techniques remain limited. For many procedures, the trainers and trainees are hindered by the lack of sufficient case volume in the given technique to be taught. The availability of expert mentors to teach required skills can be another major impediment to training opportunities. Heightened attention to training the endoscopic teacher has emerged to address this need.
The increased demand for high‐quality training and the supply limitations due to the costs and time required for this labor‐intensive process have driven the development of novel teaching tools which aim to increase the efficiency of training, and where possible increase the potential for independent learning. A proliferation of online resources to supplement standard fellowship education has occurred over the past decade to fill some of this gap. The field of simulation has progressed steadily in the past decade, growing in popularity and access.
The purpose of this book is to provide a comprehensive examination of the principles and specific components of training in endoscopy. It was envisioned as a practical guide for teachers and trainees alike. For each procedure and technique considered, the authors describe what needs to be learned, how best to learn it, and how to ensure that sufficient training has taken place to ensure competency. The chapters examine both the generalized skills sets and specific procedure‐related tasks that must be mastered in learning a particular technique. They contain specific descriptions of accessories required, standard training methods for the procedure, and optimal utilization of novel learning modalities such as simulators. Quality measures and objective parameters for competency are considered when available, along with available tools for assessing competency once training has been completed.
The first section explores the important concepts of training and describes the range of tools that have been utilized in this regard. The next two sections provide in‐depth discussion of the major current endoscopic procedure categories as well as most specialized diagnostic and therapeutic techniques. For each of these chapters, the authors have considered prerequisite skills for training, skill sets to be mastered, step‐by‐step components that must be taught and assessed by trainers, typical learning curve for trainees, and objective measures of competency which trainees must strive to attain. For some of these topics, there has been scant literature to define these parameters. Accordingly,