Successful Training in Gastrointestinal Endoscopy. Группа авторов. Читать онлайн. Newlib. NEWLIB.NET

Автор: Группа авторов
Издательство: John Wiley & Sons Limited
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Жанр произведения: Медицина
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isbn: 9781119529682
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apparent to the pioneer generation of flexible fiberoptic endoscopy. As early as 1962, the then recently renamed ASGE conducted a symposium entitled “Teaching Methods in Gastrointestinal Endoscopy” in New York City [3]. Two years later, the ASGE formed a committee to examine the requirements for training endoscopists; the conclusions established training as a priority and created a framework that guided formal endoscopy training for many years to follow. Three items were required: (1) full training in medicine or surgery, (2) special training specifically in gastrointestinal (GI) endoscopy under the supervision of an appropriately skilled teacher, and (3) performance of an adequate number of procedures. Soon to follow was the first annual postgraduate training course.

Photo depicts an example of a typical apprenticeship contract in colonial America, circa 1750.

      Within these training programs, didactic information about endoscopy is included in the curriculum to an extent, but much of the actual endoscopic training remains directly imparted from instructor to student in the course of the performance of actual procedures on actual patients. Such hands‐on supervision allows for increasing independence on the part of the trainee, as the teacher constantly assesses both technical and cognitive progress [6, 7]. In this process, the endoscopy teacher must give the trainee sufficient time to develop skills while protecting the patient’s safety at all times, and must be able to give appropriate feedback [8, 9]. This process is both time and labor intensive. Additionally, sufficient case volume is necessary to allow for development of necessary skills through repetitive deliberate practice, and enough variation in pathology needs to be present to allow the development of cognitive skills to go along with advances in technical expertise [10, 11]. Mere possession of clinical judgment and endoscopic proficiency do not guarantee that an individual is qualified to be a good endoscopic teacher. The importance of having instructors who know how to teach and the constraints that limit the time such mentors have to devote to teaching can pose significant challenges for this “traditional method” of endoscopy training—challenges which some of the newer complementary teaching tools discussed later in this chapter were developed to address. While many of the chapters in this book refer to the importance and characteristics of good mentors, very little investigation has yet been conducted to understand how to best train the trainers to teach endoscopy. This topic is addressed in detail in Chapter 4.

      What must be learned?

      Guidelines for training in gastrointestinal endoscopy have been published and widely disseminated [4, 5]. Skill sets that trainees must acquire to successfully perform endoscopic procedures have been outlined [12–16] and include the following:

      1 Understanding of the indications and contraindications for endoscopic procedures and risk factors for complications.

      2 Knowledge of the endoscopic equipment and accessories and how to set up this equipment for use.

      3 Familiarity with the endoscope control dials and buttons.

      4 Dexterity in controlling the scope range of motion using the dials and torque applied to the endoscope shaft.

      5 Hand–eye coordination to produce deliberate, precise manipulation of the endoscope within the lumen and of accessories.

      6 Communication with nursing and technical staff regarding required assistance during the procedure.

      7 Knowledge of normal anatomic landmarks and possible abnormal pathologies that might be encountered.

      8 Interpretive skills to correctly identify abnormalities that are detected.

      9 Judgment of how to manage appropriately those lesions that are encountered.

      10 Familiarity with patient monitoring and the administration of moderate sedation.

      11 Awareness of how to recognize and manage adverse events.

      12 Understanding of risks and benefits of intended procedures and the ability to obtain informed consent.

      13 Documentation of findings.

      14 Communication of results to patients and other physicians.

      Since the early establishment that training in endoscopy was a high‐priority activity among academic endoscopy centers and GI societies, a great deal of effort has been devoted to assess the efficacy of training, determine learning curves for various procedures, and explore new methods for imparting proficiency. A number of important guidelines on the subject have incorporated much of this data and expert opinion on the subject