Train‐the‐trainer programs
In the endoscopy training community, the UK system has frequently been referenced due to the system changes that occurred in direct response to quality measures in their health care system [70–72]. The JAG in the United Kingdom, which was established in 1994 to standardize endoscopy training across specialties, has developed a robust endoscopy training system which includes a competency‐based certification process and transparent benchmarks for endoscopists and procedure‐specific “train‐the‐trainer” courses for faculty who teach endoscopy [70]. Additionally, accreditation standards for endoscopy units are directly linked to provision of adequate endoscopy training [73]. Colonoscopy quality outcomes in the United Kingdom have subsequently improved substantially [70, 74]. While the reason for this improvement was likely multifactorial, nationally driven training‐related interventions likely played a large role, including more structured training for both trainees and trainers, development of national training courses, and ongoing assessment of training quality within endoscopy units.
The JAG’s “train‐the‐trainer” program was shared with the Canadian Association of Gastroenterology, who adapted the program and developed the SEE Program (https://www.cag‐acg.org/education/see‐program) which includes endoscopy and polypectomy‐related hands‐on courses. Both the UK and Canadian systems formally train faculty to conscious competence [18]. These programs provide quality assurance of training by standardizing training structure and techniques, language, assessment, and feedback provision. The influence of such training programs has spread worldwide to include countries such as Australia, Malawi, Norway, Portugal, Poland, South Africa, and the United States in varying degrees [70]. The Polish group, for instance, published a randomized trial to demonstrate the beneficial impact of the course on adenoma detection rates in their trainers [75]. Similarly, a Canadian study found that faculty who attended SEE Program courses, which aim to enhances faculty’s conscious competence, administered significantly lower sedation doses during colonoscopy, both immediately after and 8‐months following the course. These studies provide supportive evidence that formal train‐the‐trainer efforts not only improve trainers’ teaching skills but also improve their colonoscopy performance [76]. There is no doubt that the interest among endoscopists for formal training will continue to increase as more endoscopists experience the benefits of structured training based on sound pedagogical principles.
Conclusions
High‐quality training is a key component to provision of safe, efficient, and effective endoscopic care. Endoscopy is a complex skill that can be very challenging to teach, and trainers are often not adequately prepared. Successful training requires preparation and structure, and access to consciously competent trainers who are capable of providing performance enhancing instruction and feedback to ensure the session is both effective and relevant. As an endoscopic community, we need to ensure our future workforce is trained to a high standard irrespective of location. This requires endoscopic training that is well supported (e.g., time allocation and funding), evidence‐based, efficient, and patient‐centered. It also demands trainers who are committed to continually developing their endoscopic teaching skills. Although there is not a robust evidence base that documents the impact of a standardized training framework or “train‐the‐trainer” programs on trainees’ learning and post‐certification practice outcomes, real‐world experience from programs that have embraced these concepts has clearly demonstrated ongoing direct benefits to patient care and quality of education.
References
1 1 Rodriguez‐Paz JM, Kennedy M, Salas E, et al.: Beyond “see one, do one, teach one”: toward a different training paradigm. Postgrad Med J 2009; 85(1003):244–249.
2 2 Coderre S, Anderson J, Rostom A, McLaughlin K: Training the endoscopy trainer: from general principles to specific concepts. Can J Gastroenterol 2010; 24(12):700–704.
3 3 Anderson J: The future of gastroenterology training: instruction in technical skills. Frontline Gastroenterol 2012; 3(Suppl 1):i13–i18. [DOI: 10.1136/flgastro‐2011‐100065.]
4 4 Walsh CM, Anderson JT, Fishman DS: An evidence‐based approach to training pediatric gastrointestinal endoscopy trainers. J Pediatr Gastroenterol Nutr 2017; 64(4):501–504.
5 5 Hitchins CR, Metzner M, Edworthy J, Ward C: Non‐technical skills and gastrointestinal endoscopy: a review of the literature. Frontline Gastroenterol 2018; 9(2):129–134.
6 6 Walsh CM: In‐training gastrointestinal endoscopy competency assessment tools: types of tools, validation and impact. Best Pract Res Clin Gastroenterol 2016; 30(3):357–374.
7 7 Bollipo S, Bilal M, Siau K, Charabaty A: How to introduce scopemanship into your training program. Gastroenterology 2020; 159(5):1648–1652.
8 8 Adler DG, Bakis G, Coyle WJ, et al.: Principles of training in GI endoscopy. Gastrointest Endosc 2012; 75(2):231–235.
9 9 Mark JA, Kramer RE: Impact of fellow training level on adverse events and operative time for common pediatric GI endoscopic procedures. Gastrointest Endosc 2018; 88(5):787–794.
10 10 McCashland T, Brand R, Lyden E, de Garmo P: The time and financial impact of training fellows in endoscopy. CORI Research Project. Clinical Outcomes Research Initiative. Am J Gastroenterol 2000; 95(11):3129–3132.
11 11 Depew WT, Hookey LC, Vanner SJ, et al.: Opportunity costs of gastrointestinal endoscopic training in Canada. Can J Gastroenterol 2010; 24(12):733–738.
12 12 Zanchetti DJ, Schueler SA, Jacobson BC, Lowe RC: Effective teaching of endoscopy: a qualitative study of the perceptions of gastroenterology fellows and attending gastroenterologists. Gastroenterol Rep 2016; 4(2):125–130.
13 13 Gabrani A, Monteiro IM, Walsh CM: Exploring use of endoscopy simulation in North American pediatric gastroenterology fellowship training programs. J Pediatr Gastroenterol Nutr 2020; 70(1):25–30.
14 14 Thuraisingam AI, MacDonald J, Shaw IS: Insights into endoscopy training: a qualitative study of learning experience. Med Teach 2006; 28(5):453–459.
15 15 Waschke KA, Anderson J, Valori RM, et al.: ASGE principles of endoscopic training. Gastrointest Endosc 2019; 90(1):27–34.
16 16 Peyton JWR: The learning cycle. In: Peyton JWR (ed), Teaching and Learning in Medical Practice. Rickmansworth, UK: Manticore Europe Limited, 1998:13–19.
17 17 Logan GD: Toward an instance theory of automatization. Psychol Rev 1988; 95(4):492–527.
18 18 Waschke KA, Anderson J, Macintosh D, Valori RM: Training the gastrointestinal endoscopy trainer. Best Pract Res Clin Gastroenterol 2016; 30(3):409–419.
19 19 Canadian Association of Gastroenterology. Skills enhancement for endoscopy program. Published 2016. Available: https://www.cag‐acg.org/education/see‐program (accessed May 1, 2021).
20 20 Joint Advisory Group on GI Endoscopy. Course finder, JAG edoscopy training system. 2021. Available: https://www.jets.thejag.org.uk/FindCourseHome.aspx (accessed May 1, 2021).
21 21 Pourmand K, Sewell JL, Shah BJ, Francisco S: What makes a good endoscopic teacher: a qualitative analysis. J Surg Educ 2018; 75(5):1195–1199.
22 22 Kumar NL, Smith BN, Lee LS, Sewell JL: Best practices in teaching endoscopy based on a Delphi survey of gastroenterology program directors and experts in endoscopy education. Clin Gastroenterol Hepatol 2020; 18(3):574–579.
23 23 Wells C: The characteristics of an excellent endoscopy trainer. Frontline Gastroenterol 2010; 1(1):13–18.
24 24 Joint Advisory Group on GI Endoscopy. JAG Endoscopy Trainer Pathway: How to Become and Develop as an Endoscopy Trainer. London, UK: Royal College of Physicians of London, 2006.
25 25