A nationwide survey of gastroenterologists and their acquisition of knowledge

Training in basic gastrointestinal endoscopic procedures: a European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement

This ESGE Position Statement provides structured and evidence-based guidance on the essential requirements and processes involved in training in basic gastrointestinal (GI) endoscopic procedures. The document outlines definitions; competencies required, and means to their assessment and maintenance; the structure and requirements of training programs; patient safety and medicolegal issues. 1:  ESGE and ESGENA define basic endoscopic procedures as those procedures that are commonly indicated, generally accessible, and expected to be mastered (technically and cognitively) by the end of any core training program in gastrointestinal endoscopy. 2:  ESGE and ESGENA consider the following as basic endoscopic procedures: diagnostic upper and lower GI endoscopy, as well as a limited range of interventions such as: tissue acquisition via cold biopsy forceps, polypectomy for lesions ≤ 10 mm, hemostasis techniques, enteral feeding tube placement, foreign body retrieval, dilation of simple esophageal strictures, and India ink tattooing of lesion location. 3:  ESGE and ESGENA recommend that training in GI endoscopy should be subject to stringent formal requirements that ensure all ESGE key performance indicators (KPIs) are met. 4:  Training in basic endoscopic procedures is a complex process and includes the development and acquisition of cognitive, technical/motor, and integrative skills. Therefore, ESGE and ESGENA recommend the use of validated tools to track the development of skills and assess competence. 5:  ESGE and ESGENA recommend incorporating a multimodal approach to evaluating competence in basic GI endoscopic procedures, including procedural thresholds and the measurement and documentation of established ESGE KPIs. 7:  ESGE and ESGENA recommend the continuous monitoring of ESGE KPIs during GI endoscopy training to ensure the trainee's maintenance of competence. 9:  ESGE and ESGENA recommend that GI endoscopy training units fulfil the ESGE KPIs for endoscopy units and, furthermore, be capable of providing the dedicated personnel, infrastructure, and sufficient case volume required for successful training within a structured training program. 10:  ESGE and ESGENA recommend that trainers in basic GI endoscopic procedures should be endoscopists with formal educational training in the teaching of endoscopy, which allows them to successfully and safely teach trainees.

Testing Test-Enhanced Continuing Medical Education: A Randomized Controlled Trial

PURPOSE

The authors investigated the impact of the use of an efficient multiple-choice question (MCQ) test-enhanced learning (TEL) intervention for continuing professional development (CPD) on knowledge retention as well as self-reported learning behaviors.

METHOD

The authors conducted a randomized controlled trial comparing knowledge retention among learners who registered for an annual CPD conference at the University of Toronto in April 2016. Participants were randomized to receive an online preworkshop stand-alone MCQ test (no feedback) and a postworkshop MCQ test (with feedback) after a 14-day delay. Controls received no pre-/posttesting. The primary outcome measure was performance on a clinical vignette-based retention and application test delivered to all participants four weeks post conference. Secondary outcomes included self-reported changes in learning behavior, satisfaction, and efficiency of TEL.

RESULTS

Three hundred eight physicians from across Canada registered for the four-day conference; 186 physicians consented to participate in the study and were randomized to receive TEL or to the control group in 1 of 15 workshops, with 126 providing complete data. A random-effects meta-analysis demonstrated a pooled effect size indicating moderate effect of TEL (Hedges g of 0.46; 95% CI: 0.26-0.67). The majority of respondents (65%) reported improved CPD learning resulting from pretesting.

CONCLUSIONS

Testing for learning can be leveraged to efficiently and effectively improve outcomes for CPD. Testing remains an underused education intervention in CPD, and the use of formative assessment to enhance professional development should be a key target for research.

State of Adult Trainee Inflammatory Bowel Disease Education in the United States: A National Survey

BACKGROUND

The fundamentals of inflammatory bowel disease (IBD) education begin during gastroenterology fellowship training. We performed a survey of gastroenterology fellowship program directors (PDs) and trainees with the aim to further examine the current state of IBD training in the United States.

METHODS

A 15-question PD survey and 19-question trainee survey was performed using an online platform.

RESULTS

Surveys were completed by 43/161 (27%) PDs and 160 trainees. All trainee years were equally represented. A significant proportion of trainees was unsure or believed that their inpatient (32%) or outpatient (43%) training was inadequate. Only 28% of trainees were satisfied with their current level of IBD exposure during training. Fewer than half the trainees reported comfort in the management of pouch or stoma issues, pregnant patients with IBD, or postoperative management. The proportion of PDs viewing a competency as essential for trainee education strongly correlated with trainee comfort in that area (Pearson's rho = 0.793; P < 0.01). In multivariate logistic regression, monthly IBD didactics was the only variable independently associated with satisfaction with the current level of training (odds ratio, 4.1 95% CI, 1.9-9.0).

CONCLUSIONS

Over one-third of participating gastroenterology trainees did not feel "confident" or "mostly comfortable" with their level of IBD training, with varying comfort regarding different competencies in IBD management. These findings suggest that specific areas of IBD training may require additional focus during training and can provide the basis for the development of an IBD core competency curriculum.

Information-seeking behavior during residency is associated with quality of theoretical learning, academic career achievements, and evidence-based medical practice: a strobe-compliant article

Data regarding knowledge acquisition during residency training are sparse. Predictors of theoretical learning quality, academic career achievements and evidence-based medical practice during residency are unknown. We performed a cross-sectional study on residents and attending physicians across several residency programs in 2 French faculties of medicine. We comprehensively evaluated the information-seeking behavior (I-SB) during residency using a standardized questionnaire and looked for independent predictors of theoretical learning quality, academic career achievements, and evidence-based medical practice among I-SB components using multivariate logistic regression analysis. Between February 2013 and May 2013, 338 fellows and attending physicians were included in the study. Textbooks and international medical journals were reported to be used on a regular basis by 24% and 57% of the respondents, respectively. Among the respondents, 47% refer systematically (4.4%) or frequently (42.6%) to published guidelines from scientific societies upon their publication. The median self-reported theoretical learning quality score was 5/10 (interquartile range, 3-6; range, 1-10). A high theoretical learning quality score (upper quartile) was independently and strongly associated with the following I-SB components: systematic reading of clinical guidelines upon their publication (odds ratio [OR], 5.55; 95% confidence interval [CI], 1.77-17.44); having access to a library that offers the leading textbooks of the specialty in the medical department (OR, 2.45, 95% CI, 1.33-4.52); knowledge of the specialty leading textbooks (OR, 2.12; 95% CI, 1.09-4.10); and PubMed search skill score ≥5/10 (OR, 1.94; 95% CI, 1.01-3.73). Research Master (M2) and/or PhD thesis enrolment were independently and strongly associated with the following predictors: PubMed search skill score ≥5/10 (OR, 4.10; 95% CI, 1.46-11.53); knowledge of the leading medical journals of the specialty (OR, 3.33; 95% CI, 1.32-8.38); attending national and international academic conferences and meetings (OR, 2.43; 95% CI, 1.09-5.43); and using academic theoretical learning supports several times a week (OR, 2.23; 95% CI, 1.11- 4.49). This study showed weaknesses in the theoretical learning framework during residency. I-SB was independently associated with quality of academic theoretical learning, academic career achievements, and the use of evidence-based medicine in everyday clinical practice.

STUDY REGISTRATION

CNIL No.1797639.

Endoscopic biopsy as quality assurance for endoscopic services

Gastroendoscopy (GS) procedures are not only performed by gastroenterologists (GE) but also by hepatologists (HT) in many countries. Endoscopic biopsy (EBx) remains the gold standard for the investigation and documentation of esophago-gastro-duodenal pathology. EBx is subjectively performed by an endoscopist, and the level of skill and experience of the endoscopist may affect the quality of the endoscopic service. Reasons for this discrepancy included lack of experience practitioners to order EBx when required of GS issues between in GE and HT limit access. Ideally, services should be safe and of high quality. This study assessed the EBx/GS ratio as the endoscopic quality assurance as an index of GS services. This was a cohort study of endoscopists at Kaohsiung Chang Gung Memorial Hospital, a teaching hospital in southern Taiwan. There were 34,570 episodes of EBx in 199,877 GS procedures. The 25 endoscopists were divided into GE (n = 13) and HT (n = 12) groups, and correlation coefficients were calculated over a 14.5-year duration of intervention. The Trimmean of EBx/GS was 19.29% in 14.5 years (34570/199877 with Trimmean 0.2 percentile ratio correlations), and the Pearson correlation coefficient was 0.90229. There were significantly more EBx procedures in the GE group than in the HT group at 1 and 5 years (21.5% vs. 15.1% and 20.9% vs. 17.3%, respectively, P<0.00001). Junior GE attempted significantly more EBx than both the senior GE (24.06% vs. 20.41%, P<0.0001), and junior HT (24.06% vs. 13.2%, P<0.0001). In conclusion, quality assurance for gastrointestinal endoscopy involves numerous aspects of unit management and patient safety. Quality measures used with the EBx/GS ratio may be one of the best ways to ensure the quality of endoscopic procedures in a teaching hospital.