Endoscopy services and training: a national survey of general surgeons

'What would my peers say?' Comparing the opinion-based method with the prediction-based method in Continuing Medical Education course evaluation

Background

Although medical courses are frequently evaluated via surveys with Likert scales ranging from "strongly agree" to "strongly disagree," low response rates limit their utility. In undergraduate medical education, a new method with students predicting what their peers would say, required fewer respondents to obtain similar results. However, this prediction-based method lacks validation for continuing medical education (CME), which typically targets a more heterogeneous group than medical students.

Methods

In this study, 597 participants of a large CME course were randomly assigned to either express personal opinions on a five-point Likert scale (opinion-based method; n = 300) or to predict the percentage of their peers choosing each Likert scale option (prediction-based method; n = 297). For each question, we calculated the minimum numbers of respondents needed for stable average results using an iterative algorithm. We compared mean scores and the distribution of scores between both methods.

Results

The overall response rate was 47%. The prediction-based method required fewer respondents than the opinion-based method for similar average responses. Mean response scores were similar in both groups for most questions, but prediction-based outcomes resulted in fewer extreme responses (strongly agree/disagree).

Conclusions

We validated the prediction-based method in evaluating CME. We also provide practical considerations for applying this method.

The Call for Neuroendoscopy Cadaveric Workshops in Lower-Middle Income Countries

OBJECTIVE

This study aims to assess the impact of the workshops organized during Neuroendocon 23 on the perspective and confidence of neurosurgeons toward endoscopy in a lower-middle income country.

METHODS

Neuroendocon 23 had cranial and spinal endoscopy cadaveric workshops with 30 delegates each. A pre and postworkshop survey was disseminated among the delegates, and statistical analysis was performed with SPSS (version 26) using P < 0.05.

RESULTS

A total of 24 delegates (40%) consented to participate in the study, with only 1 female respondent (4.17%). After the cranial endoscopy workshop, there was an increase in the level of confidence of delegates in cranial endoscopic approaches (P < 0.001). Similarly, after the spine endoscopy workshop, the respondents had increased confidence in managing spine conditions with the endoscopic approach (P = 0.040), to the extent that they preferred the endoscopic over the microsurgical technique (P < 0.001). All respondents (n = 24, 100%) believed that endoscopy should be promoted in lower-middle income countries and integrated into residency curricula.

CONCLUSIONS

Cranial and spinal endoscopy cadaveric workshops could be the first step in stimulating the interest of neurosurgeons in endoscopy.

The utility of intraoperative endoscopy in esophagogastric surgery

Flexible endoscopy (FE) plays a major role in the diagnosis and treatment of gastrointestinal disease. Although its intraoperative use has spread over the years, its use by surgeons is still limited in our setting. FE training opportunities are different among many institutions, specialties, and countries. Intraoperative endoscopy (IOE) presents peculiarities that increase its complexity compared to standard FE. IOE has a positive impact on surgical results, due to increased safety and quality, as well as a reduction in the complications. Due to its innumerable advantages, its intraoperative use by surgeons is currently a current project in many countries and is part of the near future in others because of the creation of better structured training projects. This manuscript reviews and updates the indications and uses of intraoperative upper gastrointestinal endoscopy in esophagogastric surgery.

Gynaecology, general surgery and urology residents' perspective and exposure to endoscopy training and practice: a cross-sectional study of resident doctors in four residency training centres in Abuja, Nigeria from June to August, 2020

Introduction

the use of endoscopy in the surgical management of a wide range of ailments has revolutionised the practice of surgery. Endoscopy however has been underutilised in developing nations. Optimal training exposure during the residency training program is considered as very crucial to the improvement of endoscopy practice in this region. The objective of this study was to evaluate the perception and endoscopy training exposure of resident doctors in gynaecology, general surgery and urology in four residency training centres in Abuja.

Methods

this was an analytical cross-sectional study of endoscopy exposure of gynaecology, general surgery and urology resident doctors in four residency training centres in Abuja from June through August 2020. Using a structured questionnaire, information was obtained on demography, perception of endoscopy, exposure to and expectations for endoscopy training and practice. Data were analysed with SPSS version 25 (IBM Corp., Armonk, NY, USA).

Results

a total of 125 questionnaires were distributed with a 92% response rate. The mean age of the respondents was 36.17±4.62 years with a mean duration of training of 53.91±28.02 months. Eighteen (15.8%) were satisfied with endoscopy practice in their centre and only five respondents (4.4%) had attained competence in operative endoscopy. Twelve trainees (10.5%) reported that they had received formal training in endoscopy outside their workplace and 109 (95.6%) desired to have post-fellowship training. Competence was statistically significantly higher among the senior registrars compared to registrars (Fisher 51.81, P=< 0.001). Lack of funding was the most reported limiting factor to endoscopy training (66.7%) while most (85.1%) desired the incorporation of structured endoscopy training into the residency training curriculum.

Conclusion

this study showed poor endoscopy training exposure, a high level of dissatisfaction with the state of endoscopy practice and high expectations of the trainees for improved training facilities and human capacity.

Changhai advanced endoscopy courses for ERCP (CHANCE) training program: A short-term training model in China

BACKGROUND

There is huge shortage of ERCP practitioners (ERCPists) in China, and ERCP training is urgently needed. ChangHai Advanced eNdoscopy Courses for ERCP (CHANCE) is a 4-month program for ERCP training since 2004. This study evaluated the efficiency of this short-term training model, and reported on the ERCP careers of the trainees following completion of the CHANCE program.

METHODS

This study was a retrospective investigation included all the CHANCE trainees from Jan 2004 to Dec 2014. Questionnaires were sent to all trainees. The career competence percentage, ERCP careers and predictive factors of career competence were investigated and analyzed.

RESULTS

A total of 413 trainees participated in the CHANCE program over 11 years covered by the survey and 258 questionnaires were valid for the study. The mean (SD) age of the trainees was 35.36 (4.17), and the male to female ratio was 4.4:1. The average follow-up time was 7.77 (3.44) years. A total of 173 (67.1%) trainees had achieved career competence. In terms of ERCP careers, the mean annual ERCP volume was 120.60 (96.67), with a complication percentage of 8.2%. Hospital qualification, compliance with follow-up learning guidance, participating academic activity, and practitioner type were identified predictive factors of career competence.

CONCLUSIONS

As a short-term training program, the CHANCE achieved an acceptable career competence percentage, providing endoscopists more chances to learn ERCP and giving them appropriate training guidance for career competence. This training mode is worth promoting in developing countries with shortage of ERCPists.

Detecting Task Difficulty of Learners in Colonoscopy: Evidence from Eye-Tracking

Eye-tracking can help decode the intricate control mechanism in human performance. In healthcare, physicians-in-training require extensive practice to improve their healthcare skills. When a trainee encounters any difficulty in the practice, they will need feedback from experts to improve their performance. Personal feedback is time-consuming and subjected to bias. In this study, we tracked the eye movements of trainees during their colonoscopic performance in simulation. We examined changes in eye movement behavior during the moments of navigation loss (MNL), a signature sign for task difficulty during colonoscopy, and tested whether deep learning algorithms can detect the MNL by feeding data from eye-tracking. Human eye gaze and pupil characteristics were learned and verified by the deep convolutional generative adversarial networks (DCGANs); the generated data were fed to the Long Short-Term Memory (LSTM) networks with three different data feeding strategies to classify MNLs from the entire colonoscopic procedure. Outputs from deep learning were compared to the expert's judgment on the MNLs based on colonoscopic videos. The best classification outcome was achieved when we fed human eye data with 1000 synthesized eye data, where accuracy (91.80%), sensitivity (90.91%), and specificity (94.12%) were optimized. This study built an important foundation for our work of developing an education system for training healthcare skills using simulation.

Admission discipline and timing of admission may influence outcomes for gastrointestinal bleeding patients

BACKGROUND

Bleeding of the gastrointestinal tract (BGIT) is a common gastrointestinal emergency. There is no consensus whether this condition should be admitted to medical or surgical discipline. Timing of presentation may also impact patient outcomes due to differences in healthcare resource availability. This study thus aims to investigate the impact of admitting discipline and timing of admission on patient outcomes in BGIT.

METHODS

A 2-year tertiary institution database was retrospectively reviewed. Outcome measures included 30-day mortality, 30-day readmissions and rebleeding requiring repeat endoscopic, angiographic or surgical interventions. Secondary outcome measures included time to endoscopy, percutaneous angiographic interventions and surgery. The effect of admission discipline (medical versus surgical) and time of admission (office-hours versus after office-hours) were analysed using a propensity-score-adjusted estimate.

RESULTS

A total of 1384 patients were included for analysis, medical (n = 853), surgical (n = 530); during office-hours (n = 785) and after office-hours (n = 595). After propensity-score-adjusted analysis, no significant differences in mortality or readmissions were noted between medical or surgical admissions. Patients admitted under surgery were less likely to sustain rebleeding (P = 0.004) for lower BGIT and had an earlier time to endoscopy for upper BGIT (P = 0.04). Patients admitted after office-hours had similar outcomes with those admitted during office hours apart from a delay in time to endoscopy (P = 0.02).

CONCLUSION

For BGIT patients, admission to a surgical discipline compared to a medical discipline appeared to have at least equivalent patient outcomes. Patients presenting with BGIT after office-hours were more likely to experience a delay to endoscopy, although it did not affect patient mortality.

Colorectal trainees in the UK struggle to meet JAG certification standards in colonoscopy by the end of their training

AIM

Colonoscopy certification in the UK is taken in two parts - provisional and full - mandating lifetime procedure counts of 200 or 300, respectively. The aim of this study was to determine the number of procedures performed by colorectal trainees by the end of training compared with their gastroenterology peers and to determine the factors associated with achieving the 300-procedure target for full certification.

METHOD

Dates of entry onto the specialist register were obtained from the General Medical Council. This list was cross-referenced with procedure counts from the Joint Advisory Group on Gastrointestinal Endoscopy (JAG) Endoscopy Training System database to determine the number of colonoscopies and polypectomies performed during training. Factors associated with achieving 300 procedures were analysed by logistic regression.

RESULTS

Procedures numbers were obtained for 234 gastroenterology and 148 colorectal surgery trainees. Over the last 5 years, the number of colonoscopies performed during training has declined for colorectal surgery trainees but increased for gastroenterology trainees. Gastroenterology trainees are more likely to achieve provisional and full certification. For trainees completing training in 2017, 19% of colorectal surgery trainees compared with 88% of gastroenterology trainees were able to reach the threshold of 300 procedures for full certification.

CONCLUSION

Colorectal surgery trainees lag behind their gastroenterology counterparts in accruing endoscopy experience. This affects the ability of colorectal surgery trainees to achieve certification prior to completion of training. An urgent debate is required to decide what endoscopy training is required of a colorectal surgeon and how a robust training system can be put in place to ensure this is achieved.

Trends in UK endoscopy training in the BSG trainees' national survey and strategic planning for the future

BACKGROUND

Improvements in the structure of endoscopy training programmes resulting in certification from the Joint Advisory Group in Gastrointestinal Endoscopy have been acknowledged to improve training experience and contribute to enhanced colonoscopy performance.

OBJECTIVES

The 2016 British Society of Gastroenterology trainees' survey of endoscopy training explored the delivery of endoscopy training - access to lists; level of supervision and trainee's progression through diagnostic, core therapy and subspecialty training. In addition, the barriers to endoscopy training progress and utility of training tools were examined.

METHODS

A web-based survey (Survey Monkey) was sent to all higher specialty gastroenterology trainees.

RESULTS

There were some improvements in relation to earlier surveys; 85% of trainees were satisfied with the level of supervision of their training. But there were ongoing problems; 12.5% of trainees had no access to a regular training list, and 53% of final year trainees had yet to achieve full certification in colonoscopy. 9% of final year trainees did not feel confident in endoscopic management of upper GI bleeds.

CONCLUSIONS

The survey findings provide a challenge to those agencies tasked with supporting endoscopy training in the UK. Acknowledging the findings of the survey, the paper provides a strategic response with reference to increased service pressures, reduced overall training time in specialty training programmes and the requirement to support general medical and surgical on-call commitments. It describes the steps required to improve training on the ground: delivering additional training tools and learning resources, and introducing certification standards for therapeutic modalities in parallel with goals for improving the quality of endoscopy in the UK.

Endoscopic training: A nationwide survey of French fellows in gastroenterology

BACKGROUND

During their 4 years of training, French fellows in gastroenterology should acquire theoretical and practical competency in gastrointestinal (GI) endoscopy.

AIMS

To evaluate the delivery of endoscopy training to French GI fellows and perception of learning.

METHODS

A nationwide electronic survey was carried out of French GI fellows using an anonymous, 17-item electronic questionnaire.

RESULTS

A total of 291 out of 484 (60%) GI fellows responded to the survey. Only 40% of subjects had access to theoretical training and/or virtual simulators. Only 49% and 35% of fourth year fellows had reached the threshold numbers of EGD and colonoscopies recommended by the European section and Board of gastroenterology and hepatology. Sixty-two percent and 57% of trainees reported having insufficient knowledge in interpreting gastric and colic lesions. Access to dedicated endoscopy activity for at least 8 weeks during the year was the only independent factor associated with the achievement of the recommended annual threshold number of procedures.

CONCLUSION

The access of fellows to theoretical training and to preclinical virtual simulators is still insufficient. Personalized support and regular assessment of cognitive and technical acquisition over the 4 years of training seems to be necessary.

Emergency Endoscopy and the Importance of Endoscopy Training in General Surgery Residency: A Survey-Based Study

Background

Emergency endoscopy is a life-saving technique of great significance. The aim of our study was to draw attention to endoscopy training activities of general surgeons and their opinions on this issue.

Material/Methods

We asked general surgery specialists where they received their general surgery training, the institution where they currently worked, how many years they had been practicing, if they had endoscopy training during or after residency, if a gastroenterologist was available in their hospital, and whether they used endoscopy. We also asked some questions, including ‘Should general surgeons perform emergency or elective endoscopy?’, ‘Is endoscopy training required in general surgery’, and ‘What is your opinion regarding this issue?’, and we assessed the answers.

Results

Of the 138 general surgeons undertaking surveys, 63% of participants received their general surgery training in university hospitals and 37% in training and research hospitals. The duration of practicing as a general surgeon was 5 years for 23.9%, 5–15 years for 38.4%, 15–20 years for 20.3%, and over 20 years for 17.4% of participants. The rate of receiving endoscopy training at residency was 51.4%, 25.4% did not have endoscopy training, and 23.2% had postgraduate training. All participants replied affirmatively to the question ‘Should general surgeons perform emergency or elective endoscopy?’.

Conclusions

Although endoscopy has been widely used recently, gastroenterologists are not available in every hospital. Consequently, it is evident that endoscopy should be part of general surgery training.

The role of surgeons on the development and performance of endoscopy

Endoscopy is being frequently performed for both diagnostic and therapeutic applications in surgical practice. Surgery, as a scientific area, has an important role in the propagation of therapeutic endoscopic procedures. The contribution of surgeons to the evolution of endoscopic applications and its practice is a triggering factor for the improvement of endoscopic instruments and their widespread use. Training and education on basic diagnostic and therapeutic surgical endoscopy should be implemented as part of general surgery residency core program, according to accepted standardized criteria, in order for general surgeons to perform endoscopic applications in the future. In light of this information, it can be concluded that endoscopy training and skills should be standardized within accepted general principles. Standards to be used during post-graduate endoscopic practice should be precisely stated. In addition to accreditation of both surgeons and endoscopic centers, theoretical and practical education programs should be composed and organized.