Thread by @NavinKumarMD

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A few years ago I became an attending and was struck by how hard it was to teach endoscopy. So I did a little #meded research with @GIMedEd and @BrighamGI to identify best practices.

Here’s what we found bit.ly/2SRtYYk

@AGA_CGH @AmerGastroAssn @BrighamBEI

@GIMedEd @BrighamGI @AGA_CGH @AmerGastroAssn @BrighamBEI 2/

We first developed 18 endoscopy teaching competencies that spanned the endoscopy teaching encounter. We further refined this list after interviews with experts in the field.

@GIMedEd @BrighamGI @AGA_CGH @AmerGastroAssn @BrighamBEI 3/

We then invited GI fellowship PDs and endoscopy education experts to participate in a Delphi process, which involves a series of survey rounds to help reach consensus amongst a group of experts.

@GIMedEd @BrighamGI @AGA_CGH @AmerGastroAssn @BrighamBEI 4/

For reach round, our experts rated each competency as
1) Essential
2) Important but not essential
3) Not important

We defined consensus as reaching 70% agreement for any competency.

@GIMedEd @BrighamGI @AGA_CGH @AmerGastroAssn @BrighamBEI 5/

After round 1 (94% response rate), 10 competencies reached consensus.

After round 2 (91% response rate), 14 competencies reached consensus.

Here are the 10 that reached consensus as “Essential.”

@GIMedEd @BrighamGI @AGA_CGH @AmerGastroAssn @BrighamBEI 6/

Before each session:
#1. Assesses trainee’s current procedural competency

@GIMedEd @BrighamGI @AGA_CGH @AmerGastroAssn @BrighamBEI 7/
Before each procedure:

#2. Discusses patient history and plans for procedure with trainee
#3. Confirms patient is aware of trainee’s participation and role

@GIMedEd @BrighamGI @AGA_CGH @AmerGastroAssn @BrighamBEI 8/

During the procedure:

#4. Maintains attention throughout the case
#5. Provides appropriate amount of feedback during the procedure

@GIMedEd @BrighamGI @AGA_CGH @AmerGastroAssn @BrighamBEI 9/

(continued):

#6. Uses standardized endoscopic language to guide trainee through procedure
#7. Assumes control of procedure if trainee unable to progress or patient safety concerns arise

@GIMedEd @BrighamGI @AGA_CGH @AmerGastroAssn @BrighamBEI 10/

After each procedure:

#8. Discusses next steps in management for the patient
#9. Reviews procedure notes and provides feedback as needed to the trainee

@GIMedEd @BrighamGI @AGA_CGH @AmerGastroAssn @BrighamBEI 11/

After each session:

#10. Provides feedback to the trainee

@GIMedEd @BrighamGI @AGA_CGH @AmerGastroAssn @BrighamBEI 12/Take-Home

For me, I like to remind myself of these 10 “essentials” before scoping with a fellow. I don’t hit all of them each time, but I try to hit as many as I can while emphasizing fellow scope time and patient safety.

@GIMedEd @BrighamGI @AGA_CGH @AmerGastroAssn @BrighamBEI Ok one more (counting is challenging):

Thanks to @GIMedEd for the excellent mentorship on this project and @aga @cgh for publishing our work. Excited to keep building the evidence to inform how we teach! @harvardmacy @BrighamWomens