Competence and quality assessment: the future of training in GI endoscopy
Year: 2014
Type: dissertation
Study design: Systematic Review
Abstract: __Abstract__ \n \n__Introduction__: Training procedural skills in gastrointestinal endoscopy once focused on \nthreshold numbers. However, as threshold numbers poorly reflect individual competence, the \nfocus gradually shifts towards a more individual approach. Tools to assess and document \nindividual learning progress are being developed and incorporated in dedicated training curricula. \nHowever, there is a lack of consensus and training guidelines differ worldwide, which \nreflects uncertainties on optimal set-up of a training program. \n__Aims__: The primary aim of this systematic review was to evaluate the currently available literature \nfor the use of training and assessment methods in GI endoscopy. Secondly, we aimed \nto identify the role of simulator-based training as well as the value of continuous competence \nassessment in patient-based training. Thirdly, we aimed to propose a structured training curriculum \nbased on the presented evidence. \n__Method__s: A literature search was carried out in the available medical and educational literature \ndatabases. The results were systematically reviewed and studies were included using a \npredefined protocol with independent assessment by two reviewers and a final consensus \nround. \n__Results__: The literature search yielded 5846 studies. Ninety-four relevant studies on simulators, \nassessment methods, learning curves and training programs for gastrointestinal endoscopy \nmet the inclusion criteria. Twenty-seven studies on simulator validation were included. Good \nvalidity was demonstrated for four simulators. Twenty-three studies reported on simulator \ntraining and learning curves, including 17 RCT’s. Increased performance on a virtual reality \nsimulator was shown in all studies. Improved performance in patient-based assessment was \ndemonstrated in 14 studies. Four studies reported on the use of simulators for assessment \nof competence levels. Simulator-based performance did not reflect competence in patientbased \nendoscopy. Eight out of fourteen studies on colonoscopy, ERCP and EUS reported \non learning curves in patient-based endoscopy and proved the value of this approach for \nmeasuring performance. Ten studies explored the numbers needed to gain competence, but \nthe proposed thresholds varied widely between them. Five out of nine studies describing \nthe development and evaluation of assessment tools for gastrointestinal endoscopy provided \ninsight in performance of endoscopists. Five out of seven studies proved that intense training \nprograms result in good performance. \n__Conclusions__: The use of validated virtual reality simulators in the early training setting accelerates \nlearning of practical skills. Learning curves are valuable for continuous assessment \nof performance and are more relevant than threshold numbers. Future research will strengthen \nthese conclusions by evaluating simulation-based as well as patient-based training in gastrointestinal \nendoscopy. A complete curriculum with assessment of competence throughout \ntraining needs to be developed for all gastrointestinal endoscopy procedures.
Author: Vivian E. Ekkelenkamp
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W153626138