Measures of trainee performance in advanced endoscopy: A systematic review

被引:22
|
作者
James, P. D. [1 ,2 ]
Antonova, L. [1 ,2 ]
Martel, M. [3 ]
Barkun, A.
Kinnear, Douglas G. [3 ,4 ]
机构
[1] Ottawa Hosp, Dept Med, Ottawa, ON, Canada
[2] Ottawa Hosp Res Inst, Ottawa, ON, Canada
[3] McGill Univ, McGill Univ Hlth Ctr, Div Gastroenterol, Montreal, PQ, Canada
[4] McGill Univ, McGill Univ Hlth Ctr, Epidemiol & Biostat & Occupat Hlth, Montreal, PQ, Canada
关键词
Advanced endoscopy; Gastrointestinal endoscopy; Training; Performance; FINE-NEEDLE-ASPIRATION; DOUBLE-BALLOON ENTEROSCOPY; EUS-GUIDED FNA; LEARNING-CURVE; COLONOSCOPIC POLYPECTOMY; ENDORECTAL ULTRASOUND; TECHNICAL COMPETENCE; ERCP PERFORMANCE; HANDS-ON; IN-VIVO;
D O I
10.1016/j.bpg.2016.05.003
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Introduction: The diversity, technical skills required, and risk inherent to advanced endoscopy techniques all contribute to complex training curricula and steep learning curves. Since trainees develop endoscopy skills at different rates, there has been a shift towards competency-based training and certification. Validated endoscopy performance measures for trainees are, therefore, necessary. The aim of this systematic review was to describe and critically assess the existing evidence regarding measures of performance for trainees in advanced endoscopy. Methods: A systematic review of the literature from January 1980 to January 2016 was carried out using the MEDLINE, EMBASE, CENTRAL, and ISI Web of knowledge databases. MeSH terms related to 'advanced endoscopy' and 'performance' were applied to a highly sensitive search strategy. The main outcomes were face, content, and construct validity, as well as reliability. Results: The literature search yielded 1,662 studies and 77 met the inclusion criteria after abstract and full-text review (endoscopic retrograde cholangiopancreatography (ERCP) = 23, endoscopic ultrasound (EUS) = 30, colonoscopic polypectomy (CP) = 11, balloon-assisted enteroscopy (BAE) = 7, luminal stenting =3, radiofrequency ablation (RFA) 2, and endoscopic muscosal resection (EMR) = 1). Good validity and reliability were found for measurement tools of overall performance in ERCP, EUS and CP, with applications for both patient-based and simulator training models. A number of specific technical skills were also shown to be valid measures of performance. These include: selective biliary cannulation, sphincterotomy, biliary stent placement, stone extraction and procedure time for ERCP; pancreatic solid mass T-staging, EUS-guided fine needle aspiration (EUS-FNA) procedure time, number of EUS-FNA passes and puncture precision for EUS; procedure time and en bloc resection rate for CP; retrograde fluoroscopy time for BAE; and mean number of endoscopy sessions required to achieve complete eradication of intestinal metaplasia (CIEM) for RFA. The evidence for EMR and luminal stenting is of insufficient quality to make recommendations. Conclusions: We have identified multiple valid and readily available performance measures for advanced endoscopy trainees for ERCP, EUS, CP, BAE and RFA procedures. These tools should be considered in advanced endoscopy training programs wishing to move away from apprenticeship-based training and towards competency-based learning with the help of patient-based and simulator tools. (C) 2016 Elsevier Ltd. All rights reserved.
引用
收藏
页码:421 / 452
页数:32
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