Acquisition of technical and procedural skills: lessons learned from teaching laparoscopic surgery.
Video 2.2 Demonstration of the Thompson Endoscopic Skills Trainer (TEST), developed to emphasize fundamental endoscopic technical skills for basic maneuvers including retroflexion, tip deflection, torque, polypectomy, navigation, and loop reduction.
References
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3 Training to Become a High‐Quality Endoscopist: Mastering the Nonprocedural Aspects
Sahar Ghassemi1 and Douglas O. Faigel2
1 University of Washington, Seattle, WA, USA
2 Mayo Clinic, Scottsdale, AZ, USA
Quality is not an act, it is a habit
— Aristotle
It is quality rather than quantity that matters
— Seneca
In training programs across the country, there is a growing pressure to perform a higher volume of procedures in a patient population that is often new to the institution and referred through open access without prior clinic visitation. With these increased demands on quantity, the urgency to provide the highest quality of care requires deliberate effort and defined standards. The practice of medicine is fraught with the same limitations as the human health it serves to restore. Medical procedures are imperfect even in the most competent of hands, and unrealistic patient expectation and overzealous litigation are real factors in the climate within which we practice medicine. With the advent of more involved therapeutic procedures and access to an electronic medical record comes a growing responsibility toward the patient prior to the initiation of sedation and long after the completion of the therapeutic task. Apart from gaining competence in procedural skills, a trainee must exhibit a mastery of the quality measures by which his/her procedure will be assessed.
The American Society for Gastrointestinal Endoscopy (ASGE) has used published data and expert consensus to define the major determinants for high‐quality endoscopy and have published these guidelines [1]. These measures are increasingly utilized by third parties (hospitals, insurers, and regulatory agencies, lawyers) to assess if proper and careful consideration was performed by a physician. The trainee must understand these standards and learn to make them an integral part of his/her practice. These measures can be broken down into three categories: preprocedure, intraprocedure, and postprocedure quality measures. Each is equally relevant and must be considered separately. Although each type of endoscopic procedure will have specific quality indicators, the common principles are reviewed in this chapter.
Preprocedure
The preprocedure period encompasses all contact between the care provider(s) and the patient before administration of sedation and commencement of endoscopy. Important quality measures include proper indication for the procedure, informed consent, a focused history and physical exam, appropriate use of prophylactic antibiotics, a management plan for anticoagulants, the sedation plan, and a team pause (Table 3.1).
Studies have shown that when endoscopic procedures are performed for established indications, the yield of these procedures is highest [2]. An important quality measure in the preprocedure period is limiting the number of inappropriate procedures [2, 3]. When a procedure is performed outside of standard indications, care should be taken to document the justification for the procedure. Patients with marginal indications, particularly with higher risk procedures such as ERCP, are more likely to incur complications. Importantly, patients referred through open‐access endoscopy programs know little more than an abnormality was found on imaging