Conclusion
Procedural sedation in children carries a significant number of considerations which depend on the developmental and chronological age of the patient, history of previous experiences, and individualized response to medication. In order to avoid complications, the setting for the procedure must be well equipped, and the staff performing procedural sedation must be adequately trained in pediatric pharmacology and resuscitation. Good communication between all practitioners during the procedure contributes to a safe and efficient environment, and the likelihood of procedural success.
Societal guidelines must be adapted to specific national legislation and institutional protocols. Once established, sedation and general anesthesia protocols must be controlled subjected to constant quality monitoring.
See companion website for videos relating to this chapter topic: www.wiley.com/go/gershman3e
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5 Pediatric endoscopy training and ongoing assessment
Catharine M. Walsh, Looi Ee, Mike Thomson, and Jenifer R. Lightdale
Endoscopic skill acquisition can be accelerated by recently available teaching models including virtual simulators.
Formative and summative direct observational procedural skill (DOPS) assessments are integral.
Use of a contemporaneous record of cases performed and assessment of competence should be mandatory. e.g.. www.jets.thejag.org.uk.
Hands On Courses are a useful adjunct to ongoing training.
Ideally trainers should have been trained in endoscopy training specific to pediatrics.
Introduction
Achieving proficiency in gastrointestinal endoscopy requires the acquisition of related technical, cognitive, and integrative competencies. Given the unique nature of performing endoscopy in infants and children, its training and assessment must be tailored to pediatric practice to ensure delivery of high‐quality procedural care. This chapter outlines current evidence regarding pediatric endoscopy training and assessment.
Training
Learning to perform endoscopy largely occurs during formalized pediatric gastroenterology training programs of at least two years’ duration. The traditional endoscopy teaching method is based upon the apprenticeship model, with trainees learning fundamental skills under the supervision of experienced endoscopists in the course of patient care. More recently, novel instructional aids have been utilized with the aim of accelerating learning, facilitating instruction, and helping trainees attain base levels of proficiency prior to performing procedures in the clinical environment.
Endoscopy skill acquisition
With regard to learning to perform procedures such as endoscopy, skill acquisition has been described by Fitts and Posner [1] as a sequential process involving three major phases: cognitive, associative, and autonomous. In the cognitive stage, a learner develops an initial mental understanding of the procedure through instructor explanation and demonstration. Performance during this stage is often erratic and error filled, and feedback should focus on correct procedural technique and identifying common errors. Subsequently, in the associative phase, the learner translates knowledge acquired during the cognitive stage into appropriate motor behaviors, tasks are gradually executed more efficiently, and there are fewer errors and interruptions. Feedback during the cognitive stage should aim to help learners self‐identify errors and their associated corrective actions [2]. Finally, with ongoing practice and feedback, the learner transitions to the autonomous stage, where motor performance becomes automated such that the skills are performed without significant cognitive or conscious awareness.
Endoscopy training aids
A relatively recent trend towards ensuring both quality of training and patient safety has prompted educators to seek complementary methods of teaching endoscopy to enhance apprenticeship approaches. In particular, magnetic endoscopic imaging has been developed to provide real‐time images that display three‐dimensional views of the colonoscope shaft configuration and its position within the abdomen during an endoscopic procedure [3]. A metaanalysis of 13 randomized studies found that use of magnetic endoscopic imaging during real‐life colonoscopy is associated with a lower