A standardized technique for gastroscopy: Still missing?

Abstract

The effectiveness of esophagogastroduodenoscopy (EGD) for diagnosis and management of upper gastrointestinal disorders is dependent on operator skill. Endoscopic training focuses on not only the technical skills needed for endoscope manipulation, but also cognitive skills, such as lesion identification, and non-technical skills, such as communication and teamwork [1]. Novice endoscopists encounter a prolonged learning curve, as they need to master all three skill domains to provide safe, high-quality endoscopic care [2, 3]. Despite EGD being a commonly performed procedure even taught to primary care physicians [4], there is no standardized technique or curriculum. Learning curve data suggest that novices acquire competency in EGD after 200 to 250 procedures [2, 5]. Initial technical challenges include advancement of the endoscope through the oral cavity and hypopharynx and intubation of the upper esophagus [6]. This may be further compounded by suboptimal hand positioning, as novices may not know how to move their hands and arms in a manner that is both safe for the patient and minimizes their own risk of musculoskeletal strain injury. Conversely, experienced endoscopists can use techniques such as changing their left-hand position to rotate the tip of the endoscope without twisting their right hand. Such skills are best learned through focused instruction and deliberate practice [7]. In this issue of Endoscopy International Open, Sugimoto and Osawa [8] report on a novel method to teach operator positioning to novice endoscopists. They delivered a simulation-based curriculum to 122 medical students at the Hamamatsu University School of Medicine that centered around the four-position method. In this method, the left hand is: a) held at the shoulder when inserting the endoscope; b) beside the hip when obser

Study on impact of flexible endoscopy training course for surgeons in India

“…Hence, ABS has made the residents to mandatorily take short flexible endoscopic surgery training course (FES) run by SAGES before board certification. [ 6 , 7 ]…”

Impact of Computer-Assisted System on the Learning Curve and Quality in Esophagogastroduodenoscopy: Randomized Controlled Trial

“…Changes in the medical training environment, which greatly emphasize the patients' safety, effectiveness, and quality of endoscopy procedures, are in the quest for practical tools of EGD training. Various researchers made attempts to enhance the competence among trainees through in vitro simulators, centralized feedback systems, and so on, which were validated in various training programs ( 2 – 7 , 9 , 11 , 22 – 24 ). While the motor skills can be rapidly acquired, the quality of EGD varies widely, and the unacceptably high rate of cancer misdiagnosis has arisen at endoscopy every year ( 1 , 25 ).…”

“…The effectiveness of EGD depends on the endoscopists' skills, which need a prolonged learning curve for novice trainees to perform high-quality endoscopy care. Despite the technical skills and non-technical skills, such as communication and teamwork needed for endoscopy manipulation, EGD training also requires quality control and cognitive skills, such as low blind spot rate, which is a significant indicator for EGD quality ( 2 , 3 ).…”

Simulator-based training method in gastrointestinal endoscopy training and currently available simulators

“…Owing to these factors, it is difficult to effectively train each apprentice according to the trainee's varied knowledge base, baseline dexterity, and learning style. [1][2][3][4][5][6] The apprenticeship-based training method (ABTM) is highly beneficial for endoscopic training and remains the cornerstone of the GI endoscopy training method (TM). However, owing to the numerous significant flaws of the conventional ABTM, considerable efforts for improvement have been introduced.…”

“…This necessitates access to either the domestic market or the internet. (2) From the perspective of a potential client, the simulator selected was one for which estimates of costs and manpower required for installation and maintenance could be made. Considering this, we endeavored to include as many low validity and low cost, moderate validity and moderate cost, and high validity and high cost categories as possible.…”