Objectives With the increased prevalence of childhood-onset inflammatory bowel disease (IBD), there is a greater need for a planned transition process for adolescents and young adults (AYA). The Canadian IBD Transition Network and Crohn’s and Colitis Canada joined in collaborative efforts to describe a set of care consensus statements to provide a framework for transitioning AYA from pediatric to adult care. Methods Consensus statements were drafted after focus group meetings and literature reviews. An expert panel consisting of 20 IBD physicians, nurses, surgeon, adolescent medicine physician, as well as patient and caregiver representatives met, discussed and systematically voted. The consensus was reached when greater than 75% of members voted in agreement. When greater than 75% of members rated strong support, the statement was rendered a strong recommendation, suggesting that a clinician should implement the statement for all or most of their clinical practice. Results The Canadian expert panel generated 15 consensus statements (9 strong and 6 weak recommendations). Areas of focus of the statements included: transition program implementation, key stakeholders, areas of potential need and gaps in the research. Conclusions These consensus statements provide a framework for the transition process. The quality of evidence for these statements was generally low, highlighting the need for further controlled studies to investigate and better define effective strategies for transition in pediatric to adult IBD care.
Background Assessment is necessary to ensure both attainment and maintenance of competency in gastrointestinal (GI) endoscopy, and this can be accomplished through self-assessment. We conducted a systematic review with meta-analysis to evaluate the accuracy of self-assessment among GI endoscopists. Methods This was an individual participant data meta-analysis of studies that investigated self-assessment of endoscopic competency. We performed a systematic search of the following databases: Ovid MEDLINE, Ovid EMBASE, Wiley Cochrane CENTRAL, and ProQuest Education Resources Information Center. We included studies if they were primary investigations of self-assessment accuracy in GI endoscopy that used statistical analyses to determine accuracy. We conducted a meta-analysis of studies using a limits of agreement (LoA) approach to meta-analysis of Bland–Altman studies. Results After removing duplicate entries, we screened 7138 records. After full-text review, we included 16 studies for qualitative analysis and three for meta-analysis. In the meta-analysis, we found that the LoA were wide (−41.0 % to 34.0 %) and beyond the clinically acceptable difference. Subgroup analyses found that both novice and intermediate endoscopists had wide LoA (−45.0 % to 35.1 % and −54.7 % to 46.5 %, respectively) and expert endoscopists had narrow LoA (−14.2 % to 21.4 %). Conclusions GI endoscopists are inaccurate in self-assessment of their endoscopic competency. Subgroup analyses demonstrated that novice and intermediate endoscopists were inaccurate, while expert endoscopists have accurate self-assessment. While we advise against the sole use of self-assessment among novice and intermediate endoscopists, expert endoscopists may wish to integrate it into their practice.
Background Physicians generally have inaccurate self-assessment of their performance. One type of proposed intervention to improve this inaccuracy is the use of video-based feedback. The overall impact of this intervention on self-assessment accuracy in gastrointestinal endoscopy is unclear. Aims To systematically review current literature to determine if video-based interventions can effectively improve self-assessment accuracy in endoscopy. Methods We searched the following electronic databases from inception to 2019: Ovid MEDLINE; Ovid EMBASE, the Cochrane Register of Controlled Trials (CENTRAL); Education Resources Information Center (ERIC); Education Source on EBSCO; and Canadian Business Current Affairs EBM Reviews. Specifically, we searched for terms related to self-assessment, self-report, self-efficacy, video recording, and physician. Studies were included if they met the following criteria: physicians at any level of training and/or practice; studies that used an experimental design; compared self-rated assessments with external assessments of procedural skills in endoscopy; and at least one arm of the study involved a video-based intervention. Results Our search yielded 755 articles, of which 2 met all inclusion criteria. One study explored the use of three feedback interventions (practice only with no video; observation of their own video performance; observation of expert video performance) among general surgery residents performing flexible endoscopy, which found that only participants who watched expert video performances had improved accuracy of self-assessments. The other study investigated the use of three video interventions (video of own performance; video of expert performance; video of both own and expert performances) among novice endoscopists performing esophagoduodenoscopy (EGD), which found that the video of expert performance significantly improved self-assessment accuracy compared to the group with both videos. Conclusions The current data tentatively support the use of video review of expert performance to improve self-assessment accuracy in gastrointestinal endoscopy. A meta-analysis is planned to quantitatively assess the overall impact. Funding Agencies None
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