A Simple Evaluation Tool (ET-CET) Indicates Increase of Diagnostic Skills From Small Bowel Capsule Endoscopy Training Courses

Abstract

Small bowel capsule endoscopy (SBCE) has become a first line diagnostic tool. Several training courses with a similar format have been established in Europe; however, data on learning curve and training in SBCE remain sparse.Between 2008 and 2011, different basic SBCE training courses were organized internationally in UK (n = 2), Italy (n = 2), Germany (n = 2), Finland (n = 1), and nationally in Germany (n = 10), applying similar 8-hour curricula with 50% lectures and 50% hands-on training. The Given PillCam System was used in 12 courses, the Olympus EndoCapsule system in 5, respectively. A simple evaluation tool for capsule endoscopy training (ET-CET) was developed using 10 short SBCE videos including relevant lesions and normal or irrelevant findings. For each video, delegates were required to record a diagnosis (achievable total score from 0 to 10) and the clinical relevance (achievable total score 0 to 10). ET-CET was performed at baseline before the course and repeated, with videos in altered order, after the course.Two hundred ninety-four delegates (79.3% physicians, 16.3% nurses, 4.4% others) were included for baseline analysis, 268 completed the final evaluation. Forty percent had no previous experience in SBCE, 33% had performed 10 or less procedures. Median scores for correct diagnosis improved from 4.0 (IQR 3) to 7.0 (IQR 3) during the courses (P < 0.001, Wilcoxon), and for correct classification of relevance of the lesions from 5.0 (IQR 3) to 7.0 (IQR 3) (P < 0.001), respectively. Improvement was not dependent on experience, profession, SBCE system, or course setting. Previous experience in SBCE was associated with higher baseline scores for correct diagnosis (P < 0.001; Kruskal–Wallis). Additionally, independent nonparametric partial correlation with experience in gastroscopy (rho 0.33) and colonoscopy (rho 0.27) was observed (P < 0.001).A simple ET-CET demonstrated significant improvement of diagnostic skills on completion of formal basic SBCE courses with hands-on training, regardless of preexisting experience, profession, and course setting. Baseline scores for correct diagnoses show a plateau after interpretation of 25 SBCE before courses, supporting this number as a compromise for credentialing. Experience in flexible endoscopy may be useful before attending an SBCE course.

Prospective multicenter study to evaluate capsule endoscopy competency using a validated assessment tool

“…Evaluation of hands-on CE training has shown an improvement in diagnostic accuracy but does not define competence and readiness for independent practice. 27,28 There remains ambiguity on the optimal assessment method for competence. Read et al 29 distributed an email survey to gastroenterology fellowship program directors in the United States (59 program directors responded, which was a 35.1% response rate) that indicated most gastroenterology programs (84.8%) required trainees to complete CE training during their fellowship.…”

Training in video capsule endoscopy: Current status and unmet needs

“…Albert et al[32] developed an evaluation tool (ET-CET) to assess the impact of hands-on capsule endoscopy training on the diagnostic accuracy of the examination. ET-CET consists of 10 capsule endoscopy videoclips.…”

Capsule endoscopy of the small bowel

“…Numerous studies have compared CE reading between experts, novices and nurses (59)(60)(61). Whilst some level of prior conventional endoscopy experience is probably helpful for novice CE readers in training (59,62), a high level of experience does not seem to add further benefit (63). Nurses are as capable of reading and recognising CE abnormalities as doctors: whilst they may identify additional insignificant findings, no serious pathology is missed compared to expert physicians (60,61,64).…”

“…There are currently several CE training courses established in Europe. A simple evaluation tool (ET-CET) based on interpretation of video clips was carried out to identify factors related to the learning curve of CE among trainees, nurses and doctors attending courses offering a common core curriculum (62). The study found that previous CE experience was associated with higher baseline scores (before the course) for correct diagnosis.…”