The future of gastroenterology training: instruction in technical skills

Abstract

Endoscopy training has developed extensively over the past decade but despite signifi cant improvements many challenges remain and further development of endoscopy training programmes and content is required. Endoscopy training is struggling with increasing pressure from service provision and competition for limited National Health Service (NHS) resources. There is a rapidly increasing proportion of work shifting from diagnostic to therapeutic practice in the face of limited dedicated therapeutic training provision. In addition, there is a need to align quality assurance outcomes related to endoscopic practice with the key NHS quality indicators of patient experience, clinical effectiveness and safety. A vision for the future of endoscopy training is presented focusing on the need to target training resources most effectively and developing technical skills training in parallel to non-technical skills training (eg, effective decision making, communication and teamwork). Proposals for specialist technical skills training, future information technology systems and quality assurance framework integration are developed. The need to challenge some existing culture and behaviours is explained along with a challenge to embed a life-long learning approach in endoscopy training. Endoscopy training developments aim to ensure a high quality assured endoscopy service for all patients, where a skilled workforce can be provided to meet rising demand and changing technical skills requirements.

Factors defining expertise in screening colonoscopy

“…Studies have shown that regular feedback, particularly in regard to the adenoma detection rate, can in itself improve performance 35 36 . The importance of non-technical skills alongside those targeting technical performance metrics is being increasingly acknowledged 37 . Whereas all endoscopists would acknowledge the importance of technical proficiency, the relevance of non-technical skills such as communication in a highly skilled examination is likely to be less well recognized.…”

Non-technical skills and gastrointestinal endoscopy: a review of the literature

“…It is therefore paramount that these NTS are taught and developed in staff. There is a growing body of opinion that NTS are the most important aspect of medical practice and NTS competence should be integral to training in endoscopy 5 7 9 13…”

“…NTS training has received increasing recognition in other areas of healthcare such as surgery, anaesthetics and emergency medicine, but there has been little investment in team training and development in endoscopy to date 5. There is, however, growing momentum for teaching NTS as well as, or alongside technical skills, particularly with the development of the national BCSP and advancing therapeutic endoscopy 5 9…”

“…With increasing focus on the importance of NTS, these tools may have a role in summative assessment and revalidation 5. Such tools can also be a useful aide memoire to facilitate self-reflection or debriefing after a critical incident or complex case.…”

How to Give Feedback During Endoscopy Training

“…Trainers may feel most comfortable providing feedback on technical skills, yet the teaching of nontechnical skills is equally important. 4 In this commentary, we aim to stimulate discussion of feedback among endoscopy teachers and to make practical suggestions for providing effective feedback to endoscopy learners. This commentary is not based on a systematic review of the literature, but rather on our experiences as endoscopy teachers and education researchers and scholars, and on insights from the American Society for Gastrointestinal Endoscopy's Train the Trainers course.…”