The impact of distraction minimization on endoscopic mentoring and performance

Abstract

Background and study aims Endoscopic mentoring requires active attention by the preceptor. Unfortunately, sources of distraction are abundant during endoscopic precepting. The impact of distraction minimization on endoscopic mentoring and performance is unknown. Methods Fellow and attending preceptors were paired and randomized in a prospective crossover design to perform esophagogastroduodenoscopy (EGD) and/or colonoscopy in either a “distraction minimization” (DM) or a “standard” (S) room. Cell phones, pagers, music, and computers were not permitted in DM rooms. S rooms operated under typical conditions. Fellows and attendings then completed a survey. The primary outcome was fellow satisfaction with mentoring experience (visual analogue scale: 0 = min,100 = max). Additional fellow outcomes included satisfaction of attending attentiveness, identifying landmarks, communication, and distractedness; attending outcomes included satisfaction with mentoring, attentiveness, communication, and distractedness. Endoscopic performance measures included completion of EGD, cecal intubation rate, cecal intubation time, withdrawal time, total procedure time, attending assistance, and polyp detection rate. A paired t-test was used to compare mean differences (MD) between rooms; significance set at P < 0.05. Results Eight fellows and seven attendings completed 164 procedures. Despite a trend toward less distraction between rooms (DM = 12.5 v. S = 18.3, MD = 4.1, P = 0.17), there was no difference in fellow satisfaction with training/mentoring (DM = 93, S = 93, MD = –0.04, P = 0.97), attentiveness (DM = 95, S = 92, MD = 0.86, P = 0.77), identifying pathology/landmarks (DM = 94, S = 94, MD = –1.72, P = 0.56), or communication (DM = 95, S = 95,MD = 1.0, P = 0.37). Similarly, there was no difference between rooms for any attending outcome measures or performance metrics. Conclusions DM did not improve perceived quality of endoscopic mentoring or performance for fellows or attendings; however, reduced distraction may improve attending engagement/availability.

Training in basic gastrointestinal endoscopic procedures: a European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement

“…trainees [184], scheduling the trainee-involved endoscopic procedures early in the day's endoscopy list [185], implementing simulation training for emergency situations [186], and supporting discussions in morbidity and mortality conferences can all reduce AEs and improve patient outcomes [187].…”

“…Other qualities of the trainer that ensure short- and long-term safety are formal training 182 , sound clinical judgement in how and when to intervene, and the ability to offer appropriate supervision and feedback 183 . Minimizing distractions during procedures with trainees 184 , scheduling the trainee-involved endoscopic procedures early in the day’s endoscopy list 185 , implementing simulation training for emergency situations 186 , and supporting discussions in morbidity and mortality conferences can all reduce AEs and improve patient outcomes 187 .…”