Best Practices in Teaching Endoscopy Based on a Delphi Survey of Gastroenterology Program Directors and Experts in Endoscopy Education.

BACKGROUND AND AIMS: Teaching endoscopy is a key objective of gastroenterology (GI) fellowship programs but the best approach is not known. We sought to characterize which teaching competencies experts considered most critical for endoscopy education. METHODS: We developed and refined 18 endoscopy teaching competencies based on literature review, personal experience, and interviews with experts. We invited GI fellowship program directors and endoscopy education experts to participate in a Delphi process to rate each proposed competency as essential, important but not essential, or not important using a 70% agreement threshold for consensus. Thirty-four GI fellowship program directors and 2 experts in endoscopy education participated (n = 36). RESULTS: Most survey participants were male (61.8%), associate professors (55.9%), and had performed at least a quarter of procedures with fellows (80.6%). Survey response rates were 94% (34 of 36) for round 1 and 91% (31 of 34) for round 2 (overall 31 of 36; 86.1%). After 2 rounds we achieved the predefined consensus level for most competencies. Fourteen of 18 competencies (77.8%) reached consensus after round 2: 10 (55.6%) were deemed essential and 4 (22.2%) were deemed important but not essential. Essential competencies included the following: discusses patient history and plans for procedure with trainee (100%), assumes control of procedure when trainee is unable to progress or if patient safety concerns arise (100%), maintains attention throughout the case (96.8%), and discusses the next steps in management for the patient (96.8%). CONCLUSIONS: In a national Delphi survey of endoscopy education experts, we identified 10 essential endoscopy teaching competencies. These can be used to frame faculty development and standardize GI fellowship programs to promote high-quality endoscopy education.

Liraglutide-Induced Hemorrhagic Pancreatitis in a Nondiabetic Patient.

Liraglutide is a glucagon-like peptide 1 (GLP-1) analog with a primary effect of increased glucose-dependent insulin secretion and decreased gastric emptying. It serves as a feasible medical weight loss option because of the drug's effect of invoking satiety and lowering caloric intake. Despite emerging efficacy, the GLP-1 class has been associated with severe, although rare, adverse events, including pancreatitis. Previous investigations demonstrated the greatest association between GLP-1 agonist-associated pancreatitis in diabetic populations; however, liraglutide dosing is higher in weight loss formulations, placing the weight loss population at higher risk. We present a case of liraglutide-induced acute pancreatitis in a patient without diabetes.