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2.
Medicine (Baltimore) ; 98(48): e18129, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770244

RESUMO

BACKGROUND: This study aims to assess the effect of Balint training (BT) in gastroenterology intern nurse practitioners (GINP) systematically. METHODS: This study will search EMBASE, MEDLINE, PsycINFO, Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, and China National Knowledge Infrastructure from inception to the September 30, 2019 with no language limitation. In addition, we will also search grey records, such as conference abstracts and dissertations. Study quality will be checked using Cochran risk of bias tool. Statistical analysis will be performed using RevMan 5.3 software. RESULTS: This study will systematically evaluate the effect of BT in GINP and will provide evidence to judge whether BT is effective for GINP clinically. CONCLUSION: The results of this study may provide helpful evidence of BT in GINP in the clinical training.


Assuntos
Gastroenterologia/educação , Profissionais de Enfermagem/educação , Terapia Psicanalítica/educação , Avaliação Educacional , Humanos , Projetos de Pesquisa , Revisão Sistemática como Assunto
4.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(10): 972-976, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31630496

RESUMO

Objective: To study the role of virtual gastroscopy simulator in the examination of clinical practice skills of gastrointestinal specialists. Methods: A multi-center empirical study was carried out. In June 2018, ninety participants from three tertiary care teaching hospitals in China, including Zhongshan Hospital of Fudan University, Shanghai Tongji Hospital and Xiangya Hospital of Central South University, took part in the examination. Participants were selected as follows: 30 specialists without any experience of gastroscopy exams, 30 with basic knowledge (gastroscopy exams <500 cases) and 30 with good skill (gastroscopy exams ≥500 cases). These 90 students participated in this empirical study after theoretical study and simulator training. Among them, 50 (55.6%) were undergraduates, 25 (27.8%) masters, and 15 (16.7%) doctors; 42 (46.7%) were residents, 39 (43.3%) attending physicians, and 9 (10.0%) deputy chief physicians. The assessment was divided into two parts. The first part was to use the simulator (GI mentor II) for ballooning within 10 minutes, with a total score of 40 points. The second part was a complete gastroscopy exam on the simulator, including preparation before gastroscopy exam, gastroscopy exam, post - exam management and related knowledge quiz. The difficulty and discrimination of the assessment plan were evaluated by the extreme grouping method parameters (difficulty P definition: <0.3 was difficult, 0.3 to 0.7 was medium, ≥0.7 was easy; discrimination degree D definition: <0 was poor, 0 to 0.2 was medium, ≥0.2 was good), and by comparing the virtual gastroscopy assessment scores of different experience, academic, and professional title groups. The score analysis of the student group was expressed using the mastering rate (the average score divided by the total score). The data of the normal distribution was represented by (mean±SD) (range), and the data of the nonnormal distribution was represented by M (P25, P75). Kruskal-Wallis non-parametric test was used for comparison between groups. Results: The total score of 90 students was (82.9±10.9) (55.8 to 99.0), and the mastering rate was 82.9%. The overall difficulty of the first and the second parts were 0.78 and 0.76, respectively, and the difficulty level was easy. The overall discrimination of the first and the second parts were 0.70 and 0.67, respectively, and the discrimination was good. The stratified analysis was performed according to the professional title. The median score was 83.2 (75.5, 89.0) in the residents, 82.5 (71.7, 93.6) in the attending physicians, and 93.5 (88.5, 99.0) in the deputy chief physicians, and the difference was statistically significant (H=6.213, P=0.045). According to the stratification analysis of academic qualifications, the median score was 81.7 (73.0, 87.5) in participants with undergraduate degree, 91.0 (79.0, 95.0) in those with master degree and 88.0 (81.7, 93.5) in those with doctor degree, whose difference was statistically significant (H=9.233, P=0.010). The stratified analysis of the second part showed that the median scores of the "operational process" part of the low, medium and high basis group were 33.0 (30.5, 36.5), 34.0 (32.0, 36.0) and 37.0 (35.0, 37.5), respectively, whose difference was statistically significant (H=7.603, P=0.022). The median scores of the "operational process" section of the resident, attending physician, and deputy chief physician were 33.0 (30.5, 35.0) points, 36.0 (34.0, 37.5) points and 37.0 (37.0, 37.5) points, respectively, whose difference was statistically significant (H=18.563, P=0.001). Conclusions: The virtual gastroscopy simulator can reflect the true level of gastroscopy exam skills of the students. The examination questions are moderately difficult, and there is a good discrimination of the exam.


Assuntos
Competência Clínica , Simulação por Computador , Educação de Pós-Graduação em Medicina/métodos , Gastroenterologia/educação , Gastroscopia/educação , Avaliação Educacional , Gastroscopia/métodos , Humanos
6.
Z Gastroenterol ; 57(9): 1124-1130, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31525803

RESUMO

INTRODUCTION: The specific support of medical students is indispensable in gastroenterology. The aim of this study was to identify factors that influenced members of the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS) to choose their specialty. METHODS: Using an online survey all members of the DGVS were invited to assess the following factors: earliest time point of the decision to become a gastroenterologist, important role models and mentors, important course contents and teaching methods, the role of the doctoral thesis and other influencing aspects of the specialty gastroenterology. The evaluation included an additional subgroup analysis involving work experience (≤ 8, 9-29, ≥ 30 years) and working place (university hospital, community-based hospital, private practice). RESULTS: 1358 participants representing 24.2 % of the DGVS-members took part in the survey. Physicians with ≤ 8 years of work experience decided in 62.5 % during medical school to become a gastroenterologist compared to 37.1 % of the physicians with a work experience of ≥ 9 years (p < 0.001). Senior physicians were regarded as important role models and mentors by 40.8 % of the participants. Doctoral supervisors were regarded as important mentors that influenced the selection of the specialty by 42.8 % of the participants that completed their doctoral thesis in gastroenterology. Hands-on courses like sonography were regarded as important course contents by 42.2 % of the participants. Interventional medicine in particular endoscopy and the diversity of gastroenterology were rated as important in the selection process for the specialty. CONCLUSION: The decision to become a gastroenterologist is mainly made during medical school. The main influencing role models and mentors are senior physicians. Hands-on training in ultrasound and endoscopy were regarded as important course contents and teaching methods.


Assuntos
Gastroenterologistas/psicologia , Gastroenterologia/educação , Mão de Obra em Saúde , Médicos/psicologia , Hospitais Universitários , Humanos , Medicina , Sociedades Médicas , Inquéritos e Questionários
8.
World J Gastroenterol ; 25(27): 3468-3483, 2019 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-31367151

RESUMO

Endoscopic-retrograde-cholangiopancreatography (ERCP) is now a vital modality with primarily therapeutic and occasionally solely diagnostic utility for numerous biliary/pancreatic disorders. It has a significantly steeper learning curve than that for other standard gastrointestinal (GI) endoscopies, such as esophagogastroduodenoscopy or colonoscopy, due to greater technical difficulty and higher risk of complications. Yet, GI fellows have limited exposure to ERCP during standard-three-year-GI-fellowships because ERCP is much less frequently performed than esophagogastroduodenoscopy/colonoscopy. This led to adding an optional year of training in therapeutic endoscopy. Yet many graduates from standard three-year-fellowships without advanced training intensely pursue independent/unsupervised ERCP privileges despite inadequate numbers of performed ERCPs and unacceptably low rates of successful selective cannulation of desired (biliary or pancreatic) duct. Hospital credentialing committees have traditionally performed ERCP credentialing, but this practice has led to widespread flouting of recommended guidelines (e.g., planned privileging of applicant with 20% successful cannulation rate, or after performing only 7 ERCPs); and intense politicking of committee members by applicants, their practice groups, and potential competitors. Consequently, some gastroenterologists upon completing standard fellowships train and learn ERCP "on the job" during independent/unsupervised practice, which can result in bad outcomes: high rates of failed bile duct cannulation. This severe clinical problem is indicated by publication of ≥ 12 ERCP competency studies/guidelines during last 5 years. However, lack of mandatory, quantitative, ERCP credentialing criteria has permitted neglect of recommended guidelines. This work comprehensively reviews literature on ERCP credentialing; reviews rationales for proposed guidelines; reports problems with current system; and proposes novel criteria for competency. This work advocates for mandatory, national, written, minimum, quantitative, standards, including cognitive skills (possibly assessed by a nationwide examination), and technical skills, assessed by number performed (≥ 200-250 ERCPs), types of ERCPs, success rate (approximately ≥ 90% cannulation of desired duct), and letters of recommendation by program director/ERCP mentor. Mandatory criteria should ideally not be monitored by a hospital committee subjected to intense politicking by applicants, their employers, and sometimes even competitors, but an independent national entity, like the National Board of Medical Examiners/American Board of Internal Medicine.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/normas , Competência Clínica/normas , Credenciamento/normas , Gastroenterologistas/normas , Gastroenterologia/normas , Doenças Biliares/diagnóstico por imagem , Doenças Biliares/cirurgia , Gastroenterologistas/educação , Gastroenterologia/educação , Humanos , Internato e Residência/normas , Pancreatopatias/diagnóstico por imagem , Pancreatopatias/cirurgia , Resultado do Tratamento , Estados Unidos
11.
Gastroenterol Nurs ; 42(3): 242-250, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31145248

RESUMO

Twenty percent of all ambulatory surgery cases utilizing monitored anesthesia care and sedation report at least one perioperative respiratory complication such as bronchospasm, hypoxia, laryngospasm, or aspiration (). However, the national Standards of Practice for both surgical technicians and ambulatory care nurses do not mandate emergency airway education beyond cardiopulmonary resuscitation and Basic Life Support training. A local outpatient gastroenterology clinic noticed the gap in education, and the anesthesia team decided to implement an evidence-based dual-factorial quality improvement project utilizing online education and in situ simulation. First, registered nurses and procedural technologists completed a test to assess their baseline knowledge and airway emergency performance self-efficacy levels. Then an online module was distributed that included information on the 3 most common anesthesia airway emergencies in the outpatient setting: laryngospasm, aspiration, and obstruction with resultant hypoxemia. Next, participants completed an in situ simulation of the 3 airway emergencies using low-fidelity mannequins. A post-education assessment was distributed after completion of the simulation training and again at 6 weeks and 3 months post-implementation. The data collected showed a statistically significant increase in both knowledge scores and levels of self-efficacy at 6 weeks and 3 months posteducation (p < .001).


Assuntos
Manuseio das Vias Aéreas , Assistência Ambulatorial , Anestesia , Educação a Distância , Gastroenterologia/educação , Adulto , Competência Clínica , Currículo , Emergências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autoeficácia , Treinamento por Simulação , Adulto Jovem
13.
Gastrointest Endosc ; 90(1): 13-26, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31122744

RESUMO

Interest in the use of simulation for acquiring, maintaining, and assessing skills in GI endoscopy has grown over the past decade, as evidenced by recent American Society for Gastrointestinal Endoscopy (ASGE) guidelines encouraging the use of endoscopy simulation training and its incorporation into training standards by a key accreditation organization. An EndoVators Summit, partially supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health, (NIH) was held at the ASGE Institute for Training and Technology from November 19 to 20, 2017. The summit brought together over 70 thought leaders in simulation research and simulator development and key decision makers from industry. Proceedings opened with a historical review of the role of simulation in medicine and an outline of priority areas related to the emerging role of simulation training within medicine broadly. Subsequent sessions addressed the summit's purposes: to review the current state of endoscopy simulation and the role it could play in endoscopic training, to define the role and value of simulators in the future of endoscopic training and to reach consensus regarding priority areas for simulation-related education and research and simulator development. This white paper provides an overview of the central points raised by presenters, synthesizes the discussions on the key issues under consideration, and outlines actionable items and/or areas of consensus reached by summit participants and society leadership pertinent to each session. The goal was to provide a working roadmap for the developers of simulators, the investigators who strive to define the optimal use of endoscopy-related simulation and assess its impact on educational outcomes and health care quality, and the educators who seek to enhance integration of simulation into training and practice.


Assuntos
Endoscopia Gastrointestinal/educação , Gastroenterologia/educação , Treinamento por Simulação , Humanos
14.
Gastrointest Endosc ; 90(1): 27-34, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31122745

RESUMO

This White Paper shares guidance on the important principles of training endoscopy teachers, the focus of an American Society for Gastrointestinal Endoscopy (ASGE)/World Endoscopy Organization Program for Endoscopic Teachers and Leaders of Endoscopic Training held at the ASGE Institute for Training and Technology. Key topics included the need for institutional support and continuous skills development, the importance of consensus and consistency in content and approach to teaching, the role of conscious competence and content breakdown into discreet steps in effective teaching, defining roles of supervisors versus instructors to ensure teaching consistency across instructors, identification of learning environment factors and barriers impacting effective teaching, and individualized training that incorporates effective feedback and adapts with learner proficiency. Incorporating simulators into endoscopy teaching, applying good endoscopy teaching principles outside the endoscopy room, key principles of hands-on training, and effective use of simulators and models in achieving specific learning objectives were demonstrated with rotations through hands-on simulator stations as part of the program. A discussion of competency-based assessment was followed by live sessions in which attendees applied endoscopy teaching principles covered in the program. Conclusions highlighted the need for the following: formal training of endoscopy teachers to a level of conscious competence, incorporation of formal training structures into existing training curricula, intentional teaching preparation, feedback to trainees and instructors alike aimed at improving performance, and competency-based trainee assessment. The article is intended to help motivate individuals who play a role in training other endoscopists to develop their teaching abilities, promote discussions about endoscopy training, and engage both endoscopy trainers and trainees in a highly rewarding learning process that is in the best interest of patients.


Assuntos
Competência Clínica , Endoscopia Gastrointestinal/educação , Gastroenterologia/educação , Treinamento por Simulação , Capacitação de Professores , Currículo , Feedback Formativo , Humanos , Ensino/educação
15.
Gastrointest Endosc ; 90(1): 1-12, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31122746

RESUMO

BACKGROUND AND AIMS: Simulation refers to educational tools that allow for repetitive instruction in a nonpatient care environment that is risk-free. In GI endoscopy, simulators include ex vivo animal tissue models, live animal models, mechanical models, and virtual reality (VR) computer simulators. METHODS: After a structured search of the peer-reviewed medical literature, this document reviews commercially available GI endoscopy simulation systems and clinical outcomes of simulation in endoscopy. RESULTS: Mechanical simulators and VR simulators are frequently used early in training, whereas ex vivo and in vivo animal models are more commonly used for advanced endoscopy training. Multiple studies and systematic reviews show that simulation-based training appears to provide novice endoscopists with some advantage over untrained peers with regard to endpoints such as independent procedure completion and performance time, among others. Data also suggest that simulation training may accelerate the acquisition of specific technical skills in colonoscopy and upper endoscopy early in training. However, the available literature suggests that the benefits of simulator training appear to attenuate and cease after a finite period. Further studies are needed to determine if meeting competency metrics using simulation will predict actual clinical competency. CONCLUSIONS: Simulation training is a promising modality that may aid in endoscopic education. However, for widespread incorporation of simulators into gastroenterology training programs to occur, simulators must show a sustained advantage over traditional mentored teaching in a cost-effective manner. Because most studies evaluating simulation have focused on novice learners, the role of simulation training in helping practicing endoscopists gain proficiency using new techniques and devices should be further explored.


Assuntos
Endoscopia Gastrointestinal/educação , Gastroenterologia/educação , Treinamento por Simulação/métodos , Humanos , Modelos Anatômicos , Realidade Virtual
16.
Gastroenterol Nurs ; 42(2): 169-178, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30946304

RESUMO

Healthcare professionals responsible for patients with gastrointestinal diseases need a particular level of nursing knowledge and abilities to ensure excellent care. This study aims to propose a set of core competencies for the gastroenterology nursing specialists (GNS) in China. This research integrates quantitative and qualitative research methods. Literature review, semistructured interview, and the Delphi approach were used to develop the core competency items of GNS in China. SPSS 16.0 was used to analyze the data. Finally, 28 of 30 experts participated in the study resulting in a consensual list containing 7 domains (clinical nursing practice, communication and collaboration, education and counseling, critical thinking, leadership, ethical and legal practice, and professional development), 23 aspects, and 66 competencies required for GNS. The authority coefficient (Cr) of the consensus was 0.77, and the Kendall (W) value of each level of competencies all scored above 0.5. Results of the study can serve as a foundation of work performance evaluation for GNS as well as promote nurses' professional development.


Assuntos
Competência Clínica , Gastroenterologia/educação , Enfermeiras Especialistas/educação , Inquéritos e Questionários , China , Consenso , Currículo , Técnica Delfos , Humanos , Pesquisa Qualitativa
18.
Dig Dis Sci ; 64(5): 1074-1078, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30863954

RESUMO

GOAL: To assess publicly available content derived from official websites of accredited gastroenterology fellowship programs, specifically evaluating data pertinent to prospective applicants. BACKGROUND: The Internet provides access to key information for applicants applying to gastroenterology fellowship, particularly as competition drives applicants to apply to a large number of programs. Thus, it is important for fellowship program websites to be up to date and contain accurate and pertinent information. METHODS: Twenty-nine variables, determined as important website content on the basis of prior published website analyses and from surveys of preferences, were extracted from the relevant websites of all accredited gastroenterology fellowships in the USA. Results were binary-i.e., a website either contained or did not contain each item. RESULTS: A total of 178 websites were evaluated. The mean number of online content items was 14.1(± 3.2 SD) out of a possible 29 (47.1%). Program coordinator contact information, application information, and the number of current fellows were accessible on > 80% of websites. In contrast, the typical number and types of procedures performed by fellows and number of hospitals covered by fellows on call were found on < 10% of websites. Analysis revealed that 23.2% of lifestyle, 48.3% of training, and 59.6% of program variables were met. CONCLUSIONS: Gastroenterology fellowship websites lacked important content. Websites had a lower mean percentage of lifestyle content compared to training and program-related items. An organized website containing relevant information may not only attract qualified applicants but also avert unnecessary email inquiries and inappropriate applications. This study may provide guidance to gastroenterology fellowship programs seeking to improve their websites for applicants.


Assuntos
Bolsas de Estudo/normas , Gastroenterologia/educação , Gastroenterologia/normas , Internet/normas , Internato e Residência/normas , Acreditação/tendências , Bolsas de Estudo/tendências , Gastroenterologia/tendências , Humanos , Internet/tendências , Internato e Residência/tendências
19.
Gastrointest Endosc ; 89(6): 1160-1168.e9, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30738985

RESUMO

BACKGROUND AND AIMS: Minimum EUS and ERCP volumes that should be offered per trainee in "high quality" advanced endoscopy training programs (AETPs) are not established. We aimed to define the number of procedures required by an "average" advanced endoscopy trainee (AET) to achieve competence in technical and cognitive EUS and ERCP tasks to help structure AETPs. METHODS: American Society for Gastrointestinal Endoscopy (ASGE)-recognized AETPs were invited to participate; AETs were graded on every fifth EUS and ERCP examination using a validated tool. Grading for each skill was done using a 4-point scoring system, and learning curves using cumulative sum analysis for overall, technical, and cognitive components of EUS and ERCP were shared with AETs and trainers quarterly. Generalized linear mixed-effects models with a random intercept for each AET were used to generate aggregate learning curves, allowing us to use data from all AETs to estimate the average learning experience for trainees. RESULTS: Among 62 invited AETPs, 37 AETs from 32 AETPs participated. Most AETs reported hands-on EUS (52%, median 20 cases) and ERCP (68%, median 50 cases) experience before starting an AETP. The median number of EUS and ERCPs performed per AET was 400 (range, 200-750) and 361 (range, 250-650), respectively. Overall, 2616 examinations were graded (EUS, 1277; ERCP-biliary, 1143; pancreatic, 196). Most graded EUS examinations were performed for pancreatobiliary indications (69.9%) and ERCP examinations for ASGE biliary grade of difficulty 1 (72.1%). The average AET achieved competence in core EUS and ERCP skills at approximately 225 and 250 cases, respectively. However, overall technical competence was achieved for grade 2 ERCP at about 300 cases. CONCLUSION: The thresholds provided for an average AET to achieve competence in EUS and ERCP may be used by the ASGE and AETPs in establishing the minimal standards for case volume exposure for AETs during their training. (Clinical trial registration number: NCT02509416.).


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Competência Clínica , Educação de Pós-Graduação em Medicina/normas , Endoscopia do Sistema Digestório/educação , Endossonografia , Bolsas de Estudo/normas , Gastroenterologia/educação , Curva de Aprendizado , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Humanos , Estudos Prospectivos , Esfinterotomia Endoscópica/educação
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