of an endoscope, and aided by the close tutelage of a mentor. This book is not intended to replace the eye–hand coordination required of bedside endoscopy teaching, but does provide every other aspect required for effective transfer of endoscopic knowledge from teacher to student, and does this from several aspects: the teacher, the student and practitioners who desire to learn the latest material in the field of endoscopy. All three of these separate audiences need to know what is covered in this book on Successful Training in Gastrointestinal Endoscopy.
The World Endoscopy Organization (WEO) is pleased to endorse this book since its goals are clear and well defined: in order to perform endoscopy, one needs proper training. This training is best accomplished under the watchful tutelage of a person who is dedicated, expert, and facile not only in the performance of the procedure, but also in the ability to transfer skills to the next generation of endoscopists. The WEO promotes excellence in endoscopy throughout the entire world and focuses on bringing endoscopy to underserved areas where endoscopy is underutilized.
This second edition of the book, Successful Training in Gastrointestinal Endoscopy will be an invaluable resource to trainees as well as accomplished endoscopists who desire to learn new techniques. All endoscopists who are involved in training must read this book which contains the knowledge needed to successfully teach the techniques of endoscopy.
Jerome D. Waye, MD
Past President: World Endoscopy Organization
Past President: American Society for Gastrointestinal Endoscopy
Past President: American College of Gastroenterology
Professor Emeritus: Icahn School of Medicine at Mount Sinai
Preface
The field of gastrointestinal endoscopy is evolving at a rapid pace. In the 10 years since the publication of the first edition of Successful Training in Endoscopy, several then emerging technologies and techniques have become firmly established and adopted into GI practice. There has been a steady development of new accessories and devices, and adaption of existing tools to new applications. A heightened focus on optimizing quality performance in our procedures necessarily has required a renewed attention on how to ensure that the individuals asked to practice endoscopy are fully trained to achieve the highest possible outcomes. Quality metrics initially developed for major endoscopy procedures like colonoscopy and ERCP have been defined for more specific techniques. These in turn have enabled a transition to competency‐based education, along with the development of validated formative and summative objective assessment tools.
Competing diagnostic and therapeutic modalities threaten to make some of the standard procedures obsolete and challenge the individuals who spend most of their time performing them to adapt. For many individuals caught in this crossroads mid‐career, finding the time and opportunities to retool can be very challenging, irrespective of the personal economic concerns involved in making the commitment to upgrade skills in response to the changing conditions. Innovative new opportunities for retooling and learning new skills mid‐career have been developed in the last decade.
Resources for training in major GI endoscopy procedures and in specific advanced techniques remain limited. For many procedures, the trainers and trainees are hindered by the lack of sufficient case volume in the given technique to be taught. The availability of expert mentors to teach required skills can be another major impediment to training opportunities. Heightened attention to training the endoscopic teacher has emerged to address this need.
The increased demand for high‐quality training and the supply limitations due to the costs and time required for this labor‐intensive process have driven the development of novel teaching tools which aim to increase the efficiency of training, and where possible increase the potential for independent learning. A proliferation of online resources to supplement standard fellowship education has occurred over the past decade to fill some of this gap. The field of simulation has progressed steadily in the past decade, growing in popularity and access.
The purpose of this book is to provide a comprehensive examination of the principles and specific components of training in endoscopy. It was envisioned as a practical guide for teachers and trainees alike. For each procedure and technique considered, the authors describe what needs to be learned, how best to learn it, and how to ensure that sufficient training has taken place to ensure competency. The chapters examine both the generalized skills sets and specific procedure‐related tasks that must be mastered in learning a particular technique. They contain specific descriptions of accessories required, standard training methods for the procedure, and optimal utilization of novel learning modalities such as simulators. Quality measures and objective parameters for competency are considered when available, along with available tools for assessing competency once training has been completed.
The first section explores the important concepts of training and describes the range of tools that have been utilized in this regard. The next two sections provide in‐depth discussion of the major current endoscopic procedure categories as well as most specialized diagnostic and therapeutic techniques. For each of these chapters, the authors have considered prerequisite skills for training, skill sets to be mastered, step‐by‐step components that must be taught and assessed by trainers, typical learning curve for trainees, and objective measures of competency which trainees must strive to attain. For some of these topics, there has been scant literature to define these parameters. Accordingly, the authors have drawn from their extensive experience in training and performing these procedures to provide their recommendations where data are lacking. The material presented will identify important questions about training that warrant future investigation. Over 130 accompanying edited and annotated video clips of both actual procedures and ex‐vivo animal model simulations highlight key teaching points for instructors to emphasize. The final section looks to the future of training and retraining in gastrointestinal endoscopy. Key logistical hurdles to this process are examined and the importance of keeping track of outcomes, the ultimate indicator of successful training, is emphasized. Though the focus of this textbook remains on how to learn and how to teach each technique, because doing so requires delineation and illustration of all skill sets to master, the textbook chapters and particularly the video clips unavoidably serve as learning tools for the proper performance of endoscopic techniques in addition to an authoritative primer on training.
This new edition includes updated versions of 34 chapters from the 2011 edition and 5 new chapters on the following topics:
Training the endoscopic teacher
International opportunities for endoscopy training
Online resources for endoscopic training
Training in upper GI motility procedures
Training in anorectal endoscopy procedures
Text, figures, and annotated videos are also available online in the accompanying website.
Throughout my education and career, the best teachers I have known have exuded a passion both for teaching and for lifelong learning themselves. The driving force behind this book now, as initially in 2011, was my desire to gather the collective theory and wisdom about learning endoscopy, along with training data, references to key educational resources, and insights on teaching innovation in one volume. Training in endoscopy has remained an exciting field, keeping pace with evolution in clinical practice and closely tied to efforts to deliver optimal endoscopic care to patients. This second edition of Successful Training in Endoscopy is coming together as the endoscopy community worldwide is coming together to do
