□ N/A, Study was normal (Go to question 11)
□ 1. Novice (Poor recognition of abnormalities. Misses or cannot ID significant pathology)
□ 2. Intermediate (Recognize abnormal findings but cannot interpret. “erythema”)
□ 3. Advanced (Recognizes abnormalities and correctly interprets. “colitis”)
□ 4. Superior (Competent identification and assessment. “Mild chronic appearing colitis in a pattern suggestive of UC”)
10a. Independent polyp detection by fellow
□ N/A. No polyps present□ 1. None (Staff identified all polyps)□ 2. Some (Fellow independently identified at least one polyp but not all polyps present)□ 3. All (Fellow independently ID’ed all polyps encountered)
10b. Accurate location of lesion/pathology:
□ 1. Novice (Unable to use landmarks to ID location in the colon, “I don’t know”)□ 2. Intermediate (Understands landmarks but either does not recognize or incorporate into decision‐making process)□ 3. Advanced (Good understanding and recognition of landmarks but generalizes pathology location “Descending colon”)□ 4. Superior (Very specific about location, e.g.“Splenic Flexure region approx. 60 cm from the anal verge with a straight scope”)Interventions performed by fellow:
CHECK ALL THAT APPLY
□ N/A – Fellow did not perform any interventions (go to question 12)
□ Biopsy □ APC Vascular lesion ablation (AVMs)
□ Snare polypectomy □ Hemostasis (Hemoclip, electrocautery, etc.)
□ Submucosal injection (Lift, Epinephrine, Tattoo) □ Other_____
11a. What was the fellow’s participation in the therapeutic maneuver(s) (ability to apply tool effectively)?
□ N/A. Not Assessed (i.e. Fellow observed procedure only)□ 1. Novice (Performed with significant hands‐on assistance or coaching)□ 2. Intermediate (Performed with minor hands‐on assistance or significant coaching)□ 3. Advanced (Performed independently with minor coaching)□ 4. Superior (Performed independently without coaching)
11b. What was the fellows knowledge of the therapeutic tool(s)(tool selection, knowledge of set up, cautery setting, how to employ tool)?
□ N/A. Not Assessed (i.e. Fellow observed procedure only)□ 1. Novice (Unsure of the possible tool(s) indicated or settings for pathology encountered)□ 2. Intermediate (Able to identify possible appropriate tool choices but not sure which would be ideal [Snare vs lift & snare])□ 3. Advanced (Independently selects the correct tool yet needs coaching on settings)□ 4. Superior (Independently identifies correct tool and settings as applicable)
Overall Assessment:
The fellow’s overall hands‐on skills:
□ N/A. Not Assessed (i.e. Fellow observed procedure only)
□ 1. Novice (Learning basic scope advancement; requires significant assistance and coaching)
□ 2. Intermediate (Acquired basic motor skills but still requires limited hands‐on assistance and/or significant coaching)
□ 3. Advanced (Able to perform independently with limited coaching and/or requires additional time to complete)
□ 4. Superior (Competent to perform routine colonoscopy independently)
The fellow’s overall cognitive skills (Situational Awareness (SA)/abnormality interpretation/decision‐making skills):
□ N/A. Not Assessed (i.e. Fellow observed procedure only)
□ 1. Novice (Needs significant prompting, correction or basic instruction by staff)
□ 2. Intermediate (Needs intermittent coaching or correction by staff)
□ 3. Advanced (Fellow has good SA, and interpretation/decision‐making skills)
□ 4. Superior (Competent to make interpretations and treatment decisions independently)
Figure 6.35 Learning curves. Mayo's colonoscopy skills assessment tool (MCSAT) allows ongoing monitoring of various metrics of an individual trainee's performance throughout training. These three images demonstrate how the learning curves of three different fellows (blue lines) might appear for the parameter of cecal intubation rates as compared to the average learning curves of their peers (Magenta). Fellow A is above the learning curve (a), B is following the curve closely (b), and C is repeatedly below the curve and might be identified for early remediation (c).
(Copyrighted and used with permission of Mayo Foundation for Medical Education and Research.)
Videos
Video 6.1 Endoscopic anatomy of the colon
Video 6.2 Rectal intubation techniques
Video 6.3 Locating the lumen
Video 6.4 Subtle lesions of colon
Video 6.5 Alpha‐loop
Video 6.6 N‐loop
Video 6.7 Reverse alpha‐loop
Video 6.8 Transverse colon loop
Video 6.9 Acute turn
Video 6.10 Intubation of the ileal–caecal valve
Video 6.11 Ex vivo colonoscopy model overview
Video 6.12 Ex vivo colonoscopy model setup
Video 1.6 Virtual reality colonoscopy simulator training
References
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10 10 Sawhney MS, Cury MS, Neeman N, et al.: Effect of institution‐wide policy of colonoscopy withdrawal time > or = 7 minutes on polyp detection. Gastroenterology 2008; 135:1892–1898.
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