Changing Attitudes and Improving Skills: Demonstrating the Value of the SAGES Flexible Endoscopy Course for Fellows

Aimee K Gardner, PhD1, Jeffrey M Marks, MD2, Eric M Pauli, MD3, Arnab Majumder, MD2, Brian J Dunkin, MD4. 1UT Southwestern Medical Center, 2Case Western Reserve University, 3Penn State Hershey Medical Center, 4Houston Methodist Hospital

Background: Since 2006, SAGES has sponsored a flexible endoscopy course to help MIS fellows become familiar with GI endoscopes, instruments, GI pathology, and endoscopic options for disease management. The purpose of this study was to examine the effectiveness of the course in improving fellows’ attitudes, confidence, and skills related to implementing endoscopy in practice.

Methods: Fellows participated in a two-day course consisting of case presentations, expert panels, and hands-on lab training.  Before and after the course, fellows completed a questionnaire assessing demographics, experiences in residency, practice plans, plans to implement flexible endoscopy in practice, and level of confidence performing 15 endoscopic procedures. Half of the fellows were randomly assigned to complete pre and post skills testing using a previously-validated endoscopic targeting model.

Results: Fifty-four fellows (90%; age 33.5±2.8; 58% male) completed the pre and post questionnaire. All MIS fellowship types were represented. Almost half (48.2%) reported none or very little flexible endoscopy in their current fellowship. The average prior case volume among those completing an ACGME approved residency (42/54) was 76 upper and 75 lower endoscopies with one third reporting no experience in therapeutic EGD (33%) or polypectomy (31%).  Intentions to implement flexible endoscopy in practice significantly improved after the course overall (3.72±.85 to 3.92±.69, p<.05; 1=never; 5=very frequently). Prior to the course, 38.9% of fellows reported plans to use endoscopy in practice “occasionally” or “rarely.” After, this decreased to 28% with 72% planning to implement “frequently” or “very frequently.” The most robust changes in plans to use endoscopy in practice were use in the OR to manage surgical complications (59.3% to 80.7%; p<.05) or to avoid the “politics” of working in the GI suite (5.6% to 19.3%, p<.05). Additionally, mean levels of confidence performing all 15 endoscopic tasks improved significantly after the course. Tasks that moved from a low confidence level to one high enough to be ready to adopt into practice by the majority of fellows included management of non-variceal bleeding, esophageal stenting, and RF ablation of esophageal mucosa. Skills performance for the 27 fellows improved significantly as well, with participants decreasing their time to perform the targeting task by 40% (222.3±119.8 to 133.0±70.1 seconds; p<.001) and errors by 49% (2.90±1.7 to 1.48±1.48; p<.001).

Conclusions: These results indicate that the SAGES flexible endoscopy course increases fellow confidence to implement endoscopic techniques, expands the ways in which they plan to include endoscopy in practice, and enhances their endoscopic skills. 

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