Introduction

Non-technical skills training is a key component to developing an effective endoscopy workforce. The South-West Endoscopy Training Academy (SWETA), set out to train faculty to deliver this training across multiple endoscopy units throughout our region. This initiative is fully funded by Health Education England (HEE) via SWETA.

Aims & Methods

Enthusiastic endoscopy educators were sought to attend an adapted one-day train the simulation trainers course. They learned educational theory, debriefing skills and ran their own simulation scenarios. Each participating unit received simulation equipment including a simulated vital signs monitor and manikin to be able to deliver in-situ simulation sessions on their own endoscopy units. A portfolio of endoscopy-based scenarios was made available online. A pre-intervention centralised confidence survey was used to identify areas of perceived strengths and weaknesses within the endoscopy workforce to help focus training. This will be repeated after the study period so any improvements in staff confidence can be demonstrated. Post training feedback was collected online from participants following each sim session delivered locally.
The endoscopy simulation faculty attend a quarterly network meeting online to share feedback and discuss training delivery. They are encouraged to develop their own scenarios, often based on real life events, and share any latent errors they have identified so learning can be disseminated across the region’s endoscopy units.

Results

To date, 27 endoscopy staff including consultants, clinical endoscopists and endoscopy nurses from 10 endoscopy units have been trained as faculty between Mar-Nov 2022.
Pre-training confidence surveys from 49 endoscopy staff across 3 trusts have been collected highlighting perceived anxieties e.g. acting as a team leader and initiating management in a medical emergency. There was good knowledge of where emergency drugs and equipment were located and who to call in a medical emergency.
Eleven in-situ simulation sessions have been delivered in 3 units with feedback collected from 63 endoscopy staff. Example scenarios delivered included upper GI bleeding, over sedation and an acute asthma attack. Feedback has been universally positive. Participants described a renewed confidence to deal with medical emergencies, they appreciated the opportunity to receive feedback from their colleagues and were able to practice key communication and leadership skills. Latent errors were identified such as a faulty call bell in one endoscopy room and the lack of certain equipment e.g. rebreathe mask in recovery.

Conclusion

In-situ simulation is an effective method of delivering non-technical skills training to a regional multidisciplinary endoscopy workforce.

Introduction

Contributing to the on-call Upper Gastrointestinal Bleed (UGIB) rota is a crucial part of a consultant gastroenterologist's role. There is no standardised training in managing UGIB as part of the gastroenterology curriculum in the UK, with wide variation in experience amongst registrars by completion of training. Furthermore, with UK Gastroenterology training now reduced to four years, there are fewer opportunities for trainees to gain experience in UGIB. The Bristol Endoscopy Training Collaborative (BETC) developed an Upper Gastrointestinal Haemostasis Course to provide delegates with formal upper gastrointestinal bleeding training. The JAG pilot Upper GI Haemostasis course developed by BSG EQIP initiative was used as template (1)

Aims & Methods

We ran four 1-day courses at Vesalius Clinical Training Centre, Bristol, between November 2021 and November 2022, with 8 delegates & 4 faculty per course. Each course cost approximately £3000 to deliver, including venue hire and porcine models, and was fully funded by the Southwest Endoscopy Training Academy & Health Education England.
The course programme included small group, hands-on training for use of adrenaline injection, heater probe, clip placement, haemostatic powder, variceal banding and sclerotherapy. Porcine models (MedMeats) with simulated bleeds were used with accessory & equipment support from industry partners. Hands-on training for Sengstaken Tube (Steris) insertion and oesophageal stent (Danis) placement was demonstrated with plastic models.
Non-technical skills were taught using small group discussions covering topics including on-call role play, prioritisation in UGIB, pathology recognition, and report writing. Pre- and post- course confidence surveys were sent to delegates, and comparisons were made with the Mann-Whitney-U test. If quoting a company specific product need to reference company e.g. Hemospray (Cook Medical, Indiana, USA).

Results

31 delegates attended the four courses, with fully completed questionnaires obtained from 23 delegates. Most (21 of 23) participants were gastroenterology registrars; -surgical registrars, consultant gastroenterologists and clinical endoscopists also attended.
All delegates stated they would recommend the course to a colleague. Self-reported improvements were seen for all learning objectives:recognising pathology, technical skills and report writing. Most notably, confidence in holding the out of hours on call phone for UGIBs improved from an average of 4/10 to 8/10, (p value < 0.005).

Conclusion

We describe a cost-effective single-day course to improve training in management of UGIB. This course can be reproduced at other regional centres. Those looking to refresh or up-skill UGIB management would also benefit.

References

1. http://dx.doi.org/10.1136/gutjnl-2019-BSGAbstracts.484

Introduction

Gastroenterology is a medical specialty that includes several areas of study. Endoscopy occupies a central role in professional practice, whether in hospitals or in the private sector. The quality of initial training and the different needs of trainees are key to the quality of care delivered to the population. This study aims to assess endoscopic training experience during fellowship.

Aims & Methods

This is a cross-sectional, multicenter study conducted on gastroenterology residents practicing endoscopy and in the final phase of their curriculum (6th, 7th and 8th semesters). Postgraduated doctors have been excluded from the study. An electronic survey made by Google Forms and was sent nationwide on January 9, 2024. The survey consisted of 42 questions divided into 3 parts: The first part focused on the participants' socio-demographic data and their endoscopic experience, the second part focused on the quality of training of core endoscopic skills (cognitive and motor skills) during fellowship where a 5-point Likert scale was used to express residents' satisfaction with their skills, ranging from 1="very dissatisfied", 2="dissatisfied", 3="neither satisfied nor dissatisfied", 4="satisfied" and 5="very satisfied". The third part included questions in which participants expressed their needs and expectations for improving their training in endoscopy. A statistical analysis using the Student-t test and the Fisher’s exact test were performed. P values of <0.05 were considered statistically significant. Data were analyzed using Jamovi (Version 2.3).

Results

We were able to collect data from 56 respondents. Most were female residents n=40 (71.4) with a mean age of 29.2 ± 2.5 years. The majority of fellows started practicing EGD in their 4th semester (91.1%), and colonoscopy in their 6th semester (57%). On average, the fellows are supervised by 5 senior doctors, including 2 who practice interventional endoscopy. Furthermore, 37.5% of participants report performing approximately more than 100 EGDs, 14.2% more than 100 colonoscopies, 80.4% report that they have performed less than 20 endoscopic variceal ligation and 14.3% have performed more than 10 polypectomies. An average rating score of 3.34 (1= very dissatisfied; 5= very satisfied) concerning the quality of training and feedback on cognitive aspects of endoscopy was found and we reported greatest emphasis for Procedure indication/contraindication and least on Capsule endoscopy interpretation.
The quality of training in technical aspects of endoscopy was rated higher (average rating score of 3.5). We reported greatest emphasis for Withdrawal/mucosal inspection and least on Esophageal dilation.
A significant association between motor skills and cognitive skills was found with a p<0.001.
Finally, to improve their training, 87.5% of respondents considered simulation to be important/very important, 98.2% of respondents intend to complete their endoscopy training at the end of their curriculum, and 87.5% are prepared to finance such a project (median: 1000 USD [1000;3000]).

Conclusion

Despite a significant improvement in training sites and technical facilities, training in endoscopy in healthcare institutions does not yet provide all the cognitive and technical skills required to enable fellows to be fully autonomous. With the development of endoscopic procedures, it seems essential for fellows to be able to perform more standard endoscopic procedures such as polypectomy and mucosectomy by the end of their curriculum. This may involve introducing regular endoscopy conferences and simulation training as a part of the curriculum.

Introduction

Endoscopic submucosal dissection (ESD) was developed in Japan decades ago and is now widely used as a minimally invasive treatment in Western countries. On-the-job training is the major method for acquiring ESD skills; thus, learning ESD is difficult for foreign endoscopists, who have less opportunity to perform it in their country. ENDONIX (Olympus, Tokyo, Japan) is a laptop-based next-generation 3D printed endoscopy simulator that allows basic and advanced endoscopy training. This study aims to evaluate the effectiveness of ENDONIX training for improving novice foreign endoscopists’ ESD skills.

Aims & Methods

This prospective, single-center, exploratory study was conducted at National Cancer Center Hospital (NCCH) between January 2024 and January 2025. Foreign endoscopists who had performed fewer than three ESD cases and participated in an international training program at NCCH were included. Participants were assigned 1:1 to either the Group A (Day 1-14: ENDONIX training with ESD observation followed by Day 15-28: ESD observation alone) or Group B (Day 1-14: ESD observation alone followed by Day 15-28: ENDONIX training with ESD observation). During the training period, participants performed three basic and one advanced training program on ENDONIX every day. On Days 1, 15, and 29, the endoscopists performed ESD for a 2cm lesion at the lesser curvature of the middle gastric body using a non-animal ESD model (G-Master, KOTOBUKI MEDICAL, Tokyo, Japan), and their technical performance was assessed at each time point. All procedures were supervised by a single experienced endoscopist (TU). The primary endpoint was the improvement in dissection speed (mm/min²) from Day 1 to Day 15 between the groups. Paired t-test was used to compare the corresponding continuous variables.

Results

		Group A	Group B	P value
Day 1	mean (SD) [95% CI], mm2/min	12.2 (2.8) [6.8 – 17.7]	13.4 (2.2) [9.1 – 17.7]	0.75
Day 15	mean (SD) [95% CI], mm2/min	18.6 (2.8) [13.2 – 24.1]	12.6 (1.4) [9.9 – 15.4]	0.10
Day 29	mean (SD) [95% CI], mm2/min	27.4 (2.8) [22.0 – 32.8]	18.4 (1.6) [15.2 – 21.5]	< 0.05

A total of 10 foreign endoscopists were enrolled in this study. The median age was 34 in Group A and 28 years in Group B. Nationalities in Group A were Spanish (n=3), Portuguese (n=1), and Chinese (n=1); in Group B, Spanish (n=4) and Ukrainian (n=1). All Group A endoscopists specialized in gastroenterology; Group B included four gastroenterologists and one oncologist. No significant differences were found between groups in baseline endoscopic experience. All participants completed predetermined ENDONIX training during the study period. ESD was performed on all designated days using G-Master, and en-bloc resection was achieved for the target lesions on without intraoperative perforation or damaging the resected specimen. The mean dissection speed significantly increased from Day 1 to Day 15 in Group A (“ENDONIX training with ESD observation”) (12.2 vs 18.6, p < 0.05). No significant differences were observed from Day 1 to Day 15 in Group B (“ESD observation alone”) (13.4 vs. 12.6, p = 0.81), while the mean dissection speed significantly increased from Day 15 to Day 29 (12.6 vs. 18.4, p < 0.05). Although the difference on Day 15 was not statistically significant between the groups (18.6 vs. 12.6, p = 0.10), Group A demonstrated a significantly higher dissection speed than Group B on Day 29 (27.4 vs. 18.4 p < 0.05), (Table 1).

Conclusion

The systematic endoscopy training with the ENDONIX platform improved the novice foreign endoscopists’ ESD skills. Dissection speed increased in the period receiving systematic ENDONIX training, highlighting the importance of systematic endoscopy training.

Disclosure

None