James P D, Antonova L, Martel M, Barkun A
Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Best Pract Res Clin Gastroenterol. 2016 Jun;30(3):421-52. doi: 10.1016/j.bpg.2016.05.003. Epub 2016 May 27.
The diversity, technical skills required, and risk inherent to advanced endoscopy techniques all contribute to complex training curricula and steep learning curves. Since trainees develop endoscopy skills at different rates, there has been a shift towards competency-based training and certification. Validated endoscopy performance measures for trainees are, therefore, necessary. The aim of this systematic review was to describe and critically assess the existing evidence regarding measures of performance for trainees in advanced endoscopy.
A systematic review of the literature from January 1980 to January 2016 was carried out using the MEDLINE, EMBASE, CENTRAL, and ISI Web of knowledge databases. MeSH terms related to 'advanced endoscopy' and 'performance' were applied to a highly sensitive search strategy. The main outcomes were face, content, and construct validity, as well as reliability.
The literature search yielded 1,662 studies and 77 met the inclusion criteria after abstract and full-text review (endoscopic retrograde cholangiopancreatography (ERCP)=23, endoscopic ultrasound (EUS)=30, colonoscopic polypectomy (CP)=11, balloon-assisted enteroscopy (BAE)=7, luminal stenting=3, radiofrequency ablation (RFA)=2, and endoscopic muscosal resection (EMR)=1). Good validity and reliability were found for measurement tools of overall performance in ERCP, EUS and CP, with applications for both patient-based and simulator training models. A number of specific technical skills were also shown to be valid measures of performance. These include: selective biliary cannulation, sphincterotomy, biliary stent placement, stone extraction and procedure time for ERCP; pancreatic solid mass T-staging, EUS-guided fine needle aspiration (EUS-FNA) procedure time, number of EUS-FNA passes and puncture precision for EUS; procedure time and en bloc resection rate for CP; retrograde fluoroscopy time for BAE; and mean number of endoscopy sessions required to achieve complete eradication of intestinal metaplasia (CIEM) for RFA. The evidence for EMR and luminal stenting is of insufficient quality to make recommendations.
We have identified multiple valid and readily available performance measures for advanced endoscopy trainees for ERCP, EUS, CP, BAE and RFA procedures. These tools should be considered in advanced endoscopy training programs wishing to move away from apprenticeship-based training and towards competency-based learning with the help of patient-based and simulator tools.
高级内镜技术的多样性、所需的技术技能以及内在风险，都导致了复杂的培训课程和陡峭的学习曲线。由于学员掌握内镜技能的速度不同，培训已逐渐转向基于能力的培训和认证。因此，为学员制定经过验证的内镜操作性能评估标准很有必要。本系统评价的目的是描述并严格评估关于高级内镜学员操作性能评估标准的现有证据。
使用MEDLINE、EMBASE、CENTRAL和ISI Web of knowledge数据库，对1980年1月至2016年1月的文献进行系统评价。将与“高级内镜检查”和“操作性能”相关的医学主题词应用于高度敏感的检索策略。主要结果包括表面效度、内容效度、结构效度以及信度。
文献检索共得到1662项研究，经摘要和全文审查后，77项符合纳入标准（内镜逆行胰胆管造影术（ERCP）=23项、内镜超声检查（EUS）=30项、结肠镜息肉切除术（CP）=11项、气囊辅助小肠镜检查（BAE）=7项、腔内支架置入术=3项、射频消融术（RFA）=2项、内镜黏膜切除术（EMR）=1项）。在ERCP、EUS和CP的整体操作性能测量工具方面发现了良好的效度和信度，可应用于基于患者和模拟器的培训模式。一些特定的技术技能也被证明是有效的操作性能评估指标。这些指标包括：ERCP的选择性胆管插管、括约肌切开术、胆管支架置入、结石取出及操作时间；EUS的胰腺实性肿块T分期、EUS引导下细针穿刺抽吸术（EUS-FNA）操作时间、EUS-FNA穿刺次数及穿刺精度；CP的操作时间和整块切除率；BAE的逆行透视时间；以及RFA实现肠化生完全消除（CIEM）所需的内镜检查平均次数。关于EMR和腔内支架置入术的证据质量不足以提出建议。
我们已经确定了多种适用于ERCP、EUS、CP、BAE和RFA程序的高级内镜学员有效且现成的操作性能评估指标。对于希望摆脱学徒式培训、借助基于患者和模拟器的工具转向基于能力学习的高级内镜培训项目，应考虑使用这些工具。
