Department of Surgery, Uniformed Services University of the Health Sciences/Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bethesda, MD, 20889, USA.
Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.
Surg Endosc. 2019 Apr;33(4):1189-1195. doi: 10.1007/s00464-018-6395-6. Epub 2018 Aug 27.
The SAGES flexible endoscopy course for minimally invasive surgery (MIS) fellows improves confidence and skills in performing gastrointestinal (GI) endoscopy. This study evaluated the long-term retention of these confidence levels and investigated how fellows changed practices within their fellowships due to the course.
Participating MIS fellows completed surveys 6 months after the course. Respondents rated their confidence to independently perform 16 endoscopic procedures (1 = not at all; 5 = very), barriers to use of endoscopy, and current uses of endoscopy. Respondents also noted participation in additional skills courses and status of fundamentals of endoscopic surgery (FES) certification. Comparisons of responses from the immediate post-course survey to the 6-month follow-up survey were examined. McNemar and paired t tests were used for analyses.
23 of 57 (40%) course participants returned to the 6-month survey. No major barriers to endoscopy use were identified. Fellows reported less competition with GI providers as a barrier to practice compared to their original post-course expectations (50% vs. 86%, p < 0.01). In addition, confidence was maintained in performing the majority of the 16 endoscopic procedures, although fellows reported significant decreases in confidence in independently performing snare polypectomy (- 26%; p < 0.05), control of variceal bleeding (- 39%; p < 0.05), colonic stenting (- 48%; p < 0.01), BARRX (- 40%; p < 0.05), and TIF (- 31%; p < 0.05). Fewer fellows used the GI suite to manage surgical problems than was anticipated post course (26% vs. 74%, p < 0.01). Fellows who passed FES noted no significant loss of independence, changes in use, or barriers to use. 18% made additional partnerships with industry after the course. 41% stated flexible endoscopy has influenced their post-fellowship job choice.
The SAGES flexible endoscopy course for MIS fellows results in long-term practice changes with participating fellows maintaining confidence to perform the majority of taught endoscopic procedures 6 months later. Additionally, fellows experienced no major barriers to implementing endoscopy into practice.
SAGES 微创外科内镜课程可提高学员进行胃肠内镜检查的信心和技能。本研究评估了这些信心水平的长期保持情况，并探讨了学员因该课程而如何改变其在培训中的实践。
参加微创外科培训的学员在课程结束后 6 个月完成了调查。受访者对独立进行 16 项内镜检查程序的能力进行评分（1=一点也不；5=非常），并对内镜使用的障碍以及当前内镜使用情况进行评分。受访者还记录了参加额外技能课程的情况以及内镜手术基础（FES）认证的状态。比较课程结束后即刻调查和 6 个月随访调查的回复。采用 McNemar 和配对 t 检验进行分析。
57 名课程参与者中有 23 名（40%）返回了 6 个月的调查。没有发现内镜使用的主要障碍。与最初课程结束后的预期相比，学员报告说与 GI 提供者竞争不再是实践的障碍（50%对 86%，p<0.01）。此外，大多数 16 项内镜检查程序的操作能力得到了保持，尽管学员报告说在独立进行圈套息肉切除术（-26%；p<0.05）、控制静脉曲张出血（-39%；p<0.05）、结肠支架置入术（-48%；p<0.01）、BARRX（-40%；p<0.05）和 TIF（-31%；p<0.05）方面的信心显著下降。与课程结束后的预期相比，学员较少使用 GI 套房来处理手术问题（26%对 74%，p<0.01）。通过 FES 认证的学员表示，他们没有失去独立性、使用变化或使用障碍。课程结束后，18%的学员与行业建立了额外的合作伙伴关系。41%的学员表示，内镜检查影响了他们在培训后的工作选择。
SAGES 微创外科内镜课程可使学员长期保持实践变化，参与课程的学员在 6 个月后仍保持对所学内镜检查程序的大部分操作信心。此外，学员在将内镜纳入实践中没有遇到重大障碍。
