Schlachterman Alexander, Aziz Ahmed, Alajlan Bader, Han Samuel, Machicado Jorge, Wagh Mihir S
Division of Gastroenterology and Hepatology, Thomas Jefferson University-Philadelphia, Pennsylvania, United States.
Division of Gastroenterology and Hepatology, University of Colorado-Denver, Colorado, United States.
Endosc Int Open. 2020 Dec;8(12):E1826-E1831. doi: 10.1055/a-1264-7542. Epub 2020 Nov 17.
Hands-on training for per-oral endoscopic myotomy (POEM) in the United States is limited and without a structured curriculum or assessment tool. Training to competency in POEM is critical and POEM trainees must acquire multiple cognitive and technical skills to achieve proficiency. The aim of this study was to develop a POEM training and skills evaluation tool. The training protocol included initial explant porcine models followed by live human cases, proctored by a single endoscopist experienced in POEM who prospectively graded trainees for each step ("skill") of the procedure on a 5-point scale. Procedural skills were divided into cognitive and technical skills. Acceptable passing level was considered a score ≥ 4 for each skill. Three trainees completed a total of 18 cases (8 cases on animal explant models and 10 human cases). Overall, cognitive skills were acquired early in training with scores of ≥ 4 achieved by ≤ 3 cases. Technical skills required more cases and direction with scores ≥ 4 in technical skills achieved by three porcine and eight human cases. Entry of the endoscope into the submucosal space and submucosal tunneling were the most challenging steps followed by myotomy. This pilot study introduces a POEM training and skills evaluation tool for training to competency. Submucosal entry, tunneling, and myotomy were the most challenging to learn while cognitive skills were learned early in training. Evaluation of more trainees at multiple sites will be necessary to further validate the utility of this tool.
在美国，经口内镜下肌切开术（POEM）的实践培训有限，且缺乏结构化的课程或评估工具。POEM培训至胜任水平至关重要，POEM学员必须掌握多种认知和技术技能才能达到熟练程度。本研究的目的是开发一种POEM培训和技能评估工具。培训方案包括最初的离体猪模型训练，随后是真人病例，由一名有POEM经验的内镜医师进行指导，该医师对手术过程的每一步（“技能”）按照5分制对学员进行前瞻性评分。操作技能分为认知技能和技术技能。每项技能得分≥4分被视为达到可接受的及格水平。三名学员共完成了18例手术（8例动物离体模型手术和10例真人手术）。总体而言，认知技能在培训早期即可掌握，≤3例手术的得分≥4分。技术技能需要更多的病例和指导，在3例猪手术和8例真人手术中技术技能得分≥4分。内镜进入黏膜下间隙和黏膜下隧道是继肌切开术之后最具挑战性的步骤。这项初步研究引入了一种用于培训至胜任水平的POEM培训和技能评估工具。黏膜下进入、隧道形成和肌切开术是最难掌握的，而认知技能在培训早期即可学会。有必要在多个地点对更多学员进行评估，以进一步验证该工具的实用性。
