Acad Med. 2024 Mar 1;99(3):317-324. doi: 10.1097/ACM.0000000000005538. Epub 2023 Nov 7.
Practicing endoscopists frequently perform and teach screening colonoscopies and polypectomies, but there is no standardized method to train and assess physicians who perform polypectomy procedures. The authors created a polypectomy simulation-based mastery learning (SBML) curriculum and hypothesized that completion of the curriculum would lead to immediate improvement in polypectomy skills and skill retention at 6 and 12 months after training.
The authors performed a pretest-posttest cohort study with endoscopists who completed SBML and were randomized to follow-up at 6 or 12 months from May 2021 to August 2022. Participants underwent SBML training, including a pretest, a video lecture, deliberate practice, and a posttest. All learners were required to meet or exceed a minimum passing standard on a 17-item skills checklist before completing training and were randomized to follow-up at 6 or 12 months. The authors compared simulated polypectomy skills performance on the checklist from pretest to posttest and posttest to 6- or 12-month follow-up test.
Twenty-four of 30 eligible participants (80.0%) completed the SBML intervention, and 20 of 24 (83.3%) completed follow-up testing. The minimum passing standard was set at 93% of checklist items correct. The pretest passing rate was 4 of 24 participants (16.7%) compared with 24 of 24 participants (100%) at posttest ( P < .001). There were no significant differences in passing rates from posttest to combined 6- and 12-month posttest in which 18 of 20 participants (90.0%) passed.
Before training and despite years of clinical experience, practicing endoscopists demonstrated poor performance of polypectomy skills. SBML was an effective method for practicing endoscopists to acquire and maintain polypectomy skills during a 6- to 12-month period.
有经验的内镜医生经常进行并教授筛查性结肠镜检查和息肉切除术，但目前还没有标准化的方法来培训和评估进行息肉切除术的医生。作者创建了一种基于息肉切除术模拟的掌握学习（SBML）课程，并假设完成该课程将立即提高息肉切除术技能，并在培训后 6 个月和 12 个月保持技能。
作者进行了一项前瞻性队列研究，研究对象为完成 SBML 的内镜医生，并在 2021 年 5 月至 2022 年 8 月期间随机选择在 6 个月或 12 个月进行随访。参与者接受 SBML 培训，包括预测试、视频讲座、刻意练习和后测试。所有学习者都必须在满足或超过 17 项技能检查表的最低通过标准后才能完成培训，并在 6 个月或 12 个月后进行随机随访。作者比较了从预测试到后测试以及后测试到 6 个月或 12 个月随访测试的检查表上模拟息肉切除术技能表现。
24 名符合条件的参与者（80.0%）完成了 SBML 干预，其中 20 名（83.3%）完成了随访测试。最低通过标准设定为检查表项目正确的 93%。预测试通过率为 24 名参与者中的 4 名（16.7%），而 24 名参与者中的 24 名（100%）在后测试中通过（P<0.001）。在后测试到 6 个月和 12 个月后测试的组合中，没有显著差异，有 18 名参与者（90.0%）通过。
在培训之前，尽管有多年的临床经验，内镜医生的息肉切除术技能表现仍较差。SBML 是一种有效的方法，可使内镜医生在 6 至 12 个月的时间内获得和保持息肉切除术技能。
