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Figure 4.1 Stages of endoscopy skill acquisition

      (Adapted from Peyton [16]).

      Several studies have examined core attributes of effective endoscopy trainers. Pourmand et al. analyzed qualitative comments from post‐procedure feedback cards submitted by endoscopy trainees to identify endoscopic teaching behaviors perceived as beneficial or detrimental to their learning experience [21]. Seven themes were identified that related to the learning environment, autonomy, communication, coaching, feedback, and professionalism [21]. Another study by Kumar et al. outlined 10 essential teaching competencies for endoscopy trainers that were developed through expert consensus, including assessing trainee’s procedural competency, maintaining attention, use of standardized language, and feedback provision both during and after the procedure [22]. Based on the existing literature and data generated through interviews with training leads, trainers, trainees, and nurse endoscopists, Wells et al. classified characteristics of effective endoscopy trainers into six domains, including interpersonal attributes, endoscopy attributes, technical teaching attributes, developing as a teacher attributes, motivation to teach, and patient centered [23]. These characteristics were subsequently used to inform the development of a Direct Observation of Teaching Skills (DOTS) tool that can be used to evaluate endoscopy teaching performance. Additionally, they were used in the United Kingdom (UK) by the Joint Advisory Group on Gastrointestinal Endoscopy to inform the development of a list of attributes of effective trainers which encompass a patient‐centered approach, motivation, and an ability to perform and teach endoscopy, create an effective learning environment, and promote self‐reflective practice [24]. The aforementioned attributes of effective endoscopy trainers can be used by programs to help standardize expectations for endoscopy teaching and by trainers to assess and improve their own teaching as excellent teaching is a fundamental component to ensuring a high‐quality, endoscopy workforce.

Framework for endoscopic training

The use of a standardized teaching approach among trainers is increasingly recognized as important to ensure consistency in regard to what and how particular endoscopic skills are taught [15]. The following section outlines the Preparation–Training–Wrap‐up framework that can be used by endoscopic trainers to structure a training session, including essential elements to prepare for training, deliver performance enhancing training, and provide an effective wrap‐up (Figure 4.2) [4, 25]. A training session may be a single case or a block of procedures within a single day. This framework is also useful in structuring multiple trainee–trainer interactions over time. It is not only helpful for teaching trainees within the context of a gastroenterology fellowship program but can also serve as a useful guide for endoscopic trainers involved in supporting junior colleagues to help foster their skills development. This framework can be applied to train both basic and more advanced endoscopic skills, and it can also be used to structure teaching encounters within simulation‐based environments. This framework was originally used in “train‐the‐trainer” programs [20] in the United Kingdom and was later adapted by the Canadian Skills Enhancement in Endoscopy (SEE) Program [19] with great success.

      Preparation

      The preparation phase refers to the period prior to the start of a training session, which may be a single procedure or a set of procedures. Although time is limited in a busy clinical environment, it is important to take a small amount of time to properly prepare for a training session. Both physical and verbal preparations between the trainer and trainee are required to ensure an effective, safe, and efficient learning environment. The physical component of the preparation phase relates to the set‐up of the training environment, whereas the verbal component includes assessment of the trainee’s skill level, alignment of agendas between the trainer and trainee and formation of an educational contract, including generation of learning objectives and discussion of ground rules.