Successful Training in Gastrointestinal Endoscopy - Группа авторов

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      In the endoscopy training community, the UK system has frequently been referenced due to the system changes that occurred in direct response to quality measures in their health care system [70–72]. The JAG in the United Kingdom, which was established in 1994 to standardize endoscopy training across specialties, has developed a robust endoscopy training system which includes a competency‐based certification process and transparent benchmarks for endoscopists and procedure‐specific “train‐the‐trainer” courses for faculty who teach endoscopy [70]. Additionally, accreditation standards for endoscopy units are directly linked to provision of adequate endoscopy training [73]. Colonoscopy quality outcomes in the United Kingdom have subsequently improved substantially [70, 74]. While the reason for this improvement was likely multifactorial, nationally driven training‐related interventions likely played a large role, including more structured training for both trainees and trainers, development of national training courses, and ongoing assessment of training quality within endoscopy units.

      The JAG’s “train‐the‐trainer” program was shared with the Canadian Association of Gastroenterology, who adapted the program and developed the SEE Program (https://www.cag‐acg.org/education/see‐program) which includes endoscopy and polypectomy‐related hands‐on courses. Both the UK and Canadian systems formally train faculty to conscious competence [18]. These programs provide quality assurance of training by standardizing training structure and techniques, language, assessment, and feedback provision. The influence of such training programs has spread worldwide to include countries such as Australia, Malawi, Norway, Portugal, Poland, South Africa, and the United States in varying degrees [70]. The Polish group, for instance, published a randomized trial to demonstrate the beneficial impact of the course on adenoma detection rates in their trainers [75]. Similarly, a Canadian study found that faculty who attended SEE Program courses, which aim to enhances faculty’s conscious competence, administered significantly lower sedation doses during colonoscopy, both immediately after and 8‐months following the course. These studies provide supportive evidence that formal train‐the‐trainer efforts not only improve trainers’ teaching skills but also improve their colonoscopy performance [76]. There is no doubt that the interest among endoscopists for formal training will continue to increase as more endoscopists experience the benefits of structured training based on sound pedagogical principles.

      High‐quality training is a key component to provision of safe, efficient, and effective endoscopic care. Endoscopy is a complex skill that can be very challenging to teach, and trainers are often not adequately prepared. Successful training requires preparation and structure, and access to consciously competent trainers who are capable of providing performance enhancing instruction and feedback to ensure the session is both effective and relevant. As an endoscopic community, we need to ensure our future workforce is trained to a high standard irrespective of location. This requires endoscopic training that is well supported (e.g., time allocation and funding), evidence‐based, efficient, and patient‐centered. It also demands trainers who are committed to continually developing their endoscopic teaching skills. Although there is not a robust evidence base that documents the impact of a standardized training framework or “train‐the‐trainer” programs on trainees’ learning and post‐certification practice outcomes, real‐world experience from programs that have embraced these concepts has clearly demonstrated ongoing direct benefits to patient care and quality of education.

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