Читать книгу Successful Training in Gastrointestinal Endoscopy - Группа авторов - Страница 30

Training in endoscopy began with a pioneering spirit of self‐taught innovators and quickly transitioned to a traditional apprenticeship model of learning during one‐on‐one proctored clinical experiences. Over the last 20 years, the advent of simulator‐based teaching tools and a heightened scrutiny of the optimal methods, components, and end points of training have sparked a transformation in the way endoscopy is taught.

On the technology of training, there are now an array of realistic simulators that in sum allow for an excellent training experience in most of the therapeutic procedures comprising current endoscopic practice. There is growing evidence that training using these models is of benefit. These hands‐on complementary methods are certainly popular, and thanks to the vision of the leadership of endoscopic societies and the support of the industry, opportunities to use them are increasingly available. The area of simulator‐based skills assessment remains a relatively undeveloped field, awaiting increased realism, and the development and validation of proper tests. Still, the combination of static models, ex vivo artificial models, ex vivo animal models, and computer simulators, collectively represent a substantial and powerful tool for education and training in gastrointestinal endoscopy. It is easy to see the day when there will be ready availability of hands‐on training via simulators beyond the gastroenterology fellowship setting. Paralleling the progression of technology and the continuous introduction of new devices and procedures will be a compelling need for hands‐on experience on simulators for all such new tools and techniques.

Parallel to this transformation in the methods of training have been key new concepts about how this process ought to occur. Realizing that simulator work is generally costly and labor intensive, attention is being paid to learn how to best deploy simulator experience during training; for example, work with static models might be more cost‐effective for novices than hands‐on ex vivo workshops. The benefit from such workshops is intuitively greater for trainees who already have attained some basic skills. The growing experience with simulator‐based training has taught the value of concepts such as team training of assistants along with the endoscopists, deconstructing complex procedures into their component skills, training that incorporates troubleshooting unplanned adverse events, and increasing emphasis on self‐assessment and feedback within the training process.

At the same time, the growing emphasis on maximizing quality in endoscopy has also affected guidelines and attitudes about endoscopic training. From the early days of endoscopy, thought leaders have aimed to train new endoscopists who were competent to perform procedures independently. But recently, the question they have asked has changed from “How many procedures are required for a trainee to become competent?” to “What are the objective measures of competency for a particular procedure and has a trainee reached that level of skill?” There is increasing recognition of the importance of objective measurement of success both during training and beyond. The process of keeping track of outcomes during training has the potential not only to ensure that benchmark end points of training are attained before endoscopists perform procedures independently on patients but also to facilitate that training process itself, by virtue of the feedback this information provides.

As endoscopy has evolved from its emergence to the present, there remains an optimistic conviction among endoscopy educators that training is essential to the future of the field—and the future of endoscopic training looks bright.