Читать книгу Successful Training in Gastrointestinal Endoscopy - Группа авторов - Страница 45

Sahar Ghassemi¹ and Douglas O. Faigel²

¹ University of Washington, Seattle, WA, USA

² Mayo Clinic, Scottsdale, AZ, USA

Quality is not an act, it is a habit

— Aristotle

It is quality rather than quantity that matters

— Seneca

In training programs across the country, there is a growing pressure to perform a higher volume of procedures in a patient population that is often new to the institution and referred through open access without prior clinic visitation. With these increased demands on quantity, the urgency to provide the highest quality of care requires deliberate effort and defined standards. The practice of medicine is fraught with the same limitations as the human health it serves to restore. Medical procedures are imperfect even in the most competent of hands, and unrealistic patient expectation and overzealous litigation are real factors in the climate within which we practice medicine. With the advent of more involved therapeutic procedures and access to an electronic medical record comes a growing responsibility toward the patient prior to the initiation of sedation and long after the completion of the therapeutic task. Apart from gaining competence in procedural skills, a trainee must exhibit a mastery of the quality measures by which his/her procedure will be assessed.

The American Society for Gastrointestinal Endoscopy (ASGE) has used published data and expert consensus to define the major determinants for high‐quality endoscopy and have published these guidelines [1]. These measures are increasingly utilized by third parties (hospitals, insurers, and regulatory agencies, lawyers) to assess if proper and careful consideration was performed by a physician. The trainee must understand these standards and learn to make them an integral part of his/her practice. These measures can be broken down into three categories: preprocedure, intraprocedure, and postprocedure quality measures. Each is equally relevant and must be considered separately. Although each type of endoscopic procedure will have specific quality indicators, the common principles are reviewed in this chapter.