Читать книгу Successful Training in Gastrointestinal Endoscopy - Группа авторов - Страница 133

Colonoscopy is not simply reaching the cecum and performing a careful inspection during withdrawal; it also involves the ability to identify and manage potential pathologic findings such as polyps or inflammation. Skilled detection of abnormalities requires a careful inspection process and rapid recognition of variances in the mucosa. The method of inspection was discussed earlier in this chapter. Here, the stress will be on the development of recognition of abnormalities. This skill of rapid pathology identification by experienced endoscopists is a result of the cognitive skill of pattern recognition. Pattern recognition is the ability to quickly identify small changes and understand their meaning, much like a master chess player can look at a complex arrangement of chess pieces on a board and quickly understanding the implications, such as which player will eventually win the game and how it can be done. This pattern recognition is the key factor that allows an experienced endoscopist to quickly scan the mucosa and continue the withdrawal with greater speed than trainees. This skill typically is acquired only with experiencing firsthand the broad spectrum of normal and abnormal findings with considerable repetition but can be augmented with the self‐study of photo atlases or online resources (especially for rare endoscopic findings) (Figure 6.18) (Video 6.4). Over time and with careful supervision and guidance by instructors, this skill is eventually acquired to a sufficient level to operate independently (competence), but skills will continue to be honed throughout the lifetime of the endoscopist. Education researchers have suggested that it takes roughly 10,000 hours of experience to become a “master” at whatever it is one wishes to do, be it playing chess, sports, or performing endoscopy [11]. Basic competence, however, occurs much earlier, yet what defines basic competence in this skill is difficult to assess. Later in this chapter, we will discuss how best to teach these skills of pathology recognition as well as how best to assess these skills as the trainee works toward competence.