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Teaching endoscopy is challenging for several reasons, including the complex nature of the task and the need for trainers to balance clinical and learning needs while ensuring patient safety, procedural efficiency, and provision of high‐quality care. Additionally, literature has shown that endoscopy trainers use variable teaching methods and styles of training [12–14]. Endoscopic training should be led by individuals who are committed, competent, and enthusiastic trainers. Trainers should not only demonstrate competence in the procedure(s) for which they provide training but should also have the requisite skills and behaviors required to teach endoscopy effectively, and, ideally, formal training in endoscopy teaching methodology. Additionally, it is important that trainers lead by example, through their actions, words, attitudes, and work philosophy.

Within a given training program or institution, not all endoscopists may want to train or possess the skills to teach endoscopy effectively. Trainers should possess conscious competence as well as expertise in assessment and feedback provision. Supervisors, alternatively, are competent endoscopists who can act as role models; however, they lack the requite skills to teach endoscopy effectively. Within a program or institution, the roles of individuals as either trainers or supervisors should be formally discussed and the need for a consistent approach to training across trainers emphasized [15]. Use of a structured training framework and standardization of training techniques across trainers helps to foster an effective learning environment in which trainees feel comfortable asking questions and seeking help, trainee needs are addressed, and trainees and trainers feel valued.

In acquiring endoscopic skills, individuals generally progress through four stages from being unconsciously incompetent (not understanding or knowing how to do something) to consciously incompetent (not able to do something but aware of their deficits), to consciously competent (being able to something with great thought), and finally to unconsciously competent (being able to do something without conscious effort) (Figure 4.1) [16]. By the time endoscopists reach the unconsciously competent stage, they may be highly proficient; however, their actions are largely automatic [17]. They lack an explicit understanding of what specific techniques are required to perform tasks and, consequently, are unable to verbalize instructions adequately to trainees. To be able to teach and provide feedback effectively, a trainer must be able to deconstruct tasks, understand each element, and explain the individual components to trainees in an intelligible way. It is essential that trainers develop conscious competence for performing and teaching endoscopy. This awareness enables them to objectively analyze the performance of trainees, pinpoint specific problems, and verbally explain how to perform maneuvers and troubleshoot difficulties in a clear and effective way without needing to take over control of the endoscope to demonstrate. The development of conscious competence requires repeated practice over months to years with feedback from competent, experienced trainers and self‐reflection to develop an awareness and ability to solve problems and deconstruct skills. There are also established faculty development “train‐the‐trainer” courses which aim to formally train endoscopy faculty to conscious competence, such as those in the United Kingdom and Canada [18–20].

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.