14 WORLD GASTROENTEROLOGY NEWS OCTOBER 2014 Editorial | Expert Point of View | Gastro 2015: AGW/WGO | WDHD News | WGO & WGOF News | WGO Global Guidelines | Calendar of Events Mr. John Stebbing, the current Chair of the Joint Advisory Group (JAG) on gastrointestinal endoscopy in the UK, helped give the partici-pants perspective on the functioning of the JAG in developing enduring standards in the UK. THE THREE DAY COURSE CON-SISTED OF: Day 1 Teaching and discussion in the learn-ing center and hands on teaching ses-sions in the skills laboratory on Koken simulators. There was an emphasis on ensuring that all trainers realized that in order to train they had to achieve conscious competence and break down procedures into small steps that could be easily articulated. Effective objective setting and feedback were areas that were concentrated on. In setting objectives it was emphasized that specific objectives had to be identified for a particular trainee for them to be effective. Pre-procedural discussions should focus on what the trainee feels they need to achieve which is an interesting and effective way of personalizing the objectives. The Pendelton method of feed-back was discussed. One of the issues identified with the Pendelton method is that it can become formulaic. The concept of performance enhancing feedback (PEF) was introduced. After doing a Pendelton-type feedback session, specific areas of improvement (one or two) are set for future training sessions. Ensuring that the trainee understands the PEF is ensured by asking them to repeat them in their own words. The JAG DOPS (Direct Observa-tion of Procedural Skills) forms are completed in such a way that the next trainer can easily see what mutually agreed PEF was given at the end of the previous training session and can be used for setting specific personal-ized objectives before starting the next session. These discussions were led by UK Faculty members who seldom used any PowerPoint presentations. Pow-erPoint presentations were extensively used in earlier versions of the course but this has changed to use of a flip-chart when necessary. After discussion, the list of common terms and language used in endoscopy training were identified. Ensuring standardization of these training terms allows for standardization of the instruction from trainer to trainer and institution to institution in the UK. The Use of Set, Dialogue, Closure for all teaching episodes was emphasized Each participant had been asked to prepare the following teaching scenarios: • Lead a 5 minute “one to one” teaching session on ‘scope handling’ • Lead a 5 minute “one to one” teaching session on ‘torque steering’ • Lead a 5 minute “one to one” teach-ing session on ‘loop resolution’ • Lead a 5 minute “one to one” teaching session on ‘use of a snare’ These were then practiced in the skills lab with participants acting as trainers and critiquers. The use of the standardized terms and language was emphasized. Day 2 The second day comprised of the participants acting as trainers of two nurse endoscopists who were per-forming supervised colonoscopies on patients as part of their training in separate endoscopy rooms at a well-equipped and laid out ambulatory endoscopy center. Both nurse trainee endoscopists had done over 150 colo-noscopies and were well trained in the JAG approved method of colonoscopy (torque steering, minimal sedation, frequent position change when required and minimal application of external pressure). All the procedures were aided by the Olympus scope guide which ensured early identifica-tion and resolution of loops. A limit of 30 minutes was given after which a designated UK faculty member would complete the colonoscopy if it had not been completed by then. The international TCT participant instructed the trainee verbally using methods learned the previous day. Prior to the procedure the” trainer” and the nurse endoscopist discussed the case and set specific learning objectives for the case. This was done by asking the nurse trainee what areas they felt they needed to develop in or were uncomfortable in. “Ground rules” such as the “stop” command were discussed and agreed to before the case commenced. The “trainer” was not allowed to touch the patient or the endoscope. Another interna-tional participant acted as an evalua-tor to offer feedback to the trainer. A local UK faculty was close at hand to ensure safety and to abort the training session if deemed necessary. At the end of the training session the trainer and trainee had a feedback session culminating in the setting of specific PEF. The remainder of the participants were watching procedures as well as feedback sessions via a videoconfer-encing system. All participants acted as trainer or evaluator and the trainers were subjected to a PEF of their own by the evaluator or UK faculty member. The international participants soon realized that we were not consciously competent in the UK method of colo-noscopy and that although most had good prior knowledge of Pendleton’s rules, the use of PEF was something that needed practice. Day 3 The third and final day was dedi-cated to teaching therapeutic endos-copy. A staff grade gastroenterologist underwent an EMR course that was transmitted via video link to the learn-ing center. Once again pre-procedural
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