- Email: [email protected]
985 Training in Neurogastroenterology and GI motility in USA: Preliminary Results of a Survey of Gastroenterology Fellowship Program Directors
985
Background: Neurogastroenterology and GI Motility has evolved into an important and useful discipline within gastroenterology. Patients with motility disorders account for nearly 50% of GI practice. Consequently, there is a need to offer comprehensive training in this subspecialty. Availability of GI motility training and its uniformity are unknown across GI fellowship programs. We aimed to assess the breadth and depth of GI motility training available to trainees through a survey of all 165 ACGME-accredited GI fellowship programs and if they met GI Core Curriculum requirements. Methods: A survey questionnaire of 14 items was sent to assess the size of program (number of faculty/fellows), whether GI motility training is offered, which testing is performed (esophageal manometry, pH impedance, anorectal manometry, breath tests, wireless motility capsule, biofeedback therapy, others), if fellows are trained and their level of participation - performance/observance/interpretation. Achievement of minimum standards was defined as fellow training in esophageal manometry, pH impedance, anorectal manometry, and biofeedback therapy. Large GI fellowship programs were defined as having 20 or more faculty and 10 or more GI fellows. Results:Fifty-seven of 165 GI fellowship programs (34.5%) responded to the survey. Only three programs did not provide any GI motility training to their fellows. Fifty-four programs (94.7%) trained GI fellows in esophageal manometry, 52 programs (91.2%) in pH impedance, 39 programs (68.4%) in anorectal manometry, 34 programs (59.6%) in breath testing, 34 programs (59.6%) in wireless motility capsule testing, and 22 (38.6%) in biofeedback therapy. Twentytwo (38.6%) fellowship programs met the minimum standards for GI motility training derived from the GI Core Curriculum. Of 19 large GI fellowship programs, 9 trained (47.4%) fellows on all motility testing. Amongst all other programs, 6 programs (15.8%) trained GI fellows on all motility testing. Trainees performed motility tests in 14 programs (24.6%), observed motility tests in 52 programs (96.3%), and interpreted motility tests in 53 programs (93.0%). Conclusions: This survey illustrates a significant dearth of GI motility training in the United States with only 22% of GI fellowship programs meeting the minimum standards derived from the GI Core Curriculum. Motility training is more focused on esophageal testing with limited training on anorectal manometry, breath testing, wireless motility capsule, and biofeedback therapy. Our results are limited by sampling bias and likely overestimated training, as non-responders may not be offering GI motility training. Efforts are ongoing to accurately determine status of GI motility training at each center. GI Fellowship training programs should develop resources and personnel to fulfill this large and unmet gap in trainee needs.
Improvement in knowledge and procedural skills following MN tube simulator training
987 Patterns of Applied Force Reveal Common Maneuvers Used by Experienced Colonoscopists Louis Y. Korman, Noune Sarvazyan, Tomasz Wojtera, Petr Tokar, Vladimir Egorov Background: Colonoscope insertion requires a high level of dexterity and skill. Understanding force application patterns used by colonoscopists could provide insight into technique and best practices. The colonoscopy force monitor (CFM) provides continuous recording of force and torque applied to the insertion tube. The study objective was to identify the most frequently used maneuvers during colonoscope insertion. Methods: 16 experienced endoscopists from 6 academic and community institutions participated in the study. 163 patients presenting for routine colonoscopy were included in the analysis, with 78 female (avg age = 58, range 29-74) and 95 male (avg age = 59, range 28-76) subjects. Operators used the CFM to continuously record push and pull force, right and left torques applied during insertion. Each of the four parameters were categorized into three levels: low(L), medium(M) and high(H). A time fragment of 3.3 seconds, constituting 100 CFM records, was chosen as the duration of single maneuver. The direction of force within the fragment, the absolute value of the force, and the range of change in force were used to define the maneuver pattern. Similar fragments were combined into unique patterns. An advanced digital sigmal processing(DSP) algorithm was applied to each complex force recording(Figure) to identify these patterns. Results: To simplify pattern presentation, we introduced a labelling protocol to characterize the sequence and magnitude of applied force and torque as a trajectory in 3-D space (force, torque and time). For example, for force pattern +LMLL+MHLL the + sign inidcates that the overall force is forward, 1st letter L = low avg forward force, 2nd letter M = medium interval for forward force, 3rd letter L = low avg backward force, 4th letter L = low interval for backward force. The next + sign corresponds to torque (+ is overall right torque), 5th letter M = medium avg right torque, 6th letter H = high interval for right torque, 7th letter L = low avg left torque, and 8th letter L = low interval for left torque. The DSP algorithm idenfiied the most frequent patterns. The insertion pattern +LMLL+MHLL was found in 100 of 163 examinations, +LMLL-LLMH was found in 95 examinations, +MHLL+LMLL was found in 95 examinations, +MHLL-LLLM was found in 88 examinations, +MMLL+MMLL was found in 95 examinations, and -LLLM+HHLL was found in 81 examinations. Conclusions: The colonoscopy force monitoring technique has identified individual differences and unique signatures among operators in their performance of colonoscopy. In this study, this unique advanced processing method identified common maneuvers used by experienced operators. These highly complex maneuvers can now be defined based on their pattern, taught to novices and monitored during procedures. Mastering these maneuvers could make colonoscopy easier to complete and safer.
986 Simulation-Based Training of Minnesota Tube Placement for GI fellows: Utilization of a Mastery Learning Model for Low Volume Procedural Training Michael Kriss, Courtney Pigott, Aimee E. Truesdale, Lisa M. Forman, Paul MenardKatcher, James R. Burton Introduction: The current paradigm of procedural training in GI is based upon clinical experience and training by supervisors. For low volume procedures such as Minnesota (MN) tube placement, this paradigm is often ineffective. Aim: To utilize a novel simulation tool to assess and train competency of MN tube placement by trainees. Methods: All GI trainees (N = 15) completed our standard didactic lecture after which baseline confidence, knowledge, and skills were assessed using an online questionnaire followed by our procedural simulator using an observational checklist. After baseline assessment, all fellows received training with observed placement of MN tube using our procedural simulator. Confidence, knowledge, and skills were reassessed 2 months after this educational intervention and compared to baseline. Descriptive statistics are reported as mean ± standard deviation. Comparison of means between groups was performed using student's T-test and for serial measurements using paired T-test. Pearson's correlation coefficient was used to assess relationships between baseline parameters and performance. Results: All first year fellows (N=5) had never placed a MN tube with an average of 2.6 tubes (range 0-9) placed by upper level fellows (N = 10). Baseline overall trainee self-confidence (0-10 scale) for placement and management of MN tube was 5.7±2.9 and was strongly correlated with post-graduate year (r = 0.67, p<0.01). Mean baseline knowledge reported as percent questions correct (out of 16) was 55.4±12.7%. Mean baseline skills assessment reported as percent of observation checklist items correctly performed using simulator (out of 22) was 35.5±19.7%. There was no difference in baseline knowledge or skill based on prior experience with MN tube placement. Baseline selfconfidence rating and post-graduate year had no statistically significant correlation to baseline knowledge or skill. Following simulation training, trainee knowledge was reassessed and percent of correct questions improved to 79.0±14.8% (p<0.001), a 23.6% increase. Procedural skills were also reassessed and percent of checklist items correctly performed on the simulator improved to 56.7±21.9% (p<0.001), a 21.2% increase. Trainees had a high level of satisfaction with simulation training, 4.2±0.5 (0-5 scale), with increased self-confidence (6.7±1.9 vs 3.9±1.9, p<0.001) and self-perceived skill (6.5±1.9 vs 3.4±1.9, p<0.001), both 0-10 scales, following training. Conclusions: Our model provides an effective training tool for MN tube placement. For low volume GI procedures, this simulation-based tool can be used both for training and maintenance of competency to ensure trainees remain proficient. We will expand this tool to assess and train our GI faculty as well as ICU and emergency medicine providers.
CFM Recording
S-201
X : 10052$CH01 03-28-16 00:57:27 PDFd : 10052B : o
Page 201
AGA Abstracts
AGA Abstracts
Training in Neurogastroenterology and GI motility in USA: Preliminary Results of a Survey of Gastroenterology Fellowship Program Directors Amol Sharma
Background: Neurogastroenterology and GI Motility has evolved into an important and useful discipline within gastroenterology. Patients with motility disorders account for nearly 50% of GI practice. Consequently, there is a need to offer comprehensive training in this subspecialty. Availability of GI motility training and its uniformity are unknown across GI fellowship programs. We aimed to assess the breadth and depth of GI motility training available to trainees through a survey of all 165 ACGME-accredited GI fellowship programs and if they met GI Core Curriculum requirements. Methods: A survey questionnaire of 14 items was sent to assess the size of program (number of faculty/fellows), whether GI motility training is offered, which testing is performed (esophageal manometry, pH impedance, anorectal manometry, breath tests, wireless motility capsule, biofeedback therapy, others), if fellows are trained and their level of participation - performance/observance/interpretation. Achievement of minimum standards was defined as fellow training in esophageal manometry, pH impedance, anorectal manometry, and biofeedback therapy. Large GI fellowship programs were defined as having 20 or more faculty and 10 or more GI fellows. Results:Fifty-seven of 165 GI fellowship programs (34.5%) responded to the survey. Only three programs did not provide any GI motility training to their fellows. Fifty-four programs (94.7%) trained GI fellows in esophageal manometry, 52 programs (91.2%) in pH impedance, 39 programs (68.4%) in anorectal manometry, 34 programs (59.6%) in breath testing, 34 programs (59.6%) in wireless motility capsule testing, and 22 (38.6%) in biofeedback therapy. Twentytwo (38.6%) fellowship programs met the minimum standards for GI motility training derived from the GI Core Curriculum. Of 19 large GI fellowship programs, 9 trained (47.4%) fellows on all motility testing. Amongst all other programs, 6 programs (15.8%) trained GI fellows on all motility testing. Trainees performed motility tests in 14 programs (24.6%), observed motility tests in 52 programs (96.3%), and interpreted motility tests in 53 programs (93.0%). Conclusions: This survey illustrates a significant dearth of GI motility training in the United States with only 22% of GI fellowship programs meeting the minimum standards derived from the GI Core Curriculum. Motility training is more focused on esophageal testing with limited training on anorectal manometry, breath testing, wireless motility capsule, and biofeedback therapy. Our results are limited by sampling bias and likely overestimated training, as non-responders may not be offering GI motility training. Efforts are ongoing to accurately determine status of GI motility training at each center. GI Fellowship training programs should develop resources and personnel to fulfill this large and unmet gap in trainee needs.
Improvement in knowledge and procedural skills following MN tube simulator training
987 Patterns of Applied Force Reveal Common Maneuvers Used by Experienced Colonoscopists Louis Y. Korman, Noune Sarvazyan, Tomasz Wojtera, Petr Tokar, Vladimir Egorov Background: Colonoscope insertion requires a high level of dexterity and skill. Understanding force application patterns used by colonoscopists could provide insight into technique and best practices. The colonoscopy force monitor (CFM) provides continuous recording of force and torque applied to the insertion tube. The study objective was to identify the most frequently used maneuvers during colonoscope insertion. Methods: 16 experienced endoscopists from 6 academic and community institutions participated in the study. 163 patients presenting for routine colonoscopy were included in the analysis, with 78 female (avg age = 58, range 29-74) and 95 male (avg age = 59, range 28-76) subjects. Operators used the CFM to continuously record push and pull force, right and left torques applied during insertion. Each of the four parameters were categorized into three levels: low(L), medium(M) and high(H). A time fragment of 3.3 seconds, constituting 100 CFM records, was chosen as the duration of single maneuver. The direction of force within the fragment, the absolute value of the force, and the range of change in force were used to define the maneuver pattern. Similar fragments were combined into unique patterns. An advanced digital sigmal processing(DSP) algorithm was applied to each complex force recording(Figure) to identify these patterns. Results: To simplify pattern presentation, we introduced a labelling protocol to characterize the sequence and magnitude of applied force and torque as a trajectory in 3-D space (force, torque and time). For example, for force pattern +LMLL+MHLL the + sign inidcates that the overall force is forward, 1st letter L = low avg forward force, 2nd letter M = medium interval for forward force, 3rd letter L = low avg backward force, 4th letter L = low interval for backward force. The next + sign corresponds to torque (+ is overall right torque), 5th letter M = medium avg right torque, 6th letter H = high interval for right torque, 7th letter L = low avg left torque, and 8th letter L = low interval for left torque. The DSP algorithm idenfiied the most frequent patterns. The insertion pattern +LMLL+MHLL was found in 100 of 163 examinations, +LMLL-LLMH was found in 95 examinations, +MHLL+LMLL was found in 95 examinations, +MHLL-LLLM was found in 88 examinations, +MMLL+MMLL was found in 95 examinations, and -LLLM+HHLL was found in 81 examinations. Conclusions: The colonoscopy force monitoring technique has identified individual differences and unique signatures among operators in their performance of colonoscopy. In this study, this unique advanced processing method identified common maneuvers used by experienced operators. These highly complex maneuvers can now be defined based on their pattern, taught to novices and monitored during procedures. Mastering these maneuvers could make colonoscopy easier to complete and safer.
986 Simulation-Based Training of Minnesota Tube Placement for GI fellows: Utilization of a Mastery Learning Model for Low Volume Procedural Training Michael Kriss, Courtney Pigott, Aimee E. Truesdale, Lisa M. Forman, Paul MenardKatcher, James R. Burton Introduction: The current paradigm of procedural training in GI is based upon clinical experience and training by supervisors. For low volume procedures such as Minnesota (MN) tube placement, this paradigm is often ineffective. Aim: To utilize a novel simulation tool to assess and train competency of MN tube placement by trainees. Methods: All GI trainees (N = 15) completed our standard didactic lecture after which baseline confidence, knowledge, and skills were assessed using an online questionnaire followed by our procedural simulator using an observational checklist. After baseline assessment, all fellows received training with observed placement of MN tube using our procedural simulator. Confidence, knowledge, and skills were reassessed 2 months after this educational intervention and compared to baseline. Descriptive statistics are reported as mean ± standard deviation. Comparison of means between groups was performed using student's T-test and for serial measurements using paired T-test. Pearson's correlation coefficient was used to assess relationships between baseline parameters and performance. Results: All first year fellows (N=5) had never placed a MN tube with an average of 2.6 tubes (range 0-9) placed by upper level fellows (N = 10). Baseline overall trainee self-confidence (0-10 scale) for placement and management of MN tube was 5.7±2.9 and was strongly correlated with post-graduate year (r = 0.67, p<0.01). Mean baseline knowledge reported as percent questions correct (out of 16) was 55.4±12.7%. Mean baseline skills assessment reported as percent of observation checklist items correctly performed using simulator (out of 22) was 35.5±19.7%. There was no difference in baseline knowledge or skill based on prior experience with MN tube placement. Baseline selfconfidence rating and post-graduate year had no statistically significant correlation to baseline knowledge or skill. Following simulation training, trainee knowledge was reassessed and percent of correct questions improved to 79.0±14.8% (p<0.001), a 23.6% increase. Procedural skills were also reassessed and percent of checklist items correctly performed on the simulator improved to 56.7±21.9% (p<0.001), a 21.2% increase. Trainees had a high level of satisfaction with simulation training, 4.2±0.5 (0-5 scale), with increased self-confidence (6.7±1.9 vs 3.9±1.9, p<0.001) and self-perceived skill (6.5±1.9 vs 3.4±1.9, p<0.001), both 0-10 scales, following training. Conclusions: Our model provides an effective training tool for MN tube placement. For low volume GI procedures, this simulation-based tool can be used both for training and maintenance of competency to ensure trainees remain proficient. We will expand this tool to assess and train our GI faculty as well as ICU and emergency medicine providers.
CFM Recording
S-201
X : 10052$CH01 03-28-16 00:57:27 PDFd : 10052B : o
Page 201
AGA Abstracts
AGA Abstracts
Training in Neurogastroenterology and GI motility in USA: Preliminary Results of a Survey of Gastroenterology Fellowship Program Directors Amol Sharma