- Email: [email protected]
Sa1030 The Role of Whole Body Video Monitoring and Feedback in a Laparoscopic Simulation Laboratory
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Objectives: Despite the availability of multiple therapies for patients with Crohn disease (CD), gastroenterologists continue to underutilize immunomodulators and fail to prescribe biologic agents for appropriate patients, resulting in poor symptom control and a negative effect on quality of life. The objective of this study was to evaluate the effectiveness of online CME activities in improving physician practices related to treatment of CD and the subsequent effect on patient quality of life. Methods: This study comprised 2 components: a healthcare provider survey and a patient survey. Gastroenterologists who participated in either of 2 CME online activities (http://www.medscape.org/viewarticle/767665; http://www.medscape.org/ viewarticle/768905) were sent an invitation to complete a survey to ascertain their practice patterns, attitudes, and barriers regarding the use of early aggressive therapy in appropriate patients with CD. The control group for the study consisted of physicians who did not participate in the educational activities. Following the healthcare provider survey, both participant and nonparticipant physicians were asked to distribute invitations to their patients with CD to complete an online survey based on the short inflammatory bowel disease questionnaire (SIBDQ). Patients who completed the initial survey were contacted via email 4 to 6 weeks later and asked to complete a second survey; data from the 2 time points were analyzed to characterize therapy success and overall quality of life and function. Findings were found to be significant at P £ .05. Results: A total of 98 gastroenterologists and 134 patients participated in the study. Physicians who participated in the online CME activities (n=58) reported significantly fewer barriers to the early initiation of biologic therapy in appropriate patients with CD compared to nonparticipants (n=40), indicating the education was successful in increasing physician confidence in overcoming barriers to care, such as concern for the risk of patients developing hepatosplenic T-cell lymphoma or antibodies or uncertainty as to how to taper steroid therapy to avoid steroid dependence ( P<.05). Additionally, participants were significantly less likely to consider biologics as a last-line option ( P= .05). Physician participation in online education also had measurable effects on the health of their patients with CD. Patients of physician participants in online CME activities showed a significantly improved SIBDQ score from baseline to follow-up ( P=.02) compared with no change seen in the scores of the control group ( P=.16). Conclusions: The study demonstrated that online CME activities, designed using adult learning principles, can not only effectively improve physician confidence related to the treatment of CD and promote performance change but can also improve patients' quality of life.
Number of survey participants = 47 Pre- and Post- Session Medical Student Confidence in Diet Counseling and Interprofessional Collaboration
*Number of respondents = 47
Sa1027 The Flipped Classroom in Medical Student Gastroenterology Teaching: Inferior Rating of Independent E-Learning Modules Sheryl Pfeil, Alice Hinton Background: Teaching gastroenterology (GI) in the preclinical curriculum is evolving from a traditional didactic, lecture type approach to one that is learner-centered, utilizing selfdirected learning to deliver didactic content and combining that with in-person active learning experiences as part of a "flipped classroom". In 2014/2015 (the second year of the new GI curriculum at the Ohio State University College of Medicine) approximately half of the GI topics have been converted to e-learning modules, and the remainder are delivered as traditional "sage on the stage" lectures. Students may attend lectures in person, livestream or podcast them. There are also in-class activities (dissection labs, Team Based Learning exercises, case-based discussions). A subset of students evaluates all Teaching Learning Methods (TLMs) at the conclusion of each block. Aim: To evaluate the student rating of module quality of e-learning (guided learning and pre-recorded) modules compared to the rating of traditional lecture modules. Methods: 1. The GI e-learning (guided learning) methods include interactive modules (Articulate software) as well as pre-recorded talks, selfstudy cases and questions. The lectures are live talks that students may view in-person, or remotely by live-stream or podcast. 2. Both traditional lectures and guided learning modules have accompanying power point slide sets. Students may view the slides and watch the guided learning modules and the lectures (via podcast) as many times as they wish. The elearning module authors and the lecturers are equally accessible to the students. 3. A subset of students evaluates each Gastroenterology TLM ["Rate the overall quality of these teaching/ learning experiences"] using a 4-point scale of 1 (poor) to 4 (excellent). 4. Ratings of quality of e-learning (guided learning) modules were compared to those of the lectures. The comparison was performed at year 2 of the new curriculum in order to avoid potential negative bias related to technical implementation of e-learning modules. Results: The average rating for the e-learning modules was 3.12, compared to an average rating of 3.32 for the lecture modules. The average rating for lectures was significantly higher than that of the elearning modules, p=0.0014 two-sample t-test. Conclusions: 1. In the new pedagogical model of the flipped classroom, we need to carefully assess the quality of new types of content delivery. 2. Because traditional lectures may be viewed remotely (asynchronous learning), the higher rating of lectures suggests that there are human factors involving content delivery that influence the perceived quality of GI learning modules. 3. Identification of best-practice methods, dissemination of exemplar modules and faculty support/development may be needed to help GI educators optimize teaching quality using independent learning methods. Comparison of e-Learning Modules and Lectures
Sa1029 Retrospective Safety Analysis of Trainee-Performed Liver Biopsies at the National Institutes of Health Clinical Center - A 35-Year Experience Varun Takyar, Yaron Rotman, Xiongce Zhao, Marc G. Ghany, Theo Heller, Edward Doo, Jake Liang, Jay Hoofnagle, Christopher Koh Introduction: Liver biopsy (LB) plays an important role in the diagnosis and management of patients with liver disease. However, the procedure is not without risk, and operators should be trained to recognize and treat complications. Current guidelines and advanced training requirements recommend 40 supervised LBs for proficiency; however this is based on empirical evidence and the number of LBs required for adequate training is unknown. Aims: To assess the adequacy of current training requirements in LB utilizing >35 years of experience from a training fellowship program in gastroenterology/hepatology at the National Institutes of Health Clinical Center. Methods: Consecutive LB data performed from July 1978 to November 2014 by trainees with attending supervision were collected. Complications evaluated included: moderate-through-severe pain, bleeding (±intervention), injury to other viscera, hypotension (±intervention), pulmonary (atelectasis) and neurologic. Serious complications included: death, severe pain, bleeding or hypotension requiring intervention, other organ injury and TIA. For patients with serious complications, peri-biopsy clinical, lab and radiologic data were evaluated. Results: 3664 percutaneous LBs were performed by 75 trainees (mean per operator=49±39). Most (99%) utilized a 16 gauge Klatskin needle. Transthoracic techniques included percussion (1978-1985) and ultrasound-guided (19862014) approaches. The total complication rate was 4.2% (154), and 1.7% (62) were serious. Serious bleeding occurred in 21 patients (0.6%) with 7 requiring surgical/radiological intervention and 3 (0.08%) procedure-related deaths. Other organs injured included gallbladder (n=10, 0.3%), kidney (n=2, 0.05%), and lung (n=1, 0.03%). Of 75 trainees, 33 (44%) performed a LB resulting in a serious complication. Trainees with complications performed significantly more procedures, (68 vs 24, p=<0.0001). On Kaplan-Meier analysis, the median time to any complication was 22 biopsies and to a serious complication 49 biopsies. By regression analyses of time to multiple events using the Andersen-Gill model, an earlier firsttime serious complication by a physician was associated with more overall such complications encountered, p=0.0239 with unit hazard ratio of 0.978. A similar result was found with analysis of all complications, p<0.0001 with unit hazard ratio of 0.971. Conclusion: Complications of LB are rare in training programs but are experienced by a large proportion of operators. Further exploration should be performed to confirm whether physicians who encounter serious complications early in their training are more likely to have complications in the future. Training programs and trainees should be aware that for the majority of trainees, the first serious complication tends to occur outside of the currently recommended supervised training window.
There is a significant difference in the average of the recorded/guided learning and the lectures, p=0.0014 two sample t-test
Sa1030 The Role of Whole Body Video Monitoring and Feedback in a Laparoscopic Simulation Laboratory Deepa Shah, Daniel J. Torrent, L. W. Nifong, Carl Haisch Purpose: Awareness of posture and ergonomics is lacking in many surgeons, especially in laparoscopy. Technique and positioning is imperative in order to become proficient with laparoscopic instruments and needs to be stressed early in training during residency. There
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AGA Abstracts
AGA Abstracts
The Effect of Physician Education on Improving Quality of Life in Patients With Crohn Disease Jelena Spyropoulos, Jovana Lubarda
AGA Abstracts
has not yet been a study that utilizes videography as feedback on a surgeon's posture during the procedure. This is a randomized prospective study of videography feedback in a laparoscopic simulation laboratory. Our goal is to show that video feedback is beneficial. Methods: We provided a short introductory laparoscopic instrument and handling teaching session for medical students, and asked the students to return after 3 weeks to reassess their skills. Students were randomized into a videography and non-videography group to practice their skills and perform a peg transfer (taken from Fundamentals of Laparoscopic Surgery). The videography group reviewed their individual video before practicing and performing the timed task again at the interval assessment. The time difference was calculated between interval and initial times. A univariate analysis was performed for our outcome and possible confounders. Results: A total of 17 participants with 34 assessment times were studied. Age and gender were similar between the two groups (p=0.39, 0.44 respectively). There was no association between gender and time difference (p=0.33). The time difference for the videography and non-videography group was significantly different (average time = 47.0±24.0, 28.7±13.6 seconds respectively, p<0.001). Conclusions: The group receiving video postural feedback was able to perform the timed task faster on average. Age and initial time were not different between the two groups, and gender was not associated with time difference. This eliminated these 3 variables as possible confounders. Video feedback can increase the efficiency of laparoscopic teaching, and may be a useful tool in resident education and training.
no TI attempt at month 3 versus hepatic flexure at month 1, p=0.03). In addition to clinical outcomes, simulator scores improved significantly from month 1 to month 3 (Table 2; p= 0.034) Conclusion: The part-task endoscopic simulator provides a safe non-clinical environment for trainees to practice fundamental endoscopic maneuvers and become familiar with accessories during the first several weeks of training. Additionally, this small sample size suggests that routine use of the simulator may improve trainee technical endoscopic performance during the early phases of training. Table 1. Primary outcomes. Average MCSAT motor items score and cecal intubation rate at months 1 and 3 (1=novice, 2=intermediate, 3=advanced, 4=superior)
Table 2. Secondary outcome. Training box scores at months 1 and 3
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Direct Observation and Real-Time Feedback During Gastroenterology Fellowship: A Survey of Fellows and Faculty Sumona Saha, Eric A. Gaumnitz
Counting Surgical Competence; A Gastrointestinal Perspective Tarig Abdelrahman, Charlotte E. Thomas, Cristel Santos, Mr. Gareth Griffiths, Wyn G. Lewis
Introduction: Infrequent direct observation with real-time feedback has been documented in numerous studies involving medical trainees. We assessed gastroenterology faculty and fellows' perception of the frequency with which they provide/receive feedback based on direct observation and the quality of that feedback in a busy, academic gastroenterology fellowship program. Methods: Using Qualtrics survey software fellows and faculty in the GI division at the University of Wisconsin School of Medicine were surveyed. Faculty were asked to rate the frequency with which they directly observe fellows in the outpatient GI clinic, on the inpatient consult services, and in the endoscopy lab using a 5-point scale (1= never to 5=all of the time). They were also asked to rate the quality of the feedback they provide in those settings (1=very poor to 5=very good). Fellows were similarly queried about their experience being observed. They were also asked to rate the quality of the feedback they receive (1=very poor to 5=very good). All respondents were asked about barriers to direct observation and real-time feedback. Descriptive statistics were calculated for demographic characteristics and for all survey items. Results: 8 (89%) fellows and 20 (95%) faculty completed the survey. With regards to outpatient clinic performance, faculty and fellows reported direct observation and real-time feedback to be least frequent during history taking (mean [SD] fellows 2.4+0.9; mean [SD] faculty 2.4+1.2) and while performing the physical exam (mean [SD] fellows 2.5+0.9; mean [SD] faculty 2.1+1.0) and highest during discussion of the management plan (mean [SD] fellows 4.0+0.8; mean [SD] faculty 3.5+1.4). The same trends were seen with regards to clinical skills on the inpatient consult services wherein history taking and physical examination were least likely to be observed. During endoscopy fellows and faculty were in agreement that procedures are nearly always observed generating real-time feedback (mean [SD] fellows 4.5+0.5; mean [SD] faculty 4.4 +1.2). Overall, fellows rated the quality of the feedback received to be highest during endoscopy (mean 4.1+0.6) and lowest on the inpatient consult services (mean 3.4+0.5). With regards to barriers to observation and feedback, fellows' most strongly agreed with the statement that faculty do not prioritize giving feedback (mean score 3.1+0.8) while faculty most strongly agreed with the statement that giving feedback is awkward (mean 3.1+1.2). Conclusions: Direct observation of gastroenterology fellows and real-time feedback occurs most frequently during endoscopy while non-procedural clinical skills often go unobserved. Given the importance of history taking, physical examination, and patient counseling interventions aimed at improving observation and feedback are needed in both the outpatient and inpatient settings.
Background. UK surgical education and postgraduate training is under scrutiny, not least because of its craft specialty status, but also because of a progressive onslaught of initiatives aimed at improving yet shortening training time. In 2013, guidelines were published for the award of Certification of Completion of Training (CCT) in General Surgery citing global operative experience (1600 index cases over 6 years, including 100 emergency laparotomies for all trainees and subspecialty index procedure targets) together with other professional credentials. Similar guidelines exist in the US stating a minimum of 750 operative procedures in the five years of residency. The aim of this study was to evaluate the current operative experience achieved by UK gastrointestinal (GI) surgery trainees at CCT, and to determine whether targets set are achievable within a contemporary surgical training scheme. Methods. The online portfolios of 89 UK GI surgery CCT applicants (45 Colorectal, 28 Upper GI, 14 Hepatopancreaticobiliary, 2 General) were analysed for the 2013 calendar year with specific reference to curriculum operative experience and academic achievements. Results. The median total operative caseload number was 1802 (range 783-3764, 1829 Colorectal, 1651 Upper GI, 1747 Hepatopancreaticobiliary, and 1932 General), with 56 applicants (63%) achieving the target number of 1600. The median emergency laparotomy caseload was 115 (19-328) with 61 applicants (69%) achieving the target. Complex major surgical operative targets were met by 79% (73% Colorectal, 79% UGI, 100% HPB,). The median number of publications achieved by GI trainees was 7 [0-61, median 4 (0-24) first author], and median national or international presentations 10 (1-67). The academic targets of 3 peer reviewed publications and 3 presentations was achieved by 78 (88%), and 84 (94%) respectively. Conclusions. Global operative numbers varied widely with greater than two thirds of applicants achieving elective and emergency operative targets. Measures to identify lower quartile trainees early within training allied to focused simulation should be considered to enhance GI surgical training.
Sa1034 Impact of a Year-Long Gastrointestinal Pathophysiology Teaching Fellowship During Gastroenterology Fellowship Helen M. Shields, Eric M. Goldberg, Samuel C. Somers, Win Travassos, Sonal Ullman, Seema Maroo, Daniel Leffler, Richard P. O'Farrell, Paola G. Blanco, Steven Kappler, Tyler M. Berzin, Sarah N. Flier, Paul S. Sepe, Suma Magge, Gyanprakash A. Ketwaroo, Joseph D. Feuerstein, Byron Vaughn, Hamed Nayeb-Hashemi, Edward L. Barnes, Stephen R. Pelletier
Sa1032 Endoscopic Part-Task Simulator Training Improves Endoscopic Performance in Gastroenterology Fellows Pichamol Jirapinyo, Nitin Kumar, Supisara Tintara, Vicki Bing, Hiroyuki Aihara, Molly Perencevich, Linda S. Lee, Avlin B. Imaeda, Christopher C. Thompson
Background: In 2001, a year-long unfunded Teaching Fellowship in Gastrointestinal (GI) Pathophysiology was created by the Course Director (CD) for the Second-Year Pre-Clinical Harvard Medical School GI Pathophysiology Course so that GI Fellows could learn both academic teaching and leadership skills by co-teaching the GI Pathophysiology Course. The 18 fellows were drawn from the Beth Israel Deaconess Medical Center (16) from 2001-2013 and Brigham and Women's Hospital (2) in 2013 and 2014. Fellows were selected on the basis of a self-identified interest in teaching. Teaching Fellows' (15) activities might include teaching in pathology laboratories with 40 students, tutorials with 7-9 students per tutorial, small group interactive sessions with 15-30 students and co-teaching two whole class review sessions during the 2.5 week long GI Pathophysiology course. In three years, 2010, 2012 and 2013 there were two fellows interested in teaching the course. In these years the GI Pathophysiology Teaching Fellow taught the entire course's activities while the Academic Teaching Fellow was both a tutor and small group leader (3). All Teaching Fellows began one-on-one mentoring sessions 7-8 AM weekly in July for the course occurring in March of the following year. During the actual course, the fellow and CD met daily to go over teaching sessions, quizzes and review materials. Over the 13 year period, 18 fellows (13 men and 5 women) completed the GI Pathophysiology Teaching or Academic Teaching Fellowship. Methods: An IRB approved survey using Qualtrics software was sent online to each of the 18 fellows involved indicating that participation is voluntary, e-mail addresses are made anonymous to protect privacy and all data will be presented in the aggregate. No payment was given for being the Teaching or Academic Fellow for the GI Pathophysiology Course except for face-to-face time teaching stipends provided by the medical school to each teacher in a pre-clinical course. Results: Participation rate: 83% (15/18) completed the survey. See Table 1 for specific outcomes. Conclusions: A year of exposure to formal teaching of gastrointestinal pathophysiology at a medical school was extremely successful in improving
Background: Training in endoscopy has traditionally relied upon clinical hands-on experience. Simulators may allow the development of endoscopic skills in a non-clinical environment. Aim: To assess the effect of an endoscopic part-task simulator on trainees' endoscopic performance. Methods: Simulator: An endoscopic part-task training box consisting of 5 modules (snare polypectomy, retroflexion, torque, knob control and loop reduction/navigation) and a validated scoring system. Subjects: First year gastroenterology fellows from two academic institutions. Design: Fellows were instructed to practice on the simulator for at least 45 minutes per week for the first 3 months of training, in addition to receiving traditional hands-on clinical training. All fellows were assessed for their endoscopic skill performance using the Mayo Colonoscopy Skills Assessment Tool (MCSAT) and the simulator at month 0, 1 and 3. Primary Outcomes: An average MCSAT score of motor items (hands-on participation, colonoscope advancement, loop reduction, visualization of mucosa on withdrawal and therapeutic maneuver performance) and cecal intubation rate at months 1 and 3. Secondary Outcomes: Simulator scores at months 1 and 3. Statistical Analysis: Outcomes from months 1 and 3 were compared using a paired t-test. Results: Eight first year gastroenterology fellows from two academic institutions participated in the study. All participants had not used the simulator and had no endoscopic experience prior to the study. Fellows' clinical endoscopic skills improved significantly from month 1 to month 3. Specifically, fellows received a rating of "novice-intermediate" at month 1 and "intermediate-advanced" at month 3 (Table 1; p=0.003). Cecal intubation rate also increased significantly (Table 1; p=0.006). On average, at month 3, fellows spent the same amount of time ( p=0.34), but were able to reach a farther landmark in the colon independently compared to at month 1 (cecum with
AGA Abstracts
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Objectives: Despite the availability of multiple therapies for patients with Crohn disease (CD), gastroenterologists continue to underutilize immunomodulators and fail to prescribe biologic agents for appropriate patients, resulting in poor symptom control and a negative effect on quality of life. The objective of this study was to evaluate the effectiveness of online CME activities in improving physician practices related to treatment of CD and the subsequent effect on patient quality of life. Methods: This study comprised 2 components: a healthcare provider survey and a patient survey. Gastroenterologists who participated in either of 2 CME online activities (http://www.medscape.org/viewarticle/767665; http://www.medscape.org/ viewarticle/768905) were sent an invitation to complete a survey to ascertain their practice patterns, attitudes, and barriers regarding the use of early aggressive therapy in appropriate patients with CD. The control group for the study consisted of physicians who did not participate in the educational activities. Following the healthcare provider survey, both participant and nonparticipant physicians were asked to distribute invitations to their patients with CD to complete an online survey based on the short inflammatory bowel disease questionnaire (SIBDQ). Patients who completed the initial survey were contacted via email 4 to 6 weeks later and asked to complete a second survey; data from the 2 time points were analyzed to characterize therapy success and overall quality of life and function. Findings were found to be significant at P £ .05. Results: A total of 98 gastroenterologists and 134 patients participated in the study. Physicians who participated in the online CME activities (n=58) reported significantly fewer barriers to the early initiation of biologic therapy in appropriate patients with CD compared to nonparticipants (n=40), indicating the education was successful in increasing physician confidence in overcoming barriers to care, such as concern for the risk of patients developing hepatosplenic T-cell lymphoma or antibodies or uncertainty as to how to taper steroid therapy to avoid steroid dependence ( P<.05). Additionally, participants were significantly less likely to consider biologics as a last-line option ( P= .05). Physician participation in online education also had measurable effects on the health of their patients with CD. Patients of physician participants in online CME activities showed a significantly improved SIBDQ score from baseline to follow-up ( P=.02) compared with no change seen in the scores of the control group ( P=.16). Conclusions: The study demonstrated that online CME activities, designed using adult learning principles, can not only effectively improve physician confidence related to the treatment of CD and promote performance change but can also improve patients' quality of life.
Number of survey participants = 47 Pre- and Post- Session Medical Student Confidence in Diet Counseling and Interprofessional Collaboration
*Number of respondents = 47
Sa1027 The Flipped Classroom in Medical Student Gastroenterology Teaching: Inferior Rating of Independent E-Learning Modules Sheryl Pfeil, Alice Hinton Background: Teaching gastroenterology (GI) in the preclinical curriculum is evolving from a traditional didactic, lecture type approach to one that is learner-centered, utilizing selfdirected learning to deliver didactic content and combining that with in-person active learning experiences as part of a "flipped classroom". In 2014/2015 (the second year of the new GI curriculum at the Ohio State University College of Medicine) approximately half of the GI topics have been converted to e-learning modules, and the remainder are delivered as traditional "sage on the stage" lectures. Students may attend lectures in person, livestream or podcast them. There are also in-class activities (dissection labs, Team Based Learning exercises, case-based discussions). A subset of students evaluates all Teaching Learning Methods (TLMs) at the conclusion of each block. Aim: To evaluate the student rating of module quality of e-learning (guided learning and pre-recorded) modules compared to the rating of traditional lecture modules. Methods: 1. The GI e-learning (guided learning) methods include interactive modules (Articulate software) as well as pre-recorded talks, selfstudy cases and questions. The lectures are live talks that students may view in-person, or remotely by live-stream or podcast. 2. Both traditional lectures and guided learning modules have accompanying power point slide sets. Students may view the slides and watch the guided learning modules and the lectures (via podcast) as many times as they wish. The elearning module authors and the lecturers are equally accessible to the students. 3. A subset of students evaluates each Gastroenterology TLM ["Rate the overall quality of these teaching/ learning experiences"] using a 4-point scale of 1 (poor) to 4 (excellent). 4. Ratings of quality of e-learning (guided learning) modules were compared to those of the lectures. The comparison was performed at year 2 of the new curriculum in order to avoid potential negative bias related to technical implementation of e-learning modules. Results: The average rating for the e-learning modules was 3.12, compared to an average rating of 3.32 for the lecture modules. The average rating for lectures was significantly higher than that of the elearning modules, p=0.0014 two-sample t-test. Conclusions: 1. In the new pedagogical model of the flipped classroom, we need to carefully assess the quality of new types of content delivery. 2. Because traditional lectures may be viewed remotely (asynchronous learning), the higher rating of lectures suggests that there are human factors involving content delivery that influence the perceived quality of GI learning modules. 3. Identification of best-practice methods, dissemination of exemplar modules and faculty support/development may be needed to help GI educators optimize teaching quality using independent learning methods. Comparison of e-Learning Modules and Lectures
Sa1029 Retrospective Safety Analysis of Trainee-Performed Liver Biopsies at the National Institutes of Health Clinical Center - A 35-Year Experience Varun Takyar, Yaron Rotman, Xiongce Zhao, Marc G. Ghany, Theo Heller, Edward Doo, Jake Liang, Jay Hoofnagle, Christopher Koh Introduction: Liver biopsy (LB) plays an important role in the diagnosis and management of patients with liver disease. However, the procedure is not without risk, and operators should be trained to recognize and treat complications. Current guidelines and advanced training requirements recommend 40 supervised LBs for proficiency; however this is based on empirical evidence and the number of LBs required for adequate training is unknown. Aims: To assess the adequacy of current training requirements in LB utilizing >35 years of experience from a training fellowship program in gastroenterology/hepatology at the National Institutes of Health Clinical Center. Methods: Consecutive LB data performed from July 1978 to November 2014 by trainees with attending supervision were collected. Complications evaluated included: moderate-through-severe pain, bleeding (±intervention), injury to other viscera, hypotension (±intervention), pulmonary (atelectasis) and neurologic. Serious complications included: death, severe pain, bleeding or hypotension requiring intervention, other organ injury and TIA. For patients with serious complications, peri-biopsy clinical, lab and radiologic data were evaluated. Results: 3664 percutaneous LBs were performed by 75 trainees (mean per operator=49±39). Most (99%) utilized a 16 gauge Klatskin needle. Transthoracic techniques included percussion (1978-1985) and ultrasound-guided (19862014) approaches. The total complication rate was 4.2% (154), and 1.7% (62) were serious. Serious bleeding occurred in 21 patients (0.6%) with 7 requiring surgical/radiological intervention and 3 (0.08%) procedure-related deaths. Other organs injured included gallbladder (n=10, 0.3%), kidney (n=2, 0.05%), and lung (n=1, 0.03%). Of 75 trainees, 33 (44%) performed a LB resulting in a serious complication. Trainees with complications performed significantly more procedures, (68 vs 24, p=<0.0001). On Kaplan-Meier analysis, the median time to any complication was 22 biopsies and to a serious complication 49 biopsies. By regression analyses of time to multiple events using the Andersen-Gill model, an earlier firsttime serious complication by a physician was associated with more overall such complications encountered, p=0.0239 with unit hazard ratio of 0.978. A similar result was found with analysis of all complications, p<0.0001 with unit hazard ratio of 0.971. Conclusion: Complications of LB are rare in training programs but are experienced by a large proportion of operators. Further exploration should be performed to confirm whether physicians who encounter serious complications early in their training are more likely to have complications in the future. Training programs and trainees should be aware that for the majority of trainees, the first serious complication tends to occur outside of the currently recommended supervised training window.
There is a significant difference in the average of the recorded/guided learning and the lectures, p=0.0014 two sample t-test
Sa1030 The Role of Whole Body Video Monitoring and Feedback in a Laparoscopic Simulation Laboratory Deepa Shah, Daniel J. Torrent, L. W. Nifong, Carl Haisch Purpose: Awareness of posture and ergonomics is lacking in many surgeons, especially in laparoscopy. Technique and positioning is imperative in order to become proficient with laparoscopic instruments and needs to be stressed early in training during residency. There
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AGA Abstracts
AGA Abstracts
The Effect of Physician Education on Improving Quality of Life in Patients With Crohn Disease Jelena Spyropoulos, Jovana Lubarda
AGA Abstracts
has not yet been a study that utilizes videography as feedback on a surgeon's posture during the procedure. This is a randomized prospective study of videography feedback in a laparoscopic simulation laboratory. Our goal is to show that video feedback is beneficial. Methods: We provided a short introductory laparoscopic instrument and handling teaching session for medical students, and asked the students to return after 3 weeks to reassess their skills. Students were randomized into a videography and non-videography group to practice their skills and perform a peg transfer (taken from Fundamentals of Laparoscopic Surgery). The videography group reviewed their individual video before practicing and performing the timed task again at the interval assessment. The time difference was calculated between interval and initial times. A univariate analysis was performed for our outcome and possible confounders. Results: A total of 17 participants with 34 assessment times were studied. Age and gender were similar between the two groups (p=0.39, 0.44 respectively). There was no association between gender and time difference (p=0.33). The time difference for the videography and non-videography group was significantly different (average time = 47.0±24.0, 28.7±13.6 seconds respectively, p<0.001). Conclusions: The group receiving video postural feedback was able to perform the timed task faster on average. Age and initial time were not different between the two groups, and gender was not associated with time difference. This eliminated these 3 variables as possible confounders. Video feedback can increase the efficiency of laparoscopic teaching, and may be a useful tool in resident education and training.
no TI attempt at month 3 versus hepatic flexure at month 1, p=0.03). In addition to clinical outcomes, simulator scores improved significantly from month 1 to month 3 (Table 2; p= 0.034) Conclusion: The part-task endoscopic simulator provides a safe non-clinical environment for trainees to practice fundamental endoscopic maneuvers and become familiar with accessories during the first several weeks of training. Additionally, this small sample size suggests that routine use of the simulator may improve trainee technical endoscopic performance during the early phases of training. Table 1. Primary outcomes. Average MCSAT motor items score and cecal intubation rate at months 1 and 3 (1=novice, 2=intermediate, 3=advanced, 4=superior)
Table 2. Secondary outcome. Training box scores at months 1 and 3
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Direct Observation and Real-Time Feedback During Gastroenterology Fellowship: A Survey of Fellows and Faculty Sumona Saha, Eric A. Gaumnitz
Counting Surgical Competence; A Gastrointestinal Perspective Tarig Abdelrahman, Charlotte E. Thomas, Cristel Santos, Mr. Gareth Griffiths, Wyn G. Lewis
Introduction: Infrequent direct observation with real-time feedback has been documented in numerous studies involving medical trainees. We assessed gastroenterology faculty and fellows' perception of the frequency with which they provide/receive feedback based on direct observation and the quality of that feedback in a busy, academic gastroenterology fellowship program. Methods: Using Qualtrics survey software fellows and faculty in the GI division at the University of Wisconsin School of Medicine were surveyed. Faculty were asked to rate the frequency with which they directly observe fellows in the outpatient GI clinic, on the inpatient consult services, and in the endoscopy lab using a 5-point scale (1= never to 5=all of the time). They were also asked to rate the quality of the feedback they provide in those settings (1=very poor to 5=very good). Fellows were similarly queried about their experience being observed. They were also asked to rate the quality of the feedback they receive (1=very poor to 5=very good). All respondents were asked about barriers to direct observation and real-time feedback. Descriptive statistics were calculated for demographic characteristics and for all survey items. Results: 8 (89%) fellows and 20 (95%) faculty completed the survey. With regards to outpatient clinic performance, faculty and fellows reported direct observation and real-time feedback to be least frequent during history taking (mean [SD] fellows 2.4+0.9; mean [SD] faculty 2.4+1.2) and while performing the physical exam (mean [SD] fellows 2.5+0.9; mean [SD] faculty 2.1+1.0) and highest during discussion of the management plan (mean [SD] fellows 4.0+0.8; mean [SD] faculty 3.5+1.4). The same trends were seen with regards to clinical skills on the inpatient consult services wherein history taking and physical examination were least likely to be observed. During endoscopy fellows and faculty were in agreement that procedures are nearly always observed generating real-time feedback (mean [SD] fellows 4.5+0.5; mean [SD] faculty 4.4 +1.2). Overall, fellows rated the quality of the feedback received to be highest during endoscopy (mean 4.1+0.6) and lowest on the inpatient consult services (mean 3.4+0.5). With regards to barriers to observation and feedback, fellows' most strongly agreed with the statement that faculty do not prioritize giving feedback (mean score 3.1+0.8) while faculty most strongly agreed with the statement that giving feedback is awkward (mean 3.1+1.2). Conclusions: Direct observation of gastroenterology fellows and real-time feedback occurs most frequently during endoscopy while non-procedural clinical skills often go unobserved. Given the importance of history taking, physical examination, and patient counseling interventions aimed at improving observation and feedback are needed in both the outpatient and inpatient settings.
Background. UK surgical education and postgraduate training is under scrutiny, not least because of its craft specialty status, but also because of a progressive onslaught of initiatives aimed at improving yet shortening training time. In 2013, guidelines were published for the award of Certification of Completion of Training (CCT) in General Surgery citing global operative experience (1600 index cases over 6 years, including 100 emergency laparotomies for all trainees and subspecialty index procedure targets) together with other professional credentials. Similar guidelines exist in the US stating a minimum of 750 operative procedures in the five years of residency. The aim of this study was to evaluate the current operative experience achieved by UK gastrointestinal (GI) surgery trainees at CCT, and to determine whether targets set are achievable within a contemporary surgical training scheme. Methods. The online portfolios of 89 UK GI surgery CCT applicants (45 Colorectal, 28 Upper GI, 14 Hepatopancreaticobiliary, 2 General) were analysed for the 2013 calendar year with specific reference to curriculum operative experience and academic achievements. Results. The median total operative caseload number was 1802 (range 783-3764, 1829 Colorectal, 1651 Upper GI, 1747 Hepatopancreaticobiliary, and 1932 General), with 56 applicants (63%) achieving the target number of 1600. The median emergency laparotomy caseload was 115 (19-328) with 61 applicants (69%) achieving the target. Complex major surgical operative targets were met by 79% (73% Colorectal, 79% UGI, 100% HPB,). The median number of publications achieved by GI trainees was 7 [0-61, median 4 (0-24) first author], and median national or international presentations 10 (1-67). The academic targets of 3 peer reviewed publications and 3 presentations was achieved by 78 (88%), and 84 (94%) respectively. Conclusions. Global operative numbers varied widely with greater than two thirds of applicants achieving elective and emergency operative targets. Measures to identify lower quartile trainees early within training allied to focused simulation should be considered to enhance GI surgical training.
Sa1034 Impact of a Year-Long Gastrointestinal Pathophysiology Teaching Fellowship During Gastroenterology Fellowship Helen M. Shields, Eric M. Goldberg, Samuel C. Somers, Win Travassos, Sonal Ullman, Seema Maroo, Daniel Leffler, Richard P. O'Farrell, Paola G. Blanco, Steven Kappler, Tyler M. Berzin, Sarah N. Flier, Paul S. Sepe, Suma Magge, Gyanprakash A. Ketwaroo, Joseph D. Feuerstein, Byron Vaughn, Hamed Nayeb-Hashemi, Edward L. Barnes, Stephen R. Pelletier
Sa1032 Endoscopic Part-Task Simulator Training Improves Endoscopic Performance in Gastroenterology Fellows Pichamol Jirapinyo, Nitin Kumar, Supisara Tintara, Vicki Bing, Hiroyuki Aihara, Molly Perencevich, Linda S. Lee, Avlin B. Imaeda, Christopher C. Thompson
Background: In 2001, a year-long unfunded Teaching Fellowship in Gastrointestinal (GI) Pathophysiology was created by the Course Director (CD) for the Second-Year Pre-Clinical Harvard Medical School GI Pathophysiology Course so that GI Fellows could learn both academic teaching and leadership skills by co-teaching the GI Pathophysiology Course. The 18 fellows were drawn from the Beth Israel Deaconess Medical Center (16) from 2001-2013 and Brigham and Women's Hospital (2) in 2013 and 2014. Fellows were selected on the basis of a self-identified interest in teaching. Teaching Fellows' (15) activities might include teaching in pathology laboratories with 40 students, tutorials with 7-9 students per tutorial, small group interactive sessions with 15-30 students and co-teaching two whole class review sessions during the 2.5 week long GI Pathophysiology course. In three years, 2010, 2012 and 2013 there were two fellows interested in teaching the course. In these years the GI Pathophysiology Teaching Fellow taught the entire course's activities while the Academic Teaching Fellow was both a tutor and small group leader (3). All Teaching Fellows began one-on-one mentoring sessions 7-8 AM weekly in July for the course occurring in March of the following year. During the actual course, the fellow and CD met daily to go over teaching sessions, quizzes and review materials. Over the 13 year period, 18 fellows (13 men and 5 women) completed the GI Pathophysiology Teaching or Academic Teaching Fellowship. Methods: An IRB approved survey using Qualtrics software was sent online to each of the 18 fellows involved indicating that participation is voluntary, e-mail addresses are made anonymous to protect privacy and all data will be presented in the aggregate. No payment was given for being the Teaching or Academic Fellow for the GI Pathophysiology Course except for face-to-face time teaching stipends provided by the medical school to each teacher in a pre-clinical course. Results: Participation rate: 83% (15/18) completed the survey. See Table 1 for specific outcomes. Conclusions: A year of exposure to formal teaching of gastrointestinal pathophysiology at a medical school was extremely successful in improving
Background: Training in endoscopy has traditionally relied upon clinical hands-on experience. Simulators may allow the development of endoscopic skills in a non-clinical environment. Aim: To assess the effect of an endoscopic part-task simulator on trainees' endoscopic performance. Methods: Simulator: An endoscopic part-task training box consisting of 5 modules (snare polypectomy, retroflexion, torque, knob control and loop reduction/navigation) and a validated scoring system. Subjects: First year gastroenterology fellows from two academic institutions. Design: Fellows were instructed to practice on the simulator for at least 45 minutes per week for the first 3 months of training, in addition to receiving traditional hands-on clinical training. All fellows were assessed for their endoscopic skill performance using the Mayo Colonoscopy Skills Assessment Tool (MCSAT) and the simulator at month 0, 1 and 3. Primary Outcomes: An average MCSAT score of motor items (hands-on participation, colonoscope advancement, loop reduction, visualization of mucosa on withdrawal and therapeutic maneuver performance) and cecal intubation rate at months 1 and 3. Secondary Outcomes: Simulator scores at months 1 and 3. Statistical Analysis: Outcomes from months 1 and 3 were compared using a paired t-test. Results: Eight first year gastroenterology fellows from two academic institutions participated in the study. All participants had not used the simulator and had no endoscopic experience prior to the study. Fellows' clinical endoscopic skills improved significantly from month 1 to month 3. Specifically, fellows received a rating of "novice-intermediate" at month 1 and "intermediate-advanced" at month 3 (Table 1; p=0.003). Cecal intubation rate also increased significantly (Table 1; p=0.006). On average, at month 3, fellows spent the same amount of time ( p=0.34), but were able to reach a farther landmark in the colon independently compared to at month 1 (cecum with
AGA Abstracts
S-202