Despite the dramatic technologic developments in endoscopy, our understanding of how endoscopic skills are acquired and learnt remains rudimentary. Technical training in any procedure involves three elements: didactic learning, supervised hands-on training, and unsupervised experience. Didactic learning is one of the very important component of endoscopic training and comprises formal discussions, presentations, and the use of audio-visual aids. Although didactic training methods can accelerate the evolution of procedural skills, they cannot substitute for the hands-on experience through which technical skills, including critical hand-eye coordination, develop.
During supervised hands-on training, the trainee performs tasks of increasing difficulty under expert supervision. It is important that expert themselves should be compitant enough to transfer their own extraordinary skill to trainees. Unsupervised experience, a critical element of learning, begins during the training period, with expert help available on an increasingly selective basis. Unsupervised experience obviously strats during training period in endoscopy but continues throughout an individual’s professional career. The period of supervised hands-on training starts with “easy” procedures, gradually progressing to more difficult cases. In the “real world,” endoscopists are faced with an unpredictable mix of cases with varied pathology, from straightforward diagnostic procedures to complex therapeutic ones. In practice, therefore, hands-on training often begins with limited segments of procedures, gradually extending to entire diagnostic procedures and more difficult portions of therapeutic procedures. The therapeutic aspect of endoscopy helps in many surgical field. The hand eue coordination is important in endoscopy to develop just like Laparoscopic Training.
Even when competence of endoscopy is achieved, its persistence cannot be assumed. Some institutes have developed quality assurance programs to monitor competence of their endoscopic physician as part of their recredentialing process. Prospective data for individual endoscopists and are collected regarding indications for endoscopy, extent of examination, endoscopic diagnosis, complications, and effect on therapeutic decisions. This analysis can help identify individuals whose skills fall below the accepted level of competence either through disuse, inadequate offsite training, or personal physical impairment. Sadly, few opportunities currently exist for remedial training because of limited faculty time and available resources that are largely reserved for participants in formal training programs.
A number of “advanced training programs” have already been established in regional centers of excellence in many developed countries to assure competence in highly technical procedures of endoscopy, and others are evolving in many developing countries. This all suggests that the prevailing winds may soon change direction, fostering renewed interest in how competence is best achieved.
July 25th, 2008 at 7:48 am
Laparoscopy Hospital Endoscopy Training Centre
The recently opened, state-of-the-art Endoscopy training facility at Laparoscopy Hospital is one of the excellent National centres commissioned to improve endoscopy training in India. Laparoscopy Hospital offers several different types of ‘Basic Skills’ course, including: Basic Skills in Colonoscopy
Basic Skills in GI Endoscopy
Endoscopy training the Trainers
Training the Trainers (TET)
Basic Skills in Flexible Sigmoidoscopy
Basic Skills in Therapeutic GI Endoscopy
Colonoscopy Masterclass
Courses for Nurses
Until April 2008, core courses are aimed at trainees doctor who are currently working within the India (due to the programme being funded by many companies).
After April 2008, the courses will become available to trainees across the Globe. The following fees will apply: In order to be eligible to attend the ‘Basic Skills’ courses you must have an identified trainer to supervise your endoscopy training with organised endosopy sessions for at least 6 months after the course. Details of these centres, core-course dates and contact details can be found by clicking either endoscopy skills courses or training centre contact details. For details of non-core endoscopy courses, please contact the centres directly to find out what they offer. If you wish to apply for a place on a course, please contact the centres directly. The administrator will then send you an application form and places will be allocated on a strictly first come, first served basis. Please be advised that these courses are extremely popular and there are only a very limited number of places available.
July 25th, 2008 at 12:58 pm
There are many complications of endoscopy also.
Upper endoscopy is a safe procedure and complications are uncommon. The following is a list of possible complications: Aspiration of food or fluids into the lungs if patient is not fasting, the risk of which can be minimized by refraining from eating or drinking for 6 hours before the examination.
The endoscope can cause a tear or hole in the natural orifices being examined. Like oesophagus or stomach or colon. This is a serious complication but fortunately occurs only very rarely.
Bleeding can occur from biopsies or the removal of polyps from tissue, but it is usually minimal and stops quickly on its own or can be easily controlled.
Reactions to the sedative medications are possible; the endoscopy team (doctors and nurses) will ask about previous medication allergies or reactions and about health problems such as heart, lung, kidney, or liver disease. Providing this information to the doctor ensures a safer examination.
The medications can also produce irritation or risk to the patient in the vein at the site of the intravenous line. If redness, swelling, or warmth occurs, warm wet towels applied to the site may relieve the discomfort. If discomfort persists, a patient should call their primary care provider or the endoscopy unit. If this is not possible, the patient should seek assistance in an emergency department.
The following signs and symptoms should be reported immediately: Severe abdominal pain (more than gas cramps)
A firm, distended abdomen
Vomiting
Temperature greater than 101ºF or 38ºC
Difficulty swallowing or severe throat pain
A crunching feeling under the skin.
July 25th, 2008 at 1:10 pm
BSG Working Party Consensus on Antibiotic Prophylaxis in Endoscopy (2008) what is your idea about that
All endoscopists will be aware of the current controversy and differing guidelines on endocarditis prophylaxis for GI procedures. A working group of the BSG Endoscopy Committee met in March 2006 to revise the 2001 guidance.
NICE has now considered this issue as well. It has come out against the use of antibiotic prophylaxis to prevent endocarditis during gastrointestinal endoscopy. Its guidance on endocarditis prophylaxis was unveiled on 26 March 2008: