Forty-Year Analysis of Colonoscopic Surveillance Program for Neoplasia in Ulcerative Colitis: An Updated Overview

C.R.C. was funded by the Derek Willoughby Fund for Inflammatory Research. A.L.H. and T.A.G. were funded by Higher Education Funding Council of England

Leadership training to improve adenoma detection rate in screening colonoscopy: A randomised trial

Objective Suboptimal adenoma detection rate (ADR) at colonoscopy is associated with increased risk of interval colorectal cancer. It is uncertain how ADR might be improved. We compared t

Structured assessment of competency in polypectomy

Currently, there is no national endoscopic database in England. Information regarding the volume of therapeutic endoscopic procedures such as polypectomy is obtained mainly from small prospective studies. We examined the Hospital Episode Statistics (HES) national database to assess the number of patients who underwent a therapeutic polypectomy for a primary diagnosis of a benign colorectal polyp over a 10 year period, as well as analysing outcomes from the first three years of bowel cancer screening at a single tertiary endoscopy centre. Despite the ubiquitous use of endoscopic snare polypectomy over the last four decades, there has been a void in formal training and assessment of polypectomy skills in the UK. We aimed to develop and validate an objective, structured assessment tool for assessing polypectomy competency in skilled accredited Bowel Cancer Screening endoscopists. This study led to the development of the DOPyS (Direct Observation of Polypectomy Skills) assessment tool. Validation and reliability of the DOPyS was demonstrated through assessment of polypectomy videos, performed by accredited Bowel Cancer Screening endoscopists, using Generalisability Theory (G theory). Construct validity of the DOPyS, and its ability to assess piecemeal Endoscopic Mucosal Resection, were determined through separate studies. The DOPyS validation studies highlighted variability in assessor scoring and DOPyS training days were held for Bowel Cancer Screening assessors in England, in order to align opinions prior to the implementation of the DOPyS into the Bowel Cancer Screening Accreditation Process in England. Finally, in an effort to provide a structure for improved polypectomy outcomes and referral systems, a study was performed to determine the difficulty ‘level’ of a polypectomy, based on polyp characteristics.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The endoscopy safety checklist:A longitudinal study of factors affecting compliance in a tertiary referral centre within the United Kingdom

Gastrointestinal endoscopy is a widely used diagnostic and therapeutic procedure both within the United Kingdom and worldwide. With an increasingly older population the potential for complications is increased. The Wolfson Unit for Endoscopy at St. Mark's Hospital in London is a tertiary referral centre, which conducts over 14,000 endoscopic procedures annually. However, despite this high throughput, our baseline observations were that the procedure for safety checks was highly variable. Over a seven-day period we conducted a questionnaire-based survey to all staff members involved with endoscopy within our unit. We found that there was little consensus between team members, both in terms of essential safety checks and designating responsibility for the checks. A panel of experts was convened in order to devise a safety checklist and a strategy for increasing compliance with the checklist among all staff members. Using a combination of electronic and physical reminders and incentives, we found that there was a significant increase in completed checklist (53% to 66%, p = 0.021) and decrease in the number of checklists left blank post intervention (10% to 2%, p=0.03). We believe that post implementation validation of safety checklists is an important method to ensure their proper use

Quality assurance of training in diagnostic and therapeutic gastrointestinal endoscopy

Previous evidence has shown that standards of performance in gastrointestinal endoscopy are variable and that there are disparities in training outcomes. Many changes have been made recently to both training and assessment of endoscopy in the UK. However, no prospective methods of evaluating their outcome have been put in place. The aims of this research were to evaluate current and new training processes and assessments in order to quality assure the outcomes and improve the training process. Two audits were undertaken demonstrating improvements in colonoscopy training over 5 years within a single region and in trainee perceptions of their training nationally. Two studies were done investigating a novel computer colonoscopy simulator for assessment of colonoscopic skills, demonstrating excellent construct validity. A multi-centre randomised controlled trial evaluated the use of this simulator in novice training, which was shown to be equivalent to standard bed-side training with a high degree of skills transfer to real-life colonoscopy. Assessment tools for therapeutic endoscopic procedures were developed, validated and used to quality assure a course in therapeutic endoscopy. This course resulted in significant improvements in practical skills for three of the four therapeutic procedures following training. Web-based training and assessment modules for lesion recognition at capsule endoscopy were developed, validated and piloted. This demonstrated the effectiveness of using new training methodologies for skills improvement in this area. A training course for radiographers in virtual colonoscopy was developed and the training evaluated. This demonstrated competence in practical performance and improvements in knowledge and interpretative skill. Finally, two qualitative studies on non-technical skills in endoscopy were undertaken in order to widen the assessment domains from purely knowledge and skill. An interview study provided the basis for development of a nontechnical skills taxonomy and a video-analysis study resulted in production of a marker system for professional behaviour within gastrointestinal endoscopy.EThOS - Electronic Theses Online ServiceOlympus KeymedSchrodersGBUnited Kingdo

Endoscopic non-technical skills team training:The next step in quality assurance of endoscopy training

AIM: To investigate whether novel, non-technical skills training for Bowel Cancer Screening (BCS) endoscopy teams enhanced patient safety knowledge and attitudes. METHODS: A novel endoscopy team training intervention for BCS teams was developed and evaluated as a pre-post intervention study. Four multi-disciplinary BCS teams constituting BCS endoscopist(s), specialist screening practitioners, endoscopy nurses and administrative staff (A) from English BCS training centres participated. No patients were involved in this study. Expert multidisciplinary faculty delivered a single day’s training utilising real clinical examples. Pre and post-course evaluation comprised participants’ patient safety awareness, attitudes, and knowledge. Global course evaluations were also collected. RESULTS: Twenty-three participants attended and their patient safety knowledge improved significantly from 43%-55% (P ≤ 0.001) following the training intervention. 12/41 (29%) of the safety attitudes items significantly improved in the areas of perceived patient safety knowledge and awareness. The remaining safety attitude items: perceived influence on patient safety, attitudes towards error management, error management actions and personal views following an error were unchanged following training. Both qualitative and quantitative global course evaluations were positive: 21/23 (91%) participants strongly agreed/agreed that they were satisfied with the course. Qualitative evaluation included mandating such training for endoscopy teams outside BCS and incorporating team training within wider endoscopy training. Limitations of the study include no measure of increased patient safety in clinical practice following training. CONCLUSION: A novel comprehensive training package addressing patient safety, non-technical skills and adverse event analysis was successful in improving multi-disciplinary teams’ knowledge and safety attitudes