Faculty Bibliography

Endoscopic training is a complex process, combining both cognitive and psychomotor skill development and can be challenging for the educator. This challenge extends into clinical practice as quality benchmarks evolve and the path to individual improvement still requires clarity. The aim of this manuscript is to simplify this challenge for educators and clinical endoscopists alike. We review tools that the educator can employ such as effective feedback, clinical coaching, and mastery learning. We discuss factors that may impact how trainees learn endoscopy and review of cognitive load theory. After establishing these tools for the educator, the manuscript proceeds to review assessment methods for endoscopic training and the data that has driven the evolution away from a standard number of procedures to a competency-based assessment. The role of simulators and validated endoscopic assessment tools within competency based, endoscopic teaching is reviewed as well. Moving from endoscopy training into clinical practice, this manuscript explores how these feedback and coaching techniques might also be used in clinical practice to aid struggling endoscopists to meet clinical quality benchmarks and credentialing standards. Lastly, we identify potential opportunities for future scholarship in this arena.

Introduction: The objective structured clinical examination (OSCE) has been shown to not only assess but also improve the performance of trainees. Our group has previously demonstrated the benefits of OSCEs to assess gastroenterology (GI) fellows. We have successfully assessed performance across numerous milestones. Typically, OSCEs are held in person, however the COVID-19 pandemic has precipitated the need for virtual learning. We accordingly transitioned to a virtual zoom OSCE (Z-OSCE) and evaluated trainees' perception of this program.
Method(s): Fourteen first- and second-year GI fellows from five programs across multiple states participated in a four-station virtual OSCE on Zoom. Afterwards, participants answered a survey to share their perspectives and provide feedback. Learners were asked to rate the usefulness of the virtual OSCE and compare it to other in-person and virtual educational modalities. These questions were rated on a 10-point Likert scale (Figure 1). Additionally, free-text responses regarding any aspect of the OSCE were evaluated for comments on the virtual format.
Result(s): In comparing the usefulness of the virtual OSCE to other in-person modalities, trainees rated it a mean of 7.15 (range 5-10), and 31% of respondents rated it a 9 or 10. Trainees rated the virtual OSCE compared to other virtual learning modalities a mean of 8.15 (range 5-10), and 43% rated it 9 or 10. When asked whether they would recommend this OSCE as a training tool, the trainees gave a mean recommendation of 7.77 (range 5-10), and 38% gave a 9 or 10. General feedback regarding the nature of the OSCE noted the virtual format worked well, orientation to the format was important and could be improved by providing it in an email beforehand.
Conclusion(s): Virtual learning has been necessary during the COVID-19 pandemic, and it is crucial to evaluate the value of the novel Z-OSCE. Participants found the virtual OSCE may be more useful than in-person learning modalities and it compared favorably to other virtual learning modalities. One benefit of this modality was the easier inclusion of fellows from geographically disparate areas negating the need to travel for this program, a benefit given lack of universal access to simulation using standardized patients. To improve future exams, orientation prior to the day of the OSCE may improve trainees' experiences.

Introduction: gFOBT, FIT, FIT-DNA are non-invasive colorectal cancer screening tools often used inappropriately. Furthermore, clinical decisions are then predicated on these test results leading to consequences ranging from delay of healthcare to unnecessary invasive procedures. The purpose of this project was to identify misconceptions among health care providers, and to educate utilizing interventions aimed at developing life-long evidence-based practices regarding correct use, understanding and knowledge of non-invasive colorectal cancer screening tests.
Method(s): Three 1-hour long interactive lectures based on current guidelines were conducted and made available online to internal and emergency medicine residents, medical students, nurses and physician assistants. Participants completed a pre- and post-test questionnaire, with questionnaires paired to each individual. Question stems were created to focus on topics gauging ability to assess higher level of thinking, recall, and knowledge of evidence based medicine regarding gFOBT, FIT and FIT-DNA. Participants were also asked frequency in using screening tests for symptoms of abdominal pain, hematochezia or melena and if educational intervention was informative. Data was analyzed using descriptive statistics and paired T tests to assess an improvement in knowledge.
Result(s): 85 participants were involved including residents within internal (n=28) and emergency medicine (n=13), 3rd and 4th year medical students (n=24), physician assistants (n=8) and clinical nursing staff (n=12). Most common misconceptions identified were screening timeline guidelines, when and how to perform tests and next-best step following positive stool test results. (Table) The use of stool based screening tests are commonly used for symptoms such as hematochezia or melena. Pre and post-test averages showed statistically significant improvement after educational intervention in all groups. (Graph 1)
Conclusion(s): There is a gap in knowledge regarding appropriate use of stool- based testing for colorectal cancer screening. A simple educational intervention based on current guidelines showed a statistically significant increase in knowledge in medical students, residents, physician assistants and nursing staff. 100% of participants who responded found the interactive lecture and questionnaire informative. Future plans include assessing knowledge retention 3 months after initial intervention along with comparing the use of stool based tests before and after the intervention. (Table Presented)

INTRODUCTION/BACKGROUND:Gastroenterologists at all levels of practice benefit from formal mentoring. Much of the current literature on mentoring in gastroenterology is based on expert opinion rather than data. In this study, we aimed to identify gender-related barriers to successful mentoring relationships from the mentor and mentee perspectives. METHODS:A voluntary, web-based survey was distributed to physicians at 20 academic institutions across the United States. Overall, 796 gastroenterology fellows and faculty received the survey link, with 334 physicians responding to the survey (42% response rate), of whom 299 (90%; 129 women and 170 men) completed mentorship questions and were included in analysis. RESULTS:Responses of women and men were compared. Compared with men, more women preferred a mentor of the same gender (38.6% women vs 4.2% men, P < 0.0001) but less often had one (45.5% vs 70.2%, P < 0.0001). Women also reported having more difficulty finding a mentor (44.4% vs 16.0%, P < 0.0001) and more often cited inability to identify a mentor of the same gender as a contributing factor (12.8% vs 0.9%, P = 0.0004). More women mentors felt comfortable advising women mentees about work-life balance (88.3% vs 63.8%, P = 0.0005). Nonetheless, fewer women considered themselves effective mentors (33.3% vs 52.6%, P = 0.03). More women reported feeling pressured to mentor because of their gender (39.5% vs 0.9% of men, P < 0.0001). Despite no gender differences, one-third of respondents reported negative impact of the COVID-19 pandemic on their ability to mentor and be mentored. DISCUSSION/CONCLUSIONS:Inequities exist in the experiences of women mentees and mentors in gastroenterology, which may affect career advancement and job satisfaction.