Training and competency in endoscopic mucosal resection

Techniques in Gastrointestinal Endoscopy Pub Date : 2017-07-01 DOI:10.1016/j.tgie.2017.06.002

Ralph F. Lee MD, MMEd (Dist), FRCPC , Steven J. Heitman MD, MSc, FRCPC , Michael J. Bourke MBBS, FRACP

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引用次数: 5

Abstract

Endoscopic mucosal resection (EMR) should be the preferred method of removal for colonic laterally spreading lesions ≥2 cm in size since it is safer, more efficient, and more cost-effective than endoscopic submucosal dissection or surgery. Although competent endoscopists should be comfortable in removing colonic lesions up to 2 cm in size, removal of larger laterally spreading lesions by modern EMR requires advanced skills and meticulous execution of systematic technique to minimize incomplete resection and subsequent interval cancer. Determinations of competency in EMR are important to minimize patient risks and maximize patient outcomes. Assessments of competency may include procedural volumes, direct observational tools, simulators, and other metrics. Advanced training in EMR should be systematic, competency-based; learner- and patient-centered; and must include continual assessment, feedback, reflection, analysis ,and application of identified strategies for improvement. Two models for EMR training, in both the postgraduate and continuing education settings, are proposed along with resources for learning.

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内镜黏膜切除术的培训和能力

内镜下粘膜切除术(EMR)相对于内镜下粘膜剥离或手术更安全、更有效、更经济，因此对于≥2cm的结肠横向扩散病变，应首选内镜下粘膜切除术(EMR)。虽然称职的内窥镜医师应该能够自如地切除2厘米大小的结肠病变，但通过现代EMR切除较大的横向扩散病变需要先进的技能和系统技术的细致执行，以尽量减少不完全切除和随后的间隔期癌。EMR能力的确定对于最小化患者风险和最大化患者预后非常重要。能力评估可能包括程序量、直接观察工具、模拟器和其他指标。电子病历高级培训应该是系统化的、以能力为基础的;以学习者和患者为中心;并且必须包括持续的评估、反馈、反思、分析，以及对确定的改进策略的应用。在研究生和继续教育环境中，提出了两种电子病历培训模式，以及学习资源。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Techniques in Gastrointestinal Endoscopy GASTROENTEROLOGY & HEPATOLOGY-

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期刊介绍： The purpose of each issue of Techniques in Gastrointestinal Endoscopy is to provide a comprehensive, current overview of a clinical condition or surgical procedure in gastrointestinal endoscopy, combining the effectiveness of an atlas with the timeliness of a journal. Each issue places a vigorous emphasis on diagnosis, rationale for and against a procedure, actual technique, management, and prevention of complications. The journal features abundant illustrations, line drawings and color artwork to guide readers through even the most complicated procedure.