Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(12): E1804-E1810
DOI: 10.1055/a-1265-6731
Original article

The impact of distraction minimization on endoscopic mentoring and performance

Sean C. Rice
1   Division of Gastroenterology, Vanderbilt University, Nashville, Tennessee, United States
,
James C. Slaughter
2   Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, United States
,
Walter Smalley
1   Division of Gastroenterology, Vanderbilt University, Nashville, Tennessee, United States
3   Division of Gastroenterology, Nashville Veterans Affairs Hospital, Nashville, Tennessee, United States
,
Keith L. Obstein
1   Division of Gastroenterology, Vanderbilt University, Nashville, Tennessee, United States
4   Department of Mechanical Engineering, Vanderbilt University, Nashville, Tennessee, United States
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background and study aims Endoscopic mentoring requires active attention by the preceptor. Unfortunately, sources of distraction are abundant during endoscopic precepting. The impact of distraction minimization on endoscopic mentoring and performance is unknown.

Methods Fellow and attending preceptors were paired and randomized in a prospective crossover design to perform esophagogastroduodenoscopy (EGD) and/or colonoscopy in either a “distraction minimization” (DM) or a “standard” (S) room. Cell phones, pagers, music, and computers were not permitted in DM rooms. S rooms operated under typical conditions. Fellows and attendings then completed a survey. The primary outcome was fellow satisfaction with mentoring experience (visual analogue scale: 0 = min,100 = max). Additional fellow outcomes included satisfaction of attending attentiveness, identifying landmarks, communication, and distractedness; attending outcomes included satisfaction with mentoring, attentiveness, communication, and distractedness. Endoscopic performance measures included completion of EGD, cecal intubation rate, cecal intubation time, withdrawal time, total procedure time, attending assistance, and polyp detection rate. A paired t-test was used to compare mean differences (MD) between rooms; significance set at P < 0.05.

Results Eight fellows and seven attendings completed 164 procedures. Despite a trend toward less distraction between rooms (DM = 12.5 v. S = 18.3, MD =  4.1, P = 0.17), there was no difference in fellow satisfaction with training/mentoring (DM = 93, S = 93, MD = –0.04, P = 0.97), attentiveness (DM = 95, S = 92, MD = 0.86, P = 0.77), identifying pathology/landmarks (DM = 94, S = 94, MD = –1.72, P = 0.56), or communication (DM = 95, S = 95,MD = 1.0, P = 0.37). Similarly, there was no difference between rooms for any attending outcome measures or performance metrics.

Conclusions DM did not improve perceived quality of endoscopic mentoring or performance for fellows or attendings; however, reduced distraction may improve attending engagement/availability.



Publication History

Received: 06 July 2020

Accepted: 06 August 2020

Article published online:
17 November 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Cass OW. Training to competence in gastrointestinal endoscopy: a plea for continuous measuring of objective end points. Endoscopy 1999; 31: 751-754
    Thieme ConnectPubMedSearch in Google Scholar
  • 2 Sedlack RE. Training to competency in colonoscopy: assessing and defining competency standards. Gastrointest Endosc 2011; 74: 355-366.e351-352
    CrossrefPubMedSearch in Google Scholar
  • 3 Ende A, Zopf Y, Konturek P. et al. Strategies for training in diagnostic upper endoscopy: a prospective, randomized trial. Gastrointestinal endoscopy 2012; 75: 254-260
    CrossrefPubMedSearch in Google Scholar
  • 4 Faulx AL, Soyka C. Simulator training in colonoscopy: when less is better. Gastrointest Endosc 2015; 81: 974-975
    CrossrefPubMedSearch in Google Scholar
  • 5 Berenholtz SM, Schumacher K, Hayanga AJ. et al. Implementing standardized operating room briefings and debriefings at a large regional medical center. Joint Commission J Quality Patient Safety 2009; 35: 391-397
    CrossrefPubMedSearch in Google Scholar
  • 6 Hay JM, Barnette W, Shaw SE. Changing practice in gastrointestinal endoscopy: reducing distractions for patient safety. Gastroenterol Nursing 2016; 39: 181-185
    CrossrefPubMedSearch in Google Scholar
  • 7 West P, Sculli G, Fore A. et al. Improving patient safety and optimizing nursing teamwork using crew resource management techniques. J Nursing Admin 2012; 42: 15-20
    CrossrefPubMedSearch in Google Scholar
  • 8 Atkins L, Hunkeler EM, Jensen CD. et al. Factors influencing variation in physician adenoma detection rates: a theory-based approach for performance improvement. Gastrointest Endosc 2016; 83: 617-626.e612
    CrossrefPubMedSearch in Google Scholar
  • 9 Rex DK, Bond JH, Winawer S. et al. Quality in the technical performance of colonoscopy and the continuous quality improvement process for colonoscopy: recommendations of the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 2002; 97: 1296-1308
    CrossrefPubMedSearch in Google Scholar
  • 10 Wheelock A, Suliman A, Wharton R. et al. The impact of operating room distractions on stress, workload, and teamwork. Ann Surg 2015; 261: 1079-1084
    CrossrefPubMedSearch in Google Scholar
  • 11 Laborde CJ, Bell CS, Slaughter JC. et al. Evaluation of a novel tablet application for improvement in colonoscopy training and mentoring (with video). Gastrointest Endosc 2017; 85: 559-565.e551
    CrossrefPubMedSearch in Google Scholar
  • 12 Harris PA, Taylor R, Thielke R. et al. Research electronic data capture (REDCap) – a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Informat 2009; 42: 377-381
    CrossrefPubMedSearch in Google Scholar
  • 13 Klimek L, Bergmann KC, Biedermann T. et al. Visual analogue scales (VAS): Measuring instruments for the documentation of symptoms and therapy monitoring in cases of allergic rhinitis in everyday health care: Position Paper of the German Society of Allergology (AeDA) and the German Society of Allergy and Clinical Immunology (DGAKI), ENT Section, in collaboration with the working group on Clinical Immunology, Allergology and Environmental Medicine of the German Society of Otorhinolaryngology, Head and Neck Surgery (DGHNOKHC). Allergo J Int 2017; 26: 16-24 
    CrossrefPubMedSearch in Google Scholar