Pediatric endoscopy training across Europe: a survey of the ESPGHAN National Societies Network 2016–2019

Abstract

Background and study aims The ability to perform endoscopy procedures safely and effectively is a key aspect of quality clinical care in Pediatric Gastroenterology, Hepatology and Nutrition (PGHN). The aim of this survey, which was part of a global survey on PGHN training in Europe, was to assess endoscopy training opportunities provided across Europe.

Methods Responses to standardized questions related to endoscopy training were collected from training centers across Europe through the presidents/representatives of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition National Societies from June 2016 to December 2019.

Results A total of 100 training centers from 19 countries participated in the survey. In 57 centers, the endoscopy suit was attached to the PGHN center, while in 23, pediatric endoscopies were performed in adult endoscopy facilities. Ninety percent of centers reported the availability of specialized endoscopy nurses and 96 % of pediatric anesthetists. Pediatric endoscopies were performed by PGHN specialists in 55 centers, while 31 centers reported the involvement of an adult endoscopist and 14 of a pediatric surgeon. Dividing the number of procedures performed at the training center by the number of trainees, ≤ 20 upper, lower, or therapeutic endoscopies per trainee per year were reported by 0 %, 23 %, and 56 % of centers, respectively, whereas ≤ 5 wireless capsule endoscopies per trainee per year by 75 %. Only one country (United Kingdom) required separate certification of competency in endoscopy.

Conclusions Differences and deficiencies in infrastructure, staffing, and procedural volume, as well as in endoscopy competency assessment and certification, were identified among European PGHN training centers limiting training opportunities in pediatric endoscopy.

Publikationsverlauf

Eingereicht: 28. März 2022

Angenommen nach Revision: 04. Juli 2022

Artikel online veröffentlicht:
17. Oktober 2022

• References

• 1 European Training Requirements for Training in Paediatric Gastroenterology, Hepatology and Nutrition. https://www.espghan.org/knowledge-center/education/ESPGHAN_Training_Syllabus_2019
• 2 Broekaert I, Tzivinikos C, Narula P. et al. European Society for Paediatric Gastroenterology, Hepatology and Nutrition Position Paper on Training in Paediatric Endoscopy. J Pediatr Gastroenterol Nutr 2020; 70: 127-140
• 3 Cohen J, Pike IM. Defining and measuring quality in endoscopy. Gastrointest Endosc 2015; 81: 1-2
• 4 Armstrong D, Barkun A, Bridges R. et al. Canadian association of gastroenterology consensus guidelines on safety and quality indicators in endoscopy. Can J Gastroenterol 2012; 26: 17-31
• 5 Faigel DO, Pike IM, Baron TH. et al. Quality indicators for gastrointestinal endoscopic procedures: An introduction. Am J Gastroenterol 2006; 101: 866-872
• 6 Kramer RE, Walsh CM, Lerner DiG. et al. Quality Improvement in Pediatric Endoscopy: A Clinical Report from the NASPGHAN Endoscopy Committee. J Pediatr Gastroenterol Nutr 2017; 65: 125-131
• 7 Narula P, Broughton R, Howarth L. et al. Paediatric Endoscopy Global Rating Scale: Development of a Quality Improvement Tool and Results of a National Pilot. J Pediatr Gastroenterol Nutr 2019; 69: 171-175
• 8 Rutter MD, Rees CJ. Quality in gastrointestinal endoscopy. Endoscopy 2014; 46: 526-528
• 9 Leichtner AM, Gillis LA, Gupta S. et al. NASPGHAN Training Committee; North American Society for Pediatric Gastroenterology. NASPGHAN guidelines for training in pediatric gastroenterology. J Pediatr Gastroenterol Nutr 2013; 56: S1-S8
• 10 Thomson M, Tringali A, Dumonceau JM. et al. Paediatric Gastrointestinal Endoscopy: European Society for Paediatric Gastroenterology Hepatology and Nutrition and European Society of Gastrointestinal Endoscopy Guidelines. J Pediatr Gastroenterol Nutr 2017; 64: 133-153
• 11 Pall H, Lerner D, Khlevner J. et al. Developing the Pediatric Gastrointestinal Endoscopy Unit: A Clinical Report by the Endoscopy and Procedures Committee. J Pediatr Gastroenterol Nutr 2016; 63: 295-306
• 12 Ward ST, Mohammed MA, Walt R. et al. An analysis of the learning curve to achieve competency at colonoscopy using the JETS database. Gut 2014; 63: 1746-1754
• 13 Broekhart I, Jahnel J, Moes N. et al. Evaluation of a European-wide survey on pediatric endoscopy training. Frontline Gastroenterol 2019; 10: 188-193
• 14 Papadopoulou A, Ribes-Koninckx C, Noni M. et al. Training in pediatric hepatology across Europe: a survey of the ESPGHAN National Societies Network 2016–2019. Ann Gastroenterol 2022; 35: 1-7
• 15 Athiana I, Légeret C, Bontems P. et al. Significant variations across European centres in implementing recommended guidelines for the paediatric gastroenterology endoscopy suite during the COVID-19 pandemic. JPGN Reports 2021;
• 16 International Database: World Population Estimates and Projections. https://www.census.gov/data-tools/demo/idb/#/map?COUNTRY_YR_ANIM=2021&menu=mapViz&COUNTRY_YEAR=
• 17 Royal College of Physicians. UK Inflammatory Bowel Disease Audit: A summary report on the quality of healthcare provided to people with inflammatory bowel disease. 2014 https://www.rcplondon.ac.uk/file/2441/download
• 18 Orel R, Brecelj J, Dias JA. et al. Review on sedation for gastrointestinal tract endoscopy in children by non-anesthesiologists. World J Gastrointest Endosc 2015; 7: 895-911
• 19 Oliva S, Dias JA, Alateeqi A. et al. The pediatric endoscopy practice in Europe: preliminary results of a web-based survey on behalf of the Endoscopy Special Interest Group of European Society for Paediatric Gastroenterology, Hepatology and Nutrition. Gastrointest Endosc 2020; 91: AB501 https://www.giejournal.org/article/S0016-5107%2820%2933229-6/fulltext
• 20 Parry BR, Williams SM. Competency and the colonoscopist: a learning curve. Aust N Z J Surg 1991; 61: 419-422
• 21 PGHN Guidance Checklist. https://studylib.net/doc/7595104/pghn-guidance-checklist
• 22 Ward ST, Mohammed MA, Walt R. et al. An analysis of the learning curve to achieve competency at colonoscopy using the JETS database. Gut 2014; 63: 1746-1754
• 23 DʼAntiga L, Nicastro E, Papadopoulou A. et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition syllabus for subspecialty training: Moving towards a European standard. J Pediatr Gastroenterol Nutr 2014; 59: 417-422
• 24 Faulx AL, Lightdale JR, Acosta RD. et al. Guidelines for privileging, credentialing, and proctoring to perform GI endoscopy. Gastrointest Endosc 2017; 85: 273-281
• 25 Jorgensen JE, Elta GH, Stalburg CM. et al. Do breaks in gastroenterology fellow endoscopy training result in a decrement in competency in colonoscopy?. Gastrointest Endosc 2013; 78: 503-509
• 26 Singh S, Sedlack RE, Cook DA. Effects of simulation-based training in gastrointestinal endoscopy: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2014; 12: 1611-1623.e4
• 27 Walsh CM. Training and assessment in pediatric endoscopy. Gastrointest Endosc Clin N Am 2016; 26: 13-33
• 28 Sewell JL, Boscardin CK, Young JQ. et al. Learner, patient, and supervisor features are associated with different types of cognitive load during procedural skills training: implications for teaching and instructional design. Acad Med 2017; 92: 1622-1631
• 29 Huang C, Hopkins R, Huang K. et al. Standardizing endoscopy training: a workshop for endoscopy educators. MedEdPORTAL 2020; 16: 11015
• 30 Umar SB, Oxentenko AS. Training the trainers: setting standards for faculty in gastroenterology. Clin Gastroenterol Hepatol 2021; 19: 861-868
• 31 Zanchetti DJ, Schueler SA, Jacobson BC. et al. Effective teaching of endoscopy: a qualitative study of the perceptions of gastroenterology fellows and attending gastroenterologists. Gastroenterol Rep (Oxf) 2016; 4: 125-130
• 32 Romano PS, Volpp K. The ACGMEʼs 2011 changes to resident duty hours: Are they an unfunded mandate on teaching hospitals?. J Gen Intern Med 2012; 27: 136-138
• 33 Epstein RM. Assessment in medical education. N Engl J Med 2007; 356: 387-396
• 34 Walsh CM, Ling SC, Walters TD. et al. Development of the gastrointestinal endoscopy competency assessment tool for pediatric colonoscopy (GiECATKIDS). J Pediatr Gastroenterol Nutr 2014; 59: 480-486
• 35 (Model) Specialty Training Regulations 2018. German Medical Association (Joint Association of the State Chambers of Physicians in Germany). https://www.bundesaerztekammer.de/fileadmin/user_upload/downloads/pdf-Ordner/Weiterbildung/20210630_MWBO_2018.pdf