Successful Training in Gastrointestinal Endoscopy. Группа авторов
| ASGE Assessment of Competency in Endoscopy (ACE). Colonoscopy Skills Assessment Tool Fellow: Staff: Date of procedure: Time of Intubation: Time of Maximal Insertion Extent: Time of Extubation: |
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Fellow’s knowledge of the indication and pertinent medical issues (INR, Vitals, Allergies, PMH, etc.):
□ N/A. Not Assessed (i.e. Fellow observed procedure only)
□ 1. Novice (Poor knowledge of patient’s issue, or started sedating without knowing the indication)
□ 2. Intermediate (Missed an Important element, i.e. Allergies, GI Surgical History, or INR in pt on Coumadin) □ 3. Advanced (Missed minor elements)
□ 4. Superior (Appropriate knowledge and integration of patient information)
Management of patient discomfort during this procedure (Sedation titration, Insufflation management, Loop reduction):
□ N/A Fellow observed
□ 1. Novice (Does not quickly recognize patient discomfort or requires repeated staff prompting to act)
□ 2. Intermediate (Recognizes pain but does not address cause [loop or sedation problems] in a timely manner)
□ 3. Advanced (Adequate recognition and corrective measures)
□ 4. Superior (Competent continuous assessment and management, i.e. intermittently reassess level of sedation and comfort)
Effective and efficient use of air, water, and suction:
□ N/A. Not Assessed (i.e. Fellow observed procedure only)
□ 1. Novice (Repeated prompting due to too much/little air, inadequate washing, or repeated suctioning of mucosa)
□ 2. Intermediate (Occasional prompting due to too much/little air, inadequate washing or repeated suctioning of mucosa)
□ 3. Advanced (Adequate use of air, water and suctioning, but room to improve on efficiency)
□ 4. Superior (Efficient and effective management of washing, suctioning, and air)
Lumen identification:
□ N/A. Not Assessed (i.e. Fellow observed procedure only)
□ 1. Novice (Generally only able to recognize lumen if in direct view)
□ 2. Intermediate (Can grossly interpret large folds to help locate which direction the lumen is located)
□ 3. Advanced (Can use more subtle clues [Light/shadows, arcs of fine circular muscles in wall] but struggles at times)
□ 4. Superior (Quickly and reliably recognizes where lumen should be based on even subtle clues)
Scope steering technique during advancement:
□ N/A. Not Assessed (i.e. Fellow observed procedure only)
□ 1. Novice (Primarily “Two‐hand knob steering”, unable to perform two steering maneuvers simultaneously)
□ 2. Intermediate (Frequent 2‐hand knob steering, limited use of simultaneous steering maneuvers [i.e. torque, knob, advance])
□ 3. Advanced (Primarily uses torque steering, can perform simultaneous steering techniques)
□ 4. Superior (Effortlessly combines simultaneous steering techniques [torque, knob, advance] to navigate even many difficult turns)
Fine tip control:
□ N/A. Not Assessed (i.e. Fellow observed procedure only)
□ 1. Novice (Primarily gross tip control only, frequently in red out)
□ 2. Intermediate (Limited fine tip control, “frequently over‐steers turns, struggles with biopsy forceps/snare targeting”)
□ 3. Advanced (loses fine control when keeping lumen or targeting tools at difficult turns when torque or knobs are needed)
□ 4. Superior (Excellent fine tip control or tool targeting even in difficult situation.)
Loop reduction techniques (pull‐back, external pressure, patient position change):
□ N/A. Not Assessed (i.e. Fellow observed procedure only)
□ 1. Novice (Unable to reduce/avoid loops without hands‐on assistance)
□ 2. Intermediate (Needs considerable coaching on when or how to perform loop‐reduction maneuvers)
□ 3. Advanced (Able to reduce/avoid loops with limited coaching)
□ 4. Superior (Without coaching, uses appropriate ext. pressure/position changes/loop‐reduction techniques)
What is the farthest landmark the fellow reached without any hands‐on assistance?
□ N/A. Fellow observed only or Procedure terminated before completion.
□ 1.Rectum, □ 2. Sigmoid, □ 3. Splenic flexure, □ 4. hepatic flexure,
□ 5. Cecum No TI attempt (Reached cecum with no attempt at TI intubation)
□ 6. Cecum Failed TI attempt (Reached cecum but Failed attempt at TI intubation)
□ 7. Terminal Ileum (Successful intubation of TI)
□ 8. Other‐Post surgical anatomy encountered, fellow reached maximal intubation
Adequately visualized mucosa during withdrawal
□ N/A. Not Assessed (i.e. Fellow observed procedure only)
□ 1. Novice (Red out much of the time, does not visualize significant portions of the mucosa or requires assistance)
□ 2. Intermediate (Able to visualize much of the mucosa but requires direction to re‐inspect missed areas)
□ 3. Advanced (Able to adequately visualize most of the mucosa without coaching)
□ 4. Superior (Good visualization around difficult corners and folds and good use of suction/cleaning techniques)
Pathology identification/interpretation:
□ N/A, Study was normal (Go to question 11)
□ 1. Novice (Poor recognition of abnormalities. Misses or cannot ID significant pathology)
□ 2. Intermediate (Recognize abnormal findings but cannot interpret. “erythema”)
□ 3. Advanced (Recognizes abnormalities and correctly interprets. “colitis”)
□ 4. Superior (Competent identification and assessment. “Mild chronic appearing colitis in a pattern suggestive of UC”)
10a. Independent polyp detection by fellow
□ N/A. No polyps present□ 1. None (Staff identified all polyps)□ 2. Some (Fellow independently identified at least one polyp but not all polyps present)□ 3. All (Fellow independently ID’ed all polyps encountered)
10b. Accurate location of lesion/pathology:
□ 1. Novice (Unable to use landmarks to ID location in the colon, “I don’t know”)□ 2. Intermediate (Understands landmarks but either does not recognize or incorporate into decision‐making process)□ 3. Advanced (Good understanding and recognition of landmarks but generalizes pathology location “Descending colon”)□ 4. Superior (Very specific about location, e.g.“Splenic Flexure region approx. 60 cm from the anal verge with a straight scope”)Interventions performed by fellow:
CHECK ALL THAT APPLY
□ N/A – Fellow did not perform any interventions (go to question 12)
□ Biopsy □ APC Vascular lesion ablation (AVMs)
□ Snare polypectomy □ Hemostasis (Hemoclip, electrocautery, etc.)
□ Submucosal injection (Lift, Epinephrine, Tattoo) □ Other_____
11a. What was the fellow’s participation in the therapeutic maneuver(s) (ability to apply tool effectively)?
□ N/A. Not Assessed (i.e. Fellow observed procedure only)□ 1. Novice (Performed with significant hands‐on assistance or coaching)□ 2. Intermediate (Performed with minor hands‐on assistance or significant coaching)□ 3. Advanced (Performed independently with minor coaching)□ 4. Superior (Performed independently without coaching)
11b. What was the fellows knowledge of the therapeutic tool(s)(tool selection, knowledge of set up, cautery setting, how to employ tool)?
□ N/A. Not Assessed (i.e. Fellow observed procedure only)□ 1. Novice (Unsure of the possible tool(s) indicated or settings for pathology encountered)□ 2. Intermediate (Able to identify possible appropriate tool choices but not sure which would be ideal [Snare vs lift & snare])□ 3. Advanced (Independently selects the correct tool yet needs coaching on settings)□ 4. Superior (Independently identifies correct tool and settings as applicable)
Overall Assessment:
The fellow’s overall hands‐on skills:
□ N/A. Not Assessed (i.e. Fellow observed procedure only)
□ 1. Novice (Learning basic |