Post written by Samuel Han, MD, MSCS, and Sachin Wani, MD, from the Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA.
In this study, we aimed to perform a multicenter, randomized, controlled trial examining the effect of individualized feedback on learning curves in EGD and colonoscopy among GI fellows.
Becoming competent in EGD and colonoscopy is a key component of GI training. Given the lack of objective ways to measure competence, we wanted to demonstrate how to use a validated assessment tool, the ACE tool, to assess fellows and track performance in these 2 procedures. Most importantly, we wanted to examine how to accelerate these learning curves to help trainees develop competence more efficiently. We chose individualized feedback in the form of learning curves created using cumulative sum analysis as our intervention, hypothesizing that allowing fellows to regularly see their progress in concrete skills in EGD and colonoscopy would enhance their performance.
Our study did not demonstrate any significant improvement in technical and cognitive skills for both EGD and colonoscopy in fellows who received feedback through individualized cumulative sum learning curves. While this specific intervention did not accelerate learning, we do not want to discount feedback as ineffective. There are many forms of feedback, and the importance of feedback in medical education has been described in numerous studies, suggesting that further studies will be needed within the field of GI training to identify effective forms of feedback.
While the results of this study may be construed as negative, the most important aspect of this study was demonstrating the feasibility of a nationwide real-time assessment system that can be used to document progress of GI fellows in their endoscopy skills. This can enable fellows and program directors to identify potential areas for improvement, thus providing the platform for which individualized training plans can be made. Furthermore, this system can be used to document competence, which remains an important quality measure for GI fellowships throughout the country.
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