Best Practices in Teaching Endoscopy According to a Delphi Survey of Gastroenterology Fellows and a Pilot Study of an Instructional Checklist at a Major Academic Medical Center

Abstract

Endoscopy is a core component of gastroenterology (GI) fellowship training, yet there are no guidelines on how to teach the procedure. Previously, we surveyed a national cohort of GI fellowship program directors and identified 10 essential teaching practices for endoscopy education using a Delphi method. In follow-up of this study, we expand our understanding of best practice by characterizing the perspective of GI fellows. Using the same Delphi method, we invited a national cohort of 28 GI fellows to rate each competency as “essential,” “important but not essential,” or “not important.” After two rounds, 15 of 18 competencies (83.3%) reached consensus. 10 competencies (55.6%) were deemed essential, 9 of which had been previously identified as essential by program directors. We subsequently developed a simple, dichotomous checklist of essential teaching practices. Using an explanatory, sequential mixed-methods design, we piloted this checklist among a sample of GI fellows and supervising gastroenterologists at Brigham and Women’s Hospital. All data was kept anonymous. Fellows were invited to evaluate their supervising attending, and faculty were invited to self-evaluated their own performance. In the initial quantitative phase, 6 checklists were submitted by fellows and 4 were submitted by faculty. Of eleven possible essential teaching practices, fellows reported a mean performance score of 10.2 (92.7%) and faculty self-reported a mean performance score of 10.5 (95.4%). In the subsequent qualitative phase, we conducted 1:1 semi-structured interviews with study participants to understand user experience with the checklist. Both phases were limited by sample size. To address sampling issues, as well as incorporate suggestions from our participants, we hope to eventually trial a modified checklist among a multi-site cohort of faculty and fellows from ACGME-accredited GI fellowship programs.