Devise a method for assessing the competence/proficiency of your learners.
Be prepared to discuss it in class. You may use the RIME model if you wish, or
any other method. The point of the exercise is to review ways to effectively
assess and evaluate your learners on a specific activity.
Michael D Brown
We have been working on a single procedure evaluation form for
colonoscopy so that feedback will become immediate, behavior specific
real time and traceable over time. To date there is no consensus a to
what skills or behaviors during a colonoscopy constitute the various
Dreyfus skill levels of beginner, advanced beginner, competent,
proficient, expert and master.
As a fellowship program we need to bring all fellows to competence with
all ABIM required procedures. It may be possible for some fellows to
reach proficiency in some procedures. We cannot bring fellows to the
expert or mater level in a 3 year fellowship so our evaluation form need
not go into those behaviors only the first 4 Dreyfus levels.
Our current training involves the following:
1. An orientation didactic on the basics of endoscopy (2 hours during
the 1-day orientation session)
2. Simulation lab colonoscopy simulator orientation and procedural practice in
first month for all first year fellows. All fellows do all 40 colonoscopy
procedures in the simulation machine at least 3 times each of which 40 are
supervised. All fellows complete a minimum of 120 simulated colonoscopies
before starting endoscopy rotations in August. All must be logged into the
simulator computer before any live cases done and signed off by PD
3. All beginners do 10 live colonoscopies on outpatients withdrawing only.
After 10 withdrawals then they start with insertions. All procedures are
directly supervised by an attending THROUGHOUT 3 the fellowship.
4. Oral formative reviews of each procedure are typically given the fellows and
summative evaluations at the end of the 1-month rotation.
5. New addition will be a form filled out describing procedural behaviors by a
Dreyfus skill level which the attending will fill out for most colonoscopies
completed by the fellows and turn in to the PD to allow tracing of skills. This
will ensure that the fellow over time progresses in skill development to
competency. This will also allow us to detect stagnation in skill acquisition
and address it quickly rather than retrospectively at month’s or year’s end. It
is also a clear documentation of progression to competence for privileging.
6. Fellows are rated in each behavior as follows:
Proficient: Highly skilled performance; no supervisor input/correction whatsoever.
Competent: Competent and safe throughout procedure, no uncorrected errors; very
minimal verbal input, no hands on input
Advanced Beginner: Some standards not yet met, aspects to be improved, some
errors uncorrected without verbal input, little hands on input
Beginner: Accepted standards not yet met, frequent errors; uncorrected without
verbal or hands on input
n/a Not applicable
Assessment, consent,
communication
Obtains informed consent using
a structured approach
Demonstrates respect for
patient’s views and dignity
during the procedure
Communicates clearly with
patient, including outcome of
procedure with
appropriate management and
follow up plan. Full endoscopy
report.
Safety and sedation
Safe and secure IV access
Gives appropriate dose of
analgesia and sedation and
ensures adequate oxygenation
and monitoring of patient
Demonstrates good
communication with the nursing
staff, including dosages and
vital signs
Endoscopic skills during
insertion and procedure
Checks endoscope function
before intubation
Performs time out
Maintains luminal view / inserts
in luminal direction
Beginner
Adv
Beginner
Competent
Profecient
Demonstrates awareness of
patient’s consciousness and
pain during the procedure and
takes appropriate action
Uses torque steering and
control knobs appropriately
Uses distension, suction and
lens washing appropriately
Recognizes and logically
resolves loop formation
Uses position change and
abdominal pressure to aid
luminal views
Completes procedure in
reasonable time
Diagnostic and therapeutic
ability
Adequate mucosal visualization
Recognizes cecal landmarks or
incomplete examination
Accurate identification and
management of pathology
Uses diathermy and therapeutic
techniques appropriately and
safely
Recognizes and manages
complications appropriately