title: Development of a program to train physician extenders to perform transnasal esophagoscopy and screen for Barrett's esophagus.
abstract: OBJECTIVE
  Screening for Barrett's esophagus (BE) and esophageal adenocarcinoma is not recommended because it was not found to be cost effective. However, physician extenders (PEs) are able to perform unsedated procedures; their involvement might reduce the costs of BE screening. We examined the feasibility of training PEs to independently perform transnasal esophagoscopy (TNE) and screen patients for BE and measured their learning curve.
  
  
  METHODS
  Two PEs at a Veterans Affairs (VA) medical center underwent a structured didactic training program and observed nasopharyngoscopies before performing TNE under the supervision of attending endoscopists. Individual technical and cognitive components of TNE were rated on a 9-point structured scale. Learning curves were constructed using cumulative summation. Once the PEs were judged to be technically competent, each PE performed 10 independent videotaped TNEs, which were graded.
  
  
  RESULTS
  Both PEs identified anatomic landmarks after 18 consecutive procedures. PE1 and PE2 performed satisfactory nasal intubations after 20 and 25 procedures and esophageal intubations after 29 and 35 procedures, respectively. They acquired overall competence after supervised training on 43 and 47 procedures, respectively.
  
  
  CONCLUSIONS
  We developed a program at a VA medical center to train PEs to perform TNE to screen for BE. The PEs were able to perform TNE and recognize esophageal landmarks independently after a modest number of supervised procedures.
authors.affiliation: Section of Gastroenterology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio.
authors.forename: Bronia
authors.initials: B
authors.lastname: Alashkar
authors.affiliation: Section of Gastroenterology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio; Division of Gastroenterology and Hepatology, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Ashley L
authors.initials: AL
authors.lastname: Faulx
authors.affiliation: Division of Gastroenterology and Hepatology, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Ashley
authors.initials: A
authors.lastname: Hepner
authors.affiliation: Section of Gastroenterology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio.
authors.forename: Richard
authors.initials: R
authors.lastname: Pulice
authors.affiliation: Section of Gastroenterology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio.
authors.forename: Srikrishna
authors.initials: S
authors.lastname: Vemana
authors.affiliation: Section of Gastroenterology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio; Division of Gastroenterology and Hepatology, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Katarina B
authors.initials: KB
authors.lastname: Greer
authors.affiliation: Section of Gastroenterology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio; Division of Gastroenterology and Hepatology, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Gerard A
authors.initials: GA
authors.lastname: Isenberg
authors.affiliation: Section of Gastroenterology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio.
authors.forename: Yngve
authors.initials: Y
authors.lastname: Falck-Ytter
authors.affiliation: Division of Gastroenterology and Hepatology, University Hospitals Case Medical Center, Cleveland, Ohio. Electronic address: axc22@cwru.edu.
authors.forename: Amitabh
authors.initials: A
authors.lastname: Chak
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000517:prevention & control*; D001471:Barrett Esophagus / Q000150:complications / Q000175:diagnosis*; D004502:Education, Medical, Continuing / Q000379:methods*; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D004945:Esophagoscopy / Q000193:education* / Q000379:methods; D006302:Health Services Research; D006801:Humans; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data; D010823:Physician Assistants
keywords: CUSUM; Cost Reduction; Esophageal Cancer Screening; Prevention