Do Surgeons and Gastroenterologists Describe Endoscopic Retrograde Cholangiopancreatography Differently? A Qualitative Study.
BACKGROUND
Endoscopic retrograde cholangiopancreatography (ERCP) is a technically challenging procedure performed by both surgeons and gastroenterologists. There is controversy in the field regarding the training necessary to perform ERCP. Widely disparate requisite volumes of experience to achieve proficiency have been published by representatives of each specialty. The basis for these differences has not been fully explored, with particular reference to the cognitive mindset of the different specialties.


METHODS
Structured cognitive task analytic interviews were conducted with 7 expert gastroenterologists and 4 expert surgeons from 4 institutions, each of whom performs ERCP as a common procedure in their clinical practice. A qualitative analysis and grounded theory approach was used, focusing specifically on duct cannulation as a critical procedural element. Transcripts were analyzed using Atlas.ti software.


RESULTS
The qualitative analysis of 11 transcripts identified 173 unique codes from a total of 653 quotes. In all, 5 themes were found to describe the codes: judgment, teaching, techniques, principles, and equipment. Significant differences were noted between gastroenterologists and surgeons across these themes. Gastroenterologists placed emphasis on issues of judgment including rationale, and emphasized explanation and clarification in teaching. Surgeons placed more emphasis on use of visual cues, and emphasized technique and equipment nuances.


CONCLUSIONS
The data suggest that gastroenterologists deconstruct ERCP competence based on application of rules and rationale through reflection. Surgeons focus more on visual and tactile cues in task deconstruction, and may be more likely to measure proficiency based on technical response to such cues. Based on this study, it is proposed that both specialties might have complementary roles in training therapeutic endoscopists.
Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois.
Margaret L
ML
Boehler
Medical Education and Academic Affairs Office, Sophie Davis School of Biomedical Education, City College of New York, New York, New York.
Nicole
N
Roberts
Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois.
Hilary
H
Sanfey
Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois. Electronic address: jmellinger@siumed.edu.
John
J
Mellinger
D002760:Cholangiopancreatography, Endoscopic Retrograde; D005762:Gastroenterology; D036301:Qualitative Research; D013043:Specialties, Surgical
Interpersonal and Communication Skills; Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; cognitive task analysis; endoscopic retrograde cholangiopancreatography (ERCP); endoscopic training; gastroenterology; gastrointestinal tract surgery; grounded theory