title: A Simple Evaluation Tool (ET-CET) Indicates Increase of Diagnostic Skills From Small Bowel Capsule Endoscopy Training Courses: A Prospective Observational European Multicenter Study.
abstract: Small bowel capsule endoscopy (SBCE) has become a first line diagnostic tool. Several training courses with a similar format have been established in Europe; however, data on learning curve and training in SBCE remain sparse.Between 2008 and 2011, different basic SBCE training courses were organized internationally in UK (n = 2), Italy (n = 2), Germany (n = 2), Finland (n = 1), and nationally in Germany (n = 10), applying similar 8-hour curricula with 50% lectures and 50% hands-on training. The Given PillCam System was used in 12 courses, the Olympus EndoCapsule system in 5, respectively. A simple evaluation tool for capsule endoscopy training (ET-CET) was developed using 10 short SBCE videos including relevant lesions and normal or irrelevant findings. For each video, delegates were required to record a diagnosis (achievable total score from 0 to 10) and the clinical relevance (achievable total score 0 to 10). ET-CET was performed at baseline before the course and repeated, with videos in altered order, after the course.Two hundred ninety-four delegates (79.3% physicians, 16.3% nurses, 4.4% others) were included for baseline analysis, 268 completed the final evaluation. Forty percent had no previous experience in SBCE, 33% had performed 10 or less procedures. Median scores for correct diagnosis improved from 4.0 (IQR 3) to 7.0 (IQR 3) during the courses (P < 0.001, Wilcoxon), and for correct classification of relevance of the lesions from 5.0 (IQR 3) to 7.0 (IQR 3) (P < 0.001), respectively. Improvement was not dependent on experience, profession, SBCE system, or course setting. Previous experience in SBCE was associated with higher baseline scores for correct diagnosis (P < 0.001; Kruskal-Wallis). Additionally, independent nonparametric partial correlation with experience in gastroscopy (rho 0.33) and colonoscopy (rho 0.27) was observed (P < 0.001).A simple ET-CET demonstrated significant improvement of diagnostic skills on completion of formal basic SBCE courses with hands-on training, regardless of preexisting experience, profession, and course setting. Baseline scores for correct diagnoses show a plateau after interpretation of 25 SBCE before courses, supporting this number as a compromise for credentialing. Experience in flexible endoscopy may be useful before attending an SBCE course.
authors.affiliation: From the Department of Internal Medicine I, JW Goethe Universität, Frankfurt, Germany (JGA); Department of Internal Medicine, Bethesda Krankenhaus Bergedorf, Hamburg, Germany (OH, MK); Department of Gastroenterology, University Hospital, Sheffield, United Kingdom (MEM); Department of Gastroenterology, South Tyneside NHS Trust, South Tyneside, United Kingdom (CD); Department of Gastroenterology, Kreiskrankenhaus Bergstrasse, Heppenheim, Germany (US); Wolfson Unit, St. Marks's Hospital, London, United Kingdom (CF); 1st Medical Department, Asklepios Klinik Altona, Hamburg, Germany (FH, MK); Department of Gastroenterology, Sana Klinikum Lichtenberg, Berlin, Germany (EN); Endoscopy Unit, Università Cattolica, Roma, Italy (CS, MER); Department of Gastroenterology, Klinikum, Augsburg, Germany (JB); Institute of Biostatistics and Mathematical Modeling, JW Goethe Universität, Frankfurt, Germany (NF).
authors.forename: J G
authors.initials: JG
authors.lastname: Albert
authors.forename: O
authors.initials: O
authors.lastname: Humbla
authors.forename: M E
authors.initials: ME
authors.lastname: McAlindon
authors.forename: C
authors.initials: C
authors.lastname: Davison
authors.forename: U
authors.initials: U
authors.lastname: Seitz
authors.forename: C
authors.initials: C
authors.lastname: Fraser
authors.forename: F
authors.initials: F
authors.lastname: Hagenmüller
authors.forename: E
authors.initials: E
authors.lastname: Noetzel
authors.forename: C
authors.initials: C
authors.lastname: Spada
authors.forename: M E
authors.initials: ME
authors.lastname: Riccioni
authors.forename: J
authors.initials: J
authors.lastname: Barnert
authors.forename: N
authors.initials: N
authors.lastname: Filmann
authors.forename: M
authors.initials: M
authors.lastname: Keuchel
mesh_terms: D053704:Capsule Endoscopy / Q000193:education* / Q000592:standards; D002983:Clinical Competence; D004521:Educational Measurement / Q000379:methods*; D005060:Europe; D006801:Humans; D007421:Intestine, Small; D011446:Prospective Studies