title: Changing attitudes and improving skills: demonstrating the value of the SAGES flexible endoscopy course for fellows.
abstract: The purpose of this study was to examine the effectiveness of the SAGES flexible endoscopy course in improving fellows' attitudes, confidence, and skills related to implementing endoscopy in practice.
  
  
  
  Fellows participated in a 2-day course consisting of case presentations, expert panels, and hands-on laboratory training. Before and after the course, fellows completed a questionnaire assessing demographics, experiences in residency, practice plans, plans to implement flexible endoscopy in practice, and level of confidence performing 15 endoscopic procedures. Half of the fellows were randomly assigned to complete pre- and post-skills testing using a previously validated endoscopic targeting model.
  
  
  
  Fifty-four fellows (90 %; age 33.5 ± 2.8; 58 % male) completed the pre- and post-questionnaire. All MIS fellowship types were represented. Almost half (48 %) reported none or very little flexible endoscopy in their current fellowship. The average prior case volume among those completing an ACGME-approved residency (42/54) was 76 upper and 75 lower endoscopies with one-third reporting no experience in therapeutic EGD (33 %) or polypectomy (31 %). Intentions to implement flexible endoscopy in practice significantly improved after the course overall (3.72 ± .85-3.92 ± .69, p < 0.05; 1 = never; 5 = very frequently). Prior to the course, 39 % of fellows reported plans to use endoscopy in practice "occasionally" or "rarely." After, this decreased to 28 with 72 % planning to implement "frequently" or "very frequently." Mean levels of confidence performing all 15 endoscopic tasks improved significantly after the course. Skills performance for the 27 fellows improved significantly as well; participants decreased their time to perform the targeting task by 40 % (222.3 ± 119.8-133.0 ± 70.1 s; p < 0.001) and decreased errors by 49 % (2.9 ± 1.7-1.5 ± 1.5; p < 0.001).
  
  
  
  These results indicate that the SAGES flexible endoscopy course increases fellow confidence to implement endoscopic techniques, expands the ways in which they plan to include endoscopy in practice, and enhances their endoscopic skills.
authors.affiliation: University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA. aimee.gardner@utsouthwestern.edu.
authors.forename: Aimee K
authors.initials: AK
authors.lastname: Gardner
authors.affiliation: Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Marks
authors.affiliation: Penn State Hershey Medical Center, Hershey, PA, USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Pauli
authors.affiliation: Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Arnab
authors.initials: A
authors.lastname: Majumder
authors.affiliation: Houston Methodist Hospital, Houston, TX, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Dunkin
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D019723:Endoscopes; D004724:Endoscopy / Q000193:education*; D005257:Fellowships and Scholarships; D005260:Female; D006801:Humans; D008297:Male; D009820:Ohio
keywords: Course; Fellows; Flexible endoscopy; Minimally invasive