PMID- 30031806
OWN - NLM
STAT- MEDLINE
DCOM- 20190221
LR  - 20190221
IS  - 1097-6779 (Electronic)
IS  - 0016-5107 (Linking)
VI  - 88
IP  - 5
DP  - 2018 Nov
TI  - Impact of fellow training level on adverse events and operative time for common 
      pediatric GI endoscopic procedures.
PG  - 787-794
LID - S0016-5107(18)32851-7 [pii]
LID - 10.1016/j.gie.2018.07.010 [doi]
AB  - BACKGROUND AND AIMS: Previous studies on pediatric endoscopic training have not 
      examined in detail if adverse events (AEs) are affected by the fellow's training 
      level. We aimed to determine whether trainee presence and educational level 
      increase AEs or operative time (OT) for pediatric intestinal endoscopy. METHODS: 
      This was a prospective observational study of AEs for all endoscopic procedures 
      and retrospective analysis of OT (time of endoscope insertion until removal) for 
      a sample of specified procedures at a tertiary children's hospital. AEs were 
      categorized by severity grades: 1, home management; 2, outpatient evaluation; 3, 
      hospitalization and/or repeat endoscopy; 4, surgery and/or intensive care unit 
      admission; and 5, death. RESULTS: A total of 15,886 procedures (6257 with 
      trainee) including 1627 therapeutic procedures (733 with trainee) were analyzed 
      for AEs. Four hundred thirteen total AEs (2.60%) and 213 AEs grade 2 to 4 (1.34%) 
      were identified. Fellow presence at any training level did not increase AE rates 
      for any procedures. Median OT for 3762 EGDs decreased from 17 to 11 minutes from 
      the first quarter to the fourth quarter of first-year fellowship and then 
      remained stable. EGDs without fellows were shorter (9 minutes, P < .0001) 
      compared with any training level. Median times of 1291 colonoscopies with EGD 
      decreased from 55 to 51 to 47 minutes for fellows in the first half, second half 
      of first-year fellowship, and second and third year, respectively. Attendings 
      alone were faster (37 minutes, P < .0001). CONCLUSIONS: Current pediatric 
      endoscopic training for is safe regardless of fellow training level. Trainee 
      efficiency improves during and after fellowship.
CI  - Copyright (c) 2018 American Society for Gastrointestinal Endoscopy. Published by 
      Elsevier Inc. All rights reserved.
FAU - Mark, Jacob A
AU  - Mark JA
AD  - Section of Gastroenterology, Hepatology and Nutrition and the Digestive Health 
      Institute, Children's Hospital Colorado, University of Colorado Denver School of 
      Medicine, Aurora, Colorado, USA.
FAU - Kramer, Robert E
AU  - Kramer RE
AD  - Section of Gastroenterology, Hepatology and Nutrition and the Digestive Health 
      Institute, Children's Hospital Colorado, University of Colorado Denver School of 
      Medicine, Aurora, Colorado, USA.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20180719
PL  - United States
TA  - Gastrointest Endosc
JT  - Gastrointestinal endoscopy
JID - 0010505
SB  - IM
MH  - Adverse Outcome Pathways
MH  - *Clinical Competence
MH  - Cohort Studies
MH  - Education, Medical, Graduate/*methods
MH  - Endoscopy/*adverse effects/education
MH  - Endoscopy, Gastrointestinal/*adverse effects/*education
MH  - Fellowships and Scholarships/*methods
MH  - Female
MH  - Humans
MH  - Male
MH  - Operating Rooms/organization & administration
MH  - Operative Time
MH  - Patient Care Team
MH  - Patient Safety/*statistics & numerical data
MH  - Pediatrics
MH  - Postoperative Complications/epidemiology/physiopathology
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - United States
EDAT- 2018/07/23 06:00
MHDA- 2019/02/23 06:00
CRDT- 2018/07/23 06:00
PHST- 2018/02/28 00:00 [received]
PHST- 2018/07/11 00:00 [accepted]
PHST- 2018/07/23 06:00 [pubmed]
PHST- 2019/02/23 06:00 [medline]
PHST- 2018/07/23 06:00 [entrez]
AID - S0016-5107(18)32851-7 [pii]
AID - 10.1016/j.gie.2018.07.010 [doi]
PST - ppublish
SO  - Gastrointest Endosc. 2018 Nov;88(5):787-794. doi: 10.1016/j.gie.2018.07.010. Epub 
      2018 Jul 19.