Portuguese Society of Digestive Endoscopy (SPED)www.sped.pt

SPED School

The Portuguese Society of Digestive Endoscopy (SPED) established Education as one of its main ideological purposes, and it has been assured by the Education Committee of SPED along the years. As expected, the focus of this committee is being the development and monitoring of training activities in the field of Digestive Endoscopy.

However, the rapid evolution of endoscopic techniques over the last few years, has challenged the learning landscape of our members and ourselves. The mastery of diverse technical and cognitive skills is now required. Endoscopic training that was traditionally based on a supervised ‘learning by doing’ model in a direct clinical environment, leads to some known drawbacks [1]. And an increasing number of medical centres worldwide have already incorporated in their curriculum new methods for teaching endoscopy [2] ensuring patient safety through well-prepared trainees from simulation-based scenarios.

Virtual reality, ex vivo and in vivo models are available, and some proved to be beneficial to reach better and faster results in endoscopic practice [3]. Virtual reality simulators have already been validated and proved discriminative abilities for dexterity and competence levels in forward viewing flexible endoscopy, a clear speeding up of the learning curve in the beginning of practice [4]. Ex vivo animal models seem to be more appropriate for the training of therapeutic procedures, providing a more realistic and cheaper approach when compared to other simulators [5]. In vivo animal models, particularly the porcine model, is described as the more realistic training model, with anatomic similarities and vascularized organs, moving along breathing movements. Some authors advocate it for advanced endoscopy programs in which trainees have enough experience for maximal benefit [3] [6].

Thus the sole use of the classic master-apprentice model for teaching endoscopy became less accepted nowadays, and we decided to complement the regular bedside coaching done in the Portuguese Gastroenterology Departments, with a training program that includes structured theoretical and hands-on parts in specific models. Moreover, assuming that the final stage of learning will always be in some extent patient-based [3], we want to expand the oportunities for interchange experiences, between national and international departments of endoscopy, with new and wide grants for our members. At this moment, It should be emphasized that besides all the studies and information in this area there is no single optimal method for integrating these approaches in the training programmes [7].

Since 2017 the SPED School became the vehicle and the external interface of the Education Committee, and embarrasses 2 main tasks in this field:

1. Design and implement a structured training program in endoscopy and endoscopic techniques for residents of Gastroenterology, with increasing complexity from the 1^st up to the 5^th year of formation.

2. Regulation and allocation of several national and international training grants for residents and specialists.

COURSE	Year	Structure	Model
ENDOSCOPY I	1st	Theoretical introduction Hands-on sessions with tutor (15H)	VR simulator
ENDOSCOPY II	2nd
CEBE	2nd 3rd	Evidence Based Endoscopy Course (12H)
BASIC ENDOSCOPIC TECHNIQUES	3rd	Variceal and nonvariceal hemostasis, polipectomy, foreign bodies removal (8H)	Ex vivo, porcine
ADVANCED ENDOSCOPIC TECHNIQUES	4th 5th	Strictures (dilation/stents), diverticulotomy, EMR/ESD, complications approach (8H)	In vivo, porcine

GRANTS
International Scholarships (residents)	2 grants, up to 2500 € each
National Scholarships (residents)	3 grants, up to 600 € each
Fellowship Grant (fully trained endoscopists)	1 grant, up to 2500 €

This is the first year and implementation is ongoing, but it is already assumed for consolidation during 2019 and 2020. In a later step, this work can be extended to other areas of endoscopy, as ERCP or EUS. Our drive follows also the opportunity to evaluate the impact of this kind of programme in our residents and to introduce the crescent idea of competence based evaluation, that should no longer rely on threshold numbers only.

We assume the ambition of the presented goals and the conscious commitment with the implied financial investment, Education is pivotal in the SPED intervention.

On behalf of the Education Committee of SPED

Rolanda C, Eliseu L, Vilas Boas F, Sadio A, Loureiro R, Veloso N, Dinis-Ribeiro M

• References

• 1 Ekkelenkamp VE, Koch AD, de Man RA. et al. Training and competence assessment in GI endoscopy: a systematic review. Gut 2016; 65 (04) 607-15
• 2 Sedlack RE. The State of Simulation in Endoscopy Education: Continuing to Advance Toward Our Goals. Gastroenterology 2013; 144: 9-12
• 3 Van der Wiel SE, Küttner Magalhães R, Rocha GonçalvesCR. et al. Simulator training in gastrointestinal endoscopy – From basic training to advanced endoscopic procedures. Best Pract Res Clin Gastroenterol 2016; 30 (03) 375-87
• 4 Koch AD, Buzink SN, Heemskerk J. et al. Expert and construct validity of the Simbionix GI Mentor II endoscopy simulator for colonoscopy. Surg Endosc Other Interv Tech 2008; 22: 158-162
• 5 Maiss J, Wiesnet J, Proeschel A. et al. Objective benefit of a 1-day training course in endoscopic hemostasis using the “compactEASIE” endoscopy simulator. Endoscopy 2005; 37: 552-558
• 6 Parra-Blanco A, Arnau M, Nicolás-Pérez D. et al. Endoscopic submucosal dissection training with pig models in a Western country. World Journal of Gastroenterology 2010; 16: 2895-2900
• 7 Siau K, Hawkes ND, Dunckley P. Training in Endoscopy. Curr Treat Options Gastroenterol 17.07.2018; [Epub ahead of print] DOI: 10.1007/s11938-018-0191-1.