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S Thomas-Gibson

Publications and source records attributed to S Thomas-Gibson.

5 recordsLinked to original sources
PubMed2006

Development of a video assessment scoring method to determine the accuracy of endoscopist performance at screening flexible sigmoidoscopy.

BACKGROUND AND AIMS: Variation in the adenoma detection rate (ADR) at flexible sigmoidoscopy screening has been shown to be due to variation in endoscopist performance. There are no objective methods for scoring an endoscopist's performance reliably, and the aim of this study was to develop a valid and reliable objective scoring method using video footage of screening flexible sigmoidoscopies. METHODS: In a series of five experiments, experienced endoscopists (the scorers) independently scored a sample (n = 43) of the 40 000 flexible sigmoidoscopy extubations recorded as part of the United Kingdom Flexible Sigmoidoscopy Screening Trial (UK FSST). The scoring system, the parameters scored, and their definitions evolved over the course of the five experiments. The initial visual analogue score (range 0-100) used in the first two experiments evolved into a five-point score that ranged from 1 (E, poor) to 5 (A, excellent) in the last three experiments. The final parameters scored were: time spent viewing the mucosa, re-examination of poorly viewed areas, suctioning of fluid pools, distension of the lumen, lower rectal examination, and overall quality of the examination. The first four experiments scored one individual case per endoscopist; in experiment 5, an overall score was awarded for five cases performed by each endoscopist being assessed. RESULTS: Scoring five cases examined by an individual endoscopist using the A-E grading system was the most reliable method (interclass correlation coefficient 0.89). Cluster analysis demonstrated that the endoscopists in the high-scoring ADR group (ADR 14.7-15.9 %) could be differentiated from those in the intermediate- and low-scoring ADR groups (ADR 8.6-12.6 %). CONCLUSIONS: An objective scoring system for assessing the accuracy of performance at screening flexible sigmoidoscopy, based on video footage, is described. Endoscopists who might benefit from further training can be identified using this method.

Adenoma↗
PubMed2006

Judgement of the quality of bowel preparation at screening flexible sigmoidoscopy is associated with variability in adenoma detection rates.

BACKGROUND AND STUDY AIMS: Adenoma detection rates (ADRs) at screening flexible sigmoidoscopy are known to vary between endoscopists. Variability in the technique used and in the quality of bowel preparation may explain this. The aim of this study was to establish whether there is a relationship between the grading of bowel preparation and the ADR. MATERIALS AND METHODS: The relationship between the ADR and assessment of bowel preparation was examined using the full United Kingdom Flexible Sigmoidoscopy Screening Trial data set (n = 38 601). The consistency of the bowel preparation classification was then investigated by six experienced endoscopists (video scorers), who examined 260 flexible sigmoidoscopy cases - 20 from each of the 13 trial endoscopists. RESULTS: Overall, the ADR was significantly higher in flexible sigmoidoscopy examinations with excellent or good bowel preparation ( P = 0.02). However, endoscopists with a higher ADR coded a smaller proportion of their examinations as having excellent/good preparation ( P = 0.002). Video scorers agreed with the trial endoscopists' definition of bowel preparation in 48.9 % of the readings, but they scored the quality of preparation as poorer than the trial endoscopists in 36.4 % and 40.6 %, respectively, in the intermediate-performance group (10 % < ADR < 14 %) and lower-performance group (ADR </= 10 %) in comparison with only 12.9 % in the high-performance group (ADR > or =14 %). There was a significant linear trend between the proportion scored as having poor bowel preparation and the ADR ( P < 0.001), varying from 2.7 % in the higher-performance ADR group to 13.4 % in the lower-performance group. CONCLUSIONS: Endoscopists with a higher ADR are more likely to be critical of the quality of bowel preparation. Training in judgement processes such as non-acceptance of suboptimal bowel preparation is required in order to ensure universally high standards in screening procedures.

Adenoma↗
PubMed2005

Development and validation of a multiple-choice question paper in basic colonoscopy.

BACKGROUND AND STUDY AIMS: Factual knowledge underpins competence in all clinical skills. A multiple-choice question paper (MCQ) was designed as part of an accelerated colonoscopy training week (ACTW). In the United Kingdom, there are no validated methods of assessing core knowledge in colonoscopy. The aims of this study were to develop an MCQ paper, to demonstrate its construct validity, and to establish whether the ACTW improved core knowledge. MATERIALS AND METHODS: Two 30-question MCQ papers (A and B) were designed. Delegates attending the British Society of Gastroenterology (BSG) 2004 meeting responded either to MCQ paper A or B. Demographic data were collected on their experience in colonoscopy. Doctors attending the ACTW completed either MCQ paper A or B before the course, and the other paper after the course. RESULTS: Seventy-eight delegates at the BSG meeting completed the MCQ. There was a significant difference in the scores between those who had carried out less than 200 colonoscopies (mean 32.5 %) and those who had performed more than 200 (mean 58.4 %; P < 0.0001). Seventeen doctors attending the ACTW completed the MCQ. The mean score for papers A and B increased significantly following the course--57.2 % before the ACTW, 67 % after it ( P = 0.003). CONCLUSION: This MCQ is capable of differentiating between endoscopists with different levels of experience in colonoscopy. Doctors attending an ACTW significantly improve their knowledge in colonoscopy. A validated MCQ such as this could be used as part of the assessment process to ascertain competence in colonoscopy.

Clinical Competence↗
PubMed2003

Effect of real-time magnetic endoscope imaging on the teaching and acquisition of colonoscopy skills: results from a single trainee.

BACKGROUND AND STUDY AIMS: Most trainees have little concept of the loops that occur during colonoscopy, and have difficulty in appreciating the combination of withdrawal and torquing manoeuvres that are essential to achieving complete colonoscopy. Real-time magnetic endoscope imaging (MEI) allows visualization of shaft looping, and so makes intuitive the manoeuvres necessary to straighten the colonoscope shaft. PATIENTS AND METHODS: Consecutive routine colonoscopies were performed by a single trainee (with previous experience of 15 colonoscopies). Procedures were randomly assigned to be carried out either with the trainee viewing the MEI display, or without the MEI view, which was recorded throughout all examinations. RESULTS: In total, 71 procedures were performed. To assess the trend for learning, procedures were analysed in blocks of 24 consecutive examinations (periods 1 to 3). In the first 24 procedures (period 1), the number of attempts at straightening the colonoscope and duration of looping were significantly less, and the intubation time was shorter, for examinations performed with the MEI view. In periods 2 to 3, there was a continued trend towards improved performance, but without a significant difference between procedures performed with or without MEI. CONCLUSIONS: During training, real-time colonoscope imaging using MEI appears to enhance the endoscopist's appreciation of looping and improves the learning of the manoeuvres required to straighten the colonoscope shaft. A prospective, multicentre study assessing a larger number of trainees is needed to clarify these findings.

Adult↗