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   Table of Contents - Current issue
Coverpage
March-April 2022
Volume 11 | Issue 2
Page Nos. 89-152

Online since Saturday, April 23, 2022

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EDITORIAL  

Acquiring and ensuring competence in EUS in the 21st century p. 89
Leizl Joy Nayahangan, Peter Vilmann, Lars Konge
DOI:10.4103/EUS-D-21-00127  
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COMMENTARY Top

Diagnosis and staging of lung cancer using transesophageal ultrasound: Training and assessment p. 92
Kristoffer Mazanti Cold, Paul Frost Clementsen
DOI:10.4103/EUS-D-21-00129  
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REVIEW ARTICLES Top

Defining medical simulators for simulation-based education in EUS: Theoretical approach and a narrative review p. 95
Morten Bo Søndergaard Svendsen, Michael Patrick Achiam
DOI:10.4103/EUS-D-21-00123  
Choosing the right simulator for tasks in simulation-based education in medicine will affect the trainees' skills. However, there is a shortage in the vocabularies used for describing medical simulators and the contextual usage of simulators. We propose methods for approaching the task of choosing and defining the simulators needed, regardless of it being an acquisition or development process. It is advocated that efforts are made in defining the simulator's requirements before making any choice in regards to development processes. Multiple advantages are attained by keeping the simulator simple, both educational and development wise. Issues on validating simulators are discussed and highlighted as actions where interprofessional communication is likely to fail. The following conventional terms in medical education are problematic in regard to establishing a clear communication: Virtual reality, fidelity, validation, and simulation. The text is finalized in a short discussion on applying the methods in an EUS/endobronchial ultrasound (EBUS) context. The work is the authors' interpretation of an invitation having the title “Development of EUS and EBUS training models and simulators.
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Developing a simulation-based training curriculum in transesophageal ultrasound with the use of the endobronchial ultrasound-endoscope p. 104
Leizl Joy Nayahangan, Paul Frost Clementsen, Alison Doubleday, Janet Riddle, Jouke T Annema, Lars Konge
DOI:10.4103/EUS-D-21-00126  
There is an increasing need to focus on how best to train respiratory physicians to perform EUS with bronchoscope-guided fine-needle aspiration biopsy (EUS-B-FNA). At current, training is mostly performed in the clinical environment under expert supervision; however, the advent of simulation-based education now provides a low-risk setting for novice trainees to learn and practice basic endosonography skills from identifying and understanding normal anatomy as well as pathology, maneuvering of endoscope, interpretation of images, and mastering of sampling techniques. In this descriptive educational paper, we used a six-step approach as a framework to describe the development of a structured training program combining EUS-B-FNA with the already well-established certification training program in endobronchial ultrasound transbronchial needle aspiration. This comprehensive training curriculum includes a theoretical course to achieve foundational knowledge, followed by simulation-based training until mastery standards are met, and supervised clinical apprenticeship. All steps should end with an objective assessment to achieve certification. This systematic development will hopefully encourage endosonography leaders and educators to collaborate and implement an evidence-based comprehensive endosonography curriculum that aims to provide the trainee with the essential EUS-B competencies to ensure that lung cancer patients are diagnosed and staged correctly.
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ORIGINAL ARTICLES Top

Design and validation of a therapeutic EUS training program using a live animal model: Taking training to the next level p. 112
Leonardo Sosa-Valencia, Jerôme Huppertz, Fanélie Wanert, Francois Haberzetser, Lee Swanström, Benedetto Mangiavillano, Pierre Eisendrath, Pierre Deprez, Carlos Robles-Medranda, Silvia Carrara, Mohammad A Al-Haddad, Peter Vilmann, Stephane Koch, Alberto Larghi, Mouen Khashab
DOI:10.4103/EUS-D-21-00124  
Background and Objectives: EUS has evolved into a therapeutic modality for gastrointestinal disorders. Simulators, ex vivo models, and phantoms are the current teaching methods for therapeutic EUS (TEUS). We create and evaluate a high-fidelity simulated live animal model (HiFi SAM) for teaching endoscopists TEUS. Materials and Methods: Designing a curriculum that uses HiFi SAM and enables trainees to perform realistic procedures with expert mentors. Results: Twenty-seven trainees participated in a 3-day program with 6 h of theoretical and 14 h of hands using life HiFi SAM. Eighteen experts participated. Twenty-two (20–25) TEUS were defined for each HiFi SAM, and 616 were performed in all. Of 616/264 (43%) were evaluated with a mean of 88 per course (ranging between 80 and 95). Ninety-one percent (240/264) of the procedures were completed successfully. In 24, success was not achieved due to technical and/or model problems. Student rating of HiFi SAM was: 71% excellent rating (scale 8–10) and 95% excellent/good. The HiFi SAM procedure evaluation was (scale 1–5): fine-needle biopsy: 4.79, radiofrequency: 4.76, common bile duct and gallbladder drainage: 4.75, cystic drainages: 4.72, neurolysis: 4.55, microbiopsy: 4.50, and hepatogastric drainage: 4.04, with an overall satisfaction rate of 4.56 (91%). A short survey showed: 83% would recommend absolutely (17% most likely), 33% think that ITEC training was sufficient for their practice, and 66% would like additional training, especially more practice in specific techniques rather than more clinical case discussion. Regarding impact on their practice, 66% of the trainees started a new procedure and/or noted improvement in previous ones. Conclusion: HiFi SAM is a complex model; however, experts and trainees are satisfied with the training this new curriculum provided.
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A core curriculum for basic EUS skills: An international consensus using the Delphi methodology p. 122
John Gásdal Karstensen, Leizl Joy Nayahangan, Lars Konge, Peter Vilmann, The EUS Delphi Panel
DOI:10.4103/EUS-D-21-00125  
Background and Objectives: During recent years, the demand for EUS has increased. However, standardized training programs and assessments of clinical quality measures are lacking. We therefore aimed to establish a basic curriculum for EUS fellows that includes a prioritized list of interpretational capabilities and technical skills. Materials and Methods: International key-opinion leaders were invited to participate in a Delphi process. An electronic three-round iterative survey was performed to attain consensus on skills that 70% of the participants found either very important or essential for a newly graduated endosonographer. Results: Of 125 invited experts, 77 participated in the survey. Initially, 1,088 skills were suggested, resulting in a core curriculum containing 29 interpretational skills and 12 technical skills. The top-five interpretation skills included abilities to discern between normal anatomy and pathology, to identify the entire pancreas and ampullary region, to identify solid versus fluid-filled structures, to detect bile duct and gallstones, and to identify a pancreatic mass of 5 mm or larger. For technical skills, ability to insert the endoscope from the mouth to the second part of duodenum, to obtain FNA adequately and safely, to navigate the scope tip to follow anatomical landmark structures, to achieve endoscopic position of each of the four stations, and to perform passage of the scope past a hiatal hernia were given the highest ranking. Conclusions: After a structured Delphi process involving 77 international experts, a consensus was reached for a basic curriculum for EUS fellows to be included during training.
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Training and certification of EUS operators in China p. 133
Xun Hou, Jinyu Liang, Lars Konge, Wenjie Hu
DOI:10.4103/EUS-D-21-00128  
Background and Objectives: EUS has become a very frequently used procedure for both diagnostic and therapeutic indications. However, skilled operators are essential for improved outcomes and patient safety which make efficient training and certification programs essential. Our aim was to explore the acquisition and assessment of EUS competencies in China as practiced in the past, today, and in the future. Methods: We identified key opinion leaders (KOLs) from hospitals in different cities in China. Each KOL answered 43 questions regarding demographics and EUS experience, their learning experience as a trainee, experience as a supervisor, and their thoughts about current and future training. Descriptive statistics were used for reporting the results. Results: Eleven men and five females from eight major Chinese cities (Beijing, Changsha, Chengdu, Chongqing, Guangzhou, Shanghai, Shenzhen, and Wuhan) were included. They offered a good variance regarding age (33–53 years old), EUS experience (½–20 years), and performed procedures (20–6000 procedures). Most (n = 13) learned EUS through apprenticeship training model but three were self-taught. The KOLs also used the apprenticeship model to train their own trainees. First, they demonstrated EUS for median 2 months before their trainees took over the scope and performed a median 50 supervised procedures during a median of 3 months. Then they were allowed to perform EUS procedures independently. Simulation-based training and standardized assessment of competence were used very sparingly, but most of the KOLs wanted to shift towards these contemporary methods in the future. Conclusions: The classical apprenticeship training is still used to learn EUS in China and the amount of training required before being allowed to practice independently varies considerably. Several of the KOLs requested improved conditions for training and wanted a standardized curriculum leading to certification of new EUS operators based on a valid assessment of competence.
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IMAGES AND VIDEOS Top

Antegrade brushing cytology through the EUS-guided pancreatic duct drainage route (with video) p. 141
Takeshi Ogura, Saori Ueno, Atsushi Okuda, Nobu Nishioka, Kazuhide Higuchi
DOI:10.4103/EUS-D-20-00258  PMID:34213432
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Usefulness of a gel immersion-assisted EUS-guided fine-needle aspiration/biopsy for ampullary lesions (with videos) p. 143
Yosuke Minoda, Shuzaburo Nagatomo, Nao Fujimori, Kei Nishioka, Shotaro Kakehashi, Katsuhito Teramatsu, Yu Takamatsu, Haruei Ogino, Eikichi Ihara
DOI:10.4103/EUS-D-21-00043  PMID:34494587
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An unexpected complication during EUS-FNA p. 145
Khaled Ragab, Ahmed Mohammed Elmeligui, Hassan Atalla, Hussein Hassan Okasha
DOI:10.4103/EUS-D-21-00017  PMID:34494583
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Lumen-apposing metal stents salvage that accidentally dislodged during a necrosectomy of a WON (with video) p. 147
Dominic Staudenmann, Sanjivan Mudaliar, Arthur John Kaffes, Payal Saxena
DOI:10.4103/EUS-D-21-00054  PMID:34677146
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LETTERS TO EDITOR Top

EUS takes the challenge of postsurgical patients p. 149
Giacomo Tamanini, Andrea Lisotti, Pietro Fusaroli
DOI:10.4103/EUS-D-21-00061  
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EUS-guided fine-needle biopsy for gastric submucosal tumors: Does one size fit all? p. 151
Fabio Cortellini, Silvia Carrara, Pietro Fusaroli
DOI:10.4103/EUS-D-21-00095  PMID:34755708
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