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A Canadian first for colonoscopists

MasterclassLeading experts in colonoscopy and adult learning from the United Kingdom delivered an innovative training program in June in Nova Scotia. The purpose of the program: to help the current generation of physicians improve their skill in performing colonoscopies, and to enhance the learning experience of the next generation of colonoscopists through a train-the-trainer approach.

Six colonoscopists (who are credentialed with the Colon Cancer Prevention Program) from across the province participated in the two day Master Class – the first of this type of intensive, hands-on training for physicians to be held in Canada.

On each of two days three colonoscopists – the maximum number for this kind of continuing medical education – participated in the program under the guidance of leading experts from England: Dr. Roland Valori and Dr. John Anderson.

“We went beyond discussing techniques and approaches,” says Dr. Donald MacIntosh, a gastroenterologist with Capital Health and Chair of the Quality and Standards Committee with Cancer Care Nova Scotia’s Colon Cancer Prevention Program. “This was a practical, hands-on experience. Each participant actually performed colonoscopies, with guidance from an instructor and while they were doing the procedures, another instructor facilitated a discussion with remaining participants as they watched and listened to what was happening in real time in a separate room.”

The ability to participate in the entire two-day program utilized leading edge technology – a close circuit video system broadcast three simultaneous views: one screen monitored what was going on in the procedure room, another allowed the view through the colonoscope that was seen by the person performing the colonoscopy to be shared with other participants, and the third screen provided a real time image of the actual scope configuration called a scope guide (provided through the generosity of Olympus Canada.) “The guide allows you to see what the scope is doing inside the patient during the procedure,” says Dr. MacIntosh. “With the imager you can show people how to reduce risk and discomfort for the patient.”

This unique arrangement allowed the other participants to listen to the guidance given by the instructor in the procedure room and also to participate in a discussion with the remaining participants, led by the other instructor in the viewing room.

The training was very beneficial – and practical, says Dr. Bernard Badley, Medical Director of CCNS’s Colon Cancer Prevention Program. “This training helps physicians better understand the advances and changes that have occurred in colonoscopy. Then we can put those into practice.”

For Dr. Robert Sers, a general surgeon and credentialed colonoscopist with the Colon Cancer Prevention Program who works in Antigonish, the Master Class was an “excellent course.” “It’s always good to go and speak with people who face the same technical challenges and to meet with experts at the forefront of new knowledge and techniques. The problems we experience are common. It’s also good to have a fresh look at what you are doing.”

For many physicians, it may have been awhile since their last training in colonoscopy. “When we graduate and start to practice, we’re not assessed again,” notes Dr. MacIntosh. “We need to make sure we’re doing the best we can possibly do.”

Colonoscopists credentialed through the Colon Cancer Prevention Program are required to have completed 500 procedures in the preceding three years with an intention to remain at this level. Even so, Dr. Badley says, “it is a procedure that is technically challenging. The training is an opportunity to upgrade and refresh our skills.”

Indeed, says Dr. Sers, “If you want to make something excellent, you keep looking at how you can improve.”

The other component of the program – train the trainer – allowed three experienced Nova Scotia colonoscopists to benefit from the expertise of Dr. Roland Valori and Dr. John Anderson, in helping residents and practicing colonoscopists to enhance their colonoscopy skills. “This course, which ran for two days, teaches you how to be a better teacher,” says Dr. MacIntosh. “After the procedure, we debriefed as a team. The trainees spoke about how the training went and the trainers learned how to improve their teaching techniques.”

As a result of this training, notes Dr. Badley, “We now have three people in Halifax who can deliver future colonoscopy Master Classes.”

Considering the success of the June session, other Master classes may begin as early as this fall. “The whole idea is to offer this on a regular basis,” says Dr. MacIntosh. “These courses are an important overall step in improving the quality of colonoscopies in Nova Scotia.”