S611 Quantitative Analysis of Teaching Behaviors by Endoscopy Educators During Trainee-Performed Colonoscopy

Introduction: Within competency-based medical education, Directly Observed Procedural Skills (DOPS) is a recommended method for assessing trainee procedural skills. With the rise of train-the-trainer courses educating endoscopy trainers on best practices for teaching endoscopy, a similar assessment of Directly Observed Teaching Skills (DOTS) may be beneficial. We previously created and held a workshop teaching a standardized approach to endoscopy training1. Our study aims to quantify directly observed teaching behaviors by endoscopy trainers near the time of our workshop. Methods: Participants (attendings) were filmed supervising trainees (fellows) performing colonoscopy procedures up to 7 months before and 5 months after our workshop intervention. Data encoded from videos included timing of teaching behaviors by attendings, timing and ability of trainees performing polypectomy, trainee ergonomics, and management of any distractions. Videos were encoded by a second-year GI fellow. The study was approved by Boston University IRB H-36951. Results: Out of 109 total filmed procedures, 50 colonoscopies (37 pre-, 13 post-intervention) involving 11 attendings have been encoded at the time of this abstract. Uneven group sizes precluded a robust pre- and post-intervention comparison.On average, attendings provided verbal instruction 5.27 (SD 4.65) times during insertion and 8.61 (SD 7.2) times during withdrawal. Instructional behaviors are further quantified in Table. (Table) A mean of 0.5 (SD 0.68) distractions occurred per colonoscopy, and 5.32% (SD 22.93%) of distractions were addressed by the attending. Of an average 1.18 (SD 1.77) polypectomies per session, fellows took the lead in 63.8% (SD 48.0%) of instances. Monitor height was appropriate in 82% of procedures. Bed height was appropriate in all cases. Fellows showed none to very little neck craning in 68% of procedures. Fellows showed good posture for the entire or majority of the case in 82% of procedures. Conclusion: We performed a quantitative analysis of teaching behaviors and ergonomics filmed during trainee-performed colonoscopy. Our observations reinforce two main teaching points. Endoscopy trainers should recognize and address distractions during colonoscopy. Trainee endoscopy position and ergonomics should always be observed and corrected. Completion of video encoding will allow for pre- and post-intervention analysis. Table 1. - Proportion of Trainee-Performed Colonoscopy Involving Directly Observed Teaching Behaviors by Attendings InsertionMean (SD) WithdrawalMean (SD) Positioned appropriately to observe patient, trainee, and monitor 68.4% (41.2%) 71.5% (37.0%) Provided verbal instruction 20.7% (36.2%) 19.2% (21.0%) Provided hands-on instruction (holding the colonoscope) 3.3% (11.7%) 4.7% (13.6%)