在上胃肠道出血的紧急内镜中获得能力的学习曲线:需要多少经验?
Gabriel Allo1, Sonja Lang2, Anna Martin2
1Department of Gastroenterology and Hepatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany gabriel.allo@uk-koeln.de.
BMJ open gastroenterology
|March 8, 2024
概括
在紧急内镜上部胃肠道出血 (UGIB) 获得能力需要大量的实践. 数据表明,在血液静止干预中,至少有20个程序用于熟练,50个程序用于专业知识.
科学领域:
- 胃肠病学 胃肠病学
- 内镜检查是指内镜检查.
- 医学教育 医学教育
背景情况:
- 上部胃肠道出血 (UGIB) 管理已取得进展,但对于血液静止干预能力所需的紧急内镜数量的数据是有限的.
- 定义熟练度基准对于培训内镜师管理急性UGIB至关重要.
研究的目的:
- 确定学习曲线和紧急内镜检查的最低数量,以获得内镜师在UGIB的血液静止干预方面的能力.
- 为独立执行紧急内镜手术制定能力基准.
主要方法:
- 787次 oesophagogastroduodenoscopies 对最近出血 (2015-2022) 的回顾性分析.
- 学习曲线绘制治疗失败率与之前的紧急内镜手术的数量.
- 治疗失败被定义为失败的血液静止,再出血,或需要手术/放射学.
主要成果:
- 治疗失败发生在28.6%的病例中.
- 在9次手术后观察到故障率的显著下降,在20-50次手术之间停滞不前.
- 经过<10次手术的内镜师的失败率高于经过>51次手术或咨询师的内镜师 (p=0.039,p=0.041).
结论:
- 建议至少进行20次紧急食管胃管腺镜检查,以确定内镜师在UGIB管理方面的熟练程度.
- 至少需要50个血液静止程序才能被认为是先进的专家.
- 将这些最低程序数整合到培训计划中,可以提高学员在管理急性UGIB方面的信心和能力.
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