This document discusses assessing procedural competency for gastroenterology fellows. It notes that while minimum procedure numbers are often cited, competency depends more on skills and achieving defined performance standards. Tools like procedure logs and evaluation forms can help programs more fully assess fellows' abilities. The adoption of milestones in competency-based medical education will further shift the focus from mere numbers to demonstrating progress along a continuum of skills. Programs will need to carefully define competency criteria and have reliable, validated ways to track fellows' performance over time.
Bringing Quality to Life - QMS in an NHS Investigator SitePiran Sucindran
This is a brief description of work done with the Guys and St Thomas' Oncology and Haematology Clinical Trials team in developing a Quality Management System for clinical trials. Included is a scalable model for an investigator site QMS. This was originally presented at the Arena Conference - Clinical Operations in Oncology in 2015.
Excel/VBA model for nurse scheduling in outpatient wardsParijat Sinha
A model is proposed and evaluated using an Excel/VBA simulation to schedule full time and part time nurses in outpatient wards in face of probabilistic patient arrivals.
Dr. Darwin Reicks - Pre-screening of stud boars for low fertility: What are t...John Blue
Pre-screening of stud boars for low fertility: What are the options? - Dr. Darwin Reicks, Swine Vet Services, from the 2011 The Allen D. Leman Swine Conference, September 17-20, 2011, St Paul, MN, USA.
Bringing Quality to Life - QMS in an NHS Investigator SitePiran Sucindran
This is a brief description of work done with the Guys and St Thomas' Oncology and Haematology Clinical Trials team in developing a Quality Management System for clinical trials. Included is a scalable model for an investigator site QMS. This was originally presented at the Arena Conference - Clinical Operations in Oncology in 2015.
Excel/VBA model for nurse scheduling in outpatient wardsParijat Sinha
A model is proposed and evaluated using an Excel/VBA simulation to schedule full time and part time nurses in outpatient wards in face of probabilistic patient arrivals.
Dr. Darwin Reicks - Pre-screening of stud boars for low fertility: What are t...John Blue
Pre-screening of stud boars for low fertility: What are the options? - Dr. Darwin Reicks, Swine Vet Services, from the 2011 The Allen D. Leman Swine Conference, September 17-20, 2011, St Paul, MN, USA.
Colorectal Cancer Screening for Family Physicians - What's NewJarrod Lee
Colorectal cancer is the the most common cancer in Singapore and in many developed countries. The past decade has seen many countries implement colorectal cancer screening programs to decrease its mortality. Established cancer programs utilize tests such as fecal occult blood and colonoscopy to detect colorectal cancer in its early stages or even in its precancerous adenoma stage. Studies in recent years reinforce the benefit, accuracy and risks of these screening modalities. Nonetheless, screening rates remain suboptimal. The past 5 years have seen many new advances in colorectal cancer screening, including new screening modalities. Of these, 3 new modalities have already been approved by the US FDA and in various parts of the world. There are: stool DNA test, blood septin 9 test, and capsule colonoscopy. We discuss about these new developments in colorectal cancer screening and how they may impact our practice in the near future.
Clinical prediction of chronic periodontitisHtun Teza
Presentation for The 7th Regional Conference on Graduate Research 2021 - 13/01/21 Master of Science in Data Science for Healthcare ( International Program ) ( Clinical Epidemiology and Biostatistics, Mahidol University, Thailand )
Colorectal Cancer Screening - What does the evidence really say?Jarrod Lee
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Présentation du système de téléconsultation neurologique et de téléradiologie chez des patients atteints d’accident vasculaire cérébral, mis en place par le réseau interhospitalier TEMPiS (Telemedical Project for Integrative Stroke Care)
Docteur MÜLLER-BARNA, Klinikum Harlaching de Munich - TEMPiS
Quality in clinical laboratory is a continuous journey of improving processes through team work, innovative solutions, regulatory compliance with final objective to meet the evolving needs of clinicians & patients.
QUALITY
Conformance to the requirements of users or customers satisfaction of their needs and expectations.
Total Quality Management
A management approach that focuses on processes and their improvement.
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Since the development of our NGS-based CNV solutions for VarSeq and SVS, we've generated a long list of content demonstrating simple workflows to help isolate clinically relevant events for a given sample. However, it's just as important to talk about the exclusionary filters that help remove any extraneous CNVs from the analysis.
Golden Helix stands alone in our delivery of multiple methods for filtering down to top-quality, rare, and clinically relevant variants. This webcast will focus on the application of the various CNV annotations, discussing their purpose and usability in quickly removing CNVs with high-population frequency, duplicated regions inherent to the human genome, benign events, and events known in healthy individuals.
Please join us in an exploration of VarSeq's unique CNV annotation capabilities to see how users can overcome the challenges of NGS-based CNV detection.
What will you learn in this webcast?
Initial assessment of sample and CNV event quality
General review and understanding of various CNV annotations in VarSeq
The application of CNV annotations to eliminate common and benign CNVs
Systematic error means that your measurements of the same thing will vary in predictable ways: every measurement will differ from the true measurement in the same direction, and even by the same amount in some cases
Random error is a chance difference between the observed and true values of something (e.g., a researcher misreading a weighing scale records an incorrect measurement).
Colorectal Cancer Screening for Family Physicians - What's NewJarrod Lee
Colorectal cancer is the the most common cancer in Singapore and in many developed countries. The past decade has seen many countries implement colorectal cancer screening programs to decrease its mortality. Established cancer programs utilize tests such as fecal occult blood and colonoscopy to detect colorectal cancer in its early stages or even in its precancerous adenoma stage. Studies in recent years reinforce the benefit, accuracy and risks of these screening modalities. Nonetheless, screening rates remain suboptimal. The past 5 years have seen many new advances in colorectal cancer screening, including new screening modalities. Of these, 3 new modalities have already been approved by the US FDA and in various parts of the world. There are: stool DNA test, blood septin 9 test, and capsule colonoscopy. We discuss about these new developments in colorectal cancer screening and how they may impact our practice in the near future.
Clinical prediction of chronic periodontitisHtun Teza
Presentation for The 7th Regional Conference on Graduate Research 2021 - 13/01/21 Master of Science in Data Science for Healthcare ( International Program ) ( Clinical Epidemiology and Biostatistics, Mahidol University, Thailand )
Colorectal Cancer Screening - What does the evidence really say?Jarrod Lee
Colorectal cancer is one of the most common cancers around the world. Screening has been proven to detect cancers in early curable stages, and to even prevent them. Yet, few topics are as controversial as colorectal cancer screening in medicine today. We take an evidence based approach to examine what the science truly says about the different modalities of cancer screening.
Présentation du système de téléconsultation neurologique et de téléradiologie chez des patients atteints d’accident vasculaire cérébral, mis en place par le réseau interhospitalier TEMPiS (Telemedical Project for Integrative Stroke Care)
Docteur MÜLLER-BARNA, Klinikum Harlaching de Munich - TEMPiS
Quality in clinical laboratory is a continuous journey of improving processes through team work, innovative solutions, regulatory compliance with final objective to meet the evolving needs of clinicians & patients.
QUALITY
Conformance to the requirements of users or customers satisfaction of their needs and expectations.
Total Quality Management
A management approach that focuses on processes and their improvement.
CNV Annotations: a crucial step in your variant analysisGolden Helix
Since the development of our NGS-based CNV solutions for VarSeq and SVS, we've generated a long list of content demonstrating simple workflows to help isolate clinically relevant events for a given sample. However, it's just as important to talk about the exclusionary filters that help remove any extraneous CNVs from the analysis.
Golden Helix stands alone in our delivery of multiple methods for filtering down to top-quality, rare, and clinically relevant variants. This webcast will focus on the application of the various CNV annotations, discussing their purpose and usability in quickly removing CNVs with high-population frequency, duplicated regions inherent to the human genome, benign events, and events known in healthy individuals.
Please join us in an exploration of VarSeq's unique CNV annotation capabilities to see how users can overcome the challenges of NGS-based CNV detection.
What will you learn in this webcast?
Initial assessment of sample and CNV event quality
General review and understanding of various CNV annotations in VarSeq
The application of CNV annotations to eliminate common and benign CNVs
Systematic error means that your measurements of the same thing will vary in predictable ways: every measurement will differ from the true measurement in the same direction, and even by the same amount in some cases
Random error is a chance difference between the observed and true values of something (e.g., a researcher misreading a weighing scale records an incorrect measurement).
6. Minimum Cited Numbers
• Flex sigs 25-30
• EGDs 130
• Colons 140
– Based on goal of cecal intubation > 90%
– Others found competence at 275 cases1
– Others found competence at 500 cases2
1
Using Sedlack data
2
Using Spier data
8. Spier BJ, et al. Gastrointest Endosc 2010;71:319-24.
9. Procedure Logs:
Not Just Numbers Anymore!
• “A skilled preceptor must be available to
teach and supervise the fellows in the
performance and interpretation of
procedures, which must be documented
in each fellow's record, including
indications, outcomes, diagnoses, and
supervisor(s).”
IV.A.6.d).(2) on Page 19, GI Program Requirements, “Tracked Changes” document
11. Procedure Logging
• “Assessment of procedural competence should include
a formal evaluation process and NOT be based solely
on a minimum number of procedures performed.
• Each program must define criteria for competence for
all required and elective procedures.
• The record of evaluation must include the fellow’s
logbook or an equivalent method to demonstrate that
each fellow has achieved competence in the
performance of required procedures.”
V.A.1.a).(2) and 1.b).(1).(a) on Page 20-21, GI Requirements, “Tracked Changes” document
12. Multi-Society Evaluation Form
(MSEF)
• AASLD, ACG, AGA, ASGE
• Part of the GI Core Curriculum
• Third Edition, May 2007
http://www.asge.org/WorkArea/showcontent.aspx?id=3584
13.
14. Any Downfalls of the MSEF?
• Lacks anchoring characteristics for all points
• Not validated for continuous assessment
• Grade inflation (our problem, not the form’s)
• Compare graduates across programs?
• What constitutes competent?
15. Mayo Colonoscopy Skills
Assessment Tool (MCSAT)
• 13-item survey
• Staff completed on each colon
• Took < 1 minute to complete
• Embedded in MERGE database
– Allowed for recording of procedure
# for fellow, fellow name, etc.
Sedlack RE. Gastrointest Endosc 2010;72:1125-33.
19. Barriers of the MCSAT or
Similar Systems?
• Many procedures performed
– Assessment needs to be quick/simple
• Differing procedures performed
– Similar models needed: EGD, PEGs, capsules, etc
• Compliance with completion
– Too easy for staff to forget or not take the time
• Differing endoscopy database systems
– No communication across programs
23. Pros/Cons of ProVation
• PROS:
• Compliance with completion
– Automatic pop-up on all fellow EGDs and colons
– Staff cannot sign off until complete
• CONS:
• Yet another database
– How long with it be around?
– Not everyone has it
– Dependent on others to add features desired
• Detail desired
– Has to fit into radio buttons, brief, succinct
25. The Game Has Changed in
the Setting of NAS
• No longer a numbers game
• No longer a competency yes/no game
• Now it is all about meeting milestones
on the way to becoming competent
http://www.acgme-nas.org/assets/pdf/NEJMfinal.pdf
26. A Blueprint for Milestones
or Competency?
Unacceptable Competent Ideal
Adenoma >20%
Detection Rate
Colonoscopy > 6 min
Withdrawal Time
Cecal Intubation > 95%
Rate
Complication Rate < 1/200 bleed
<1/1000 perf
Polyp Retrieval > 95% > 10 mm
Rate > 80% < 10 mm
Patient Tolerance > 90% fair to
excellent
27. A Blueprint for Milestones
or Competency?
Unacceptable Competent Ideal
Adenoma > 20% >20%
Detection Rate
Colonoscopy 7-15 min > 6 min
Withdrawal Time
Cecal Intubation > 90% > 95%
Rate
Complication Rate < 1/200 bleed
<1/1000 perf
Polyp Retrieval > 95% > 10 mm
Rate > 80% < 10 mm
Patient Tolerance > 90% fair to
excellent
28. A Blueprint for Milestones
or Competency?
Unacceptable Competent Ideal
Adenoma < 15% > 20% >20%
Detection Rate
Colonoscopy > 20 min 7-15 min > 6 min
Withdrawal Time
Cecal Intubation < 80% > 90% > 95%
Rate
Complication Rate < 1/200 bleed
<1/1000 perf
Polyp Retrieval > 95% > 10 mm
Rate > 80% < 10 mm
Patient Tolerance > 90% fair to
excellent
30. Summary
• Procedure numbers are not enough
– An anchor at which competency
assessment should begin
• Procedure details are now needed
– Indication, findings, complications
• Competency tracking is required
– Milestones will pave the way, and they
need to be carefully developed