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Sunday Poster Session

Category: General Endoscopy

P0564 - Initial Deficiencies in Gastroenterology Fellow’s Endoscopic Skills During COVID-19 Remain With Additional Training

Sunday, October 22, 2023
3:30 PM – 7:00 PM PT
Location: Exhibit Hall
Has Audio
Abraham Z. Cheloff, MD, MS, Briton Lee, MD, Michelle Kim, MD, Andrew Dikman, MD, Renee Williams, MD, FACG, Michael Poles, MD, PhD, Violeta Popov, MD, PhD, FACG
NYU Langone Health, New York, NY

Introduction: During the COVID-19 pandemic, a reduction in the number of outpatient colonoscopies had a negative impact on the development of endoscopic skills by novice trainees, with lower scores on the ASGE Assessment of Competency in Endoscopy (ACE) tool. The ACE scores of 1st-year trainees were reduced in several domains for those who started during COVID compared to their pre-COVID peers. In order to assess whether this had a long-lasting effect on the trainees’ endoscopic skills, we continued to follow the performance of the COVID cohort by comparing their ACE scores in the 2nd and 3rd years of training to the scores of pre-COVID fellows.

Methods: 2nd and 3rd-year gastroenterology fellows who began training in July 2020 (COVID), and those at the same program who completed their training between 2016 to early 2020 (pre-COVID) were evaluated on endoscopic skills throughout their training using the ACE tool. End-of-year ACE score means between the pre-COVID and COVID groups were compared across all ACE domains. Mean ACE scores in each domain were compared using a single-tailed t-test, with a significance level of 0.05.

Results: The COVID cohort consisted of 5 gastroenterology fellows with mean ACE score data based on 89 colonoscopies. The pre-COVID cohort consisted of 19 fellows with data from 229 colonoscopies. Full results are displayed in Table 1. The 2nd-year COVID fellows no longer showed any statistically significant differences in ACE scores compared with pre-COVID colleagues. However, multiple domains showed scores trended higher in pre-COVID fellows including effective use of air, water, and suction, knowledge of therapeutic tools, overall hands-on skill, and overall ACE scores. By the end of the 3rd year, effective use of air, water, and suction was significantly higher in the pre-COVID cohort. Overall hands-on skill, overall cognitive skill, and overall ACE score all trended higher in the pre-COVID cohort without significance.

Discussion: The reduction in endoscopic procedures during the COVID-19 pandemic had a negative impact on the initial and subsequent training of gastroenterology fellows. Prior studies showed deficiencies in the 1st year, and here we demonstrated that some deficiencies remain through the 3rd year of training with many ACE domains trending towards significance. This study supports the need for early case volume in fellowship in order to acquire procedural skills.
ACE Domain
Year 1
Year 2
Year 3
pre-COVID
COVID
P-value
pre-COVID
COVID
P-value
pre-COVID
COVID
P-value
Fellow’s knowledge of the indication & pertinent medical issues
 3.39
3.08
0.03*
3.73
3.70
0.42
3.92
3.91
0.45
Management of patient discomfort during this procedure
2.89 
2.94
0.77
3.22 
3.27
0.44
3.68
3.24
0.06
Effective and efficient use of air, water and suction
2.88 
2.45
0.04*
 3.77
3.62
0.13
3.85
3.57
0.03*
Lumen identification
2.85 
2.53
0.15
3.63
3.67
0.43
3.78
3.81
 0.43
Scope steering technique during advancement
 2.81
2.54
0.11
3.53
3.53
0.49
3.78
3.57
0.08
Fine tip control
2.74 
2.46
0.08
3.50
3.47
0.42
3.71
3.57
0.24
Loop reduction techniques
 2.63
2.34
0.14
3.37
3.44
0.34
3.61
3.51
0.31
Farthest landmark the fellow reached without any hands-on assistance
 NR
NR 
N/A 
5.86 
5.54
0.10
5.83
5.93
0.43
Adequately visualized mucosa during withdrawal
2.99
2.77
0.28
3.70
3.56
0.19
3.84
3.63
0.10
Pathology identification/ interpretation
3.08 
2.50
0.01*
3.52
3.60
0.35
3.68
3.65
0.45
Independent polyp detection by fellow
 NR
NR
N/A
 3.15
2.92
0.08
2.91
3.03
0.35
Accurate location of lesion/ pathology
 NR
 NR
 N/A
 3.59
3.49
0.47
3.81
3.62
0.16
Fellow’s participation in the therapeutic maneuver(s)
 NR
NR 
 N/A
 3.69
3.56
0.28
3.64
3.57
0.35
Fellow's knowledge of the therapeutic tool(s)
NR 
NR 
 N/A
 3.76
3.62
0.24
3.91
3.67
0.05
Fellow’s overall hands-on
 2.85
2.36
0.01*
3.60
3.43
0.15
3.88
3.67
0.07
Fellow’s overall cognitive skills
3.03 
3.69
0.06
3.59
3.67
0.34
3.97
3.67
0.05
Overall ACE score
2.89 
2.60
0.004*
3.70
3.63
0.34
3.86
3.72
0.26

Table: Comparison of pre-COVID and COVID gastroenterology fellows Assessing Competency in Endoscopy (ACE) scores in fellowship (* = p<0.05, NR = not reported, N/A = not applicable)


Disclosures:
Abraham Cheloff indicated no relevant financial relationships.
Briton Lee indicated no relevant financial relationships.
Michelle Kim indicated no relevant financial relationships.
Andrew Dikman indicated no relevant financial relationships.
Renee Williams: Boston Scientific – Stock-publicly held company(excluding mutual/index funds). Universal Dx – Advisory Committee/Board Member.
Michael Poles indicated no relevant financial relationships.
Violeta Popov indicated no relevant financial relationships.


Abraham Z. Cheloff, MD, MS, Briton Lee, MD, Michelle Kim, MD, Andrew Dikman, MD, Renee Williams, MD, FACG, Michael Poles, MD, PhD, Violeta Popov, MD, PhD, FACG. P0564 - Initial Deficiencies in Gastroenterology Fellow’s Endoscopic Skills During COVID-19 Remain With Additional Training, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.