,#,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,#,ERCP Training and Assessment in the U.S.,美国,ERCP,培训与评估,Joseph Leung,MD.,FRCP.,FACP.,FASGE.,MACG.,Mr.&Mrs.C.W.Law Professor of Medicine,University of California,Davis School of Medicine,Chief,Section of Gastroenterology,VA Northern California Health Care System.,ERCP Training and Assessment i,ERCP Training in the U.S.,美国的,ERCP,培训,Part of a GI Fellowship(ABIM accredited),胃肠医生培训的一部分,(,美国内科学委员会,认证,),ERCP training offered in 3,rd,year(trainees exposed to ERCP but not necessarily competent in performing),第,3,年开始进行,ERCP,培训,(,学员只需,ERCP,知识,并不要求独立操作）,Additional(advanced)4,th,year training(not ABIM accredited),第,4,年,高级,培训一年（非美国内科学委员会,认证,要求）,Trainees expected to complete 180-200 cases,with 80%success rate,including 75%therapeutic procedures,要求学员完成,180-200,例操作，成功率达,80%,以上（其中包括,75%,的治疗性操作）,ERCP Training in the U.S.美国的E,Why ERCP Training?,为什么要进行,ERCP,培训？,ERCP is effective in management of pancreaticobiliary diseases,ERCP,在胆胰系统疾病诊治方面效果显著,It is complex and potentially hazardous,ERCP,技术复杂，有相当高的潜在风险,Requires effective clinical/technical teaching,需要有效的临床基础和操作技巧指导,Objective assessment to determine quality,需要客观的评估，判断学员操作能力,Apprenticeship,传统的学徒式教学,Why ERCP Training?为什么要进行ERCP培,Key Questions in ERCP TrainingERCP,培训中的关键问题,Who should be trained?,谁来学？,What should be taught,and how?,教什么，怎样教？,Who should teach?,谁来教？,How are training and competence assessed?,如何对培训效果及学员能力进行有效评估？,What level of performance is acceptable?,培训目标如何确定？,Key Questions in ERCP Training,Who Should be Trained?,谁来学？,GI/Surgical trainees,部分消化科内医生和外科医生,Available training positions are variable,按照不同的阶段目标 获得多样化培训,Expectation-those who received training should reach acceptable level of competence for safe independent practice,预期在结束培训时，学员能够达到相应阶段培训标准,可以独立安全的开展业务,Who Should be Trained?谁来学？GI/,What Should be Taught,and How?,教什么，怎么教？,Knowledge in pancreaticobiliary diseases,胆胰系统疾病的临床理论知识,Skills in ERCP including alternative diagnostic and therapeutic methods,ERCP,的实际操作技能，包括,其他,诊断性和治疗性操作,方法,Skilled in basic tenets of patient care,医学精神以及收治过程中,与,病人沟通能力,What Should be Taught,and How,Levels of ComplexityERCP,技术难度分级（,2011,）,Cotton et al.Grading the complexity of endoscopic procedures:results of an ASGE working party.GIE 2011;73:868-74,1.,深插管，胆道支架置入,/,交换,/,取出,Levels of ComplexityERCP技术难度分,Goals of ERCP trainingERCP,培训目标,Able to provide fundamental(life-saving)ERCP procedures at the community level e.g.urgent biliary draining for acute(suppurative)cholangitis,初级培训：能够在当地医院急诊情况下提供最基本的,（,”,救命式,”,）,ERCP,操作，如急性化脓性胆管炎引流,Those completed training should be competent in performing level 1 and 2 procedures,完,成,培训：能够熟练掌握技术难度,1,、,2,级的,ERCP,操作,Levels 3 and 4 procedures will require advanced training,3,4,级技术难度的操作需要,高级,的培训,Goals of ERCP trainingERCP培训目,Training Curriculum,培训科目,Differences between ASGE and SAGES,美国胃肠镜学会与胃肠道内镜外科医生学会,要求,的,分,别,Lectures,didactics,atlases,videos and books,讲座，授课，图片，视频以及教科书,Supervised clinical practice,监督下的临床实践,History/physical exam,laboratory tests,病史，体征，实验室检查,Management of pancreaticobiliary problems as in-and outpatients,with discussion on diagnostic and treatment options,including assessment of risks,胆胰系统疾病 门诊及住院病人的处理,诊断和治疗的选择以及风险评估,Multi-disciplinary approach(surgery/radiology),多学科讨论,（外科、放射科）,Training Curriculum培训科目Differ,Concept of Training,(Preparing the endoscopist),培训的概念,How to do it(basic skills),怎样做,When to use it(clinical application),何时应用于临床,Specific procedures,具体步骤,Management of complications,并发症的处理,Documentation of performance,操作记录,Credentialing,证书,1/2015,Concept of Training 1/2015,Training Methods,培训方法,Self studies:videos,recorded lectures,self assessment,自学：视频，,听,课,自我评估,Radiological interpretation,safety with fluoroscopy,影像学资料学习，,放射学,安全,Observation of clinical procedures,临床操作观摩学习,Laboratory practice of basic skills,including handling scope and accessories,内镜室基础操作，包括持镜，附件等,Clinical training:hands-on practice with scope handling and selective cannulation,临床操作培训：控制十二指肠镜和选择性插管的练习,Guide wire manipulation and operate different accessories,导丝和其他附件操作,Learning in steps and eventually able to assimilate skills and complete entire procedure,循序渐进掌握,ERCP,操作技巧,Successful procedure with no complications,成功独立操作,没有并发症的手术,Trainees also learn how to assist with ERCP procedure,学员同时应当学习如何当好,ERCP,助手,Training Methods培训方法Self stud,Supplemental Training,补充培训,Seminars and workshops,研讨会和培训班,Model practice including simulators,包括模拟器在内的模拟训练,Hands-on team practice to improve coordination with assistants(TEAM work),手把手,ERCP,团队协作训练,Supplemental Training补充培训Semi,Simulation,(Optional),Training,模拟器（可选择）培训,Understand anatomy,motility,理解解剖及胃肠蠕动特性,Practice with real scope and accessories,使用十二指肠镜和附件练习,Familiar with scope handling,熟悉持镜技巧,Learn and practice basic steps,学习掌握基本操作步骤,Coordinated practice with assistant without risking a patient,与助手合作练习 减少病人风险,(RCT show