Adult Gastroenterology Training Program

Resident Practice Audit Program Gastro-Enterology (RPAGE)

Competence in performing endoscopy is an essential component of a Gastroenterology trainee’s professional development, and yet the standards that both facilitate and confirm the achievement of competency are poorly defined. Increasingly, objective assessment of performance is recognized as a critical assessment parameter in determining endoscopic competence accurately. Furthermore, the ASGE training guidelines mandated that each trainee’s acquisition of technical and cognitive skills be monitored on a regular basis. Most training programs do so by the use of procedure logs or subjective evaluation by proctors. Unfortunately, performance of a minimum number of procedures, while a prerequisite for skill acquisition, does not guarantee competence. Furthermore, subjective observation is neither valid nor reliable. Tracking quality indicators for trainees may provide more reliable outcome data to improve educational programs and establish training requirements. As such, the objective of the RPAGE program is to measure specific endoscopic quality indicators for trainees to determine if outcome can be used to assess the quality of procedure training and contribute to more objective means of establishing uniform training requirements among programs.

The Resident Practice Audit Program Gastro-Enterology (RPAGE) is an innovative program that was developed by the Division of Gastroenterology at McMaster University (Dr. Ted Xenodemetropoulos, Dr. Frances Tse, Dr. David Armstrong) in collaboration with the Canadian Association of Gastroenterology (CAG). The RPAGE is a natural and logical extension of the Practice Audit in Gastroenterology (PAGE) program for practicing Canadian endoscopists. Over the last 6 – 7 years, the PAGE program has developed into a powerful, real time instrument for practice audit, continuing professional development and quality improvement, recognized by the Royal College of Physicians and Surgeons of Canada with their 2011 Innovations in Accreditation Award.

The RPAGE program is designed to provide trainees with a point-of-care, peer-comparator practice audit tool. With the help of the endoscopic trainers, all trainees enter details of each procedure they complete in real-time. Anonymized trainee, patient and practice data are collected using touchscreen smartphones or desktop computer with automated data upload for data analysis and review by participants. The program allows trainees to objectively record key endoscopic quality indicators (e.g. gastroscope and colonoscope insertion and withdrawal times, segments of procedure performed independently or with assistance, bowel preparation quality, sedation, immediate complications and polypectomy, biopsy rates). There is also an evaluation tool built in the program that allows trainees to have their endoscopic performance objectively evaluated by their trainers on a regular basis. The RPAGE program will allow trainees to review their own performance and compare this with their peers, promoting the identification of learning needs and objectives, as well as the basis for the development of targeted education programs. The Program Director can review procedure volumes, endoscopic quality indicators and evaluation results on a regular basis.

To assess the usability of the RPAGE program, pilot testing is currently undertaken at McMaster University. The project was presented to the Program Directors at the Canadian Digestive Disease Week in 2012 and was met with great enthusiasm. The plan is to gradually roll out the fully functioning RPAGE program to other GI training programs (adult and pediatric) across the country by the end of 2012. It is anticipated that this program will foster the ability for trainees and programs to benchmark themselves and provide impetus for quality improvement in endoscopy training.