美国ERCP培训与评估(梁永昌)分析报告.ppt

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 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 3rd 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) 4th 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） 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 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？ 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 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 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.