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Teaching Cognitive Skills
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Question for Discussion
• Who is the audience?
• How do you teach fellows cognitive skills?
– Setting
– Style
– Substance
• How does it fit in the structure of your
program?
• Resources
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Questions to Consider:
• How can the endoscopy teacher promote
trainee detection and identification of
abnormal findings?
• How much of this must be learned as
pathology arises during cases?
• What resources or methods of exposure
can make this learning process more
efficient
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Teaching Novices Cognitive Skills:
Breaking it Down
• Teaching trainees to detect
abnormalities—and not miss things
• Teaching trainees to correctly identify
those abnormalities they discover
• Teaching trainees how to know what
to do once they identify an
abnormality
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Tips for Teaching Novices to
Recognize Abnormalities
• Look closer – Know what to look for [Normal vs. Abnormal]
• Look slower
• Look more completely – Know where to look
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Freeze Frame
• Capture button
allows more than
taking nice
pictures
• Image
stabilization
allows time to
assess details
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Look for Subtle Alterations
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Notice Color Differences
Hyperplastic Polyp
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Adenomas
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Detection—Close Focus
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Detection of Tiny Cancer
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Know Where to Look!
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Detection: Know What to Look For
and Where to Look:
Mucous & Debris / Egg-Drop Soup
Tadepalli U. et al. Gastrointest Endosc 2011;1360-1368.
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Knowing What to Look For: Anything Unusual Below?
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Steps in Learning Pattern Recognition:
• Lesion characterization: knowing what it is
that you are seeing
– Identify component features of pathologies
– Process sum of all features and deduce the
most likely pathology with varying confidence
– Alternatively, based on exposure to multiple
examples recognize the entire pattern as a
whole akin to facial recognition
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OR . . .
Feathers + Web feet + Beak, and it Flies = A Duck
It Looks Like a Duck = A Duck!
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Teach Characteristic Features
• Stark color difference from surrounding mucosa
• Thick brown vessels around white structures
• Branched & oval white structures surrounded by brown
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Recognizing and Identifying
Atypical and Worrisome Lesions How Would You Maximize the Teaching Moment
When Your Fellow Encounters This Finding?
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How do novices actually get this
cognitive training? • What are the practical considerations in
your program?
• What resources do you use outside the
endo unit?
• How do you deal with infrequent
pathologies?
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Detection & Recognition:
Case Scenario • 2 cases of routine screening colonoscopy
• “On-demand colonoscopy” with no
indication of any particular increased risk
for neoplasia
• No history of major co-morbid illnesses,
abnormal immune function, or particular
abdominal or perirectal complaints
• Normal pre-procedure routine lab tests
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Recognizing Abnormal IPCL’s:
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Squamous esophagus IPCL patterns
(intra-epithelial papillary capillary loops)
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Tips to Didactic Presentations of Imaging Material
• Theoretical background-how it works
• Introduce characteristic features to identify
• Provide many examples
– Annotate images to clearly point out identifying features
– Illustrate contrasting features
• Testing with feedback
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Repetition of Examples is Key
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Tubulogyrus pattern - Adenoma
Linear or convoluted
tubular structures
Annotated Images Helpful
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NBI patterns- Areas of Confusion: Juxtapose Contrasting Findings
Circular pattern with dots
(Hyperplastic polyp)
Round or Oval pattern
(Adenoma)
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Exercise: Examples for Practice
• Polyp Color: ( ) Brown from vessels
( ) Same as background
• Polyp Vessels: ( ) Brown around white
( ) None or lacy
• Surface Pattern of Polyp: ( ) Oval, tubular or branched
white surrounded by vessels
( ) Dark spots surrounded by white
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Immediate Review of Answers
• Polyp Color: ( X) Brown from vessels
( ) Same as background
• Polyp Vessels: (X) Brown around white
( ) None or lacy
• Surface Pattern of Polyp: ( X) Oval, tubular or branched
white surrounded by vessels
( ) Dark spots surrounded by white
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Teaching Appropriate Management
of Endoscopic Findings • Intra-procedure teaching
• Post-procedure activities
• Real time endotherapy decision making
• When and how best to sample
• Understanding quality indicators
• Maximizing safety/minimizing risk
• EBM awareness and application
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Cognitive Teaching: Management
of Endoscopic Findings
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Summary Discussion:
Any Take Home Ideas?