Train the Endoscopy Trainers — Day 1, Colonoscopy

Roland and John give the course framing. Each faculty member introduces themselves and names what they want to get out of the day. Sets up vocabulary that pays off across the day. (~18 min)

59-year-old gentleman, FOBT positive. Adam (experienced Canadian fellow) trained by Manmeet; Roland super-trains. Educational contract focuses on conscious competence. Cecum in 90 seconds; one pedunculated polyp cold with injection, one small polyp on retroflex. Feedback deconstructs ergonomics gap, too-fast withdrawal, hand-off-scope retroflex technique (safety flag) and rushed polyp characterisation. (~75 min)

50-year-old screening positive, propofol. Luigi (very experienced Italian fellow) — Nick's job is to push conscious competence, not teach scope skills. "Problem → solution → execution" (PASE) decision-analysis frame introduced. Retroflex-on-the-way-in, water immersion insertion, textbook N-spiral loop resolved with clockwise torque. Nick's super-trainer review with John drills the failed "innominate grooves" reference and how to detect when a trainee hasn't truly understood. (~80 min)

50-year-old screening with diverticular disease. Cecilia (most junior trainee, Italian resident). Pieter Jan trained as the trainer (basic-level). Roland super-trains. Fast intubation but bad views; Buscopan ambiguity ("normally I wouldn't"). Roland's feedback drills missed instruction opportunities — failure to follow the trainee's lead, fast insertion at expense of views, polypectomy "haircut" analysis. (~45 min)

53-year-old SC2 site check; previous 35mm adenoma resected 2024 with CAST technique. Adam (second case of the day) under sedation — awake, French-speaking patient. Contract: loop avoidance, slowing down, position change, fine tip control. Includes N-spiral roll-to-back, water vs CO2 switching at splenic, and John's mid-case redirect to an underwater view of the scar from the right side. John's feedback: "control the trainee, not the scope" message; splenic-flexure algorithm laid out. (~54 min)

Delegate-requested side-bar between cases. Roland & John discuss what buy-in is, why trainees don't buy in (culture, muscle memory, belief, unit context), and how to engineer it — PASE algorithm, demonstration, "performance-dip" warning. The conceptual companion to the in-room moments. (~12 min)

Elizabeth Bird-Lieberman

Roland Valori

JOHN ANDERSON

Surveillance after ascending ESD (curative pT1aSM1). Fully awake patient. The cleanest training case of the day — source of "I just pause you", "you're doing it unconsciously", the four-axis time-out ("hands · trainee · patient · scope"), Socratic question chain, and awake-patient communication ("This might be a bit uncomfortable — we're coming up to a bend"). The exemplar against which the morning cases are measured. (~50 min)

Round-table on who should train (not-train / supervise / formal-train / super-train), the polypectomy training gap, dedicated upskilling lists, and the "shared list" approach between senior endoscopists (Oxford specialist-list model). (~14 min)

70-year-old, no sedation (patient asked for awake). Adam (third case, pacey). Known colonic lipoma — "pillow sign" moment in sigmoid. Includes the patient-safety incident: Adam tries to unwind an external loop while a hook is still on at splenic, dragging tip into mucosa. Feedback walks the video through what happened, "when do we put loop in umbilicus" theoretical drill, plus missed ischaemic patches in the cecum spotted by John. Critical teaching block. (~50 min)

Final case. Cecilia's second case — now more confident, awake patient. Designed to test position change + PASE on an awake patient. Scope-guide loop reading, sigmoid loop prevention by position change, lateral compression demo at splenic. Roland's feedback drills the missed PASE moment (miscommunication: sigmoid vs splenic) and introduces "facilitated tip-steering" — Cecilia never touched the left-right wheel in the left colon in either of her cases. Strongest single teaching moment of her two cases. (~47 min)

John whiteboards the full competency framework: Preparation (contract / assessment / agenda / ergonomics / objectives) → Training (control / cognitive load / wide-angle lens / PASE / decision training / performance-enhancing training / clarity-of-language) → Feedback (PEF / consolidated take-homes). The conceptual through-line of the whole day. (~6 min)

Roland goes round all trainees and trainers for a take-home reflection (Cecilia, Pieter Jan, Manmeet, Beth, Luigi, Nick), followed by Roland's day-close and preview of Day 2 (therapeutic endoscopy). (~15 min)