Diary log by Dr Muhammad Saad

Dr Saad works as a Specialty Gastroenterology Registrar ay Royal Wolverhampton NHS Trust. This is his diary log of the immersive training.

Immersive training, it works as the name suggests. You literally get immersed into the world of colonoscopy.

Previously, I would do scattered colonoscopies on ad hoc lists, and managed around 110 with that approach. Everything that my trainer would say, seemed like a task for me to implement. It wasn’t working out for me like people said it would. Like any skill, it’s supposed to be second nature to you, embedded enough to flow out at ease but it wasn’t how it was happening for me. 

Then I got the opportunity to enroll into this wonderful initiative taken by my academic team. I was excited!

Day one

Was hard to cope with physically, aching wrists, strained shoulders, I felt exhausted. 8 scopes in one day seemed like a marathon but one thing that was working was my progression from struggling to reach rectum to managing to get to the left side with ease, all in one day. I found hope again. 

Day two and onwards

I continued working from the targets of the first day and then came the next week, luckily, I had the same trainer that week for first session and they were surprised to see the improvement in skills.

The second week

We set new targets as left side colonoscopy was managed effectively. Right side was still a struggle, resolving loops and anticlockwise torque which was proving hard to maneuver. 

Weeks three and four

Each week went in with new targets and with the bulk of 16 colonoscopies in 1 week, the goals for the next week seemed less daunting. To be honest, it’s the learning environment where you feel there are no time constraints and I, as the trainee is the priority.

To go into a bit of detail, a typical day in immersive training included 4 colons in the morning session and 4 in the afternoon, with the same routine the next day. I had different trainers in all sessions, all of whom were gastroenterology consultants but liaised well with each other and they were aware of my progress after each session.

As I wanted to pursue advanced endoscopy including HPB, this training has helped me achieve better tip control, scope handling, contemplating torque and wheel control which in my opinion are the most pertinent skills to master to become a good endoscopist.

Achievements

What I managed to achieve was a lot more than just skill. Reaching the caecum did feel momentous but being able to understand the physiology of scope guide and scope maneuvering brought forth more insight. I am quite confident now that I will easily be able to critique myself if I were to be unsuccessful in any odd case in the future. 

Lastly, I would strongly recommend this kind of training for trainees to be deemed mandatory and I am certain just this one month would take a trainee a long way in their career.