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The U.S. Department of Education recently reported that single educational technology courses are not sufficient experiences to properly prepare preservice teachers for future technology-rich K-12 classrooms. Rather, continuous exposure to instructional technology is most effective in improving attitudes and beliefs toward technology and sustaining deep pedagogical practice. It is essential that all attempts to create digitally literate teachers should originate from within a cohesive program design rather than through single “drive-by” courses that integrate technology. The purpose of this chapter is to describe a programmatic approach used to design a comprehensive digital literacy experience for pre-service teachers (PSTs) using the U.S. DOE's recommendations. The chapter will discuss various examples, including specific course assignments the EPP uses to guide PSTs as they learn to become competent digitally literate educators. Examples of implementation, copies of PST work, and reflective discussions continued challenges to sustain the design are included.

Narrow-band imaging (NBI) allows real-time histologic classification of colorectal polyps. We investigated whether endoscopists without prior training in NBI can achieve the following thresholds recommended by the American Society for Gastrointestinal Endoscopy: for diminutive colorectal polyps characterized with high confidence, a ≥90% negative predictive value for adenomas in the rectosigmoid and a ≥90% agreement in surveillance intervals.Twenty-six endoscopists from 2 tertiary care centers underwent standardized training in NBI interpretation. Endoscopists made real-time predictions of diminutive colorectal polyp histology and surveillance interval predictions based on NBI. Their performance was evaluated by comparing predicted with actual findings from histologic analysis. Multilevel logistic regression was used to assess predictors of performance. Cumulative summation analysis was used to characterize learning curves.The endoscopists performed 1451 colonoscopies and made 3012 diminutive polyp predictions (74.3% high confidence) using NBI. They made 898 immediate post-procedure surveillance interval predictions. An additional 505 surveillance intervals were determined with histology input. The overall negative predictive value for high-confidence characterizations in the rectosigmoid was 94.7% (95% confidence interval: 92.6%-96.8%) and the surveillance interval agreement was 91.2% (95% confidence interval: 89.7%-92.7%). Overall, 97.0% of surveillance interval predictions would have brought patients back on time or early. High-confidence characterization was the strongest predictor of accuracy (odds ratio = 3.42; 95% confidence interval: 2.72-4.29; P.001). Performance improved over time, however, according to cumulative summation analysis, only 7 participants (26.9%) identified adenomas with sufficient sensitivity such that further auditing is not required.With standardized training, gastroenterologists without prior expertise in NBI were able to meet the negative predictive value and surveillance interval thresholds set forth by the American Society for Gastrointestinal Endoscopy. The majority of disagreement in surveillance interval brought patients back early. Performance improves with time, but most endoscopists will require ongoing auditing of performance. ClinicalTrials.gov ID NCT02441998.

The Accreditation Council for Graduate Medical Education (ACGME) emphasizes the importance of medical trainees meeting specific performance benchmarks and demonstrating readiness for unsupervised practice. The aim of this study was to examine the readiness of Gastroenterology (GI) fellowship programs for competency-based evaluation in endoscopic procedural training.ACGME-accredited GI program directors (PDs) and GI trainees nationwide completed an online survey of domains relevant to endoscopy training and competency assessment. Participants were queried about current methods and perceived quality of endoscopy training and assessment of competence. Participants were also queried about factors deemed important in endoscopy competence assessment. Five-point Likert items were analyzed as continuous variables by an independent t-test and χ(2)-test was used for comparison of proportions.Survey response rate was 64% (94/148) for PDs and 47% (546/1,167) for trainees. Twenty-three percent of surveyed PDs reported that they do not have a formal endoscopy curriculum. PDs placed less importance (1—very important to 5—very unimportant) on endoscopy volume (1.57 vs. 1.18, P0.001), adenoma detection rate (2.00 vs. 1.53, P0.001), and withdrawal times (1.96 vs. 1.68, P=0.009) in determining endoscopy competence compared with trainees. A majority of PDs report that competence is assessed by procedure volume (85%) and teaching attending evaluations (96%). Only a minority of programs use skills assessment tools (30%) or specific quality metrics (28%). Specific competencies are mostly assessed by individual teaching attending feedback as opposed to official documentation or feedback from a PD. PDs rate the overall quality of their endoscopy training and assessment of competence as better than overall ratings by trainees.Although the majority of PDs and trainees nationwide believe that measuring specific metrics is important in determining endoscopy competence, most programs still rely on procedure volume and subjective attending evaluations to determine overall competence. As medical training transitions from an apprenticeship model to competency-based education, there is a need for improved endoscopy curricula which are better suited to demonstrate readiness for unsupervised practice.

Background: Insufficient inhibition of gastric acid during Helicobacter pylori treatment and bacterial resistance to antibiotics frequently results in failure to eradicate infection. Twicedaily dosing (b.i.d.) of a proton pump inhibitor (PPI) using standard eradication therapy has shown difficulty in maintaining high gastric pH values for 24 h in patients. However, four-times-daily dosing (q.i.d.) achieves these goals, irrespective of CYP2C19 genotype status, and might therefore be an optimal regimen for use in eradicating H. pylori infection. The fluoroquinolone sitafloxacin (STFX) was recently reported to have a lower minimum inhibitory concentration for H. pylori compared with levofloxacin and has become clinically available as a third-line treatment and for patients with penicillin allergy. An STFX-based eradication regimen with maintenance of acid inhibition might therefore have a high success rate. We investigated the efficacy of this treatment and maintenance of acid inhibition by PPI q.i.d. treatment. Methods: In 136 H. pylori-positive Japanese patients (for first-line treatment: n=40, second-line: n=30, third-line: n=66), the efficacy of the following treatment regimen was investigated: a PPI (rabeprazole 10 mg, q.i.d.), metronidazole (250 mg, b.i.d.), and STFX (100 mg, b.i.d.) for 1 week, irrespective of CYP2C19 genotype status and numbers of previous eradication therapy. At four to eight weeks after treatment, patients underwent the [13C]-urea breath test to assess successful eradication. Results: First-resistance to antimicrobial agents was 51.4% for clarithromycin, 56.7% for metronidazole and 30.0% for levofloxacin. The intention-to-treat eradication rate in the tailored group was 93.4% (95%CI: 87.8%-96.9%, 127/136). Although the eradication rate in patients treated as first-line therapy (100%, 95%CI: 92.8%-100%, 40/40) was higher than that in those treated as second-line (93.3%, 95%CI: 77.9%-99.2%, 28/30) and third-line therapy (89.4%, 95%CI: 87.8%-96.9%, 59/66), no significant differences were shown among numbers of previous eradication therapy (p = 0.08). The eradication rates were similar among all three CYP2C19 genotype groups (extensive metabolizer, 91.7% [66/73]; intermediate metabolizer, 96.1% [49/51]; poor metabolizer, 91.7% [11/12]), exceeding 90% for all genotypes. Conclusions: A sitafloxacinbased H. pylori eradication regimen based on maintaining acid secretion (rabeprazole 10 mg, q.i.d.) achieved an eradication rate of more than 90%, irrespective of eradication history and CYP2C19 genotype. In addition, as this regimen reduces the cost of CYP2C19 genotyping and culture tests, it might be more cost-effective than CYP2C19 genotype-based treatments.