Musculoskeletal Injuries; Endoscopy is a complex skill that requires training and practice to ensure that the procedure is performed competently. Frequently, the focus of initial training is to ensure that a trainee has the skills to technically complete the procedure before assimilating some of the more cognitive elements of endoscopic practice.
Eagerness to complete the procedure by trainees is often facilitated by trainers; so who can be guilty of training technical completion with little if any attention given to the ergonomics involved in endoscopy. The consequences of poor ergonomics may result in acute or persistent musculoskeletal problems for the endoscopist, which can result in periods of inability to work or train.
The Musculoskeletal Injuries
Once the basic skill is mastered, other elements including strategy and tactics are added to try to achieve a competitive advantage. Throughout training, individuals are manage to minimize fatigue, strain or injury. One can argue that endoscopists should be train more like athletes in relation to ergonomics.
This poses a significant challenge as MSIs can be detrimental to the individual (chronic pain, disability, confidence, premature retirement), endoscopy service (missed days at work) and the patient. Moreover, the burden of MSIs in trainees is relatively unknown. In this issue, Villa and colleagues present their US survey of MSIs in 156 gastrointestinal endoscopy fellows.
The authors report that 47 % had succumb to an endoscopy relate MSI, 69 %; so of which occur within the first 6 months of training, with the wrist, thumb, back, and neck being predominantly affect. Such data point to an impending “ergonomics crisis” in a relatively evidence-free zone within endoscopy. Can endoscopy learn from sports? Certain sports that involve use of equipment may be comparable to endoscopy, e. g. archery, javelin, rifling, snooker etc.
Accessory against gravity
In archery, one arm is dedicate to stabilizing an accessory against gravity; so whereas the other arm draws the arrow under tension and subjects the fingers to high pinch forces. Like endoscopists, archers require a stable core stance with consideration given to placement of the feet, hip, spine; also neck to provide proper posture and balance. Other similarities and differences may be appraise using the mnemonic; which covers ergonomically-relevant considerations.
The AGA provides recommendations on ergonomics; but these remain unavailable elsewhere. A concert effort from endoscopy societies is need to standardize ergonomics training; also to ensure that working environments are ergonomically sound. In light of these results; so they should reevaluate how we appraise the “custom of work” in our trainee endoscopists; so both with regard to MSI prevention and rehabilitation.
The ERGONOMICS framework is a starting point. Finally, the goal of training in endoscopy is to ensure that trainees have develop the necessary technical; also cognitive competencies to perform “safely” and effectively in different situations. Perhaps It is time for the concept of safety to extend beyond the patient and to include the endoscopist.