Project title

SCALE-ENDO: Study of Communication and Adaptive capacity using in-situ Learning Environments based on real- life risks in ENDOscopy




Gastrointestinal endoscopy settings can be high-risk environments with previous evidence showing that up to a quarter of safety incidents in such settings have the potential to lead to severe harm. A National Confidential Enquiry into Patient Outcomes and Deaths highlighted the role of poor non-technical skills in adverse outcomes during therapeutic endoscopy. Enhancing the safety of gastrointestinal endoscopy does not only necessitate interventions aimed at improving technical and non-technical skills. Understanding the role of systemic factors are arguably just as, if not more important. Yet, current research does not adequately identify what the different contributory factors to incidents in endoscopy settings are nor explore how endoscopy teams operate when faced with such systemic constraints.

A structured analysis of nationally reported incidents and near-misses can provide insights into the frontline and organisational factors influencing safety in gastrointestinal endoscopy. In-situ simulations centring on these real-life situations impacting on patient journeys are valuable in the development of collective competence, trust and mutual understanding within teams. Research has shown their efficacy in enhancing staff's self-reported confidence in managing emergency scenarios, improving communication and leadership skills, and increasing preparedness to handle safety incidents in endoscopy settings.


The SCALE-ENDO project aims to improve safety in gastrointestinal endoscopy by developing and evaluating team-based in-situ simulations, grounded in real-world risks in endoscopy settings as identified through a mixed-methods analysis of a national database of endoscopy incidents and near-misses. Using innovative video-based methods within a multi-qualitative-method evaluation of in-situ endoscopy simulations, the study will generate novel insights into the interaction and adaptation of multi-professional endoscopy teams to deliver safe endoscopy care. This work will draw insights from an interdisciplinary team with expertise in safety science, human factors, medical education, communication and gastrointestinal endoscopy.


This research project will develop a framework for studying team interaction and adaptive capacity through simulation in endoscopy settings. This framework will provide guidance on using in-situ multi-professional simulation to learn from real-life safety incidents and near-misses, analyse team interactions, and understand adaptations in endoscopy teams.