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1
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Coluccio C, Jacques J, Hritz I, Boskoski I, Abdelrahim M, Bove V, Cunha Neves JA, de Jonge PJF, Dell'Anna G, Esposito G, Facciorusso A, Gincul R, Giuffrida P, Kalapala R, Kapizioni C, Longcroft-Wheaton G, Nagl S, Tziatzios G, Voiosu T, Dray X, Barbieri B, Gralnek IM, Fuccio L. Simulators and training models for diagnostic and therapeutic gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Technical and Technology Review. Endoscopy 2025. [PMID: 40185129 DOI: 10.1055/a-2569-7736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2025]
Abstract
Gastrointestinal (GI) endoscopy comprises both diagnostic and therapeutic procedures involving the luminal GI tract as well as the biliary tree, liver, and pancreas. GI endoscopy is challenging to learn, requiring both cognitive (nontechnical) and technical skills, and requires extensive practice to attain proficiency. Simulation-based training has been shown to assist trainees and young endoscopists in acquiring new skills and accelerating the learning curve. Moreover, simulation-based training creates an ideal environment for trainees to initially learn and practice skills while making mistakes with no risk to patients.This review, divided in two parts, offers a comprehensive summary of the different classes of simulators available for GI endoscopic training.In Part I, only mechanical simulators are reported and described. In Part II, animal simulators (ex vivo/in vivo) and virtual reality models are detailed, together with prototypes that are currently not commercially available.
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Affiliation(s)
- Chiara Coluccio
- Gastroenterology and Digestive Endoscopy Unit, Forli-Cesena Hospitals, AUSL Romagna, Forlì Cesena, Italy
| | - Jérémie Jacques
- Department of Hepatogastroenterology, Limoges University Hospital Center, Limoges, France
- Department of Gastroenterology, McGill University Health Center, Montreal, Canada
| | - Istvan Hritz
- Department of Surgery, Transplantation and Gastroenterology, Division of Interventional Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Ivo Boskoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Mohamed Abdelrahim
- Academic Directorate of Gastroenterology, Royal Hallamshire Hospital, and University of Sheffield, Sheffield, UK
| | - Vincenzo Bove
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - João A Cunha Neves
- Department of Gastroenterology, Algarve University Hospital Centre, Portimão, Portugal
| | - Pieter J F de Jonge
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, The Netherlands
| | - Giuseppe Dell'Anna
- Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Hospital, Milan, Italy
- Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Gianluca Esposito
- Medical-Surgical Sciences and Translational Medicine Department, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Antonio Facciorusso
- Department of Experimental Medicine, Gastroenterology Unit, Università del Salento, Lecce, Italy
| | - Rodica Gincul
- Department of Gastroenterology, Jean Mermoz Private Hospital, Lyon, France
| | - Paolo Giuffrida
- Gastroenterology and Digestive Endoscopy Unit, Forli-Cesena Hospitals, AUSL Romagna, Forlì Cesena, Italy
| | - Rakesh Kalapala
- Bariatric Endoscopy & Center for Artificial Intelligence and Innovation, Asian Institute of Gastroenterology, Hyderabad, India
| | | | | | - Sandra Nagl
- Department of Gastroenterology, University Hospital Augsburg, Germany
| | - Georgios Tziatzios
- Department of Gastroenterology, General Hospital of Nea Ionia "Konstantopoulio-Patision", Athens, Greece
| | - Theodor Voiosu
- Gastroenterology Department Colentina Clinical Hospital/UMF Carol Davila Faculy of Medicine, Bucharest, Romania
| | - Xavier Dray
- Sorbonne University, Centre for Digestive Endoscopy, Saint Antoine Hospital, APHP, Paris, France
| | - Bridget Barbieri
- Senior Project Manager, European Society of Gastrointestinal Endoscopy (ESGE), Munich, Germany
| | - Ian M Gralnek
- Gastroenterology, Emek Medical Center, Afula, Israel
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences, University of Bologna, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Rabinowitz R, Drake CB, Talan JW, Nair SS, Hafiz A, Andriotis A, Kogan R, Du X, Li J, Hua W, Lin M, Kaufman BS. Just-in-Time Simulation Training to Augment Overnight ICU Resident Education. J Grad Med Educ 2024; 16:713-722. [PMID: 39677310 PMCID: PMC11641875 DOI: 10.4300/jgme-d-24-00268.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/26/2024] [Accepted: 08/16/2024] [Indexed: 12/17/2024] Open
Abstract
Background Patients who decompensate overnight experience worse outcomes than those who do so during the day. Just-in-time (JIT) simulation could improve on-call resident preparedness but has been minimally evaluated in critical care medicine (CCM) to date. Objective To determine whether JIT training can improve residents' performance in simulation and if those skills would transfer to better clinical management in adult CCM. Methods Second-year medicine residents participated in simulated decompensation events aligned to common medical intensive care unit (MICU) emergencies predicted to occur overnight by their attending intensivist. Simulation faculty scored their performance via critical action checklists. If the event occurred, MICU attendings rated residents' clinical management as well. At the rotation's conclusion, a variant of one previously trained scenario was simulated to assess for performance improvement. Resident perceptions were surveyed before, during, and after completion of the study. Results Twenty-eight residents participated; 22 of 28 (79%) completed the curriculum. Management of simulated decompensations improved following training (initial simulation checklist completion rate 60% vs 80% final simulation, P≤.001, Wilcoxon r=0.5). Predicted events occurred in 27 (45%) of the 60 shifts evaluated, with no observed difference in faculty ratings of overnight performance (median rating 4.5 if trained vs 3.0 if untrained; U=58.50; P=.12; Mann-Whitney r=0.30). Residents' self-reported preparedness to manage MICU emergencies improved significantly following training, from a median of 3.0 to 4.0 (P=.006, Wilcoxon r=0.42). Conclusions JIT simulation training improved residents' performance in simulation.
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Affiliation(s)
- Raphael Rabinowitz
- Raphael Rabinowitz, MD, is Clinical Assistant Professor, Department of Medicine, New York University (NYU) Grossman School of Medicine, New York, New York, USA
| | - Carolyn B. Drake
- Carolyn B. Drake, MD, MPH, is Clinical Assistant Professor, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Jordan W. Talan
- Jordan W. Talan, MD, MHPE, is Assistant Professor, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Sunil S. Nair
- Sunil S. Nair, MD, is Clinical Assistant Professor, Department of Medicine, Jefferson Health-Abington, Abington, Pennsylvania, USA
| | - Ali Hafiz
- Ali Hafiz, MD, is Adjunct Instructor, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Anthony Andriotis
- Anthony Andriotis, MD, is Assistant Professor, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Rebecca Kogan
- Rebecca Kogan, MD, is a Fellow, Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Xinyue Du
- Xinyue Du, MSc, is Statistician, LLX Solutions, LLC, Waltham, MA, USA
| | - Jian Li
- Jian Li, MSc, is Research Data Analyst, Johns Hopkins University, Baltimore, Maryland, USA
| | - Wanyu Hua
- Wanyu Hua, MSc, is Research Assistant, University of Hong Kong, Hong Kong, Pokfulman, Hong Kong
| | - Miao Lin
- Miao Lin, MSc, is Data Analyst, Massachusetts General Hospital, Boston, Massachusetts, USA; and
| | - Brian S. Kaufman
- Brian S. Kaufman, MD, is Professor, Departments of Anesthesiology, Medicine, and Neurosurgery, NYU Grossman School of Medicine, New York, New York, USA
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Mu Y, Yang X, Guo F, Ye G, Lu Y, Zhang Y, Xue W, Bian Z. Colonoscopy Training on Virtual-Reality Simulators or Physical Model Simulators: A Randomized Controlled Trial. JOURNAL OF SURGICAL EDUCATION 2024; 81:1339-1345. [PMID: 39153329 DOI: 10.1016/j.jsurg.2024.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 07/15/2024] [Accepted: 07/28/2024] [Indexed: 08/19/2024]
Abstract
OBJECTIVE This study employed a randomized controlled trial to assess the efficacy of virtual-reality (VR) simulators and physical model simulators on colonoscopy training to explore the optimal and evidence-based simulation training. DESIGN Forty participants were divided into 2 groups and randomized as dyads: the VR simulator group and the physical model simulator group. All the participants performed a baseline test through porcine colonoscopy. After a 6 h simulation training, each participant underwent a post-test on a pig after bowel preparation, and the procedures were video-recorded. Both the baseline test and the post-test were blindly assessed by 2 experienced assistant director physicians based on the GAGES-C scoring system. SETTING Simulation center, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai. PARTICIPANTS Forty surgical residents without colonoscopy experience. RESULTS Both the VR simulator group and the physical model simulator group improved significantly over the baseline test. The VR simulator group performed significantly better than the physical model simulator group, p=0.042. The participants in both groups expressed a high level of simulator satisfaction. CONCLUSIONS Novice residents can benefit from both VR simulators and physical model simulators. The VR simulator was shown to be more effective for colonoscopy training. VR simulators were more recommended for novices conducting basic colonoscopy training.
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Affiliation(s)
- Yifei Mu
- Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Simulation Centre, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xinyi Yang
- Simulation Centre, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Feng Guo
- Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Simulation Centre, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Guangyao Ye
- Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Simulation Centre, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yihong Lu
- Simulation Centre, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Zhang
- Simulation Centre, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wei Xue
- Department of Urology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhengqian Bian
- Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Simulation Centre, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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凡 小, 罗 斌, 杨 丽. [Role of Virtual Reality in Gastrointestinal Endoscopy Training and Teaching]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2024; 55:315-320. [PMID: 38645845 PMCID: PMC11026882 DOI: 10.12182/20240360302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Indexed: 04/23/2024]
Abstract
Gastrointestinal (GI) endoscope is one of the instruments used extensively in the diagnosis and treatment of digestive tract disorders. China is confronted with a great demand for endoscopists working in grassroots healthcare facilities. Furthermore, endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasonography (EUS), and endoscopic submucosal dissection (ESD) are becoming the prevailing methods of endoscopic treatment of digestive diseases. Therefore, there is a growing demand for senior endoscopists. Currently, an important focus of GI endoscopy training is the acceleration of standardized training for endoscopists working in grassroots health facilities and advanced training for senior endoscopists. Simulation devices based on virtual reality technology exhibit strengths in objectivity, authenticity, and an immersive experience. These devices show advantages in the training method, the number of participants, and assessment over traditional training programs for GI endoscopy. Their application provides a new approach to the training and teaching of GI endoscopy. Herein, we summarized the explorations and practices of using virtual reality technology in the training and teaching of GI endoscopy, analyzed its application status in China, and discussed its prospects for future application.
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Affiliation(s)
- 小丽 凡
- 四川大学华西医院 消化内科，四川大学-牛津大学华西消化道肿瘤联合研究中心 （成都 610041）Department of Gastroenterology and Hepatology, Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 斌阳 罗
- 四川大学华西医院 消化内科，四川大学-牛津大学华西消化道肿瘤联合研究中心 （成都 610041）Department of Gastroenterology and Hepatology, Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 丽 杨
- 四川大学华西医院 消化内科，四川大学-牛津大学华西消化道肿瘤联合研究中心 （成都 610041）Department of Gastroenterology and Hepatology, Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, West China Hospital, Sichuan University, Chengdu 610041, China
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Antonelli G, Voiosu AM, Pawlak KM, Gonçalves TC, Le N, Bronswijk M, Hollenbach M, Elshaarawy O, Beilenhoff U, Mascagni P, Voiosu T, Pellisé M, Dinis-Ribeiro M, Triantafyllou K, Arvanitakis M, Bisschops R, Hassan C, Messmann H, Gralnek IM. Training in basic gastrointestinal endoscopic procedures: a European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement. Endoscopy 2024; 56:131-150. [PMID: 38040025 DOI: 10.1055/a-2205-2613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
This ESGE Position Statement provides structured and evidence-based guidance on the essential requirements and processes involved in training in basic gastrointestinal (GI) endoscopic procedures. The document outlines definitions; competencies required, and means to their assessment and maintenance; the structure and requirements of training programs; patient safety and medicolegal issues. 1: ESGE and ESGENA define basic endoscopic procedures as those procedures that are commonly indicated, generally accessible, and expected to be mastered (technically and cognitively) by the end of any core training program in gastrointestinal endoscopy. 2: ESGE and ESGENA consider the following as basic endoscopic procedures: diagnostic upper and lower GI endoscopy, as well as a limited range of interventions such as: tissue acquisition via cold biopsy forceps, polypectomy for lesions ≤ 10 mm, hemostasis techniques, enteral feeding tube placement, foreign body retrieval, dilation of simple esophageal strictures, and India ink tattooing of lesion location. 3: ESGE and ESGENA recommend that training in GI endoscopy should be subject to stringent formal requirements that ensure all ESGE key performance indicators (KPIs) are met. 4: Training in basic endoscopic procedures is a complex process and includes the development and acquisition of cognitive, technical/motor, and integrative skills. Therefore, ESGE and ESGENA recommend the use of validated tools to track the development of skills and assess competence. 5: ESGE and ESGENA recommend incorporating a multimodal approach to evaluating competence in basic GI endoscopic procedures, including procedural thresholds and the measurement and documentation of established ESGE KPIs. 7: ESGE and ESGENA recommend the continuous monitoring of ESGE KPIs during GI endoscopy training to ensure the trainee's maintenance of competence. 9: ESGE and ESGENA recommend that GI endoscopy training units fulfil the ESGE KPIs for endoscopy units and, furthermore, be capable of providing the dedicated personnel, infrastructure, and sufficient case volume required for successful training within a structured training program. 10: ESGE and ESGENA recommend that trainers in basic GI endoscopic procedures should be endoscopists with formal educational training in the teaching of endoscopy, which allows them to successfully and safely teach trainees.
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Affiliation(s)
- Giulio Antonelli
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome, Italy
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
| | - Andrei M Voiosu
- Department of Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Katarzyna M Pawlak
- Endoscopy Unit, Gastroenterology Department, Hospital of the Ministry of Interior and Administration, Szczecin, Poland
- The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Tiago Cúrdia Gonçalves
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Nha Le
- Gastroenterology Division, Internal Medicine and Hematology Department, Semmelweis University, Budapest, Hungary
| | - Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
- Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium
| | - Marcus Hollenbach
- Division of Gastroenterology, Medical Department II, University of Leipzig Medical Center, Leipzig, Germany
| | - Omar Elshaarawy
- Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Menoufia, Egypt
| | | | - Pietro Mascagni
- IHU Strasbourg, Strasbourg, France
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Theodor Voiosu
- Department of Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Maria Pellisé
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Mário Dinis-Ribeiro
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
- MEDCIDS/Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Marianna Arvanitakis
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, Leuven, Belgium
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, Leuven, Belgium
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Helmut Messmann
- Department of Gastroenterology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Ian M Gralnek
- Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine Technion Israel Institute of Technology, Haifa, Israel
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Chitkara R, Bennett M, Bohnert J, Yamada N, Fuerch J, Halamek LP, Quinn J, Padua K, Gould J, Profit J, Xu X, Lee HC. In Situ Simulation and Clinical Outcomes in Infants Born Preterm. J Pediatr 2023; 263:113715. [PMID: 37659586 PMCID: PMC10841094 DOI: 10.1016/j.jpeds.2023.113715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVE To evaluate impact of a multihospital collaborative quality improvement project implementing in situ simulation training for neonatal resuscitation on clinical outcomes for infants born preterm. STUDY DESIGN Twelve neonatal intensive care units were divided into 4 cohorts; each completed a 15-month long program in a stepped wedge manner. Data from California Perinatal Quality Care Collaborative were used to evaluate clinical outcomes. Infants with very low birth weight between 22 through 31 weeks gestation were included. Primary outcome was survival without chronic lung disease (CLD); secondary outcomes included intubation in the delivery room, delivery room continuous positive airway pressure, hypothermia (<36°C) upon neonatal intensive care unit admission, severe intraventricular hemorrhage, and mortality before hospital discharge. A mixed effects multivariable regression model was used to assess the intervention effect. RESULTS Between March 2017 and December 2020, a total of 2626 eligible very low birth weight births occurred at 12 collaborative participating sites. Rate of survival without CLD at participating sites was 74.1% in March to August 2017 and 76.0% in July to December 2020 (risk ratio 1.03; [0.94-1.12]); no significant improvement occurred during the study period for both participating and nonparticipating sites. The effect of in situ simulation on all secondary outcomes was stable. CONCLUSIONS Implementation of a multihospital collaborative providing in situ training for neonatal resuscitation did not result in significant improvement in survival without CLD. Ongoing in situ simulations may have an impact on unit practice and unmeasured outcomes.
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Affiliation(s)
- Ritu Chitkara
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Center for Advanced Pediatric and Perinatal Education (CAPE), Stanford, CA.
| | - Mihoko Bennett
- California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA
| | - Janine Bohnert
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA
| | - Nicole Yamada
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Center for Advanced Pediatric and Perinatal Education (CAPE), Stanford, CA
| | - Janene Fuerch
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Center for Advanced Pediatric and Perinatal Education (CAPE), Stanford, CA
| | - Louis P Halamek
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Center for Advanced Pediatric and Perinatal Education (CAPE), Stanford, CA
| | - Jenny Quinn
- California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA
| | - Kimber Padua
- California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA
| | - Jeffrey Gould
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA
| | - Jochen Profit
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA
| | - Xiao Xu
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Henry C Lee
- California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA; Division of Neonatology, Department of Pediatrics, University of California San Diego, San Diego, CA
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7
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Siau K, Pelitari S, Green S, McKaig B, Rajendran A, Feeney M, Thoufeeq M, Anderson J, Ravindran V, Hagan P, Cripps N, Beales ILP, Church K, Church NI, Ratcliffe E, Din S, Pullan RD, Powell S, Regan C, Ngu WS, Wood E, Mills S, Hawkes N, Dunckley P, Iacucci M, Thomas-Gibson S, Wells C, Murugananthan A. JAG consensus statements for training and certification in flexible sigmoidoscopy. Frontline Gastroenterol 2023; 14:181-200. [PMID: 37056324 PMCID: PMC10086722 DOI: 10.1136/flgastro-2022-102259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/04/2022] [Indexed: 01/28/2023] Open
Abstract
IntroductionJoint Advisory Group (JAG) certification in endoscopy is awarded when trainees attain minimum competency standards for independent practice. A national evidence-based review was undertaken to update standards for training and certification in flexible sigmoidoscopy (FS).MethodsA modified Delphi process was conducted between 2019 and 2020 with multisociety representation from experts and trainees. Following literature review and Grading of Recommendations, Assessment, Development and Evaluations appraisal, recommendation statements on FS training and certification were formulated and subjected to anonymous voting to obtain consensus. Accepted statements were peer-reviewed by national stakeholders for incorporation into the JAG FS certification pathway.ResultsIn total, 41 recommendation statements were generated under the domains of: definition of competence (13), acquisition of competence (17), assessment of competence (7) and postcertification support (4). The consensus process led to revised criteria for colonoscopy certification, comprising: (A) achieving key performance indicators defined within British Society of Gastroenterology standards (ie, rectal retroversion >90%, polyp retrieval rate >90%, patient comfort <10% with moderate-severe discomfort); (B) minimum procedure count ≥175; (C) performing 15+ procedures over the preceding 3 months; (D) attendance of the JAG Basic Skills in Lower gastrointestinal Endoscopy course; (E) satisfying requirements for formative direct observation of procedural skill (DOPS) and direct observation of polypectomy skill (SMSA level 1); (F) evidence of reflective practice as documented on the JAG Endoscopy Training System reflection tool and (G) successful performance in summative DOPS.ConclusionThe UK standards for training and certification in FS have been updated to support training, uphold standards in FS and polypectomy, and provide support to the newly independent practitioner.
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Affiliation(s)
- Keith Siau
- Department of Gastroenterology, Royal Cornwall Hospital, Truro, UK
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Stavroula Pelitari
- Department of Gastroenterology, Royal Free London NHS Foundation Trust, London, UK
| | - Susi Green
- Department of Gastroenterology, University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - Brian McKaig
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Arun Rajendran
- Department of Gastroenterology, Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Mark Feeney
- Department of Gastroenterology, Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - Mo Thoufeeq
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - John Anderson
- Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Vathsan Ravindran
- Department of Gastroenterology, St Mark's Hospital and Academic Institute Wolfson Unit for Endoscopy, Harrow, UK
| | - Paul Hagan
- Endoscopy, Royal Derby Hospital, Derby, UK
| | - Neil Cripps
- Colorectal Surgery, University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - Ian L P Beales
- University of East Anglia, Norwich, UK
- Department of Gastroenterology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | | | - Elizabeth Ratcliffe
- Department of Gastroenterology, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
- Division of Diabetes, Endocrinology and Gastroenterology Faculty of Biology, Medicine and Health School of Medical Sciences, The University of Manchester, Manchester, UK
| | - Said Din
- Department of Gastroenterology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Rupert D Pullan
- Colorectal Surgery, Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - Sharon Powell
- Endoscopy, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Catherine Regan
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Wee Sing Ngu
- Colorectal Surgery, City Hospitals Sunderland NHS Foundation Trust, South Shields, UK
| | - Eleanor Wood
- Gastroenterology, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Sarah Mills
- Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
- Imperial College London, London, UK
| | - Neil Hawkes
- Department of Gastroenterology, Royal Glamorgan Hospital, Llantrisant, UK
| | - Paul Dunckley
- Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Marietta Iacucci
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
- Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Siwan Thomas-Gibson
- Imperial College London, London, UK
- St Mark's Hospital and Academic Institute Wolfson Unit for Endoscopy, Harrow, UK
| | - Christopher Wells
- Department of Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Hartlepool, UK
| | - Aravinth Murugananthan
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
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8
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Siau K, Pelitari S, Green S, McKaig B, Rajendran A, Feeney M, Thoufeeq M, Anderson J, Ravindran V, Hagan P, Cripps N, Beales ILP, Church K, Church NI, Ratcliffe E, Din S, Pullan RD, Powell S, Regan C, Ngu WS, Wood E, Mills S, Hawkes N, Dunckley P, Iacucci M, Thomas-Gibson S, Wells C, Murugananthan A. JAG consensus statements for training and certification in colonoscopy. Frontline Gastroenterol 2023; 14:201-221. [PMID: 37056319 PMCID: PMC10086724 DOI: 10.1136/flgastro-2022-102260] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/04/2022] [Indexed: 01/28/2023] Open
Abstract
IntroductionIn the UK, endoscopy certification is awarded when trainees attain minimum competency standards for independent practice. A national evidence-based review was undertaken to update and develop standards and recommendations for colonoscopy training and certification.MethodsUnder the oversight of the Joint Advisory Group (JAG), a modified Delphi process was conducted between 2019 and 2020 with multisociety expert representation. Following literature review and Grading of Recommendations, Assessment, Development and Evaluations appraisal, recommendation statements on colonoscopy training and certification were formulated and subjected to anonymous voting to obtain consensus. Accepted statements were peer reviewed by JAG and relevant stakeholders for incorporation into the updated colonoscopy certification pathway.ResultsIn total, 45 recommendation statements were generated under the domains of: definition of competence (13), acquisition of competence (20), assessment of competence (8) and postcertification support (4). The consensus process led to revised criteria for colonoscopy certification, comprising: (1) achieving key performance indicators defined within British Society of Gastroenterology standards (ie, unassisted caecal intubation rate >90%, rectal retroversion >90%, polyp detection rate >15%+, polyp retrieval rate >90%, patient comfort <10% with moderate–severe discomfort); (2) minimum procedure count 280+; (3) performing 15+ procedures over the preceding 3 months; (4) attendance of the JAG Basic Skills in Colonoscopy course; (5) terminal ileal intubation rates of 60%+ in inflammatory bowel disease; (6) satisfying requirements for formative direct observation of procedure skills (DOPS) and direct observation of polypectomy skills (Size, Morphology, Site, Access (SMSA) level 2); (7) evidence of reflective practice as documented on the JAG Endoscopy Training System reflection tool; (8) successful performance in summative DOPS.ConclusionThe UK standards for training and certification in colonoscopy have been updated, culminating in a single-stage certification process with emphasis on polypectomy competency (SMSA Level 2+). These standards are intended to support training, improve standards of colonoscopy and polypectomy, and provide support to the newly independent practitioner.
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Affiliation(s)
- Keith Siau
- Department of Gastroenterology, Royal Cornwall Hospitals NHS Trust, Truro, Cornwall, UK
- University of Birmingham College of Medical and Dental Sciences, Birmingham, Birmingham, UK
| | - Stavroula Pelitari
- Department of Gastroenterology, Royal Free London NHS Foundation Trust, London, London, UK
| | - Susi Green
- Department of Gastroenterology, University Hospitals Sussex NHS Foundation Trust, Worthing, West Sussex, UK
| | - Brian McKaig
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, Wolverhampton, UK
| | - Arun Rajendran
- Department of Gastroenterology, Hillingdon Hospitals NHS Foundation Trust, Uxbridge, Greater London, UK
| | - Mark Feeney
- Department of Gastroenterology, Torbay and South Devon NHS Foundation Trust, Torquay, Torbay, UK
| | - Mo Thoufeeq
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, Sheffield, UK
| | - John Anderson
- Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, Gloucestershire, UK
| | - Vathsan Ravindran
- Gastroenterology, St Mark's Hospital and Academic Institute Wolfson Unit for Endoscopy, Harrow, London, UK
| | - Paul Hagan
- Endoscopy, Royal Derby Hospital, Derby, UK
| | - Neil Cripps
- Colorectal Surgery, University Hospitals Sussex NHS Foundation Trust, Worthing, West Sussex, UK
| | - Ian L P Beales
- Department of Gastroenterology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
- University of East Anglia, Norwich, Norfolk, UK
| | | | - Nicholas I Church
- Department of Gastroenterology, NHS Lothian, Edinburgh, Edinburgh, UK
| | - Elizabeth Ratcliffe
- Faculty of Medical and Human Sciences, The University of Manchester, Manchester, Manchester, UK
- Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, Wigan, UK
| | - Said Din
- Department of Gastroenterology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Rupert D Pullan
- Colorectal Surgery, Torbay and South Devon NHS Foundation Trust, Torquay, Torbay, UK
| | - Sharon Powell
- Endoscopy, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, Wolverhampton, UK
| | - Catherine Regan
- Endoscopy, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, Wolverhampton, UK
| | - Wee Sing Ngu
- Colorectal Surgery, City Hospitals Sunderland NHS Foundation Trust, South Shields, Tyne and Wear, UK
| | - Eleanor Wood
- Department of Gastroenterology, Homerton University Hospital NHS Foundation Trust, London, London, UK
| | - Sarah Mills
- Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
- Imperial College London, London, UK
| | - Neil Hawkes
- Department of Gastroenterology, Royal Glamorgan Hospital, Llantrisant, UK
| | - Paul Dunckley
- Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, Gloucestershire, UK
| | - Marietta Iacucci
- University of Birmingham College of Medical and Dental Sciences, Birmingham, Birmingham, UK
- Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK
| | - Siwan Thomas-Gibson
- Imperial College London, London, UK
- St Mark's Hospital and Academic Institute Wolfson Unit for Endoscopy, Harrow, London, UK
| | - Christopher Wells
- Department of Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Hartlepool, Hartlepool, UK
| | - Aravinth Murugananthan
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, Wolverhampton, UK
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
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9
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Kim Y, Lee JH, Lee GH, Kim GH, Huh G, Hong SW, Jung HY. Simulator-based training method in gastrointestinal endoscopy training and currently available simulators. Clin Endosc 2023; 56:1-13. [PMID: 36604834 PMCID: PMC9902695 DOI: 10.5946/ce.2022.191] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/19/2022] [Indexed: 01/07/2023] Open
Abstract
The apprenticeship-based training method (ABTM) is highly effective for gastrointestinal (GI) endoscopic training. However, the conventional ABTM has significant issues. Although many supplementary training methods (TMs) have been developed and utilized, they cannot entirely replace the ABTM, which remains the major TM strategy. Currently, new TM construction is crucial and necessary due to financial constraints, difficulty of obtaining sufficient training time due to patient safety-related regulations, and catastrophic damage caused by disasters such as the coronavirus disease 2019 pandemic. The simulator-based TM (SBTM) is widely accepted as an alternative to the ABTM, owing to the SBTM's advantages. Since the 1960s, many GI endoscopy training simulators have been developed and numerous studies have been published on their effectiveness. While previous studies have focused on the simulator's validity, this review focused on the accessibility of simulators that were introduced by the end of 2021. Although the current SBTM is effective in GI endoscopic education, extensive improvements are needed to replace the ABTM. Incorporating simulator-incorporated TMs into an improved ABTM is an attempt to overcome the incompleteness of the current SBTM. Until a new simulator is developed to replace the ABTM, it is desirable to operate a simulator-integrated and well-coordinated TM that is suitable for each country and institution.
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Affiliation(s)
- Yuri Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea,Correspondence: Gin Hyug Lee Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea E-mail:
| | - Ga Hee Kim
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Gunn Huh
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Wook Hong
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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10
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Reperfused human cadaver as a new simulation model for colonoscopy: a pilot study. Surg Endosc 2022; 37:3224-3232. [PMID: 36443563 PMCID: PMC9707156 DOI: 10.1007/s00464-022-09763-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/06/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The reperfused human cadaver is a validated simulator for surgery. We aimed to use it as a colonoscopy simulator. METHODS Novices, intermediates and skilled participants in gastrointestinal endoscopy were included. They performed one colonoscopy on a reperfused human cadaver and reaching rates, time, and length needed to reach anatomical landmarks were reported for construct validity analysis. We also assessed our model realism (SRS survey), educational content (CVS survey) and task load (NASA-TLX index). Score items were collected and defined as "favorable" when items were rated ≥ 5/7 with an inter-quartile range (IQR) overlapping four, and "very favorable" when rated ≥ 5/7 with an IQR excluding four (neutral). Primary endpoints were the rectosigmoid junction (RSJ) reaching rate and the descending colon (DC) reaching time. Secondary objectives were SRS, CVS and NASA-TLX questionnaire results. RESULTS A total of 11 skilled participants, 5 intermediates and 8 novices were included. Skilled participants reached RSJ more often than novice and intermediary groups, respectively, 100%, 80% and 75% without differing significantly. They reached DC more frequently (100% for skilled, 80% for intermediates and 50% for novices, p = 0.018). The median time to reach RSJ (59, 272 and 686 s for skilled, intermediates and novices group, respectively) and DC (90, 534 and 1360 s for skilled, intermediates and novices) was significantly shorter for skilled participants (both p < .01). Nineteen out of the 22 items composing the realism survey obtained "very favorable" and "favorable" scores. Educational content was designated as "very favorable". Mental, physical, and technical demands were gradually higher the lower the initial level of experience. CONCLUSIONS Reperfused human cadaver model has the potential to be valid simulation tool for diagnostic colonoscopy training.
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11
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Zhang C, Feng S, He R, Fang Y, Zhang S. Gastroenterology in the Metaverse: The dawn of a new era? Front Med (Lausanne) 2022; 9:904566. [PMID: 36035392 PMCID: PMC9403067 DOI: 10.3389/fmed.2022.904566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/26/2022] [Indexed: 12/03/2022] Open
Abstract
2021 is known as the first Year of the Metaverse, and around the world, internet giants are eager to devote themselves to it. In this review, we will introduce the concept, current development, and application of the Metaverse and the use of the current basic technologies in the medical field, such as virtual reality and telemedicine. We also probe into the new model of gastroenterology in the future era of the Metaverse.
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Affiliation(s)
- Chi Zhang
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shuyan Feng
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ruonan He
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yi Fang
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shuo Zhang
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
- *Correspondence: Shuo Zhang
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12
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Zhang W, Liu X, Zheng B. Virtual reality simulation in training endoscopic skills: A systematic review. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2021. [DOI: 10.1016/j.lers.2021.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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13
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Use of Augmented and Virtual Reality in Remote Higher Education: A Systematic Umbrella Review. EDUCATION SCIENCES 2020. [DOI: 10.3390/educsci11010008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In this systematic umbrella review we aggregate the current knowledge of how virtual and augmented reality technologies are applicable to and impact remote learning in higher education; specifically, how they impact such learning outcomes as performance and engagement in all stages of higher education from course preparation to student evaluation and grading. This review was done as part of a state wide research effort of Latvia, to mitigate the impact of COVID-19 and specifically to provide a framework for a technological transformation of education in this context. In this work we search the Scopus and Web of Science databases for articles describing the use of virtual and/or augmented reality technologies in remote learning for higher education and their impact on learning outcomes. We identified 68 articles from which, after multiple screening and eligibility phases, nine review articles were left for extraction phase in which 30 structural elements with corresponding interventions and measured effects were extracted. Of these, 24 interventions had a measured effect on student performance (11 positive, seven negative, six no impact) and six interventions had a measured effect on student engagement (all six positive).
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14
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Dokoutsidou E, Alodat M, Mavrogiannis C, Georgiou K, Giannakoulopoulou E, Galanis P, Loukas C, Enochsson L, Georgiou E. Performance Assessment of Subjects With Nursing Education Trained in Sigmoidoscopy by Means of a Simulator. Gastroenterol Nurs 2020; 43:411-421. [PMID: 33055543 DOI: 10.1097/sga.0000000000000489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Reports evaluating simulation-based sigmoidoscopy training among nurses are scarce. The aim of this prospective nonrandomized study was to assess the performance of nurses in simulated sigmoidoscopy training and the potential impact on their performance of endoscopy unit experience, general professional experience, and skills in manual activities requiring coordinated maneuvers. Forty-four subjects were included: 12 nurses with (Group A) and 14 nurses without endoscopy unit experience (Group B) as well as 18 senior nursing students (Group C). All received simulator training in sigmoidoscopy. Participants were evaluated with respect to predetermined validated metrics. Skills in manual activities requiring coordinated maneuvers were analyzed to draw possible correlations with their performance. The total population required a median number of 5 attempts to achieve all predetermined goals. Groups A and C outperformed Group B regarding the number of attempts needed to achieve the predetermined percentage of visualized mucosa (p = .017, p = .027, respectively). Furthermore, Group A outperformed Group B regarding the predetermined duration of procedure (p = .046). A tendency was observed for fewer attempts needed to achieve the overall successful endoscopy in both Groups A and C compared with Group B. Increased score on playing stringed instruments was associated with decreased total time of procedure (rs = -.34, p = .03) and with decreased number of total attempts for successful endoscopy (rs = -.31, p = .046). This study suggests that training nurses and nursing students in simulated sigmoidoscopy is feasible by means of a proper training program. Experience in endoscopy unit and skills in manual activities have a positive impact on the training process.
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Affiliation(s)
- Eleni Dokoutsidou
- Eleni Dokoutsidou, PhD, is Assistant Professor of Nursing, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Moussa Alodat, MD, is Consultant Gastroenterologist, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Christos Mavrogiannis, PhD, is Professor of Gastroenterology, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Konstantinos Georgiou, PhD, Biochemistry Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Eleftheria Giannakoulopoulou, PhD, is Lecturer, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Petros Galanis, PhD, is Lecturer, Center for Health Services Management and Evaluation, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Constantinos Loukas, PhD, is Assistant Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Lars Enochsson, PhD, is Professor of Surgery, Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Evangelos Georgiou, PhD, is Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Moussa Alodat
- Eleni Dokoutsidou, PhD, is Assistant Professor of Nursing, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Moussa Alodat, MD, is Consultant Gastroenterologist, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Christos Mavrogiannis, PhD, is Professor of Gastroenterology, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Konstantinos Georgiou, PhD, Biochemistry Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Eleftheria Giannakoulopoulou, PhD, is Lecturer, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Petros Galanis, PhD, is Lecturer, Center for Health Services Management and Evaluation, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Constantinos Loukas, PhD, is Assistant Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Lars Enochsson, PhD, is Professor of Surgery, Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Evangelos Georgiou, PhD, is Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Mavrogiannis
- Eleni Dokoutsidou, PhD, is Assistant Professor of Nursing, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Moussa Alodat, MD, is Consultant Gastroenterologist, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Christos Mavrogiannis, PhD, is Professor of Gastroenterology, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Konstantinos Georgiou, PhD, Biochemistry Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Eleftheria Giannakoulopoulou, PhD, is Lecturer, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Petros Galanis, PhD, is Lecturer, Center for Health Services Management and Evaluation, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Constantinos Loukas, PhD, is Assistant Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Lars Enochsson, PhD, is Professor of Surgery, Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Evangelos Georgiou, PhD, is Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Georgiou
- Eleni Dokoutsidou, PhD, is Assistant Professor of Nursing, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Moussa Alodat, MD, is Consultant Gastroenterologist, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Christos Mavrogiannis, PhD, is Professor of Gastroenterology, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Konstantinos Georgiou, PhD, Biochemistry Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Eleftheria Giannakoulopoulou, PhD, is Lecturer, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Petros Galanis, PhD, is Lecturer, Center for Health Services Management and Evaluation, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Constantinos Loukas, PhD, is Assistant Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Lars Enochsson, PhD, is Professor of Surgery, Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Evangelos Georgiou, PhD, is Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftheria Giannakoulopoulou
- Eleni Dokoutsidou, PhD, is Assistant Professor of Nursing, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Moussa Alodat, MD, is Consultant Gastroenterologist, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Christos Mavrogiannis, PhD, is Professor of Gastroenterology, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Konstantinos Georgiou, PhD, Biochemistry Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Eleftheria Giannakoulopoulou, PhD, is Lecturer, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Petros Galanis, PhD, is Lecturer, Center for Health Services Management and Evaluation, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Constantinos Loukas, PhD, is Assistant Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Lars Enochsson, PhD, is Professor of Surgery, Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Evangelos Georgiou, PhD, is Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros Galanis
- Eleni Dokoutsidou, PhD, is Assistant Professor of Nursing, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Moussa Alodat, MD, is Consultant Gastroenterologist, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Christos Mavrogiannis, PhD, is Professor of Gastroenterology, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Konstantinos Georgiou, PhD, Biochemistry Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Eleftheria Giannakoulopoulou, PhD, is Lecturer, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Petros Galanis, PhD, is Lecturer, Center for Health Services Management and Evaluation, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Constantinos Loukas, PhD, is Assistant Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Lars Enochsson, PhD, is Professor of Surgery, Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Evangelos Georgiou, PhD, is Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantinos Loukas
- Eleni Dokoutsidou, PhD, is Assistant Professor of Nursing, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Moussa Alodat, MD, is Consultant Gastroenterologist, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Christos Mavrogiannis, PhD, is Professor of Gastroenterology, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Konstantinos Georgiou, PhD, Biochemistry Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Eleftheria Giannakoulopoulou, PhD, is Lecturer, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Petros Galanis, PhD, is Lecturer, Center for Health Services Management and Evaluation, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Constantinos Loukas, PhD, is Assistant Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Lars Enochsson, PhD, is Professor of Surgery, Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Evangelos Georgiou, PhD, is Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Lars Enochsson
- Eleni Dokoutsidou, PhD, is Assistant Professor of Nursing, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Moussa Alodat, MD, is Consultant Gastroenterologist, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Christos Mavrogiannis, PhD, is Professor of Gastroenterology, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Konstantinos Georgiou, PhD, Biochemistry Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Eleftheria Giannakoulopoulou, PhD, is Lecturer, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Petros Galanis, PhD, is Lecturer, Center for Health Services Management and Evaluation, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Constantinos Loukas, PhD, is Assistant Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Lars Enochsson, PhD, is Professor of Surgery, Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Evangelos Georgiou, PhD, is Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Georgiou
- Eleni Dokoutsidou, PhD, is Assistant Professor of Nursing, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Moussa Alodat, MD, is Consultant Gastroenterologist, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Christos Mavrogiannis, PhD, is Professor of Gastroenterology, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Konstantinos Georgiou, PhD, Biochemistry Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Eleftheria Giannakoulopoulou, PhD, is Lecturer, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Petros Galanis, PhD, is Lecturer, Center for Health Services Management and Evaluation, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Constantinos Loukas, PhD, is Assistant Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Lars Enochsson, PhD, is Professor of Surgery, Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Evangelos Georgiou, PhD, is Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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McCool KE, Bissett SA, Hill TL, Degernes LA, Hawkins EC. Evaluation of a Human Virtual-Reality Endoscopy Trainer for Teaching Early Endoscopy Skills to Veterinarians. JOURNAL OF VETERINARY MEDICAL EDUCATION 2020; 47:106-116. [PMID: 31009293 DOI: 10.3138/jvme.0418-037r] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Competency in flexible endoscopy is a major goal of small animal internal medicine residency training programs. Hands-on laboratories to teach entry-level skills have traditionally used anesthetized laboratory dogs (live dog laboratory [LDL]). Virtual-reality endoscopy trainers (VRET) are used for this purpose in human medicine with the clear benefits of avoiding live animal use, decreasing trainee stress, and allowing repeated, independent training sessions. However, there are currently no commercially available veterinary endoscopy simulators. The purpose of the study was to determine whether a human VRET can be a reasonable alternative to a LDL for teaching early veterinary endoscopy skills. Twelve veterinarians with limited or no endoscopy experience underwent training with a VRET (n = 6) or a LDL (n = 6), performed two recorded esophagogastroduodenoscopies (EGD) on anesthetized dogs for evaluation purposes (outcomes laboratory), and then underwent training with the alternative method. Participants completed questionnaires before any training and following each training session. No significant differences were found between training methods based on: measured parameters from the outcomes laboratory, including duration of time to perform EGD; evaluators' assessment of skills; and, assessment of skills through blinded review of the esophageal portion of EGD recordings. The VRET was less stressful for participants than the LDL (p = .02). All participants found that the VRET was a useful and acceptable alternative to the LDL for training of early endoscopy skills. Based on this limited study, VRET can serve as a reasonable alternative to LDL for teaching endoscopy skills to veterinarians.
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Affiliation(s)
- Katherine E McCool
- Clinical Education, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University
| | | | - Tracy L Hill
- College of Veterinary Medicine, University of Georgia
| | - Laurel A Degernes
- Avian Medicine, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University
| | - Eleanor C Hawkins
- Small Animal Internal Medicine, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University
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16
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Nemani A, Kruger U, Cooper CA, Schwaitzberg SD, Intes X, De S. Objective assessment of surgical skill transfer using non-invasive brain imaging. Surg Endosc 2019; 33:2485-2494. [PMID: 30334166 PMCID: PMC10756643 DOI: 10.1007/s00464-018-6535-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 10/12/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Physical and virtual surgical simulators are increasingly being used in training technical surgical skills. However, metrics such as completion time or subjective performance checklists often show poor correlation to transfer of skills into clinical settings. We hypothesize that non-invasive brain imaging can objectively differentiate and classify surgical skill transfer, with higher accuracy than established metrics, for subjects based on motor skill levels. STUDY DESIGN 18 medical students at University at Buffalo were randomly assigned into control, physical surgical trainer, or virtual trainer groups. Training groups practiced a surgical technical task on respective simulators for 12 consecutive days. To measure skill transfer post-training, all subjects performed the technical task in an ex-vivo environment. Cortical activation was measured using functional near-infrared spectroscopy (fNIRS) in the prefrontal cortex, primary motor cortex, and supplementary motor area, due to their direct impact on motor skill learning. RESULTS Classification between simulator trained and untrained subjects based on traditional metrics is poor, where misclassification errors range from 20 to 41%. Conversely, fNIRS metrics can successfully classify physical or virtual trained subjects from untrained subjects with misclassification errors of 2.2% and 8.9%, respectively. More importantly, untrained subjects are successfully classified from physical or virtual simulator trained subjects with misclassification errors of 2.7% and 9.1%, respectively. CONCLUSION fNIRS metrics are significantly more accurate than current established metrics in classifying different levels of surgical motor skill transfer. Our approach brings robustness, objectivity, and accuracy in validating the effectiveness of future surgical trainers in translating surgical skills to clinically relevant environments.
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Affiliation(s)
- Arun Nemani
- Rensselaer Polytechnic Institute, 110, 8th Street, Troy, NY, 12180, USA
| | - Uwe Kruger
- Rensselaer Polytechnic Institute, 110, 8th Street, Troy, NY, 12180, USA
| | - Clairice A Cooper
- University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, 14228, USA
| | - Steven D Schwaitzberg
- University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, 14228, USA
| | - Xavier Intes
- Rensselaer Polytechnic Institute, 110, 8th Street, Troy, NY, 12180, USA
| | - Suvranu De
- Rensselaer Polytechnic Institute, 110, 8th Street, Troy, NY, 12180, USA.
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17
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Goodman AJ, Melson J, Aslanian HR, Bhutani MS, Krishnan K, Lichtenstein DR, Navaneethan U, Pannala R, Parsi MA, Schulman AR, Sethi A, Sullivan SA, Thosani N, Trikudanathan G, Trindade AJ, Watson RR, Maple JT. Endoscopic simulators. Gastrointest Endosc 2019; 90:1-12. [PMID: 31122746 DOI: 10.1016/j.gie.2018.10.037] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Simulation refers to educational tools that allow for repetitive instruction in a nonpatient care environment that is risk-free. In GI endoscopy, simulators include ex vivo animal tissue models, live animal models, mechanical models, and virtual reality (VR) computer simulators. METHODS After a structured search of the peer-reviewed medical literature, this document reviews commercially available GI endoscopy simulation systems and clinical outcomes of simulation in endoscopy. RESULTS Mechanical simulators and VR simulators are frequently used early in training, whereas ex vivo and in vivo animal models are more commonly used for advanced endoscopy training. Multiple studies and systematic reviews show that simulation-based training appears to provide novice endoscopists with some advantage over untrained peers with regard to endpoints such as independent procedure completion and performance time, among others. Data also suggest that simulation training may accelerate the acquisition of specific technical skills in colonoscopy and upper endoscopy early in training. However, the available literature suggests that the benefits of simulator training appear to attenuate and cease after a finite period. Further studies are needed to determine if meeting competency metrics using simulation will predict actual clinical competency. CONCLUSIONS Simulation training is a promising modality that may aid in endoscopic education. However, for widespread incorporation of simulators into gastroenterology training programs to occur, simulators must show a sustained advantage over traditional mentored teaching in a cost-effective manner. Because most studies evaluating simulation have focused on novice learners, the role of simulation training in helping practicing endoscopists gain proficiency using new techniques and devices should be further explored.
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Affiliation(s)
| | - Adam J Goodman
- Division of Gastroenterology and Hepatology, NYU Langone Medical Center, New York University School of Medicine, New York, New York, USA
| | - Joshua Melson
- Division of Digestive Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Harry R Aslanian
- Section of Digestive Diseases, Department of Internal Medicine, Yale University, New Haven, Connecticut, USA
| | - Manoop S Bhutani
- Department of Gastroenterology, Hepatology and Nutrition, MD Anderson Cancer Center, The University of Texas, Houston, Texas, USA
| | - Kumar Krishnan
- Division of Gastroenterology, Department of Internal Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David R Lichtenstein
- Division of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Rahul Pannala
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Mansour A Parsi
- Department of Gastroenterology & Hepatology, Tulane University, New Orleans, Louisiana, USA
| | - Allison R Schulman
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Amrita Sethi
- Division of Digestive and Liver Diseases, New York-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Shelby A Sullivan
- Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nirav Thosani
- Division of Gastroenterology, Hepatology and Nutrition, McGovern Medical School, UTHealth, Houston, Texas, USA
| | - Guru Trikudanathan
- Division of Gastroenterology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Arvind J Trindade
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, New Hyde Park, New York, USA
| | - Rabindra R Watson
- Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
| | - John T Maple
- Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
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He W, Bryns S, Kroeker K, Basu A, Birch D, Zheng B. Eye gaze of endoscopists during simulated colonoscopy. J Robot Surg 2019; 14:137-143. [PMID: 30929136 DOI: 10.1007/s11701-019-00950-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/23/2019] [Indexed: 01/22/2023]
Abstract
Regaining orientation during an endoscopic procedure is critical. We investigated how endoscopists maintain orientation based on video and eye gaze analysis. Novices and experts performed a simulated colonoscopy procedure. Task performance was assessed by completion time, total distance traveled, maximum depth of insertion, percentage of mucosa viewed, and air insufflation volume. Procedure videos were analyzed by transfers among three viewing areas: center of bowel lumen, edge of bowel lumen, and other structure without bowel lumen in sight. Performers' gaze features were also examined over these viewing areas. Experts required less time to complete the procedure (P < 0.001). Novices' scope traveled a greater distance (P < 0.001) and more scope was inserted compared to an expert (P < 0.001). Novices also insufflated more air than experts (P < 0.001). Experts maintained the view of bowel lumen in the middle of the screen, while novices often left it on the edge (P = 0.032). When disorientation happened, novices brought the view to the edge more frequently than the center. However, experts were able to bring it back to the center directly. Eye tracking showed that the rate of saccades in experts increased when the bowel lumen moved away from the central view, such a behavior was not observed in novices. Maintaining a centered view of the bowel lumen is a strategy used by expert endoscopists. Video and eye tracking analysis revealed a key difference in eye gaze behavior when regaining orientation between novice and experienced endoscopists.
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Affiliation(s)
- Wenjing He
- Surgical Simulation Research Lab, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 162 Heritage Medical Research Centre, 8440 112 St. NW, Edmonton, AB, T6G 2E1, Canada
| | - Simon Bryns
- Surgical Simulation Research Lab, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 162 Heritage Medical Research Centre, 8440 112 St. NW, Edmonton, AB, T6G 2E1, Canada
| | - Karen Kroeker
- 2-40 Zeidler Ledcor Centre, Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Anup Basu
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada
| | - Daniel Birch
- Department of Surgery, Centre for the Advancement of Minimally Invasive Surgery (CAMIS), University of Alberta, Edmonton, AB, Canada
| | - Bin Zheng
- Surgical Simulation Research Lab, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 162 Heritage Medical Research Centre, 8440 112 St. NW, Edmonton, AB, T6G 2E1, Canada.
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Khan R, Scaffidi MA, Grover SC, Gimpaya N, Walsh CM. Simulation in endoscopy: Practical educational strategies to improve learning. World J Gastrointest Endosc 2019; 11:209-218. [PMID: 30918586 PMCID: PMC6425285 DOI: 10.4253/wjge.v11.i3.209] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/06/2019] [Accepted: 03/11/2019] [Indexed: 02/06/2023] Open
Abstract
In gastrointestinal endoscopy, simulation-based training can help endoscopists acquire new skills and accelerate the learning curve. Simulation creates an ideal environment for trainees, where they can practice specific skills, perform cases at their own pace, and make mistakes with no risk to patients. Educators also benefit from the use of simulators, as they can structure training according to learner needs and focus solely on the trainee. Not all simulation-based training, however, is effective. To maximize benefits from this instructional modality, educators must be conscious of learners' needs, the potential benefits of training, and associated costs. Simulation should be integrated into training in a manner that is grounded in educational theory and empirical data. In this review, we focus on four best practices in simulation-based education: deliberate practice with mastery learning, feedback and debriefing, contextual learning, and innovative educational strategies. For each topic, we provide definitions, supporting evidence, and practical tips for implementation.
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Affiliation(s)
- Rishad Khan
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London ON N6A 5C1, Canada
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto ON M5B 1W8, Canada
- Department of Medicine, University of Toronto, Toronto ON M5G 2C4, Canada
| | - Michael A Scaffidi
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto ON M5B 1W8, Canada
- Department of Medicine, University of Toronto, Toronto ON M5G 2C4, Canada
- Faculty of Health Sciences, School of Medicine, Queen’s University, Kingston ON K7L 3N6, Canada
| | - Samir C Grover
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto ON M5B 1W8, Canada
- Department of Medicine, University of Toronto, Toronto ON M5G 2C4, Canada
| | - Nikko Gimpaya
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto ON M5B 1W8, Canada
- Department of Medicine, University of Toronto, Toronto ON M5G 2C4, Canada
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology, and Nutrition and the Research and Learning Institutes, Hospital for Sick Children, University of Toronto, Toronto ON M5G 1X8, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto ON M5G 1X8, Canada
- The Wilson Centre, Faculty of Medicine, University of Toronto, Toronto ON M5G 2C4, Canada
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20
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Placek SB, Franklin BR, Ritter EM. Simulation in Surgical Endoscopy. COMPREHENSIVE HEALTHCARE SIMULATION: SURGERY AND SURGICAL SUBSPECIALTIES 2019. [DOI: 10.1007/978-3-319-98276-2_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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21
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Khan R, Plahouras J, Johnston BC, Scaffidi MA, Grover SC, Walsh CM. Virtual reality simulation training for health professions trainees in gastrointestinal endoscopy. Cochrane Database Syst Rev 2018; 8:CD008237. [PMID: 30117156 PMCID: PMC6513657 DOI: 10.1002/14651858.cd008237.pub3] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Endoscopy has traditionally been taught with novices practicing on real patients under the supervision of experienced endoscopists. Recently, the growing awareness of the need for patient safety has brought simulation training to the forefront. Simulation training can provide trainees with the chance to practice their skills in a learner-centred, risk-free environment. It is important to ensure that skills gained through simulation positively transfer to the clinical environment. This updated review was performed to evaluate the effectiveness of virtual reality (VR) simulation training in gastrointestinal endoscopy. OBJECTIVES To determine whether virtual reality simulation training can supplement and/or replace early conventional endoscopy training (apprenticeship model) in diagnostic oesophagogastroduodenoscopy, colonoscopy, and/or sigmoidoscopy for health professions trainees with limited or no prior endoscopic experience. SEARCH METHODS We searched the following health professions, educational, and computer databases until 12 July 2017: the Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Ovid Embase, Scopus, Web of Science, BIOSIS Previews, CINAHL, AMED, ERIC, Education Full Text, CBCA Education, ACM Digital Library, IEEE Xplore, Abstracts in New Technology and Engineering, Computer and Information Systems Abstracts, and ProQuest Dissertations and Theses Global. We also searched the grey literature until November 2017. SELECTION CRITERIA We included randomised and quasi-randomised clinical trials comparing VR endoscopy simulation training versus any other method of endoscopy training with outcomes measured on humans in the clinical setting, including conventional patient-based training, training using another form of endoscopy simulation, or no training. We also included trials comparing two different methods of VR training. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility and methodological quality of trials, and extracted data on the trial characteristics and outcomes. We pooled data for meta-analysis where participant groups were similar, studies assessed the same intervention and comparator, and had similar definitions of outcome measures. We calculated risk ratio for dichotomous outcomes with 95% confidence intervals (CI). We calculated mean difference (MD) and standardised mean difference (SMD) with 95% CI for continuous outcomes when studies reported the same or different outcome measures, respectively. We used GRADE to rate the quality of the evidence. MAIN RESULTS We included 18 trials (421 participants; 3817 endoscopic procedures). We judged three trials as at low risk of bias. Ten trials compared VR training with no training, five trials with conventional endoscopy training, one trial with another form of endoscopy simulation training, and two trials compared two different methods of VR training. Due to substantial clinical and methodological heterogeneity across our four comparisons, we did not perform a meta-analysis for several outcomes. We rated the quality of evidence as moderate, low, or very low due to risk of bias, imprecision, and heterogeneity.Virtual reality endoscopy simulation training versus no training: There was insufficient evidence to determine the effect on composite score of competency (MD 3.10, 95% CI -0.16 to 6.36; 1 trial, 24 procedures; low-quality evidence). Composite score of competency was based on 5-point Likert scales assessing seven domains: atraumatic technique, colonoscope advancement, use of instrument controls, flow of procedure, use of assistants, knowledge of specific procedure, and overall performance. Scoring range was from 7 to 35, a higher score representing a higher level of competence. Virtual reality training compared to no training likely provides participants with some benefit, as measured by independent procedure completion (RR 1.62, 95% CI 1.15 to 2.26; 6 trials, 815 procedures; moderate-quality evidence). We evaluated overall rating of performance (MD 0.45, 95% CI 0.15 to 0.75; 1 trial, 18 procedures), visualisation of mucosa (MD 0.60, 95% CI 0.20 to 1.00; 1 trial, 55 procedures), performance time (MD -0.20 minutes, 95% CI -0.71 to 0.30; 2 trials, 29 procedures), and patient discomfort (SMD -0.16, 95% CI -0.68 to 0.35; 2 trials, 145 procedures), all with very low-quality evidence. No trials reported procedure-related complications or critical flaws (e.g. bleeding, luminal perforation) (3 trials, 550 procedures; moderate-quality evidence).Virtual reality endoscopy simulation training versus conventional patient-based training: One trial reported composite score of competency but did not provide sufficient data for quantitative analysis. Virtual reality training compared to conventional patient-based training resulted in fewer independent procedure completions (RR 0.45, 95% CI 0.27 to 0.74; 2 trials, 174 procedures; low-quality evidence). We evaluated performance time (SMD 0.12, 95% CI -0.55 to 0.80; 2 trials, 34 procedures), overall rating of performance (MD -0.90, 95% CI -4.40 to 2.60; 1 trial, 16 procedures), and visualisation of mucosa (MD 0.0, 95% CI -6.02 to 6.02; 1 trial, 18 procedures), all with very low-quality evidence. Virtual reality training in combination with conventional training appears to be advantageous over VR training alone. No trials reported any procedure-related complications or critical flaws (3 trials, 72 procedures; very low-quality evidence).Virtual reality endoscopy simulation training versus another form of endoscopy simulation: Based on one study, there were no differences between groups with respect to composite score of competency, performance time, and visualisation of mucosa. Virtual reality training in combination with another form of endoscopy simulation training did not appear to confer any benefit compared to VR training alone.Two methods of virtual reality training: Based on one study, a structured VR simulation-based training curriculum compared to self regulated learning on a VR simulator appears to provide benefit with respect to a composite score evaluating competency. Based on another study, a progressive-learning curriculum that sequentially increases task difficulty provides benefit with respect to a composite score of competency over the structured VR training curriculum. AUTHORS' CONCLUSIONS VR simulation-based training can be used to supplement early conventional endoscopy training for health professions trainees with limited or no prior endoscopic experience. However, we found insufficient evidence to advise for or against the use of VR simulation-based training as a replacement for early conventional endoscopy training. The quality of the current evidence was low due to inadequate randomisation, allocation concealment, and/or blinding of outcome assessment in several trials. Further trials are needed that are at low risk of bias, utilise outcome measures with strong evidence of validity and reliability, and examine the optimal nature and duration of training.
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Affiliation(s)
- Rishad Khan
- Schulich School of Medicine and Dentistry, Western UniversityDepartment of MedicineLondonCanada
| | - Joanne Plahouras
- University of Toronto27 King's College CircleTorontoOntarioCanadaM5S 1A1
| | - Bradley C Johnston
- Dalhousie UniversityDepartment of Community Health and Epidemiology5790 University AvenueHalifaxNSCanadaB3H 1V7
| | - Michael A Scaffidi
- St. Michael's Hospital, University of TorontoDepartment of Medicine, Division of GastroenterologyTorontoONCanada
| | - Samir C Grover
- St. Michael's Hospital, University of TorontoDepartment of Medicine, Division of GastroenterologyTorontoONCanada
| | - Catharine M Walsh
- The Hospital for Sick ChildrenDivision of Gastroenterology, Hepatology, and Nutrition555 University AveTorontoONCanadaM5G 1X8
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Abstract
PURPOSE OF THE REVIEW Progress towards the goal of high-quality endoscopy across health economies has been founded on high-quality structured training programmes linked to credentialing practice and ongoing performance monitoring. This review appraises the recent literature on training interventions, which may benefit performance and competency acquisition in novice endoscopy trainees. RECENT FINDINGS Increasing data on the learning curves for different endoscopic procedures has highlighted variations in performance amongst trainees. These differences may be dependent on the trainee, trainer and training programme. Evidence of the benefit of knowledge-based training, simulation training, hands-on courses and clinical training is available to inform the planning of ideal training pathway elements. The validation of performance assessment measures and global competency tools now also provides evidence on the effectiveness of training programmes to influence the learning curve. The impact of technological advances and intelligent metrics from national databases is also predicted to drive improvements and efficiencies in training programme design and monitoring of post-training outcomes. Training in endoscopy may be augmented through a series of pre-training and in-training interventions. In conjunction with performance metrics, these evidence-based interventions could be implemented into training pathways to optimise and quality assure training in endoscopy.
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Affiliation(s)
- Keith Siau
- Department of Gastroenterology, Dudley Group Hospitals NHS Foundation Trust, Dudley, UK. .,Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK.
| | - Neil D Hawkes
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK.,Department of Gastroenterology, Cwm Taf University Health Board, Llantrisant, UK
| | - Paul Dunckley
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK.,Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, UK
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23
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Waschke KA, Coyle W. Advances and Challenges in Endoscopic Training. Gastroenterology 2018; 154:1985-1992. [PMID: 29454788 DOI: 10.1053/j.gastro.2017.11.293] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/29/2017] [Accepted: 11/29/2017] [Indexed: 02/06/2023]
Abstract
One of the challenges of the current era is ensuring that endoscopic training is accomplished effectively in the face of multiple competing demands. As health care delivery evolves, with rising patient complexity and increasing productivity requirements, there is mounting pressure on the time available for training in the clinical setting. The practice of endoscopy itself continues to expand to include increasingly complex procedures (eg, therapeutic endoscopic ultrasound, endoscopic submucosal dissection, and peroral endoscopic myotomy) that require dedicated endoscopy training. The rapid pace of progress in the field of endoscopy means that the demand for endoscopy training is not limited to the formal period of training, but instead spans the spectrum to include physicians already in practice. In light of recent advances in our understanding of endoscopy training, this review will serve to highlight the current state of affairs with respect to endoscopic training and how we can consider approaching these challenges.
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Affiliation(s)
- Kevin A Waschke
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
| | - Walter Coyle
- Gastroenterology Division, Scripps Clinic, San Diego, California
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Preisler L, Bulut M, Svendsen MS, Svendsen LB, Konge L. An automatic measure of progression during colonoscopy correlates to patient experienced pain. Scand J Gastroenterol 2018; 53:345-349. [PMID: 29334276 DOI: 10.1080/00365521.2017.1423373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Colonoscopy screening and surveillance programs depend on patient's tolerable experience, which is associated with competence of the endoscopist. The Colonoscopy Progression Score (CoPS) is an automated tool based on recording of the Magnetic Scope Imager (MEI) picture in order to track progression. CoPS deliver a numeric score and a graphic map. A high score expresses a rapid and smooth progression. Aims of study were to explore the correlation between CoPS and patient experienced pain and to identity locations associated with pain. METHODS AND MATERIALS Patients listed for colonoscopy were included and asked to reply to pain by pressing a rubber ball. The signal was recorded simultaneous to CoPS. Patients evaluated the experience on a Visual Analogue Scale (VAS). CoPS and recorded pain events were used to create a pain sensitive CoPS-map (S-CoPS map). RESULTS A total of 58 complete recordings were used for evaluation. We demonstrated a moderate correlation between CoPS and patient experienced pain, Pearson's r = -0.47 (p < .001). A low CoPS was associated with a painful colonoscopy and a high CoPS excluded severe pain. Sensitivity and specificity was 0.79 and 0.60 and AUC was 0.61 Passage of the sigmoid colon, right and left flexures were associated with pain for 51%, 33% and 25% of the patients, respectively. CONCLUSION A moderate correlation between CoPS and patient experienced pain suggest that CoPS measure inserting skills but might also be a measure of a gentle performance. The graphic S-CoPS-map can be used to point-out painful passages and aid planning of future colonoscopies.
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Affiliation(s)
- Louise Preisler
- a Department of Surgical Gastroenterology and Transplantation , Rigshospitalet, Denmark and University of Copenhagen , Copenhagen , Denmark
| | - Mustafa Bulut
- b Department of Surgical Gastroenterology , Køge Hospital University of Copenhagen , Koege , Denmark
| | - Morten Soendergaard Svendsen
- c Copenhagen Academy for Medical Education and Simulation (CAMES) , The Capital Region of Denmark and University of Copenhagen , Copenhagen , Denmark.,d Marine Biological Section, Department of Biology , University of Copenhagen , Denmark Copenhagen
| | - Lars Bo Svendsen
- a Department of Surgical Gastroenterology and Transplantation , Rigshospitalet, Denmark and University of Copenhagen , Copenhagen , Denmark
| | - Lars Konge
- c Copenhagen Academy for Medical Education and Simulation (CAMES) , The Capital Region of Denmark and University of Copenhagen , Copenhagen , Denmark
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Simulation Research in Gastrointestinal and Urologic Care-Challenges and Opportunities: Summary of a National Institute of Diabetes and Digestive and Kidney Diseases and National Institute of Biomedical Imaging and Bioengineering Workshop. Ann Surg 2017; 267:26-34. [PMID: 28562397 DOI: 10.1097/sla.0000000000002228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
: A workshop on "Simulation Research in Gastrointestinal and Urologic Care: Challenges and Opportunities" was held at the National Institutes of Health in June 2016. The purpose of the workshop was to examine the extent to which simulation approaches have been used by skilled proceduralists (not trainees) caring for patients with gastrointestinal and urologic diseases. The current status of research findings in the use and effectiveness of simulation applications was reviewed, and numerous knowledge gaps and research needs were identified by the faculty and the attendees. The paradigm of "deliberate practice," rather than mere repetition, and the value of coaching by experts was stressed by those who have adopted simulation in music and sports. Models that are most useful for the adoption of simulation by expert clinicians have yet to be fully validated. Initial studies on the impact of simulation on safety and error reduction have demonstrated its value in the training domain, but the role of simulation as a strategy for increased procedural safety remains uncertain in the world of the expert practitioner. Although the basic requirements for experienced physicians to acquire new skills have been explored, the widespread availability of such resources is an unrealized goal, and there is a need for well-designed outcome studies to establish the role of simulation in improving the quality of health care.
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Franklin BR, Placek SB, Gardner AK, Korndorffer JR, Wagner MD, Pearl JP, Ritter EM. Preparing for the American Board of Surgery Flexible Endoscopy Curriculum: Development of multi-institutional proficiency-based training standards and pilot testing of a simulation-based mastery learning curriculum for the Endoscopy Training System. Am J Surg 2017; 216:167-173. [PMID: 28974312 DOI: 10.1016/j.amjsurg.2017.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/09/2017] [Accepted: 09/16/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND The Fundamentals of Endoscopic Surgery (FES) exam is required for American Board of Surgery certification. The purpose of this study was to develop performance standards for a simulation-based mastery learning (SBML) curriculum for the FES performance exam using the Endoscopy Training System (ETS). METHODS Experienced endoscopists from multiple institutions and specialties performed each ETS task (scope manipulation (SM), tool targeting (TT), retroflexion (RF), loop management (LM), and mucosal inspection (MI)) with scores used to develop performance standards for a SBML training curriculum. Trainees completed the curriculum to determine feasibility, and effect on FES performance. RESULTS Task specific training standards were determined (SM-121sec, TT-243sec, RF-159sec, LM-261sec, MI-180-480sec, 7 polyps). Trainees required 29.5 ± 3.7 training trials over 2.75 ± 0.5 training sessions to complete the SBML curriculum. Despite high baseline FES performance, scores improved (pre 73.4 ± 7, post 78.1 ± 5.2; effect size = 0.76, p > 0.1), but this was not statistically discernable. CONCLUSIONS This SBML curriculum was feasible and improved FES scores in a group of high performers. This curriculum should be applied to novice endoscopists to determine effectiveness for FES exam preparation.
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Affiliation(s)
- Brenton R Franklin
- The Department of Surgery at the Uniformed Services University and the Walter Reed National Military Medical Center, Bethesda, MD, USA.
| | - Sarah B Placek
- The Department of Surgery at the Uniformed Services University and the Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Aimee K Gardner
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - James R Korndorffer
- Department of Surgery, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA 70112, USA
| | - Mercy D Wagner
- The Department of Surgery at the Uniformed Services University and the Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Jonathan P Pearl
- Department of Surgery, University of Maryland, 22 S. Greene Street, Baltimore, MD 21201, USA
| | - E Matthew Ritter
- The Department of Surgery at the Uniformed Services University and the Walter Reed National Military Medical Center, Bethesda, MD, USA
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Simulation-based mastery learning for endoscopy using the endoscopy training system: a strategy to improve endoscopic skills and prepare for the fundamentals of endoscopic surgery (FES) manual skills exam. Surg Endosc 2017; 32:413-420. [DOI: 10.1007/s00464-017-5697-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 06/22/2017] [Indexed: 01/09/2023]
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The Effects of Simulation-based Transvaginal Ultrasound Training on Quality and Efficiency of Care: A Multicenter Single-blind Randomized Trial. Ann Surg 2017; 265:630-637. [PMID: 28169932 DOI: 10.1097/sla.0000000000001656] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore the effect of adding simulation-based transvaginal ultrasound training to trainees' clinical training compared with only clinical training on quality of and efficiency of care. BACKGROUND Simulation-based ultrasound training may be an effective adjunct to clinical training, but no studies have examined its effects on quality and efficiency of care. METHODS Trainees from 4 University Hospitals in East Denmark were included (N = 54). Participants were randomized to either simulation-based ultrasound training and clinical training (intervention group, n = 28), or to clinical training only (control group, n = 26).The primary outcome was patient-reported discomfort during transvaginal ultrasound examinations performed by study participants. Secondary outcomes included patient-reported perceived safety and confidence in ultrasound provider. Finally, the need for trainee supervision or repeated patient examinations was recorded. RESULTS In total, 1150 patient ratings were collected. The intervention was associated with a reduction of patient discomfort by 18.5% [95% confidence interval (CI), 10.7-25.5; P < 0.001), and with a 7.9% (95% CI, 0.5-14.7; P = 0.04) increase in perceived safety. The intervention group participants received 11.1% (95% CI, 2.5-18.9) higher scores on patients' confidence compared with control group participants (P = 0.01). When the number of days of clinical training was doubled, the odds for trainee supervision or repeated patient examination was reduced by 45.3% (95% CI, 33.5-55.1) and 19.8% (95% CI, 4.1-32.9) in the intervention and control group, respectively (P = 0.005). CONCLUSIONS Simulation-based ultrasound training improved quality of care and reduced the need for repeated patient examination and trainee supervision.
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Noda K, Kitada T, Suzuki Y, Colvin HS, Hata T, Mizushima T. A novel physical colonoscopy simulator based on analysis of data from computed tomography colonography. Surg Today 2017; 47:1153-1162. [PMID: 28470438 PMCID: PMC5532419 DOI: 10.1007/s00595-017-1517-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 01/23/2017] [Indexed: 12/15/2022]
Abstract
Purpose Laparoscopic surgery is now practiced widely because of its lower postoperative morbidity. As flexible endoscopy during laparoscopic surgery minimizes surgical trauma further, training in endoscopy will become more important for surgeons. Thus, we designed a physical simulator, the Noda–Kitada–Suzuki (NKS) model, which could provide the more realistic insertion of a colonoscope. Methods We designed a colonoscopy simulator, based on information from computed tomography colonography scans of the anatomy and kinetic properties of the colon and rectum. Results The transparent skeleton body of the NKS model provides instant visual feedback to the operator and the trainer. Our novel colonoscopy simulator replicates the realistic and reproducible insertion of a colonoscope from the rectum to cecum, providing authentic views of the Houston’s valves, the flexures, and mucosal folds. This was verified through an objective questionnaire, with 14 of 16 colonoscopists preferring the NKS model over the previous CM15 model for training purposes. Moreover, the Modified Colonoscopy Simulator Realism Questionnaire analysis confirmed that the NKS model was significantly more realistic than the CM15 for 7 (21.2%) of the 33 items when assessed by 12 colonoscopists. Conclusion The NKS model provides a realistic training platform and may improve the quality of training in colonoscopy. Electronic supplementary material The online version of this article (doi:10.1007/s00595-017-1517-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katsuhisa Noda
- Noda Genki Clinic, Kawasaki Building 1F 102, 2-6-30 Minami-Sakurazuka, Toyonaka, Osaka, 561-0882, Japan.
| | - Takatoshi Kitada
- Kitada Clinic., Geo Kawanishi Residence Mark 1F, 1-2-6 Ohbe, Kawanishi, Hyogo, 666-0014, Japan
| | - Yasumoto Suzuki
- Matsushima Clinic, 3-138 Isechou Nishi-ku, Yokohama, Kanagawa, 220-0045, Japan
| | - Hugh Shunsuke Colvin
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Taishi Hata
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tsunekazu Mizushima
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Jirapinyo P, Abidi WM, Aihara H, Zaki T, Tsay C, Imaeda AB, Thompson CC. Preclinical endoscopic training using a part-task simulator: learning curve assessment and determination of threshold score for advancement to clinical endoscopy. Surg Endosc 2017; 31:4010-4015. [PMID: 28229238 DOI: 10.1007/s00464-017-5436-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 01/20/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND Preclinical simulator training has the potential to decrease endoscopic procedure time and patient discomfort. This study aims to characterize the learning curve of endoscopic novices in a part-task simulator and propose a threshold score for advancement to initial clinical cases. METHODS Twenty novices with no prior endoscopic experience underwent repeated endoscopic simulator sessions using the part-task simulator. Simulator scores were collected; their inverse was averaged and fit to an exponential curve. The incremental improvement after each session was calculated. Plateau was defined as the session after which incremental improvement in simulator score model was less than 5%. Additionally, all participants filled out questionnaires regarding simulator experience after sessions 1, 5, 10, 15, and 20. A visual analog scale and NASA task load index were used to assess levels of comfort and demand. RESULTS Twenty novices underwent 400 simulator sessions. Mean simulator scores at sessions 1, 5, 10, 15, and 20 were 78.5 ± 5.95, 176.5 ± 17.7, 275.55 ± 23.56, 347 ± 26.49, and 441.11 ± 38.14. The best fit exponential model was [time/score] = 26.1 × [session #]-0.615; r 2 = 0.99. This corresponded to an incremental improvement in score of 35% after the first session, 22% after the second, 16% after the third and so on. Incremental improvement dropped below 5% after the 12th session corresponding to the predicted score of 265. Simulator training was related to higher comfort maneuvering an endoscope and increased readiness for supervised clinical endoscopy, both plateauing between sessions 10 and 15. Mental demand, physical demand, and frustration levels decreased with increased simulator training. CONCLUSION Preclinical training using an endoscopic part-task simulator appears to increase comfort level and decrease mental and physical demand associated with endoscopy. Based on a rigorous model, we recommend that novices complete a minimum of 12 training sessions and obtain a simulator score of at least 265 to be best prepared for clinical endoscopy.
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Affiliation(s)
- Pichamol Jirapinyo
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Wasif M Abidi
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Hiroyuki Aihara
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Theodore Zaki
- Yale University School of Medicine, New Haven, CT, USA
| | - Cynthia Tsay
- Yale University School of Medicine, New Haven, CT, USA
| | - Avlin B Imaeda
- Yale University School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, USA.
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Plooy AM, Hill A, Horswill MS, Cresp AS, Karamatic R, Riek S, Wallis GM, Burgess-Limerick R, Hewett DG, Watson MO. The efficacy of training insertion skill on a physical model colonoscopy simulator. Endosc Int Open 2016; 4:E1252-E1260. [PMID: 27995185 PMCID: PMC5161130 DOI: 10.1055/s-0042-114773] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 07/29/2016] [Indexed: 12/13/2022] Open
Abstract
Background and study aims: Prior research supports the validity of performance measures derived from the use of a physical model colonoscopy simulator - the Kyoto Kagaku Colonoscope Training Model (Kyoto Kagaku Co. Ltd., Kyoto, Japan) - for assessing insertion skill. However, its use as a training tool has received little research attention. We assessed the efficacy of a brief structured program to develop basic colonoscope insertion skill through unsupervised practice on the model. Participants and methods: This was a training study with pretesting and post-testing. Thirty-two colonoscopy novices completed an 11-hour training regime in which they practiced cases on the model in a colonoscopy simulation research laboratory. They also attempted a series of test cases before and after training. For each outcome measure (completion rates, time to cecum and peak force applied to the model), we compared trainees' post-test performance with the untrained novices and experienced colonoscopists from a previously-reported validation study. Results: Compared with untrained novices, trained novices had higher completion rates and shorter times to cecum overall (Ps < .001), but were out-performed by the experienced colono-scopists on these metrics (Ps < .001). Nevertheless, their performance was generally closer to that of the experienced group. Overall, trained novices did not differ from either experience-level comparison group in the peak forces they applied (P > .05). We also present the results broken down by case. Conclusions: The program can be used to teach trainees basic insertion skill in a more or less self-directed way. Individuals who have completed the program (or similar training on the model) are better prepared to progress to supervised live cases.
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Affiliation(s)
- Annaliese M. Plooy
- School of Human Movement Studies, The
University of Queensland, St Lucia, Brisbane, Australia
| | - Andrew Hill
- School of Psychology, The University of
Queensland, St Lucia, Brisbane, Australia,Clinical Skills Development Service, Metro
North Hospital and Health Service, Herston, Brisbane,
Australia,Corresponding author Andrew Hill,
PhD Clinical Skills Development Service, Metro North
Hospital and Health ServiceSchool of
PsychologyThe University of
QueenslandSt Lucia QLD
4072Australia+61-7-3646
6500+61-7-3646 6501
| | - Mark S. Horswill
- School of Psychology, The University of
Queensland, St Lucia, Brisbane, Australia
| | - Alanna St.G. Cresp
- School of Human Movement Studies, The
University of Queensland, St Lucia, Brisbane, Australia,School of Medicine, The University of
Queensland, Herston, Brisbane, Australia
| | - Rozemary Karamatic
- Clinical Skills Development Service, Metro
North Hospital and Health Service, Herston, Brisbane,
Australia
| | - Stephan Riek
- School of Human Movement Studies, The
University of Queensland, St Lucia, Brisbane, Australia
| | - Guy M. Wallis
- School of Human Movement Studies, The
University of Queensland, St Lucia, Brisbane, Australia
| | - Robin Burgess-Limerick
- School of Human Movement Studies, The
University of Queensland, St Lucia, Brisbane, Australia
| | - David G. Hewett
- Clinical Skills Development Service, Metro
North Hospital and Health Service, Herston, Brisbane,
Australia,School of Medicine, The University of
Queensland, Herston, Brisbane, Australia
| | - Marcus O. Watson
- School of Psychology, The University of
Queensland, St Lucia, Brisbane, Australia,Clinical Skills Development Service, Metro
North Hospital and Health Service, Herston, Brisbane,
Australia,School of Medicine, The University of
Queensland, Herston, Brisbane, Australia
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Abstract
Gastrointestinal surgery, with its emphasis on endoscopy, has renewed interest in teaching surgical endoscopy. The field is rapidly evolving, with innovative techniques emanating from the laboratory to the operating room and endoscopy suite. To ensure that surgeons spearhead the field of endoscopic surgery, a new strategy for teaching surgical endoscopy to residents and practicing surgeons must be developed.
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Affiliation(s)
- Jonathan P Pearl
- Department of Surgery, Case Western Reserve University School of Medicine, USA
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van der Wiel SE, Küttner Magalhães R, Rocha Gonçalves CR, Dinis-Ribeiro M, Bruno MJ, Koch AD. Simulator training in gastrointestinal endoscopy - From basic training to advanced endoscopic procedures. Best Pract Res Clin Gastroenterol 2016; 30:375-87. [PMID: 27345646 DOI: 10.1016/j.bpg.2016.04.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/14/2016] [Accepted: 04/28/2016] [Indexed: 02/06/2023]
Abstract
Simulator-based gastrointestinal endoscopy training has gained acceptance over the last decades and has been extensively studied. Several types of simulators have been validated and it has been demonstrated that the use of simulators in the early training setting accelerates the learning curve in acquiring basic skills. Current GI endoscopy simulators lack the degree of realism that would be necessary to provide training to achieve full competency or to be applicable in certification. Virtual Reality and mechanical simulators are commonly used in basic flexible endoscopy training, whereas ex vivo and in vivo models are used in training the most advanced endoscopic procedures. Validated models for the training of more routine therapeutic interventions like polypectomy, EMR, stenting and haemostasis are lacking or scarce and developments in these areas should be encouraged.
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Affiliation(s)
- S E van der Wiel
- Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center Rotterdam, 's Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
| | - R Küttner Magalhães
- Department of Gastroenterology, Santo António Hospital, Porto Hospital Center, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal.
| | - Carla Rolanda Rocha Gonçalves
- Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal; Life and Health Sciences Research Institute/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal; Department of Gastroenterology, Hospital Braga, Portugal.
| | - M Dinis-Ribeiro
- Department of Gastroenterology, Portugese Oncology Institute of Porto, Rua Dr. Bernardino de Almeida, 4200-072 Porto, Portugal; CIDES/CINTESIS, Porto Faculty of Medicine, Portugal.
| | - M J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center Rotterdam, 's Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
| | - A D Koch
- Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center Rotterdam, 's Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
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Ekkelenkamp VE, Koch AD, de Man RA, Kuipers EJ. Training and competence assessment in GI endoscopy: a systematic review. Gut 2016; 65:607-15. [PMID: 25636697 DOI: 10.1136/gutjnl-2014-307173] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 01/08/2015] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Training procedural skills in GI endoscopy once focused on threshold numbers. As threshold numbers poorly reflect individual competence, the focus gradually shifts towards a more individual approach. Tools to assess and document individual learning progress are being developed and incorporated in dedicated training curricula. However, there is a lack of consensus and training guidelines differ worldwide, which reflects uncertainties on optimal set-up of a training programme. AIMS The primary aim of this systematic review was to evaluate the currently available literature for the use of training and assessment methods in GI endoscopy. Second, we aimed to identify the role of simulator-based training as well as the value of continuous competence assessment in patient-based training. Third, we aimed to propose a structured training curriculum based on the presented evidence. METHODS A literature search was carried out in the available medical and educational literature databases. The results were systematically reviewed and studies were included using a predefined protocol with independent assessment by two reviewers and a final consensus round. RESULTS The literature search yielded 5846 studies. Ninety-four relevant studies on simulators, assessment methods, learning curves and training programmes for GI endoscopy met the inclusion criteria. Twenty-seven studies on simulator validation were included. Good validity was demonstrated for four simulators. Twenty-three studies reported on simulator training and learning curves, including 17 randomised control trials. Increased performance on a virtual reality (VR) simulator was shown in all studies. Improved performance in patient-based assessment was demonstrated in 14 studies. Four studies reported on the use of simulators for assessment of competence levels. Current simulators lack the discriminative power to determine competence levels in patient-based endoscopy. Eight out of 14 studies on colonoscopy, endoscopic retrograde cholangiopancreatography and endosonography reported on learning curves in patient-based endoscopy and proved the value of this approach for measuring performance. Ten studies explored the numbers needed to gain competence, but the proposed thresholds varied widely between them. Five out of nine studies describing the development and evaluation of assessment tools for GI endoscopy provided insight into the performance of endoscopists. Five out of seven studies proved that intense training programmes result in good performance. CONCLUSIONS The use of validated VR simulators in the early training setting accelerates the learning of practical skills. Learning curves are valuable for the continuous assessment of performance and are more relevant than threshold numbers. Future research will strengthen these conclusions by evaluating simulation-based as well as patient-based training in GI endoscopy. A complete curriculum with the assessment of competence throughout training needs to be developed for all GI endoscopy procedures.
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Affiliation(s)
| | - Arjun D Koch
- Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | - Robert A de Man
- Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | - Ernst J Kuipers
- Erasmus MC-University Medical Center, Rotterdam, The Netherlands
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Nesbitt CI, Birdi N, Mafeld S, Stansby G. The role of simulation in the development of endovascular surgical skills. PERSPECTIVES ON MEDICAL EDUCATION 2016; 5:8-14. [PMID: 26797930 PMCID: PMC4754211 DOI: 10.1007/s40037-015-0250-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Endovascular trainees in the National Health Service still largely rely on the apprentice-apprenticeship model from the late 19th century. As the scope for endovascular therapy increases, due to the rapid innovation, evolution and refinement of technology, so too do patients' therapeutic options. This climate has also opened the door for more novel training adjuncts, to address the gaps that exist in our current endovascular training curriculum. The aim of this paper is to present a succinct overview of endovascular simulation, synthesizing the trials and research behind this rapidly evolving training as well as highlighting areas where further research is required. The authors searched MEDLINE and EMBASE for relevant manuscripts on all aspects of endovascular simulation training. A comprehensive Google search was also undertaken to look for any relevant information on endovascular training courses available and any unpublished work that had been presented at relevant scientific meetings. Papers were categorized into the four models: synthetic, animal, virtual reality and human cadaver, and separate searches for evidence of skill transfer were also undertaken. Authors of novel research projects were contacted for further details of unpublished work and permission granted to report such findings in this manuscript.
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Affiliation(s)
- Craig Iain Nesbitt
- Northern Vascular Centre, Freeman Hospital, Newcastle Upon Tyne, England
| | - Nikhil Birdi
- Department of Radiology, Freeman Hospital, Newcastle Upon Tyne, England.
| | - Sebastian Mafeld
- Department of Radiology, Freeman Hospital, Newcastle Upon Tyne, England
| | - Gerrard Stansby
- Northern Vascular Centre, Freeman Hospital, Newcastle Upon Tyne, England
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King N, Kunac A, Merchant AM. A Review of Endoscopic Simulation: Current Evidence on Simulators and Curricula. JOURNAL OF SURGICAL EDUCATION 2016; 73:12-23. [PMID: 26699281 DOI: 10.1016/j.jsurg.2015.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 08/27/2015] [Accepted: 09/01/2015] [Indexed: 06/05/2023]
Abstract
Upper and lower endoscopy is an important tool that is being utilized more frequently by general surgeons. Training in therapeutic endoscopic techniques has become a mandatory requirement for general surgery residency programs in the United States. The Fundamentals of Endoscopic Surgery has been developed to train and assess competency in these advanced techniques. Simulation has been shown to increase the skill and learning curve of trainees in other surgical disciplines. Several types of endoscopy simulators are commercially available; mechanical trainers, animal based, and virtual reality or computer-based simulators all have their benefits and limitations. However they have all been shown to improve trainee's endoscopic skills. Endoscopic simulators will play a critical role as part of a comprehensive curriculum designed to train the next generation of surgeons. We reviewed recent literature related to the various types of endoscopic simulators and their use in an educational curriculum, and discuss the relevant findings.
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Affiliation(s)
- Neil King
- Division of General Surgery, Department of General Surgery, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, New Jersey
| | - Anastasia Kunac
- Division of Trauma, Department of General Surgery, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, New Jersey
| | - Aziz M Merchant
- Division of General Surgery, Department of General Surgery, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, New Jersey.
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Harpham-Lockyer L, Laskaratos FM, Berlingieri P, Epstein O. Role of virtual reality simulation in endoscopy training. World J Gastrointest Endosc 2015; 7:1287-1294. [PMID: 26675895 PMCID: PMC4673391 DOI: 10.4253/wjge.v7.i18.1287] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/20/2015] [Accepted: 10/27/2015] [Indexed: 02/05/2023] Open
Abstract
Recent advancements in virtual reality graphics and models have allowed virtual reality simulators to be incorporated into a variety of endoscopic training programmes. Use of virtual reality simulators in training programmes is thought to improve skill acquisition amongst trainees which is reflected in improved patient comfort and safety. Several studies have already been carried out to ascertain the impact that usage of virtual reality simulators may have upon trainee learning curves and how this may translate to patient comfort. This article reviews the available literature in this area of medical education which is particularly relevant to all parties involved in endoscopy training and curriculum development. Assessment of the available evidence for an optimal exposure time with virtual reality simulators and the long-term benefits of their use are also discussed.
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Patel NR, Makai GE, Sloan NL, Della Badia CR. Traditional Versus Simulation Resident Surgical Laparoscopic Salpingectomy Training: A Randomized Controlled Trial. J Minim Invasive Gynecol 2015; 23:372-7. [PMID: 26590067 DOI: 10.1016/j.jmig.2015.11.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 11/02/2015] [Accepted: 11/08/2015] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVES To evaluate the effectiveness of the porcine training model for obstetrics-gynecology (OB/GYN) residents in laparoscopic salpingectomy. DESIGN Randomized, controlled single-blinded trial. CLASSIFICATION Canadian Task Force Classification I. SETTING A large community-based teaching hospital. PARTICIPANTS All postgraduate year 1 through year 4 OB/GYN residents were enrolled (n = 22). INTERVENTION All participants underwent a preintervention objective skills assessment test (OSAT), in which the participant performed live human laparoscopic salpingectomy. Residents were randomly assigned (using a computer-generated randomization table, in blocks of 2, stratified by ranked baseline OSAT scores) to the intervention or control group. The intervention group consisted of 1 educational session with presession assigned reading, a 40-min didactic lecture, viewing of a procedural video, and simulation and practice of laparoscopic salpingectomy on a porcine cadaver. The control group received traditional training per routine residency rotations. MEASUREMENTS AND MAIN RESULTS Laparoscopic salpingectomy was performed on live patients by study participants pre- and postintervention. These procedures were video recorded, and then scored by a single blinded evaluator of the OSATs. Nine pre- and postintervention OSAT indicators, reflecting provider knowledge and skill, were the primary outcome measures. Secondary outcomes were the changes in 10 subjective measures of comfort, assessed by a pre- and postintervention survey. The outcomes were assessed using 5-point Likert scales (for OSATs 1 = lowest score; for the subjective survey 1 = highest score). The control group OSAT scores did not change (pre: 26.6 ± 10.8, post: 26.2 ± 10.1; p = .65). There were significant improvements in 2-handed surgery (pre: 2.8 ± 1.6, post: 3.5 ± 1.3; p = .004) and use of energy (pre: 2.9 ± 1.3, post: 3.6 ± 1.0; p = .01) in the intervention group, contributing to an overall score change (pre: 26.7 ± 10.6, post: 29.9 ± 9.8; p ≤ .001). The control group had no change in comfort levels. The intervention group experienced both increases (anatomy, steps of surgery, 2-handed surgery, and use of energy) and decreases (reading and learning in operating room) in reported comfort levels. CONCLUSION This study demonstrates that simulation can improve surgical technique OSATs. However, of 45 possible points, both groups' average scores were <70% of the optimum. Thus, the improvement, although statistically significant, was relatively small and indicates that further supplementation in training is needed to substantially increase the residents' surgical skills.
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Affiliation(s)
- Nima R Patel
- Department of Minimally Invasive Gynecologic Surgery, Christiana Care Health Systems, Newark, Delaware.
| | - Gretchen E Makai
- Department of Minimally Invasive Gynecologic Surgery, Christiana Care Health Systems, Newark, Delaware
| | - Nancy L Sloan
- Department of Obstetrics and Gynecology, Women's and Children's Health Research, Christiana Care Health Systems, Newark, Delaware
| | - Carl R Della Badia
- Department of Obstetrics and Gynecology, Drexel University School of Medicine, Philadelphia, Pennsylvania
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Rozeboom ED, Broeders IAMJ, Fockens P. Feasibility of joystick guided colonoscopy. J Robot Surg 2015; 9:173-8. [PMID: 26531196 PMCID: PMC4540779 DOI: 10.1007/s11701-015-0511-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 04/28/2015] [Indexed: 12/11/2022]
Abstract
The flexible endoscope is increasingly used to perform minimal invasive interventions. A novel add-on platform allows single-person control of both endoscope and instrument at the site of intervention. The setup changes the current routine of handling the endoscope. This study aims to determine if the platform allows effective and efficient manipulation to position the endoscope at potential intervention sites throughout the bowel. Five experts in flexible endoscopy first performed three colonoscopies on a computer simulator using the conventional angulation wheels. Next they trained with the joystick interface to achieve their personal level of intubation time with low pain score. 14 PhD students (novices) without hands-on experience performed the same colonoscopy case using either the conventional angulation wheels or joystick interface. Both novice groups trained to gain the average expert level. The cecal intubation time, pain score and visualization performance (% of bowel wall) were recorded. All experts reached their personal intubation time in 6 ± 6 sessions. Three experts completed their learning curve with low pain score in 8 ± 6 sessions. The novices required 11 ± 6 sessions using conventional angulation wheels, and 12 ± 6 sessions using the joystick interface. There was no difference in the visualization performance between the novice and between the expert groups. This study shows that the add-on platform enables endoscope manipulation required to perform colonoscopy. Experts need only a relatively short training period. Novices are as effective and as efficient in endoscope manipulation when comparing the add-on platform with conventional endoscope control.
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Affiliation(s)
- Esther D Rozeboom
- Department of Robotics and Mechatronics, Faculty of Electrical Engineering, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
| | - Ivo A M J Broeders
- Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands. .,Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands.
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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Abstract
The possible involvement, although limited to the diagnostic phase of the procedure, of nonmedical staff (particularly endoscopy nurses) in lower digestive endoscopy has recently been suggested. Computer-based simulators have demonstrated objective evaluation of technical skills in digestive endoscopy. The aim of this study was to evaluate basic colonoscopy skills of endoscopy nurses (naive operators), as compared with junior physician staff and senior endoscopists, through a virtual reality colonoscopy simulator. In this single-center, prospective, nonrandomized study, 3 groups of digestive endoscopy operators (endoscopy nurses, junior doctors [<150 previous colonoscopies], expert doctors [>500 previous colonoscopies and >200/year]) completed six diagnostic cases generated by an endoscopic simulator (AccuTouch, Immersion Medical, Gaithersburg, MD). The performance parameters, collected by the simulator, were compared between groups. Five parameters have been considered for statistical analysis: time spent to reach the cecum; pain of any degree; severe/extreme pain; amount of insufflated air; percentage of visualized mucosa. Statistical analysis to compare the three groups has been performed by means of Wilcoxon test for two independent samples and by means of Kruskal-Wallis test for three independent samples (p < .05). Sixteen operators have been studied (six endoscopy nurses, five junior doctors, and five senior doctors); 96 colonoscopic procedures have been evaluated. Statistically significant differences between experts and naive operators were observed regarding time to reach the cecum and induction of severe/extreme pain, with both Kruskal-Wallis and Wilcoxon test (p < .05); all other comparisons did not reach statistical significance. Although, as expected, expert doctors exceeded both junior doctors and naive operators in some relevant quality parameters of simulated diagnostic colonoscopies, the results obtained by less expert performers--and particularly by nursing staff--appear satisfactory as in regards to most of the considered quality parameters and suggest a potential value of this device in effectively teaching basic lower digestive endoscopy to beginners in a relatively short time.
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Nerup N, Preisler L, Svendsen MBS, Svendsen LB, Konge L. Assessment of colonoscopy by use of magnetic endoscopic imaging: design and validation of an automated tool. Gastrointest Endosc 2015; 81:548-54. [PMID: 25257129 DOI: 10.1016/j.gie.2014.07.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 07/08/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Yield and safety of colonoscopy are highly dependent on operator competence. Existing tools for assessing competence is time-consuming and based on direct observation, making them prone for bias. There is a need for an easily accessible, reliable, and valid measure of endoscopic performance. OBJECTIVE The aim of this study was to develop and explore the validity of an automated, unbiased assessment tool. DESIGN We tested 10 experienced endoscopists and 11 trainees in colonoscopy on a physical simulator (Kagaku Colonoscope Training Model). Participants were tested with an easy and a difficult case. SETTING Center for Clinical Education, Capital Region of Denmark. MAIN OUTCOME MEASUREMENTS By using magnetic endoscopic imaging, we developed a colonoscopy progression score (CoPS). A pass/fail score was established by using the contrast-group method. RESULTS We found significant differences in performance between the 2 groups using the CoPS in both case scenarios (easy: P < .001, difficult: P < .01). LIMITATIONS Small sample sizes. The heterogeneity of the experienced group resulted in a high passing score for the difficult case, which led to the failing of the less experienced in the group. The CoPS does not consider polyp detection rate, tissue damage, or patient discomfort. CONCLUSIONS We developed a score of progression in colonoscopy, based on magnetic endoscopic imaging. With the same tool, a map of progression in colonoscopy can be provided. The CoPS and map of progression in colonoscopy could, with further development, be a valuable tool in colonoscopy training, providing live feedback and aid in unbiased certification.
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Affiliation(s)
- Nikolaj Nerup
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Herlev, Denmark
| | - Louise Preisler
- Department of Surgical Gastroenterology, Copenhagen University, Rigshospitalet, Copenhagen, Denmark
| | | | - Lars Bo Svendsen
- Department of Surgical Gastroenterology, Copenhagen University, Rigshospitalet, Copenhagen, Denmark
| | - Lars Konge
- Centre for Clinical Education (CEKU), Copenhagen University, Rigshospitalet, Copenhagen, Denmark
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Gomez PP, Willis RE, Van Sickle K. Evaluation of two flexible colonoscopy simulators and transfer of skills into clinical practice. JOURNAL OF SURGICAL EDUCATION 2015; 72:220-227. [PMID: 25239553 DOI: 10.1016/j.jsurg.2014.08.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 07/14/2014] [Accepted: 08/15/2014] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Surgical residents have learned flexible endoscopy by practicing on patients in hospital settings under the strict guidance of experienced surgeons. Simulation is often used to "pretrain" novices on endoscopic skills before real clinical practice; nonetheless, the optimal method of training remains unknown. The purpose of this study was to compare endoscopic virtual reality and physical model simulators and their respective roles in transferring skills to the clinical environment. METHODS At the beginning of a skills development rotation, 27 surgical postgraduate year 1 residents performed a baseline screening colonoscopy on a real patient under faculty supervision. Their performances were scored using the Global Assessment of Gastrointestinal Endoscopic Skills (GAGES). Subsequently, interns completed a 3-week flexible endoscopy curriculum developed at our institution. One-third of the residents were assigned to train with the GI Mentor simulator, one-third trained with the Kyoto simulator, and one-third of the residents trained using both simulators. At the end of their rotations, each postgraduate year 1 resident performed one posttest colonoscopy on a different patient and was again scored using GAGES by an experienced faculty. RESULTS A statistically significant improvement in the GAGES total score (p < 0.001) and on each of its subcomponents (p = 0.001) was observed from pretest to posttest for all groups combined. Subgroup analysis indicated that trainees in the GI Mentor or both simulators conditions showed significant improvement from pretest to posttest in terms of GAGES total score (p = 0.017 vs 0.024, respectively). This was not observed for those exclusively using the Kyoto platform (p = 0.072). Nonetheless, no single training condition was shown to be a better training modality when compared to others in terms of total GAGES score or in any of its subcomponents. CONCLUSION Colonoscopy simulator training with the GI Mentor platform exclusively or in combination with a physical model simulator improves skill performance in real colonoscopy cases when measured with the GAGES tool.
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Affiliation(s)
- Pedro Pablo Gomez
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
| | - Ross E Willis
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Kent Van Sickle
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Koch AD, Ekkelenkamp VE, Haringsma J, Schoon EJ, de Man RA, Kuipers EJ. Simulated colonoscopy training leads to improved performance during patient-based assessment. Gastrointest Endosc 2015; 81:630-6. [PMID: 25475901 DOI: 10.1016/j.gie.2014.09.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 09/03/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Virtual reality (VR) endoscopy simulators are increasingly being used in the training of novice endoscopists. There are, however, insufficient data regarding the effect of simulator training on the early learning curve of novice endoscopists. OBJECTIVE The aim of this study was to assess the clinical performance of novice endoscopists during colonoscopy after intensive and prolonged training on a VR endoscopy simulator. DESIGN Prospective study. SETTING Single university medical center. PATIENTS Patient-based assessment (PBA) of performance was carried out on patients routinely scheduled for colonoscopy. INTERVENTIONS Eighteen trainees without any endoscopic experience were included in the study. They were divided into 2 groups. The simulator-training program consisted of either 50 (group I) or 100 (group II) VR colonoscopies. After 10, 30, and 50 (group I) and after 20, 60, and 100 (group II) VR colonoscopies, trainees underwent both simulator-based assessment and PBA. MAIN OUTCOME MEASUREMENTS Cecal intubation time, colonic insertion depth, and cecal intubation rate. RESULTS Eighteen novices participated in the study. All completed VR training and assessments. The mean cecal intubation time on the SBA decreased from a baseline of 9.50 minutes to 2.20 minutes at completion of the training (P = .002). Colonic insertion depth during PBA improved from 29.4 cm to 63.7 cm (P < .001). The learning effect of simulator training ceased after 60 colonoscopies. LIMITATIONS Single-center study, no formal sample size calculation. CONCLUSIONS VR training by using a colonoscopy simulator leads to a significant improvement in performance with the simulator itself and, more importantly, to significantly improved performances during patient-based colonoscopy. This study demonstrates the rationale for intensive simulator training in the early learning curve of novices performing colonoscopy.
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Affiliation(s)
- Arjun D Koch
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Vivian E Ekkelenkamp
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Jelle Haringsma
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Erik J Schoon
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, the Netherlands
| | - Robert A de Man
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Preisler L, Svendsen MBS, Nerup N, Svendsen LB, Konge L. Simulation-based training for colonoscopy: establishing criteria for competency. Medicine (Baltimore) 2015; 94:e440. [PMID: 25634177 PMCID: PMC4602958 DOI: 10.1097/md.0000000000000440] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The aim of this study was to create simulation-based tests with credible pass/fail standards for 2 different fidelities of colonoscopy models. Only competent practitioners should perform colonoscopy. Reliable and valid simulation-based tests could be used to establish basic competency in colonoscopy before practicing on patients. Twenty-five physicians (10 consultants with endoscopic experience and 15 fellows with very little endoscopic experience) were tested on 2 different simulator models: a virtual-reality simulator and a physical model. Tests were repeated twice on each simulator model. Metrics with discriminatory ability were identified for both modalities and reliability was determined. The contrasting-groups method was used to create pass/fail standards and the consequences of these were explored. The consultants significantly performed faster and scored higher than the fellows on both the models (P < 0.001). Reliability analysis showed Cronbach α = 0.80 and 0.87 for the virtual-reality and the physical model, respectively. The established pass/fail standards failed one of the consultants (virtual-reality simulator) and allowed one fellow to pass (physical model). The 2 tested simulations-based modalities provided reliable and valid assessments of competence in colonoscopy and credible pass/fail standards were established for both the tests. We propose to use these standards in simulation-based training programs before proceeding to supervised training on patients.
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Affiliation(s)
- Louise Preisler
- From the Department of Surgical Gastroenterology and transplantation, Rigshospitalet, and Copenhagen University (LP,LBS), Centre for Clinical Education (CEKU) and Copenhagen University (MBSS,LK), Department of Surgical Gastroenterology, University hospital of Herlev (NN), Copenhagen University Hospital, Herlev, The Capital Region of Denmark
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Singh S, Sedlack RE, Cook DA. Effects of simulation-based training in gastrointestinal endoscopy: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2014; 12:1611-23.e4. [PMID: 24509241 DOI: 10.1016/j.cgh.2014.01.037] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 01/18/2014] [Accepted: 01/25/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Simulation-based training (SBT) in gastrointestinal endoscopy has been increasingly adopted by gastroenterology fellowship programs. However, the effectiveness of SBT in enhancing trainee skills remains unclear. We performed a systematic review with a meta-analysis of published literature on SBT in gastrointestinal endoscopy. METHODS We performed a systematic search of multiple electronic databases for all original studies that evaluated SBT in gastrointestinal endoscopy in comparison with no intervention or alternative instructional approaches. Outcomes included skills (in a test setting), behaviors (in clinical practice), and effects on patients. We pooled effect size (ES) using random-effects meta-analysis. RESULTS From 10,903 articles, we identified 39 articles, including 21 randomized trials of SBT, enrolling 1181 participants. Compared with no intervention (n = 32 studies), SBT significantly improved endoscopic process skills in a test setting (ES, 0.79; n = 22), process behaviors in clinical practice (ES, 0.49; n = 8), time to procedure completion in both a test setting (ES, 0.79; n = 16) and clinical practice (ES, 0.75; n = 5), and patient outcomes (procedural completion and risk of major complications; ES, 0.45; n = 10). Only 5 studies evaluated the comparative effectiveness of different SBT approaches; which provided inconclusive evidence regarding feedback and simulation modalities. CONCLUSIONS Simulation-based education in gastrointestinal endoscopy is associated with improved performance in a test setting and in clinical practice, and improved patient outcomes compared with no intervention. Comparative effectiveness studies of different simulation modalities are limited.
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Affiliation(s)
- Siddharth Singh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Robert E Sedlack
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - David A Cook
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota; Office of Education Research, Mayo Medical School, Rochester, Minnesota.
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Yoshida N, Fernandopulle N, Inada Y, Naito Y, Itoh Y. Training methods and models for colonoscopic insertion, endoscopic mucosal resection, and endoscopic submucosal dissection. Dig Dis Sci 2014; 59:2081-90. [PMID: 25102984 DOI: 10.1007/s10620-014-3308-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 07/17/2014] [Indexed: 12/17/2022]
Abstract
Colonoscopic examination is considered an effective examination for the detection of colorectal cancers. Additionally, early colorectal cancers can be resected using endoscopic techniques such as endoscopic mucosal resection and endoscopic submucosal dissection. However, those examinations and treatments need special techniques. Various training methods are practiced to acquire such endoscopic techniques throughout the world. In clinical cases, magnetic positioning devices help endoscopic insertion by less experienced endoscopists. There is a physical model made by polyvinyl chloride and a virtual simulator for training of colonoscopic insertion. Various techniques including a method to apply pressure to the abdomen and consideration for patient's pain can be trained using these models. In view of extensive training of endoscopic mucosal resection and endoscopic submucosal dissection, animal models are useful and actually used. Live animal models of minipig, which entails blood flow, are ideal and used frequently, but are cumbersome to prepare. On the other hand, ex vivo animal models using intestine of porcine and bovine are convenient for preparation and less expensive. Unique ex vivo animal models with blood flow have been developed recently and techniques for hemostasis can be practiced. With respect to a method of training for colorectal endoscopic submucosal dissection, a stepwise system has been adopted throughout the world. Thus, first they observe the expert's technique, then practice training of animal models, and finally, they perform clinical rectal cases. The system is useful for a safe and definite procedure. In this review, we reveal various training methods for colonoscopic examinations and treatments.
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Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan,
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White I, Buchberg B, Tsikitis VL, Herzig DO, Vetto JT, Lu KC. A virtual reality endoscopic simulator augments general surgery resident cancer education as measured by performance improvement. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2014; 29:333-336. [PMID: 24493635 DOI: 10.1007/s13187-014-0610-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Colorectal cancer is the second most common cause of death in the USA. The need for screening colonoscopies, and thus adequately trained endoscopists, particularly in rural areas, is on the rise. Recent increases in required endoscopic cases for surgical resident graduation by the Surgery Residency Review Committee (RRC) further emphasize the need for more effective endoscopic training during residency to determine if a virtual reality colonoscopy simulator enhances surgical resident endoscopic education by detecting improvement in colonoscopy skills before and after 6 weeks of formal clinical endoscopic training. We conducted a retrospective review of prospectively collected surgery resident data on an endoscopy simulator. Residents performed four different clinical scenarios on the endoscopic simulator before and after a 6-week endoscopic training course. Data were collected over a 5-year period from 94 different residents performing a total of 795 colonoscopic simulation scenarios. Main outcome measures included time to cecal intubation, "red out" time, and severity of simulated patient discomfort (mild, moderate, severe, extreme) during colonoscopy scenarios. Average time to intubation of the cecum was 6.8 min for those residents who had not undergone endoscopic training versus 4.4 min for those who had undergone endoscopic training (p < 0.001). Residents who could be compared against themselves (pre vs. post-training), cecal intubation times decreased from 7.1 to 4.3 min (p < 0.001). Post-endoscopy rotation residents caused less severe discomfort during simulated colonoscopy than pre-endoscopy rotation residents (4 vs. 10%; p = 0.004). Virtual reality endoscopic simulation is an effective tool for both augmenting surgical resident endoscopy cancer education and measuring improvement in resident performance after formal clinical endoscopic training.
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Affiliation(s)
- Ian White
- Department of Surgery, Division of General and Gastrointestinal Surgery, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Rd., Mail code L223-A, Portland, OR, 97239, USA
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Dawe SR, Pena GN, Windsor JA, Broeders JAJL, Cregan PC, Hewett PJ, Maddern GJ. Systematic review of skills transfer after surgical simulation-based training. Br J Surg 2014; 101:1063-76. [PMID: 24827930 DOI: 10.1002/bjs.9482] [Citation(s) in RCA: 269] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Simulation-based training assumes that skills are directly transferable to the patient-based setting, but few studies have correlated simulated performance with surgical performance. METHODS A systematic search strategy was undertaken to find studies published since the last systematic review, published in 2007. Inclusion of articles was determined using a predetermined protocol, independent assessment by two reviewers and a final consensus decision. Studies that reported on the use of surgical simulation-based training and assessed the transferability of the acquired skills to a patient-based setting were included. RESULTS Twenty-seven randomized clinical trials and seven non-randomized comparative studies were included. Fourteen studies investigated laparoscopic procedures, 13 endoscopic procedures and seven other procedures. These studies provided strong evidence that participants who reached proficiency in simulation-based training performed better in the patient-based setting than their counterparts who did not have simulation-based training. Simulation-based training was equally as effective as patient-based training for colonoscopy, laparoscopic camera navigation and endoscopic sinus surgery in the patient-based setting. CONCLUSION These studies strengthen the evidence that simulation-based training, as part of a structured programme and incorporating predetermined proficiency levels, results in skills transfer to the operative setting.
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Affiliation(s)
- S R Dawe
- Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S), Royal Australasian College of Surgeons, University of Adelaide, Queen Elizabeth Hospital, Adelaide, South Australia
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Qiao W, Bai Y, Lv R, Zhang W, Chen Y, Lei S, Zhi F. The effect of virtual endoscopy simulator training on novices: a systematic review. PLoS One 2014; 9:e89224. [PMID: 24586609 PMCID: PMC3931711 DOI: 10.1371/journal.pone.0089224] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 01/17/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Advances in virtual endoscopy simulators have paralleled an interest in medical simulation for gastrointestinal endoscopy training. OBJECTIVE The primary objective was to determine whether the virtual endoscopy simulator training could improve the performance of novices. DESIGN A systematic review. SETTING Randomized controlled trials (RCTs) that compared virtual endoscopy simulator training with bedside teaching or any other intervention for novices were collected. PATIENTS Novice endoscopists. INTERVENTIONS The PRISMA statement was followed during the course of the research. The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and ScienceDirect were searched (up to July 2013). Data extraction and assessment were independently performed. MAIN OUTCOME MEASUREMENTS Independent procedure completion, total procedure time and required assistance. RESULTS Fifteen studies (n = 354) were eligible for inclusion: 9 studies designed for colonoscopy training, 6 for gastroscopy training. For gastroscopy training, procedure completed independently was reported in 87.7% of participants in simulator training group compared to 70.0% of participants in control group (1 study; 22 participants; RR 1.25; 95% CI 1.13-1.39; P<0.0001). For colonoscopy training, procedure completed independently was reported in 89.3% of participants in simulator training group compared to 88.9% of participants in control group (7 study; 163 participants; RR 1.10; 95% CI 0.88-1.37; P = 0.41; I(2) = 85%). LIMITATIONS The included studies are quite in-homogeneous with respect to training schedule and procedure. CONCLUSIONS Virtual endoscopy simulator training might be effective for gastroscopy, but so far no data is available to support this for colonoscopy.
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Affiliation(s)
- Weiguang Qiao
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, China
| | - Yang Bai
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, China
| | - Ruxi Lv
- School of Traditional Chinese Medicine, Southern Medical University, Research Institute of Traditional Chinese Medicine, Guangdong Medical College, Zhanjiang City, Guangdong Province, China
| | - Wendi Zhang
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, China
| | - Yuqing Chen
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, China
| | - Shan Lei
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, China
| | - Fachao Zhi
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, China
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Abstract
OBJECTIVES Evaluating the patient impact of health professions education is a societal priority with many challenges. Researchers would benefit from a summary of topics studied and potential methodological problems. We sought to summarize key information on patient outcomes identified in a comprehensive systematic review of simulation-based instruction. DATA SOURCES Systematic search of MEDLINE, EMBASE, CINAHL, PsychINFO, Scopus, key journals, and bibliographies of previous reviews through May 2011. STUDY ELIGIBILITY Original research in any language measuring the direct effects on patients of simulation-based instruction for health professionals, in comparison with no intervention or other instruction. APPRAISAL AND SYNTHESIS Two reviewers independently abstracted information on learners, topics, study quality including unit of analysis, and validity evidence. We pooled outcomes using random effects. RESULTS From 10,903 articles screened, we identified 50 studies reporting patient outcomes for at least 3,221 trainees and 16,742 patients. Clinical topics included airway management (14 studies), gastrointestinal endoscopy (12), and central venous catheter insertion (8). There were 31 studies involving postgraduate physicians and seven studies each involving practicing physicians, nurses, and emergency medicine technicians. Fourteen studies (28 %) used an appropriate unit of analysis. Measurement validity was supported in seven studies reporting content evidence, three reporting internal structure, and three reporting relations with other variables. The pooled Hedges' g effect size for 33 comparisons with no intervention was 0.47 (95 % confidence interval [CI], 0.31-0.63); and for nine comparisons with non-simulation instruction, it was 0.36 (95 % CI, -0.06 to 0.78). LIMITATIONS Focused field in education; high inconsistency (I(2) > 50 % in most analyses). CONCLUSIONS Simulation-based education was associated with small-moderate patient benefits in comparison with no intervention and non-simulation instruction, although the latter did not reach statistical significance. Unit of analysis errors were common, and validity evidence was infrequently reported.
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