The efficacy of training insertion skill on a physical model colonoscopy simulator

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.

• References

• 1 Sedlack RE. Endoscopic simulation: where we have been and where we are going. Gastrointest Endosc 2005; 61: 216-218
• 2 Sedlack RE. Simulators in training: defining the optimal role for various simulation models in the training environment. Gastrointest Endosc Clin N Am 2006; 16: 553-563
• 3 Reznick RK, MacRae H. Teaching surgical skills – changes in the wind. N Engl J Med 2006; 355: 2664-2669
• 4 Williams CB, Thomas-Gibson S. Rational colonoscopy, realistic simulation, and accelerated teaching. Gastrointest Endosc Clin N Am 2006; 16: 457-470
• 5 Sedlack RE, Kolars JC. Computer simulator training enhances the competency of gastroenterology fellows at colonoscopy: results of a pilot study. Am J Gastroenterol 2004; 99: 33-37
• 6 Park J, MacRae H, Musselman LJ et al. Randomized controlled trial of virtual reality simulator training: transfer to live patients. Am J Surg 2007; 194: 205-211
• 7 Ahlberg G, Hultcrantz R, Jaramillo E et al. Virtual reality colonoscopy simulation: a compulsory practice for the future colonoscopist?. Endoscopy 2005; 37: 1198-1204
• 8 Cohen J, Cohen SA, Vora KC et al. Multicenter, randomized, controlled trial of virtual-reality simulator training in acquisition of competency in colonoscopy. Gastrointest Endosc 2006; 64: 361-368
• 9 Gomez PP, Willis RE, Van Sickle K. Evaluation of two flexible colonoscopy simulators and transfer of skills into clinical practice. J Surg Educ 2015; 72: 220-227
• 10 Sturm LP, Windsor JA, Cosman PH et al. A systematic review of skills transfer after surgical simulation training. Ann Surg 2008; 248: 166-179
• 11 Tsuda S, Scott D, Doyle J et al. Surgical skills training and simulation. Curr Probl Surg 2009; 46: 271-370
• 12 Hill A, Horswill MS, Plooy AM et al. A systematic evaluation of the realism of four colonoscopy simulators. Gastrointest Endosc 2012; 75: 631-640
• 13 Plooy AM, Hill A, Horswill MS et al. Construct validation of a physical model colonoscopy simulator. Gastrointest Endosc 2012; 76: 144-150
• 14 Nerup N, Preisler L, Svendsen MBS et al. Assessment of colonoscopy by use of magnetic endoscopic imaging: design and validation of an automated tool. Gastrointest Endosc 2015; 81: 548-554
• 15 Preisler L, Svendsen MBS, Nerup N et al. Simulation-based training for colonoscopy: establishing criteria for competency. Medicine (Baltimore) 2015; 94: e440
• 16 Cass OW. Objective evaluation of competence: technical skills in gastrointestinal endoscopy. Endoscopy 1995; 27: 86-89
• 17 Marshall JB. Technical proficiency of trainees performing colonoscopy: a learning curve. Gastrointest Endosc 1995; 42: 287-291
• 18 Spier BJ, Benson M, Pfau PR et al. Colonoscopy training in gastroenterology fellowships: determining competence. Gastrointest Endosc 2009; 71: 319-324
• 19 Lee SH, Chung IK, Kim SJ et al. An adequate level of training for technical competence in screening and diagnostic colonoscopy: a prospective multicenter evaluation of the learning curve. Gastrointest Endosc 2008; 67: 683-689
• 20 Chak A, Cooper GS, Blades EW et al. Prospective assessment of colonoscopic intubation skills in trainees. Gastrointest Endosc 1996; 44: 217-230
• 21 Dogramadzi S, Virk GS, Bell GD et al. Recording forces exerted on the bowel wall during colonoscopy: in vitro evaluation. Int J Med Robot 2005; 1: 89-97
• 22 Appleyard MN, Mosse CA, Mills TN et al. The measurement of forces exerted during colonoscopy. Gastrointest Endosc 2000; 52: 237-240
• 23 Fairhurst K, Strickland A, Maddern GJ. Simulation speak. J Surg Ed 2011; 68: 382-386
• 24 Kaltenbach T, Leung C, Wu K et al. Use of the colonoscope training model with the colonoscope 3D imaging probe improved trainee colonoscopy performance: a pilot study. Dig Dis Sci 2011; 56: 1496-1502
• 25 Yoshida N, Fernandopulle N, Inada Y et al. Training methods and models for colonoscopic insertion, endoscopic mucosal resection, and endoscopic submucosal dissection. Dig Dis Sci 2014; 59: 2081-2090
• 26 Brown LD, Cai TT, Das Gupta A. Interval estimation for a binomial proportion. Stat Sci 2001; 16: 101-133
• 27 Cohen J. A power primer. Psychol Bull 1992; 112: 155-159
• 28 Rosnow RL, Rosenthal R. Computing contrasts, effect sizes, and counternulls on other people’s published data: General procedures for research consumers. Psychol Meth 1996; 1: 331-340
• 29 Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, New Jersey: L. Erlbaum Associates; 1988
• 30 Kotrlik JW, Williams HA. The incorporation of effect size in information technology, learning, and performance research. Inform Technol Learn Perform J 2003; 21: 1-7
• 31 Sedlack RE. The state of simulation in endoscopy education: continuing to advance toward our goals. Gastroenterology 2013; 144: 9-12
• 32 Zupanc CM, Burgess-Limerick R, Hill A et al. A competency framework for colonoscopy training derived from cognitive task analysis techniques and expert review. BMC Med Ed 2015; 15: 216
• 33 Edwards WH. Motor learning and control: from theory to practice. Belmont, CA: Wadsworth Cengage Learning; 2011