How We Do It: Creation of a Low-Cost Endoscopic Skills Model for Fundamentals of Endoscopic Surgery Training

Democratizing Flexible Endoscopy Training: Noninferiority Randomized Trial Comparing a Box-Trainer vs a Virtual Reality Simulator to Prepare for the Fundamental of Endoscopic Surgery Exam

BACKGROUND

A considerable number of surgical residents fail the mandated endoscopy exam despite having completed the required clinical cases. Low-cost endoscopy box trainers (BTs) could democratize training; however, their effectiveness has never been compared with higher-cost virtual reality simulators (VRSs).

STUDY DESIGN

In this randomized noninferiority trial, endoscopy novices trained either on the VRS used in the Fundamental of Endoscopic Surgery manual skills (FESms) exam or a validated BT-the Basic Endoscopic Skills Training (BEST) box. Trainees were tested at fixed timepoints on the FESms and on standardized ex vivo models. The primary endpoint was FESms improvement at 1 week. Secondary endpoints were FESms improvement at 2 weeks, FESms pass rates, ex vivo tests performance, and trainees' feedback.

RESULTS

Seventy-seven trainees completed the study. VRS and BT trainees showed comparable FESms improvements (25.16 ± 14.29 vs 25.58 ± 11.75 FESms points, respectively; p = 0.89), FESms pass rates (76.32% vs 61.54%, respectively; p = 0.16) and total ex vivo tasks completion times (365.76 ± 237.56 vs 322.68 ± 186.04 seconds, respectively; p = 0.55) after 1 week. Performances were comparable also after 2 weeks of training, but FESms pass rates increased significantly only in the first week. Trainees were significantly more satisfied with the BT platform (3.97 ± 1.20 vs 4.81 ± 0.40 points on a 5-point Likert scale for the VRS and the BT, respectively; p < 0.001).

CONCLUSIONS

Simulation-based training is an effective means to develop competency in endoscopy, especially at the beginning of the learning curve. Low-cost BTs like the BEST box compare well with high-tech VRSs and could help democratize endoscopy training.

Design and Validity Evidence for a Unique Endoscopy Simulator Using a Commercial Video Game

Background Procedural simulation enhances early endoscopy training. Multiple commercial simulators are available; however, their application is limited by cost and poor user compliance. First-person "shooter" (FPS) video games are popular. In this study, we aimed to show that a novel in-house designed colonoscope controller used to play an FPS video game shares similar constructs with real-life endoscopy. Methodology Participants completed the first three levels on an FPS video game, Portal (Valve Corporation, Bellevue, WA), first using a conventional controller and then the modified endoscope controller. A total of 12 expert endoscopists and 12 surgical residents with minimal endoscopy experience were evaluated based on completion time, button presses, and hand motion analyses. Results Experts outperformed novices for completion time (expert: 944 seconds; novice: 1,515 seconds; p = 0.006) and hand movements (expert: 1,263.1; novice: 2,052.6; p = 0.004) in using the novel colonoscope controller. There was no difference in button presses or total path length traveled. Furthermore, performance did not differ using conventional game controls. Conclusions Experts outperformed novices using the endoscope but not the conventional controller with respect to the economy of movement and completion time. This result confirms that our endoscope-controlled video game shares similar paradigms with real-life endoscopy and serves as a first step toward creating a more enjoyable and cheaper alternative to commercially available endoscopy simulators.

Technology facilitation on inclusive learning; higher education institutions in Sri Lanka

Purpose

The application of technology to higher education is contributing in many ways to create a highly adaptable, inclusive learning environment for all. This study intends to analyze the role of technology facilitation in creating an inclusive learning environment in the higher education institutions (HEIs), which would connect multi-ethnic students and academics effectively in the Sri Lankan context. Therefore, the primary aim of this study is to explore how technology facilitates inclusive learning in HEIs.

Design/methodology/approach

Based on the qualitative research approach, this study generated data from 30 undergraduates and 10 academics from 5 national universities in Sri Lanka to evaluate the effectiveness of technological facilitation in promoting inclusive learning. The data were then thematically analyzed using NVivo 10.

Findings

The nature of technology facilitation in HEIs and influencing factors such as the internet, search engines, mobile apps and software, cost involved, upgraded knowledge, time efficiency and technological devices. Further, the factors contribute to the HEIs and the benefits realized, such as information gathering, time-saving, cost reduction, information sharing, connective communication, easy learning and online services. On the other hand, challenges such as the involved parties’ resistance to technological change, inadequate infrastructure facilities, lack of technical knowledge, negative perceptions and behaviors, technical failures and health issues will also be assessed.

Research limitations/implications

Implications for policy and practice include a thorough understanding of the nature of technology facilitation in an inclusive environment. The researcher has recommended some strategies and mechanisms to the policymakers that will guide them to use technology as a tool to enhance the inclusive learning practices within HEIs.

Originality/value

This paper presents an original review and it contextualizes the technology facilitations in respect of the inclusive learning environment in HEIs.