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Mousset RA, de Vos tot Nederveen Cappel WH, Pierie JPE, Brand PL, Langers AM. Endoscopy training in the Netherlands: a national survey among gastroenterology residents. Endosc Int Open 2022; 10:E1548-E1554. [PMID: 36531681 PMCID: PMC9754879 DOI: 10.1055/a-1953-9288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/30/2022] [Indexed: 10/14/2022] Open
Abstract
Background and study aims Training in endoscopy is a key objective of gastroenterology residency. There is currently no standardized or systematic training approach. This study evaluated and compared the current status of gastrointestinal endoscopy training programs in all teaching hospitals in the Netherlands from a resident perspective. Materials and methods A national online survey with open and closed questions on gastrointestinal endoscopy training was administered to all gastroenterology residents (N = 180) in the eight educational regions in the Netherlands. Results One hundred residents who had already started endoscopy training were included in the analyses. Sixty-five residents (65 %) were satisfied with their endoscopy training program. Participation in a preclinical endoscopy course was mandatory in seven of eight educational regions. Residents from the region without a mandatory endoscopy training course were significantly less likely to be satisfied with their endoscopy training program (32 %, P = .011). Criteria used to determine the level of supervision differed greatly between teaching hospitals (e. g. assessed endoscopy competence, predefined period of time or number of procedures). Only 26 residents (26 %) reported uniformity in teaching methods and styles between different supervising gastroenterologists in their teaching hospital. Conclusions Although most gastroenterology residents were satisfied with the endoscopy training program and endoscopy supervision in their teaching hospital, this study identified considerable local and regional variability. Future studies should be conducted to evaluate the trainers' perspective and trainers' behavior during endoscopy training sessions, which might eventually lead to the development of best practices regarding endoscopy training, including standardization of training programs and supervision methods.
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Affiliation(s)
- Robert A. Mousset
- Lifelong Learning, Education and Assessment Research Network (LEARN), University Medical Center Groningen, Groningen, the Netherlands,Department of Gastroenterology and Hepatology, Isala Zwolle, Zwolle, the Netherlands
| | | | - Jean-Pierre E.N. Pierie
- Department Of Surgery, Medical Center Leeuwarden, Leeuwarden, the Netherlands and Wenckebach Institute for Education and Training, University Medical Center Groningen, Groningen, the Netherlands
| | - Paul L.P. Brand
- Lifelong Learning, Education and Assessment Research Network (LEARN), University Medical Center Groningen, Groningen, the Netherlands,Department of Medical Education and Faculty Development, Isala Zwolle, Zwolle, the Netherlands
| | - Alexandra M.J. Langers
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
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Silva Mendes S, Areia M, Dinis Ribeiro M, Rolanda C. The Impact of a Structured Virtual Reality Simulation Training Curriculum for Novice Endoscopists. GE Port J Gastroenterol 2021; 29:385-392. [PMID: 36545187 PMCID: PMC9761362 DOI: 10.1159/000519927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/08/2021] [Indexed: 12/24/2022]
Abstract
Background Current evidence supports the use of virtual reality (VR) simulation-based training for novice endoscopists. However, there is still a need for a standardized induction programme which ensures sufficient preparation, with knowledge and basic skills, before their approach to patient-based training. We designed a structured progressive programme in upper endoscopy and colonoscopy and aimed to determine its impact on cognitive and technical performance. Methods Prospective, multicentre study, focused on "Endoscopy I, 2018," a course with a theoretical and a hands-on module (20 h) in the GI Mentor II®. Gastroenterology residents of the 1st year were enrolled. A pre-test and test were applied to evaluate the cognitive component, and a pre-training and post-training esophagogastroduodenoscopy (EGD) and colonoscopy VR cases were used to evaluate the technical component. The hands-on training included psychomotor exercises (Navigation I, Endobubble I), 4 EGD, and 4 colonoscopy VR cases. The metrics applied for technical skills evaluation were time to reach the second portion of duodenum (D2)/cecum (seconds), efficiency of screening (%), and time the patient was in pain (%). Results Twenty-three participants were included, majority female (67%), 26 ± 0.7 years old. Comparing the pre-test versus test, the cognitive score significantly improved (11/15 vs. 14/15; p < 0.001). Considering the technical assessment after training: in EGD, the time to D2 was significantly lower (193 vs. 63 s; p < 0.001), and the efficiency of screening significantly better (64 vs. 91%; p < 0.001); in colonoscopy, the time to reach the cecum was significantly lower (599 vs. 294 s; p = 0.001), the time the patient was in pain was significantly lower (27 vs. 10%; p = 0.005), and the efficiency of screening had a tendency towards improvement (50 vs. 68%; p = 0.062). Conclusion The proposed training curriculum in basic endoscopy for novices is aligned with international recommendations and demonstrated a significant impact on cognitive and technical skills learning achievements.
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Affiliation(s)
- Sofia Silva Mendes
- Department of Gastroenterology, Hospital Braga, Braga, Portugal,School of Medicine, University of Minho, Braga, Portugal,Life and Health Sciences Research Institute/3B's e PT Government Associate Laboratory, Braga/Guimarães, Portugal,*Sofia da Silva Mendes,
| | - Miguel Areia
- Department of Gastroenterology, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal,CIDES/CINTESIS, Porto Faculty of Medicine, Porto, Portugal
| | - Mário Dinis Ribeiro
- Department of Gastroenterology, Portuguese Oncology Institute of Porto, Porto, Portugal,CIDES/CINTESIS, Porto Faculty of Medicine, Porto, Portugal
| | - Carla Rolanda
- Department of Gastroenterology, Hospital Braga, Braga, Portugal,School of Medicine, University of Minho, Braga, Portugal,Life and Health Sciences Research Institute/3B's e PT Government Associate Laboratory, Braga/Guimarães, Portugal
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Engelke M, Grund KE, Schilling D, Beilenhoff U, Stebner F, Kugler C. Development and Pilot Validation of an Instrument Assessing Sensorimotor Skills for Percutaneous Gastral Puncture. Visc Med 2020; 37:212-218. [PMID: 34250079 DOI: 10.1159/000511350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 09/03/2020] [Indexed: 12/11/2022] Open
Abstract
Introduction The acquisition of sensorimotor skills, so-called "technical skills", plays an essential part in the professional and continuing educational training of medical and nursing staff. Facilities turn to simulator training to promote the safe and accurate performance of endoscopic examinations. Thus, this study aimed to develop and pilot-test a corresponding assessment instrument to monitor necessary sensorimotor or "technical" skills of the examiner for a safe percutaneous endoscopic gastrostomy (AS-PEG). Materials and Methods Instrument development and pilot validation involved four stages: identification of potential items and initial draft of the AS-PEG; expert panel with 11 experts (content validity index [CVI] calculated); empirical validation using a quasi-experimental intervention on simulators; revision of the pilot AS-PEG taking expert assessment, and empirical testing into consideration. Results The initial instrument yielded 13 categories and 44 items describing the PEG procedure. Experts rated 30 out of 44 items (68%) extremely or very important for the safety of the puncture of the stomach. Initial item-CVIs ranged from 0.00 to 1.00; scale-CVI was 0.61. Twenty-four trainees (7 physicians, 17 nurses) participated in the pilot simulation study. On average, 8:25 min were required for PEG placement (min-max 5:59-13:38 min, SD = 1:43). The revised AS-PEG version was reduced to 14 items with a range of the item CVI from 0.8 to 1.0, and a scale-CVI of 0.90. Conclusion The AS-PEG instrument facilitates the evaluation of sensorimotor skills during percutaneous gastric puncture procedures within the context of PEG placement, across professions and without relating to the number of procedures previously performed. The instrument is economical and shows satisfying content validity.
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Affiliation(s)
- Monika Engelke
- Department of Nursing Science, University Witten/Herdecke, Witten, Germany
| | - Karl Ernst Grund
- Center of Medical Research, University Clinics Tübingen, Tübingen, Germany
| | - Dieter Schilling
- Medical Clinic II, Diakonissen Hospital Mannheim, Mannheim, Germany
| | | | - Ferdinand Stebner
- Department of Research on Learning and Instruction/Institute of Educational Science, Ruhr University Bochum, Bochum, Germany
| | - Christiane Kugler
- Institute of Nursing Science, Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
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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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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: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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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: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [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; I2 = 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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