A Proficiency Based Skills Training Curriculum for the Sages Step (surgical Training for Endoscopic Proficiency) Program

Victor T Wilcox, MD, Ted Trus, MD, Jose M Martinez, MD, Brian J Dunkin, MD

The Methodist Hospital, Dartmouth-Hitchcock, the University of Miami

INTRODUCTION The STEP program is a collaborative project between SAGES and Olympus America Inc. dedicated to providing flexible endoscopy equipment and a curriculum for training to all surgical residency programs in the US. Currently, the STEP curriculum does not include proficiency based training on physical models that can be used with the equipment. This study developed two novel flexible endoscopy simulators, purchased a third, and then established face and content validity as well as proficiency metrics for training on all three using the STEP endoscopic equipment.

METHODS Three flexible endoscopy simulators were tested. The first was an upper gastrointestinal (UGI) tract model made from foam and cardboard that requires navigation and target identification using a gastroscope. The second was a commercially available colonoscopy model (CM-15, Olympus, Japan) configured with a redundant sigmoid colon. The third was an endoscopic targeting model (as required in biopsy and polypectomy) created from pool vacuum hose and the Operation Game (Hasbro, USA). Performance metrics with time and accuracy measures were developed for the models and the performance of twelve expert surgical endoscopists recorded for each. Proficiency scores were calculated by discarding the best and worst performance times and then calculating a mean expert proficiency time. Face and content validity were established through post test questionnaires using a 5-point Likert scale with strong descriptors.

RESULTS All experts were right handed males, average age 40, with a mean of 8 years of endoscopic practice (range 1 – 24). Eighty three percent teach residents or fellows and use simulation to do so. Most perform over 50 upper endoscopies (51 to > 500) and 100 colonoscopies (101 to > 500) per year. The average time for complete navigation of the UGI model with correct identification of all targets was 133 ± 52 seconds. Complete navigation of the colonoscopy model with correct loop reduction averaged 285 ± 97 seconds. Proper orientation and successful targeting using the Operation Game model averaged 250 ± 94 seconds with 3 errors. The Operation Game simulator had the strongest face and content validity results (100% agreed or strongly agreed that the technical skills required reflected those needed in clinical endoscopy and that the task encompassed skills sets an experienced endoscopist should have) followed by the colonoscopy model (82% respectively) and the UGI model (64% and 73% respectively). The Operation Game simulator was also the most favorably reviewed in regard to appropriate difficulty (100% agreed), usefulness for training (100% agreed), and suitability for initial training in flexible endoscopy (82% agreed). The estimated cost of the UGI model is less than $5; colonoscopy model ~ $1,800; and Operation Game model ~ $50.

CONCLUSION This study proves face and content validity for three physical flexible GI endoscopy simulators that can be used to train in upper and lower endoscopy as well as instrument targeting. It also establishes expert proficiency metrics that can be used by trainees for structured rehearsal. These relatively inexpensive models will be incorporated into the STEP curriculum.

Session: Podium Presentation

Program Number: S109

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