Mizota Tomoko, MD1, Nick Anton1, Mark Manwaring, MD2, William W Hope, MD3, Ranjan Sudan4, Raghid Bitar5, Michael Guzman1, Dimitrios Stefanidis1. 1Indiana University, 2East Carolina University, 3New Hanover Regional Medical Center, 4Duke University, 5University of North Carolina
Introduction: Gastrointestinal (GI) endoscopy is a vital skill for general surgeons. The proficiency of graduating general surgery residents in endoscopy has recently been questioned. Given that the number of endoscopic procedures performed during training is only a weak indicator of skill, the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has developed the Fundamentals of Endoscopic Surgery (FES) program that objectively assesses endoscopic knowledge and technical skill. Nevertheless, a standardized effective simulation-based curriculum for the acquisition of endoscopic skills to complement FES has currently not been established. The purpose of this study was to report our efforts with the development of a proficiency-based endoscopic skills curriculum at a state level.
Methods: Multi-institutional study across 5 residency training programs in North Carolina funded by SAGES. Five experts in endoscopy reviewed the FES online cognitive curriculum and developed a 60 multiple-choice question test for endoscopic knowledge assessment. They then performed several repetitions on select FES representative tasks on three endoscopic simulators (GI Mentor, EndoVR GI, and Kyoto model) available at the participating training programs. Experts practiced until their performance plateaued in two consecutive attempts; the scores achieved during these last two attempts on each simulator were then averaged to develop performance goals for proficiency-based training of residents on each respective simulator.
Results: Expert derived performance goals were developed for 5 tasks of the GI Mentor simulator, 6 tasks of the EndoVR GI simulator and the Kyoto colonoscopy model. Performance metrics chosen as goals included time to procedure completion, % mucosa visualization, applied force, and patient discomfort. Using an evidence-based approach informed by the newly developed performance goals and cognitive test we developed a proficiency-based endoscopic skills curriculum that can be used independent of simulator availability at each participating site.
Conclusion: A proficiency-based endoscopic skills curriculum was developed for resident training across general surgery residency programs in North Carolina agnostic to the simulator available at each institution. Using a standardized methodology expert-derived performance goals and a cognitive test have been established and incorporated into this curriculum. Our hypothesis is that successful completion of this curriculum will enable residents to reach optimal readiness for the FES exam; to test it, we are conducting a randomized controlled trial that will compare training following this curriculum vs traditional skills training in endoscopy at our participating sites.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79466
Program Number: P298
Presentation Session: Poster (Non CME)
Presentation Type: Poster