Dana A Telem, MD, David W Rattner, MD, Denise W Gee, MD
Massachusetts General Hospital
Introduction: The purpose of this study is to determine whether independent training on the GI Mentor (Simbionix, Cleveland, OH) can accelerate the acquisition of endoscopic proficiency by novice surgical interns.
Methods: Nine novice surgical interns underwent a prospective study comparing colonoscopy performance in a live swine model before and after participation in a simulator curriculum. At the beginning of the study, each intern performed a colonoscopy in a swine model to serve as his or her own baseline control. An independent observer evaluated each intern for the ability to reach the cecum within 20 minutes and also determined a score based on the validated GAGES-C assessment criteria. Each intern then underwent 12 hours of independent training on the GI mentor over 6 weeks. At the conclusion of training, a post test of 2 basic simulated colonoscopy modules was completed. Metrics evaluated included: percent of mucosal surface examined, efficiency, percentage of time with clear view, number of times luminal view was lost, and time to reach the cecum. Interns then repeated a colonoscopy in a swine model and were evaluated by the same independent observer. As a control, 3 attending physicians who routinely perform colonoscopy also performed colonoscopy in the live swine model and were evaluated by GAGES-C.
Results: Prior to simulator curriculum, 1(11%) intern successfully intubated the cecum with time to reach cecum of 19.56 minutes. Following training, 6 (67%) interns successfully intubated the cecum which was statistically significant when compared to pre-training (p<0.05). Mean time to cecum post-training was 9.2 minutes. There was also statistically significant improvement in 4 out of 5 GAGES-C criteria in interns pre- and post-simulator training(Table 1). All 3 experts were able to reach the cecum with mean time of 4.40 minutes. Comparison of expert to post-curriculum intern times demonstrated that time to cecum was significantly faster in experts (4.4vs.9.2 minutes, p<0.05), respectively. Comparison of interns who were and were not able to reach cecum following the simulator curriculum demonstrated a correlation between successful swine colonoscopy and GI Mentor in the efficiency (79% vs 67.1%, p=0.05) and time to cecum (3.37 vs.5.59 minutes, p=0.01) metrics. No other significant difference was demonstrated in GAGES-C categories or other simulator parameter.
Conclusion: Simulator training on the GI Mentor alone significantly improved endoscopic skills in novice surgical interns as demonstrated in a swine model. This study supports the role for endoscopic simulator training in surgical resident education as an adjunct to clinical experience. Future studies with a larger sample size will be necessary to evaluate endoscopic skill retention as well as endoscopic proficiency in mid-level residents.
| Gages-C criteria |
Mean Score+SD: Pre-training |
Mean Score + SD: Post-training | P-value |
| Colonoscope Navigation | 3 ± 0.5 | 3.67 ± 0.5 | 0.012 |
| Navigation Stratagies | 2.78 ± 0.67 | 3.67 ± 0.5 | 0.006 |
| Maintenance of Clear Field | 3.33 ± 0.29 | 3.56 ± 0.18 | 0.52 |
| Quality of Colonoscopy | 2.33 ± 0.5 | 3.67 ± 0.5 | 0.0001 |
| Overall Score | 11.44 ± 1.81 | 14.56 ± 1.33 | 0.008 |
Session: Poster Presentation
Program Number: P136
