Endoscopic Simulator Curriculum Improves Colonoscopy Performance in Novice Surgical Interns as Demonstrated in a Swine Model

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.

Comparison of GAGES-C Score Pre and Post Simulator Training in Novice Interns

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

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