High-Tech, or the Right-Tech? Development of a Mid-Tech, Physical Model for Endoscopic Training

Brenton R Franklin, MD¹, Tiffany C Cox, MD¹, Kristen D Trinca, MD², Mercy D Wagner, MD¹, Sarah B Placek, MD¹, Mary T O’Donnell, MD¹, Sarah M Haviland, BS³, Jonathan P Pearl, MD, FACS⁴, E. Matthew Ritter, MD, FACS¹. ¹Division of General Surgery, USU/Walter Reed Department of Surgery, Bethesda MD; National Capital Simulation Consortium, Bethesda MD, ²Division of General Surgery, USU/Walter Reed Department of Surgery, Bethesda MD, ³Divi

Objective: Currently, the American Board of Surgery requires general surgery residents to pass the Fundamentals of Endoscopic Surgery (FES) exam as part of the Flexible Endoscopy Curriculum to become board eligible. Present endoscopic training relies heavily on highly technical virtual reality (VR) simulators which are expensive, lack haptic feedback, and are prone to technical failure.  Physical models often have no built in metrics, can be overly simple, and require presence of faculty for feedback. To date, there are no physical endoscopic training platforms with automated metrics that allow trainees to improve their endoscopic skills and prepare them to pass the FES skills exam. Partially funded by a SAGES grant, we have developed a technically-enhanced physical training model that fills a void between traditional physical simulation and virtual reality.

Description and Methodology: The physical platform is based on the Kyoto Kagaku colonoscopy model.  It consists of a body form similar to the original model, and a new straight segment model incorporating electric circuit technology. Three tasks were developed for the straight model including scope manipulation, tool targeting, and a retroflexion task. Two additional tasks were developed for the body model including loop reduction and mucosal inspection, and it can also be reconfigured to simulate variations in human anatomy. Both models were designed and developed to simulate tasks that represent the domain of flexible gastrointestinal endoscopic skills. The models give accurate haptic feedback, and use basic electric circuitry to provide real-time visual and auditory feedback, potentially reducing the requirement for faculty observation through automation of fundamental performance metrics.

Preliminary Results: The early prototypes of this model have shown validity evidence when used to assess endoscopists during initial skills acquisition in previously published studies. Over a period of 24 months, preliminary testing identified and corrected minor technical flaws, which have resulted in a reliable, durable, production quality training model. Currently, a multi-institutional trial is underway to evaluate the effectiveness of this new simulator in a Mastery-learning curriculum.

Conclusions / Future Directions: This training model represents a higher fidelity physical model for endoscopic skills. We believe our “right-tech” physical simulator fills a void between current low-tech physical models and high-tech VR simulators. These new models should provide more realistic training, present fewer technical failures, and reduce additional personnel cost. Future directions aim to evaluate these models as training platforms for the FES skills exam.