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Proficiency-Based Skills Curriculum for Fundamentals of Endoscopic Surgery

Tomoko Mizota, MD, Nicholas E Anton, MS, Michael J Guzman, MD, Jennifer N Choi, MD, Dimitrios Stefanidis, MD, PhD. Indiana University School of Medicine

Introduction: Fundamentals of Endoscopic Surgery (FES) has become a requirement for all general surgery residents in order to complete residency. While the FES program provides a robust online didactic curriculum and high stakes assessment, a skills curriculum which would prepare learners’ endoscopic skill for their exam is currently lacking. Proficiency-based skills training ensures uniform skill acquisition and has been proven effective in improving clinical performance. The purpose of this study was to develop a proficiency-based endoscopic skills curriculum, assess the feasibility of its implementation in a surgical residency program, and assess its effectiveness on enabling learners to successfully complete the FES exam.

Methods: The endoscopic skills curriculum developed required the review of the FES online didactic modules and successful completion of a knowledge test (>80% correct). In addition, residents had to practice on five select modules of the GI Mentor (colonoscopy and upper endoscopy) until predetermined, expert-derived performance scores had been achieved. Simulator generated metrics and the NASA-Task Load Index (TLX) which assesses perceived work load were used for objective and subjective performance assessment. The curriculum was implemented either during a month-long endoscopy rotation alongside the resident’s clinical endoscopy experience (for PGY 2) or in isolation (other PGY levels). Resident knowledge and technical skill were assessed at the beginning and the end of training. Once residents achieved passing scores, they were allowed to take the formal FES exam. Knowledge test scores, simulator performance data, and NASA-TLX perceived scores were compared between baseline and post-training assessments with the Wilcoxon signed rank test. Successful completion of the FES exam was recorded.

Results: Fifteen general surgery residents (PGY 2-5) successfully completed the curriculum and post-training assessment. Knowledge test scores significantly improved between baseline and post-training assessments (Table). Four residents had to retake the test to achieve the passing score. Most simulator metrics improved between the two assessments. Although the percentage of mucosal surface examined slightly declined for colonoscopy, it was still higher than the proficiency level. NASA-TLX perceived performance scores also improved after training. All residents that took the FES certification exam passed.

Conclusion: The proficiency-based endoscopic skills curriculum we developed was successfully implemented in our general surgery residency program, and allowed participating residents to pass the FES exam. This curriculum may prove valuable to other residency programs.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 87937

Program Number: S081

Presentation Session: MIS Education Session

Presentation Type: Podium

65

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