Tomokazu Kishiki, MD1, Lave Patel, MD1, Matthew Zapf, BS1, Matthew Gitelis2, Brittany Lapin, PhD1, Maria A Cassera, BS3, Lee L Swanström, MD2, Michael B Ujiki, MD1. 1NorthShore University Health System, A Teaching Affiliate of the University of Chicago, 2Loyola Stritch School of Medicine, 3The Oregon Clinic
Introduction: PerOral Endoscopic Myotomy (POEM) continues to gain favor as both primary and secondary treatment options for achalasia. Several series continue to show promising long-term outcomes. As the indications for POEM continue to emerge, these techniques are increasingly being adopted by endoscopists and the need for appropriate training for such advanced techniques continues to evolve. We present a hands-on- focused approach with pre-and post testing methods to teach these skills.
Methods: Six POEM courses were taught by eleven experienced POEM endosurgeons at two independent simulation laboratories. The courses consisted of a knowledge-based quiz, demographics and feedback surveys, lectures on patient selection, technique, and troubleshooting as well as POEM procedural simulation on live porcine and ex-plant models. A scoring sheet assessed POEM performance with a likert-like scale measuring equipment setup, mucosotomy, endoscope navigation, visualization, myotomy, and closure. A pre-/post-test design forced participants to attempt the procedure and take a knowledge based quiz before lectures and the question & answer session. Post-testing was conducted at the conclusion of the course and feedback was assessed. Additionally, participants were analyzed by experience with upper-GI endoscopy: Novices <100 cases versus Experts ≥100 cases.
Results: Sixty-five participants with varying degrees of experience in upper-GI endoscopy (Range: 0-200+; median: 200+) and laparoscopic achalasia cases (Range: 0-200+ cases; median: 26-50) completed the course. Participants improved knowledge scores from 69.7% pre-test to 87.7% post-test (p<0.01). POEM performance increased from 15.1 to 25.0 (out of 30) (p<0.01) with the greatest gains in mucosotomy (1.7 v 4.4 (out of 5), p<0.01) and equipment (3.4 v 4.7 p<0.01). Ninety-two percent of participants rated the ex-vivo model as very good or excellent and 98% rated the live porcine model as excellent. Ninety-five percent praised the pre-/post-test design as very helpful and most appreciated the troubleshooting portion of the lecture series. Ninety-eight percent of subjects stated achieving all of their learning goals. Novices had significantly lower pre-test scores as compared to Experts in upper-GI endoscopy (overall pre-score: 12 ± 6 versus 16 ± 5, p<0.01). They improved significantly more over the course, and there were no differences between post-test scores (overall post-score: 24 ± 7 versus 25 ± 5, p=0.34).
Conclusions: A multimodal curriculum with procedural pre-testing was an effective curricular design for teaching POEM to experienced practitioners. The curriculum was specifically helpful for training surgeons with less upper-GI endoscopy experience. This curriculum methodology may be useful for teaching emerging procedures in the future.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79243
Program Number: S115
Presentation Session: Education Technology, Teaching and Learning
Presentation Type: Podium