Teaching PerOral Endoscopic Myotomy (POEM) to practicing surgeons: An ‘into the fire’ pre-/post-test curriculum

Matthew A Zapf, BA¹, Maria A Cassera, BS², Lee L Swanstrom, MD², Michael B Ujiki, MD³. ¹Loyola Stritch School of Medicine, ²The Oregon Clinic, ³NorthShore University HealthSystem

Introduction:

PerOral Endoscopic Myotomy (POEM) is growing due to efficacious results in achalasia and expanding indications. We evaluated a methodology for teaching a new procedure like POEM to experienced practitioners.

Methods:

Three POEM courses were taught by nine 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 POEM procedure on an ex-plant model 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.

Results:

Thirty-two participants with varying degrees of experience in upper-GI endoscopy (Range: 50-200+; median: 200+) and laparoscopic achalasia cases (Range: 0-200+; median: 26-50) completed the POEM course. Participants improved knowledge quiz scores from 68.3% pre-test to 84.7% post-test (p<0.01). POEM performance increased from 14.2 to 25.2 (p<0.001) with the greatest gains in mucosotomy (2.6 v 4.4 p<0.01) and closure (2.1 v 4.5 p<0.01). Participants rated the ex-vivo model as very good (4.4 ± 0.7) and live porcine model as excellent (4.9 ± 0.2). They praised the pre-/post-test design as very helpful (4.4 ± 0.8) and most appreciated the troubleshooting portion of the lecture series. Ninety-five percent of subjects stated achieving all of their learning goals.

Conclusions:

A multimodal curriculum with procedural pre-testing was an effective curricular design for teaching POEM to experienced practitioners. This curriculum methodology may be useful for teaching emerging procedures in the future.