Test-retest evaluation of a low-cost training tool for advanced endoscopic skills

Andrea V Kwong, MASc¹, Oscar M Crespin, MD¹, Ilay Habaz¹, Pietro Riva, MD², Ethan Weiss¹, Silvana Perretta, MD², Lee L Swanstrom, MD³, Allan Okrainec, MD¹, Eran Shlomovitz, MD¹. ¹University Health Network, Toronto, Canada, ²IRCAD-IHU, Strasbourg, France, ³The Oregon Clinic, Portland, United States

Background: The Fundamentals of Endoscopic Surgery (FES) curriculum was developed in response to the increasing use of flexible endoscopy. FES is a high stakes exam, passing of which is required for board certification in general surgery in the United States, but it currently only exists as an examination tool and does not allow students to practice before the test. As the FES system was primarily designed for evaluation purposes, there is an urgent need for an affordable, easily accessible tool for trainee practice of therapeutic endoscopic skills. We previously reported on the adaptation of the Fundamentals of Laparoscopic Surgery (FLS) trainer box to the practice of six basic endoscopic skills. As a part of ongoing validation, participants taking part in an endoscopic training course were tested on the adapted trainer box at the beginning and at completion of the course.

Methods: Participants (n=31) with varying levels of endoscopy experience were recruited from an endoscopic education course (Strasbourg, France) and consisted of general surgery and gastroenterology staff, residents, and fellows. They were evaluated on six tasks using an adapted endoscopic trainer tool on two occasions approximately 12 weeks apart. The six tasks included: (1) forward view peg transfer, (2) retroflexion view peg transfer, (3) puncturing, (4) snaring, (5) clipping, and (6) cannulation. Participants were given a maximum time of 5 minutes to complete each task. Task times were obtained by evaluators using video recordings from the gastroscope camera. Participants were categorized as experts or novices based on the number of endoscopic procedures previously performed. For each expertise group, differences in task time between test administrations were examined with pairwise comparisons using Wilcoxon tests.

Results/Conclusions: Following a formal endoscopic training course, novices improved times needed to complete six tasks on an adapted FLS trainer box for endoscopic skills. These improvements were statistically significant for four of the tasks (Table 1). In contrast, experts only showed significant improvement for the cannulation task following the training course. These pairwise comparisons may reflect the ability of the endoscopic trainer tool to show improvement with training among novices and also consistency in performance among experts.