Preclinical endoscopic training using a part-task simulator: learning curve assessment and determination of threshold score for advancement to clinical endoscopy

BackgroundPreclinical simulator training has the potential to decrease endoscopic procedure time and patient discomfort. This study aims to characterize the learning curve of endoscopic novices in a part-task simulator and propose a threshold score for advancement to initial clinical cases.MethodsTwenty novices with no prior endoscopic experience underwent repeated endoscopic simulator sessions using the part-task simulator. Simulator scores were collected; their inverse was averaged and fit to an exponential curve. The incremental improvement after each session was calculated. Plateau was defined as the session after which incremental improvement in simulator score model was less than 5%. Additionally, all participants filled out questionnaires regarding simulator experience after sessions 1, 5, 10, 15, and 20. A visual analog scale and NASA task load index were used to assess levels of comfort and demand.ResultsTwenty novices underwent 400 simulator sessions. Mean simulator scores at sessions 1, 5, 10, 15, and 20 were 78.5 ± 5.95, 176.5 ± 17.7, 275.55 ± 23.56, 347 ± 26.49, and 441.11 ± 38.14. The best fit exponential model was [time/score] = 26.1 × [session #]−0.615; r2 = 0.99. This corresponded to an incremental improvement in score of 35% after the first session, 22% after the second, 16% after the third and so on. Incremental improvement dropped below 5% after the 12th session corresponding to the predicted score of 265. Simulator training was related to higher comfort maneuvering an endoscope and increased readiness for supervised clinical endoscopy, both plateauing between sessions 10 and 15. Mental demand, physical demand, and frustration levels decreased with increased simulator training.ConclusionPreclinical training using an endoscopic part-task simulator appears to increase comfort level and decrease mental and physical demand associated with endoscopy. Based on a rigorous model, we recommend that novices complete a minimum of 12 training sessions and obtain a simulator score of at least 265 to be best prepared for clinical endoscopy.

[1]  Raúl San José Estépar,et al.  Evaluation of colonoscopy technical skill levels by use of an objective kinematic-based system. , 2011, Gastrointestinal endoscopy.

[2]  C. Thompson,et al.  Development and initial validation of an endoscopic part-task training box , 2014, Endoscopy.

[3]  R. Schmidt,et al.  Motor control and learning: A behavioral emphasis, 4th ed. , 2005 .

[4]  P. Dunckley,et al.  Training in Endoscopy , 2018, Current Treatment Options in Gastroenterology.

[5]  Robert E Sedlack,et al.  Computer Simulator Training Enhances the Competency of Gastroenterology Fellows at Colonoscopy: Results of a Pilot Study , 2004, American Journal of Gastroenterology.

[6]  Timothy D. Lee,et al.  Motor Control and Learning: A Behavioral Emphasis , 1982 .

[7]  P. Bassett,et al.  Simulator training improves practical skills in therapeutic GI endoscopy: results from a randomized, blinded, controlled study. , 2009, Gastrointestinal endoscopy.

[8]  Norman E. Lane,et al.  Skill Acquisition Rates and Patterns: Issues and Training Implications , 1987 .

[9]  Norman E. Lane,et al.  Skill Acquisition Rates and Patterns , 1987 .

[10]  Isao Sakaida,et al.  Prospective randomized study on the use of a computer‐based endoscopic simulator for training in esophagogastroduodenoscopy , 2008, Journal of gastroenterology and hepatology.

[11]  E. Kuipers,et al.  Simulated colonoscopy training leads to improved performance during patient-based assessment. , 2015, Gastrointestinal endoscopy.

[12]  R. Valori,et al.  An analysis of the learning curve to achieve competency at colonoscopy using the JETS database , 2014, Gut.

[13]  Linda S. Lee,et al.  Principles of training in GI endoscopy. , 2012, Gastrointestinal endoscopy.

[14]  Pichamol Jirapinyo,et al.  Validation of an endoscopic part-task training box as a skill assessment tool. , 2015, Gastrointestinal endoscopy.

[15]  S. Hart,et al.  Development of NASA-TLX (Task Load Index): Results of Empirical and Theoretical Research , 1988 .

[16]  R. Schoefl,et al.  Effect of virtual endoscopy simulator training on performance of upper gastrointestinal endoscopy in patients: a randomized controlled trial , 2010, Endoscopy.

[17]  R. Valori,et al.  The learning curve to achieve satisfactory completion rates in upper GI endoscopy: an analysis of a national training database , 2016, Gut.

[18]  L. Gerson,et al.  Evidence-based assessment of endoscopic simulators for training. , 2006, Gastrointestinal endoscopy clinics of North America.

[19]  E. Jaramillo,et al.  Virtual reality colonoscopy simulation: a compulsory practice for the future colonoscopist? , 2005, Endoscopy.

[20]  Y. M. Chung,et al.  Learning curves for colonoscopy: a prospective evaluation of gastroenterology fellows at a single center. , 2010, Gut and liver.

[21]  David Greenwald,et al.  Multicenter, randomized, controlled trial of virtual-reality simulator training in acquisition of competency in colonoscopy. , 2006, Gastrointestinal endoscopy.

[22]  S. Tsuda,et al.  Augmented reality telementoring (ART) platform: a randomized controlled trial to assess the efficacy of a new surgical education technology , 2014, Surgical Endoscopy.