Cohen J, Cohen SA, Vora KC, et al. Multicenter, randomized, controlled trial of virtual-reality simulator training in acquisition of competency in colonoscopy

Columbia University, New York, New York, United States
Gastrointestinal Endoscopy (Impact Factor: 5.37). 09/2006; 64(3):361-8. DOI: 10.1016/j.gie.2005.11.062
Source: PubMed


The GI Mentor is a virtual reality simulator that uses force feedback technology to create a realistic training experience.
To define the benefit of training on the GI Mentor on competency acquisition in colonoscopy.
Randomized, controlled, blinded, multicenter trial.
Academic medical centers with accredited gastroenterology training programs.
First-year GI fellows.
Subjects were randomized to receive 10 hours of unsupervised training on the GI Mentor or no simulator experience during the first 8 weeks of fellowship. After this period, both groups began performing real colonoscopies. The first 200 colonoscopies performed by each fellow were graded by proctors to measure technical and cognitive success, and patient comfort level during the procedure.
A mixed-effects model comparison between the 2 groups of objective and subjective competency scores and patient discomfort in the performance of real colonoscopies over time.
Forty-five fellows were randomized from 16 hospitals over 2 years. Fellows in the simulator group had significantly higher objective competency rates during the first 100 cases. A mixed-effects model demonstrated a higher objective competence overall in the simulator group (P < .0001), with the difference between groups being significantly greater during the first 80 cases performed. The median number of cases needed to reach 90% competency was 160 in both groups. The patient comfort level was similar.
Fellows who underwent GI Mentor training performed significantly better during the early phase of real colonoscopy training.

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    • "However , transferability of simulation to performance on live patients is incompletely proven in alimentary endoscopy. Although several studies report benefit from endoscopic simulation [16e18], these gains may diminish with clinical experience [19] [20]. The Fundamentals of Endoscopic Surgery program further necessitates flexible endoscopy simulators, for, which the fixed cost of $50e100,000 may be prohibitive among smaller programs. "
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    ABSTRACT: Background: As work hour restrictions increasingly limit some operative experiences, personalized evaluative methods are needed. We prospectively assessed the value of cumulative sum (Cusum) to measure proficiency with percutaneous endoscopic gastrostomy (PEG) among surgical trainees. Materials and methods: Nine postgraduate year 1 surgery residents each underwent a 1-month rotation dedicated to endoscopy. Procedure durations for all PEG insertions were recorded prospectively. Criteria for task failure included need for attending takeover or procedure duration >10 min. Cusum parameters were defined a priori, with acceptable and unacceptable failure rates of 5% and 15%, respectively. Concurrently, expert endoscopists blinded to Cusum results evaluated trainee proficiency weekly using a multicategory, five-point Likert-scale survey. Results: Nine surgical residents performed an average of 21 PEGs each. Expert evaluations and Cusum analyses identified eight and seven participants who attained proficiency after a median of 11.5 and 12 cases, respectively. For four of the residents who achieved proficiency by Cusum criteria, eventual relapses to inadequate performance were identified. These relapses were not detected by expert evaluation. Six participants who attained proficiency by both metrics performed a combined 32 superfluous cases, which could have been redistributed to poor-performing trainees. Conclusions: Although lacking the granular insight of expert evaluations, Cusum analysis is more sensitive to relapses of subproficient performance. Adding Cusum analysis to expert evaluations can provide longitudinal, formative feedback and promote efficient redistribution of operative experiences.
    Journal of Surgical Research 05/2014; 192(1). DOI:10.1016/j.jss.2014.05.056 · 1.94 Impact Factor
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    • "Fundamentally, there has been a long-standing assumption that skills acquired from simulation settings are transferrable to the operating room, to reduce patient-based training time, improve operating theatre efficacy and ultimately improve patient safety, hence the development of simulation training. This review concluded that on the whole simulation training does transfer to the operative setting and is a safe and effective means for adjunct surgical education particularly in novice trainees, as it helps eliminate part of the steep learning curve [16-18], and improve visuo-spatial awareness [15]. The difficulty though, is that transference cannot solely be attributed to simulator models, as other factors must also play a role, in other words acquisition of technical skill is only one aspect of surgical training [15]. "
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    ABSTRACT: Over the past decade, driven by advances in educational theory and pressures for efficiency in the clinical environment, there has been a shift in surgical education and training towards enhanced simulation training. Microsurgery is a technical skill with a steep competency learning curve on which the clinical outcome greatly depends. This paper investigates the evidence for educational and training interventions of traditional microsurgical skills courses in order to establish the best evidence practice in education and training and curriculum design. A systematic review of MEDLINE, EMBASE, and PubMed databases was performed to identify randomized control trials looking at educational and training interventions that objectively improved microsurgical skill acquisition, and these were critically appraised using the BestBETs group methodology. The databases search yielded 1,148, 1,460, and 2,277 citations respectively. These were then further limited to randomized controlled trials from which abstract reviews reduced the number to 5 relevant randomised controlled clinical trials. The best evidence supported a laboratory based low fidelity model microsurgical skills curriculum. There was strong evidence that technical skills acquired on low fidelity models transfers to improved performance on higher fidelity human cadaver models and that self directed practice leads to improved technical performance. Although there is significant paucity in the literature to support current microsurgical education and training practices, simulated training on low fidelity models in microsurgery is an effective intervention that leads to acquisition of transferable skills and improved technical performance. Further research to identify educational interventions associated with accelerated skill acquisition is required.
    Archives of Plastic Surgery 07/2013; 40(4):312-9. DOI:10.5999/aps.2013.40.4.312
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    • "Much controversy, however, exists in terms of the amount and format of pre-operating room training necessary for safe performance of various endoscopic procedures [23, 24]. Recently, multiple randomised studies have been able to show a beneficial impact on trainee’s endoscopic performance after training with innovative training devices, such as virtual reality simulators [25–29]. "
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