Multicenter, randomized, controlled trial of virtual-reality simulator training in acquisition of competency in colonoscopy
ABSTRACT 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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ABSTRACT: The aim of this study was to create simulation-based tests with credible pass/fail standards for 2 different fidelities of colonoscopy models.Only competent practitioners should perform colonoscopy. Reliable and valid simulation-based tests could be used to establish basic competency in colonoscopy before practicing on patients.Twenty-five physicians (10 consultants with endoscopic experience and 15 fellows with very little endoscopic experience) were tested on 2 different simulator models: a virtual-reality simulator and a physical model. Tests were repeated twice on each simulator model. Metrics with discriminatory ability were identified for both modalities and reliability was determined. The contrasting-groups method was used to create pass/fail standards and the consequences of these were explored.The consultants significantly performed faster and scored higher than the fellows on both the models (P < 0.001). Reliability analysis showed Cronbach α = 0.80 and 0.87 for the virtual-reality and the physical model, respectively. The established pass/fail standards failed one of the consultants (virtual-reality simulator) and allowed one fellow to pass (physical model).The 2 tested simulations-based modalities provided reliable and valid assessments of competence in colonoscopy and credible pass/fail standards were established for both the tests. We propose to use these standards in simulation-based training programs before proceeding to supervised training on patients.Medicine 01/2015; 94(4). DOI:10.1097/MD.0000000000000440 · 4.87 Impact Factor
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ABSTRACT: OBJECTIVE: Gastrointestinal endoscopy is a complex task that involves an interaction of cognitive and manual skills. There is no consensus on the optimal way to teach endoscopy. We sought to evaluate our formal endoscopy curriculum for general surgery trainees to improve the effectiveness and quality of the endoscopy teaching in this program. DESIGN: We conducted focus group sessions over a 2-year period. Participants were general surgery residents, who are at the end of their endoscopy training rotation. The goal was to obtain the opinions and perceptions of trainees actively involved in learning endoscopy. SETTING: University-based general surgery residency. PARTICIPANTS: Second-year general surgery residents. RESULTS: A total of 24 residents participated in 7 focus group sessions over 2 years. Four central themes emerged that included training structure and expectations, development of endoscopy competence, teaching approaches and teaching tools, and recommendations for improvement of the training experience. CONCLUSIONS: An assessment of the themes led to the following concrete suggestions for improvement: the development of an algorithmic approach to endoscopy for the novice learner, consideration to introduce additional experience in endoscopy later in the 5-year surgery program, and consideration to incorporate a train-the-trainer curriculum for faculty that teach endoscopy.Journal of Surgical Education 08/2014; 71(6). DOI:10.1016/j.jsurg.2014.05.016 · 1.39 Impact Factor
Article: Surgical Rehearsal Platform[Show abstract] [Hide abstract]
ABSTRACT: Surgical training has remained remarkably similar in many respects since the early days of halstedian training. Neurosurgery is a demanding field that requires extensive cognitive, perceptive, and technical training. Surgical simulation is a promising approach to facilitate acquiring proficiency in neurosurgical procedures. Simulation can permit mentoring trainees in a “safe” environment. By incorporating images that depict specific abnormalities in actual patients, simulation can provide realistic rehearsal for any given case for both novice and experienced surgeons in much the same way that data acquired from drones can be used to allow pilots to rehearse mission-critical maneuvers in a simulator before taking flight. Most neurosurgical simulators to date have focused on endovascular procedures, spinal procedures, temporal bone dissection, and stereotactic procedures. The use of simulator technology for microsurgery is in its infancy. This article describes a novel simulator technology developed by Surgical Theater LLC (http://www.surgicaltheater.net/home.html) called the Selman Surgical Rehearsal Platform. The platform shows promise for use in intracranial microvascular procedures, which require experience that is becoming increasingly limited for trainees who have to become proficient in more procedures in much less time than ever before. ABBREVIATIONS: FDA, Food and Drug Administration SSRP, Selman Surgical Rehearsal PlatformNeurosurgery 01/2013; 73:S122-S126. DOI:10.1227/NEU.0000000000000099 · 3.03 Impact Factor