Impact of a simulation training curriculum on technical and nontechnical skills in colonoscopy: a randomized trial

Samir C Grover; Ankit Garg; Michael A Scaffidi; Jeffrey J Yu; Ian S Plener; Elaine Yong; Maria Cino; Teodor P Grantcharov; Catharine M Walsh

doi:10.1016/j.gie.2015.04.008

Impact of a simulation training curriculum on technical and nontechnical skills in colonoscopy: a randomized trial

Gastrointest Endosc. 2015 Dec;82(6):1072-9. doi: 10.1016/j.gie.2015.04.008. Epub 2015 May 23.

Authors

Samir C Grover¹, Ankit Garg¹, Michael A Scaffidi¹, Jeffrey J Yu², Ian S Plener¹, Elaine Yong³, Maria Cino⁴, Teodor P Grantcharov⁵, Catharine M Walsh⁶

Affiliations

¹ Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
² Wilson Centre, University of Toronto, Toronto, Ontario, Canada.
³ Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Gastroenterology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
⁴ Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Gastroenterology, University Health Network, Toronto, Ontario, Canada.
⁵ Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada.
⁶ Wilson Centre, University of Toronto, Toronto, Ontario, Canada; Division of Gastroenterology, Hepatology and Nutrition, and the Learning Institute, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.

PMID: 26007221
DOI: 10.1016/j.gie.2015.04.008

Abstract

Background: GI endoscopy simulation-based training augments early clinical performance; however, the optimal manner by which to deliver training is unknown.

Objective: We aimed to validate a simulation-based structured comprehensive curriculum (SCC) designed to teach technical, cognitive, and integrative competencies in colonoscopy.

Design: Single-blinded, randomized, controlled trial.

Setting: Endoscopic simulation course at an academic hospital.

Participants and interventions: Thirty-three novice endoscopists were allocated to an SCC group or self-regulated learning (SRL) group. The SCC group received a curriculum consisting of 6 hours of didactic lectures and 8 hours of virtual reality simulation-based training with expert feedback. The SRL group was provided a list of desired objectives and was instructed to practice on the simulator for an equivalent time (8 hours).

Main outcome measurements: Clinical transfer was assessed during 2 patient colonoscopies using the Joint Advisory Group Direct Observation of Procedural Skills (JAG DOPS) scale. Secondary outcome measures included differences in procedural knowledge, immediate post-training simulation performance, and delayed post-training (4-6 weeks) performance during an integrated scenario test on the JAG DOPS communication and integrated scenario global rating scales.

Results: There was no significant difference in baseline or post-training performance on the simulator task. The SCC group performed superiorly during their first and second clinical colonoscopies. Additionally, the SCC group demonstrated significantly better knowledge and colonoscopy-specific performance, communication, and global performance during the integrated scenario.

Limitations: We were unable to measure SRL participants' effort outside of mandatory training. In addition, feedback metrics and number of available simulation cases are limited.

Conclusions: These results support integration of endoscopy simulation into a structured curriculum incorporating instructional feedback and complementary didactic knowledge as a means to augment technical, cognitive, and integrative skills acquisition, as compared with SRL on virtual reality simulators. (

Clinical trial registration number: NCT01991522.)

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Video-Audio Media

MeSH terms

Adult
Clinical Competence*
Colonoscopy / education*
Curriculum*
Female
Humans
Male
Ontario
Prospective Studies
Simulation Training / methods*
Single-Blind Method

Associated data

ClinicalTrials.gov/NCT01991522