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MEASURING PARAMETERS OF FLEXIBLE SIGMOIDOSCOPY PERFORMANCE ON SIMULATORS BY NURSES AND PHYSICIANS
MA Cooper1,5, CM Walsh2,5, K Gayman3, L Rabeneck1,4,5, H Carnahan5
1Sunnybrook Health Sciences Centre, 2Hospital for Sick Children, 3Princess Margaret Hospital, 4Cancer Care Ontario, 5University of Toronto
AIM: The aim of this project was to determine the effectiveness of a course on the technical performance of flexible sigmoidoscopy (FS) on FS simulators. This work was done within the context of a new course developed in Ontario to teach registered nurses (RNs) to perform FS to increase the provincial capacity to screen for colorectal cancer.
METHODS: Thirteen RNs from six different medical centres in Ontario attended a 5-day program in Toronto to learn the theory and basic technical components of performing FS. A low fidelity box simulator (a series of vertical barriers with numbered holes to be navigated by a real endoscope in a defined sequence) and a high fidelity virtual reality (VR) simulator (Immersion Medical®) were used for the practical training. The RNs were asked to perform 3 series on the box simulator and 3 scenarios on the VR simulator. They were asked to repeat these 6 simulator drills at the end of the course. Physician experts performed the same 6 simulations once to provide a comparison.
RESULTS: The performance of the RNs improved on both the box and VR simulators. On the box model, the mean insertion time decreased from 480 sec to 155 sec. The mean insertion time for the experts was 28 sec. On the computer simulator, improvement was shown in several parameters. Procedure time and percentage of time with a redout screen decreased and the ability to retroflex the scope in the rectum improved. The procedure times and other parameters, however, did not reach the level of performance of the physician experts
DISCUSSION: These results suggest that the training course was effective in producing improvements in the technical skills in performance of FS. As expected, the performance of FS by the trainees did not match that of the physician experts.
CONCLUSIONS: While the trainees demonstrated improvement in performing FS, additional experience beyond this course is required for them to achieve expert skills. The nurses have started to acquire this training in the clinical setting.