ASSESSING THE LEARNING CURVE FOR THE ACQUISITION OF COLONOSCOPY SKILLS ON A COMPUTER BASED ENDO...

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ASSESSING THE LEARNING CURVE FOR THE ACQUISITION OF COLONOSCOPY SKILLS ON A COMPUTER BASED ENDOSCOPY SIMULATOR

P Kumar¹, F Tse²
¹McMaster University; ²Hamilton Health Sciences Corporation, Hamiton, Ontario
Aims: To asssess the learning curve for the acquisition of colonoscopy skills on a computer based endoscopic simulator.
Methods: A novice group (n=of 17) was formed by a cohort of general internal medicine residents and medical students, who hadve never performed an endoscopic procedure. After receiving identical pretest instruction, the novices were asked to undertake 10 trials of colonoscopy within a 1-month period on the GI Mentor II VR simulator. Two experienced gastroenterologists with more than (> 1000 colonoscopies each) performed 2 trials each to define benchmark levels. Assessment of skills was based on parameters measured by the simulator. Efficiency, total procedure time, and time to cecum and mucosal visualization were felt to be the most relevant outcomes a priority.
Data on learning curves was analyzed by the Friedman test. Multiple comparisons were made to identify when plateau of skills hads occurred. Comparison of performance between expert and novice groupss was undertaken using the Mann-Whitney U-test. A level of p < 0.05 was considered statistically significant.
Results: Over the 10 sessions, the novices made significant improvements in their efficiency, total procedure time, time to cecum and percentage in clear view, but not in mucosal visualization, loop formation, or time patient in pain. A plateau in the learning curve was reached after the eighth repetition for efficiency and total procedure time, and after the fifth repetition for time to cecum. By the end of the training program, there were no significant differences between experts and novices for all parameters except for time to cecum (321.24 s vs 155.50 s, p = 0.023). Novices had no significant improvement in loop formation and time patient was in pain. When comparing results for the expert group with those for the novices on the 2nd attempt, there were significant differences for the total procedure time, time to cecum, efficiency, time in clear view and the number of times excessive local pressure was caused. On the 10th attempt, there was no significant difference between experts and novices for all parameters except time to cecum.
Conclusions: Novices with no endoscopic experience can improve their colonoscopy skills during short phase training on a computer based endoscopyic simulator. Simulator-based training may be used early in the learning curve for colonoscopy to ensure that novice endoscopists reach competent levels before practicing on patients. Further studies should be done to validate the simulator performance in real procedure. Work will include students to determine transferability of the skills learned in simulation to users’ performance on real patients.

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