Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jul 21;26(4):179-187.
doi: 10.4103/sjg.SJG_113_20. Online ahead of print.

Development and validation of metric-based-training to proficiency simulation curriculum for upper gastrointestinal endoscopy using a novel assessment checklist

Nahla Azzam  1 , Nehal Khamis  2 , Majid Almadi  1 , Faisal Batwa  3 , Fahad Alsohaibani  4 , Abdulrahman Aljebreen  1 , Ahmad Alharbi  5 , Yasser Alaska  6 , Turki Alameel  7 , Peter Irving  8 , Richard M Satava  9
Affiliations

Development and validation of metric-based-training to proficiency simulation curriculum for upper gastrointestinal endoscopy using a novel assessment checklist

Nahla Azzam et al. Saudi J Gastroenterol. .

Abstract

Background/aims: : This study aimed to design a structured simulation training curriculum for upper endoscopy and validate a new assessment checklist.

Materials and methods: A proficiency-based progression stepwise curriculum was developed consisting of didactic, technical and non-technical components using a virtual reality simulator (VRS). It focused on: scope navigation, anatomical landmarks identification, mucosal inspection, retro-flexion, pathology identification, and targeting biopsy. A total of 5 experienced and 10 novice endoscopists were recruited. All participants performed each of the selected modules twice, and mean and median performance were compared between the two groups. Novices pre-set level of proficiency was set as 2 standard deviations below the mean of experts. Performance was assessed using multiple-choice questions for knowledge, while validated simulator parameters incorporated into a novel checklist; Simulation Endoscopic Skill Assessment Score (SESAS) were used for technical skills.

Results: : The following VRS outcome measures have shown expert vs novice baseline discriminative ability: total procedure time, number of attempts for esophageal intubation and time in red-out. All novice trainees achieved the preset level of proficiency by the end of training. There were no statistically significant differences between experts' and trainees' rate of complications, landmarks identification and patient discomfort. SESAS checklist showed high degree of agreement with the VRS metrices (kappa = 0.83) and the previously validated direct observation of procedural skills tool (kappa = 0.90).

Conclusion: : The Fundamentals of Gastrointestinal Endoscopy simulation training curriculum and its SESAS global assessment tool have been primarily validated and can serve as a valuable addition to the gastroenterology fellowship programs. Follow up study of trainee performance in workplaces is recommended for consequences validation.

Keywords: Assessment tool; colonoscopy; curriculum; endoscopy skills; gastroenterology training; gastroscopy; metrics; simulation; training to proficiency.

PubMed Disclaimer

Conflict of interest statement

None

Figures

Figure 1
Figure 1
Flow chart
Figure 2
Figure 2
Comparison of performance of experienced and inexperienced endoscopists on VRS tasks and SESAS which was done at the end of training
Figure 3
Figure 3
Comparison of performance of experienced and inexperienced endoscopists based on DOPS and SESAS at the end of training
See this image and copyright information in PMC

References

    1. MacSween HM. Canadian Association of Gastroenterology Practice Guideline for granting of privileges to perform gastrointestinal endoscopy. Can J Gastroenterol. 1997;11:429–32. - PubMed
    1. Ziv A, Ben-David S, Ziv M. Simulation based medical education: An opportunity to learn from errors. Med Teach. 2005;27:193–9. - PubMed
    1. McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB. Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Acad Med. 2011;86:706–11. - PMC - PubMed
    1. Ekkelenkamp VE, Koch AD, de Man RA, Kuipers EJ. Training and competence assessment in GI endoscopy: A systematic review. Gut. 2016;65:607–15. - PubMed
    1. Walsh CM, Sherlock ME, Ling SC, Carnahan H. Virtual reality simulation training for health professions trainees in gastrointestinal endoscopy. Cochrane Database Syst Rev. 2012:CD008237. doi: 10.1002/14651858.CD008237.pub2. - PubMed