Impact of a simulated-based colonoscopy curriculum

Samir C. Grover, MD, MEd, FRCPC, from the Division of Gastroenterology, St. Michael’s Hospital, in Toronto, Ontario, Canada describes this Original Article, “Impact of a simulation training curriculum on technical and nontechnical skills in colonoscopy: a randomized trial.”

The optimal manner to deliver simulation-based training in endoscopy has yet to be determined. The purpose of this study was to evaluate whether a structured comprehensive curriculum (SCC) to teach colonoscopy using simulation was superior to a self-regulated learning (SRL) strategy using simulation-based training. The SCC was designed to teach technical, cognitive, and integrative competencies in colonoscopy whereas the SRL strategy allowed trainees to direct their own acquisition of these skills.

Thirty-three novice endoscopists were allocated to either the SCC group or SRL group for eight hours of training. Outcomes were performance during 2 real-patient colonoscopies, and performance on simulation-based integrated scenarios as assessed using validated evaluation tools for endoscopy. Previous studies in simulation of other procedures may suggest that a self-regulated approach may be equivalent or superior to a structured curricular model. On the other hand, simply providing trainees with simulators does not ensure their effective use, as expert feedback provided to trainees has been shown to enhance acquisition of basic endoscopic skills.

Figure 2. Participants’ JAG DOPS scores (expressed as mean ± standard deviation) during their first and second clinical colonoscopies for the SCC and SRL groups. SCC, structured comprehensive curriculum; SRL, selfregulated learning.

When tested on virtual-reality simulators, both the SCC and the SRL groups demonstrated improved performance after training, and technically performed equivalently at the end of training. However, when tested on real-patient colonoscopies, the SCC group demonstrated significantly superior overall performance. This suggests that structured teaching with experts may be of importance in translating skills learned in the simulated environment into the clinical colonoscopy setting, commensurate with educational theories on scaffolding. Also, participants in the SCC group demonstrated improved knowledge and integrative skills (e.g. communication) within the simulated setting, suggesting that curricular integration may be of relevance in teaching non-technical skills (NTS).

Dedicated studies on teaching NTS in endoscopy may be the focus of future research. In addition, a comprehensive simulation-based curriculum strategy requires significant resources, including experienced endoscopist instruction, protected trainee time from service, and costs associated with accruing and maintaining virtual reality simulator technology. As such, future research should examine the most cost-effective method of delivering a comprehensive simulation-based curriculum.

Limitations of this study included the inability to quantify the efforts of SRL participants outside of the mandatory simulation-based teaching.  Also, while we assessed immediate transfer to the clinical setting, we did not measure the longitudinal impact on clinical performance.

Read the abstract for this article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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