Post written by Rishad Khan, MD, and Samir C. Grover, MD, MEd, from the Division of Gastroenterology and the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, and the Department of Medicine, University of Toronto, Toronto, Canada.

The focus of our study was a curriculum designed to teach novice endoscopists about ergonomics during colonoscopy. The curriculum provided background on musculoskeletal injury with colonoscopy, provided novices feedback on their own posture during procedures, and allowed participants to evaluate and reflect on their own work-associated risk of injury.  

Endoscopists are at high risk of work-related injury due to high procedure volume, long procedure times, and repetitive motions. These injuries can jeopardize the longevity of endoscopists’ careers and quality of life. Novice endoscopists may be particularly susceptible if fewer ergonomic behaviors are learned early. Simulation-based training has been shown to improve technical and non-technical skill acquisition among novice endoscopists and offers an exciting medium to deliver an ergonomics training curriculum.

Participants who underwent the ergonomics training curriculum had lower musculoskeletal injury risk scores during real colonoscopies, as assessed by the rapid entire body assessment. The various components of our curriculum, rooted in the educational literature, contributed in different ways. Novices first learned about injury risk through didactic sessions. They also watched optimal ergonomic performance through a video of an expert performing a colonoscopy. Finally, the checklist used by assessors and participants themselves allowed for specific, goal-directed, and actionable feedback as well as self-reflection on ergonomic performance after each training procedure. Future work should focus on whether robust curricula to teach ergonomics to endoscopists are indeed associated with less musculoskeletal injury.

While endoscopists in the intervention group had lower injury risk, they still fell in the “medium risk” category. Addressing this important issue requires a coordinated response that targets endoscope design and endoscopy suite setup in addition to endoscopist behavior.

Figure 3. Clinical rapid upper body assessment scores.

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