Background
GI endoscopy simulation-based training augments early clinical performance; however,
the optimal manner by which to deliver training is unknown.
Objective
We aimed to validate a simulation-based structured comprehensive curriculum (SCC)
designed to teach technical, cognitive, and integrative competencies in colonoscopy.
Design
Single-blinded, randomized, controlled trial.
Setting
Endoscopic simulation course at an academic hospital.
Participants and Interventions
Thirty-three novice endoscopists were allocated to an SCC group or self-regulated
learning (SRL) group. The SCC group received a curriculum consisting of 6 hours of
didactic lectures and 8 hours of virtual reality simulation-based training with expert
feedback. The SRL group was provided a list of desired objectives and was instructed
to practice on the simulator for an equivalent time (8 hours).
Main Outcome Measurements
Clinical transfer was assessed during 2 patient colonoscopies using the Joint Advisory
Group Direct Observation of Procedural Skills (JAG DOPS) scale. Secondary outcome
measures included differences in procedural knowledge, immediate post-training simulation
performance, and delayed post-training (4-6 weeks) performance during an integrated
scenario test on the JAG DOPS communication and integrated scenario global rating
scales.
Results
There was no significant difference in baseline or post-training performance on the
simulator task. The SCC group performed superiorly during their first and second clinical
colonoscopies. Additionally, the SCC group demonstrated significantly better knowledge
and colonoscopy-specific performance, communication, and global performance during
the integrated scenario.
Limitations
We were unable to measure SRL participants’ effort outside of mandatory training.
In addition, feedback metrics and number of available simulation cases are limited.
Conclusions
These results support integration of endoscopy simulation into a structured curriculum
incorporating instructional feedback and complementary didactic knowledge as a means
to augment technical, cognitive, and integrative skills acquisition, as compared with
SRL on virtual reality simulators. (Clinical trial registration number: NCT01991522.)
Abbreviations:
ANOVA (analysis of variance), JAG DOPS (Joint Advisory Group Direct Observation of Procedural Skills), SCC (structured comprehensive curriculum), SRL (self-regulated learning)To read this article in full you will need to make a payment
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References
- Virtual reality simulation training for health professions trainees in gastrointestinal endoscopy.Cochrane Database Syst Rev. 2012; 6: CD008237
- Simulation based medical education: an opportunity to learn from errors.Med Teach. 2005; 27: 193-199
- Effects of simulation-based training in gastrointestinal endoscopy: a systematic review and meta-analysis.Clin Gastroenterol Hepatol. 2014; 12: 1611-1623
Accreditation Council for Graduate Medical Education. Program requirements for graduate medical education in gastroenterology (internal medicine). 2013. Available at: https://www.acgme.org/acgmeweb/Portals/0/PFAssets/2013-PR-FAQ-PIF/144_gastroenterology_int_med_07132013.pdf. Accessed January 15, 2015.
- The learning curve for a colonoscopy simulator in the absence of any feedback: no feedback, no learning.Surg Endosc. 2004; 18: 1224-1230
- The impact of constructive feedback on training in gastrointestinal endoscopy using high-fidelity virtual-reality simulation: a randomised controlled trial.Gut. 2010; 59: 181-185
- Concurrent versus terminal feedback: it may be better to wait.Acad Med. 2009; 84: S54-S57
- Gastrointestinal Endoscopy Competency Assessment Tool: development of a procedure-specific assessment tool for colonoscopy.Gastrointest Endosc. 2014; 79: 798-807
Cullinane M, Gray A, Hargraves C, et al. Scoping our practice. National confidential enquiry into patient outcome and death 2005;1-20. Available at http://www.ncepod.org.uk/2004report/index.htm. Accessed January 15, 2015.
Faigel DO, Baron TH, Lewis B, et al. Prepared by the ASGE Taskforce on Ensuring Competence in Endoscopy. American College of Gastroenterology Executive and Practice Management Committees. Available at http://www.asge.org/assets/0/71542/71544/a59d4f7a580e466ab9670ee8b78bc7ec.pdf. Accessed January 15, 2015.
- Canadian credentialing guidelines for colonoscopy.Can J Gastroenterol. 2008; 22: 17-22
- NASPGHAN guidelines for training in pediatric gastroenterology.J Pediatr Gastroenterol Nutr. 2013; 56: S1-S8
American Board of Surgery. Flexible endoscopy curriculum for general surgery residents. 2014. Available at: http://www.absurgery.org/xfer/abs-fec.pdf. Accessed January 15, 2015.
- Validation of a structured training and assessment curriculum for technical skill acquisition in minimally invasive surgery: a randomized controlled trial.Ann Surg. 2013; 257: 224-230
- The development of a virtual reality training curriculum for colonoscopy.Ann Surg. 2012; 256: 188-192
- The effectiveness of self-directed learning in health professions education: a systematic review.Med Educ. 2010; 44: 1057-1068
- Self-regulated learning and academic achievement : an overview.Educ Psychol. 1990; 25: 3-17
- Directed self-regulated learning versus instructor-regulated learning in simulation training.Med Educ. 2012; 46: 648-656
- Colonoscopy core curriculum.Gastrointest Endosc. 2012; 76: 482-490
- Practical gastrointestinal endoscopy: the fundamentals.John Wiley & Sons, New York, NY2008
- Development of the gastrointestinal endoscopy competency assessment tool for pediatric colonoscopy (GiECATKIDS).J Pediatr Gastroenterol Nutr. 2014; 59: 480-486
- Learning the skills of flexible sigmoidoscopy—the wider perspective.Med Educ. 2003; 37: 50-58
- The validity and reliability of a Direct Observation of Procedural Skills assessment tool: assessing colonoscopic skills of senior endoscopists.Gastrointest Endosc. 2012; 75: 591-597
- Assessing procedural skills in context: exploring the feasibility of an integrated procedural performance instrument (IPPI).Med Educ. 2006; 40: 1105-1114
- Analytic global OSCE ratings are sensitive to level of training.Med Educ. 2003; 37: 1012-1016
- Psychometric properties of an integrated assessment of technical and communication skills.Am J Surg. 2009; 197: 96-101
- Randomized controlled trial of virtual reality simulator training: transfer to live patients.Am J Surg. 2007; 194: 205-211
- Training and transfer of colonoscopy skills: a multinational, randomized, blinded, controlled trial of simulator versus bedside training.Gastrointest Endosc. 2010; 71: 298-307
- Scaffolding complex learning: the mechanisms of structuring and problematizing student work.J Learn Sci. 2004; 13: 273-304
Article info
Publication history
Published online: May 23, 2015
Accepted:
April 2,
2015
Received:
February 24,
2015
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. Research support for this study was provided by an Intramural Award in Education, Division of Gastroenterology, University of Toronto.
If you would like to chat with an author of this article, you may contact Dr Grover at [email protected]
Identification
Copyright
© 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
