Can colonoscopy simulators enhance the learning curve for trainees?

Robotic endoscope with double-balloon and double-bend tube for colonoscopy

The insertion of conventional colonoscopes can sometimes cause patients to experience pain during the procedure owing to the stretching of the mesentery. In this study, a prototype of a robotic colonoscope with a double-balloon and double-bend tube based on the conventional double-balloon endoscope was developed to simplify insertion and prevent the overstretching of the colon. Both the outer and inner tubes were confirmed to be free from interference from wires and sheaths. Additionally, all functions such as tip bending, inflation and deflation of the balloons, and actuator-driven pulling and pushing of the inner tube were operated properly. During the insertion test, the device could be reached the cecum of a colon model in approximately 442 s when operated by a non-medical operator. In addition, the device did not overstretch the colon model, thereby suggesting that the insertion mechanism can follow the shape of the colon model. As a result, the developed mechanism has the potential to navigate through a highly-bent colon without overstretching.

Evaluation of Learning Effectiveness After a Simulation-Based Training Pediatric Course for Emergency Physicians

INTRODUCTION

For emergency physicians, pediatric emergencies represent rare and challenging situations. Simulation-based training (SBT) is increasingly used in medical education and recommended for implementation in the curriculum and postgraduate training.

OBJECTIVES

The objective of this study was to explore the self-assessment of emergency physicians' and residents' clinical practice in pediatric emergency care after SBT.

METHODS

We surveyed emergency physicians and residents who successfully took a course of Pediatric Emergency Procedures (University of Poitiers, France) between 2010 and 2015. The course included didactics 50% of the time, and simulation the other 50%. According to Kirkpatrick model, 3 levels were approached: satisfaction, learning (knowledge, skills, and attitudes), and changes in clinical practice. The main results are expressed in numbers (percentages).

RESULTS

One hundred percent of the 46 included emergency physicians and residents were satisfied with the course. Sixty-nine percent agreed with the realism of low-fidelity simulation, whereas 22% disagreed. Ninety-six percent agreed with high-fidelity simulator realism. One hundred percent of responders perceived a gain in knowledge, 98% in practical skill, and 83% in improved self-confidence. Among the clinical practice changes, 91% involved anticipation, 81% procedural skills, 92% algorithms, and 79% communication and teamwork. One hundred percent expressed the wish to repeat simulation sessions at a rate of 2 ± 1 sessions per year.

CONCLUSIONS

Self-assessment of the Pediatric Emergency Procedures university course was very positive. According to the participants, this type of SBT on very specific pediatric emergency cares should be integrated to the emergency resident's curriculum. As regards pediatric emergency care, particularly dealing with low-volume, high-stake procedures, the participants were favorable to further, more regular simulation training.

The effect of model fidelity on colonoscopic skills acquisition. A randomized controlled study

INTRODUCTION

Colonoscopic simulators offer the opportunity for skill acquisition in the preclinical setting. Currently available simulators vary widely with respect to level of fidelity and technological sophistication. Despite the belief that more realistic is better, there is a paucity of evidence regarding the relative effectiveness of simulator fidelity (high vs low) on the acquisition of basic colonoscopic skills. We hypothesized that novice learners can acquire basic colonoscopic skills using simulators, however fidelity of the simulator does not make a difference.

METHODS

We randomly assigned novice third-year and fourth-year medical students to practice on either a low-fidelity or high-fidelity colonoscopy model. The low-fidelity model used is described in the module 16 of the American College of Surgeons/Association of Program Directors in Surgery surgical skills curriculum for residents, Phase 1: basic or core skills and tasks < http://elearning.facs.org/mod/resource/view.php?1d=450 >. The high-fidelity model was the AccuTouch colonoscopy simulator, Immersion Medical (AccuTouch CS) that has 6 different simulated scenarios for diagnostic colonoscopy (level 1-6). Both groups had 16 students and were given standard instruction by an expert with respect to the procedure and instrument handling on both models. Both groups were pretested and posttested on level 1 of the AccuTouch CS. The high-fidelity group practiced on level 2 and 4 of the AccuTouch CS, whereas the low-fidelity group practiced on the low-fidelity model for 2 sessions of 1 hour each. The computer-based evaluation parameters available on the AccuTouch CS were used to compare performances.

RESULTS

Both groups had similar demographics. There were no significant differences in the baseline performances of either group. Each group demonstrated significant improvement for insertion time and percentage of mucosa visualized. However, there were no significant differences between the groups on posttesting on any of the measured parameters.

CONCLUSIONS

Colonoscopic skill training on a low-fidelity model appears to be as effective as high-fidelity model training for basic endoscopic skill acquisition for novice learners.