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Kim SH, Kwon T, Choi HS, Kim C, Won S, Jeon HJ, Kim ES, Keum B, Jeen YT, Hwang JH, Chun HJ. Robot-assisted gastric endoscopic submucosal dissection significantly improves procedure time at challenging dissection locations. Surg Endosc 2024; 38:2280-2287. [PMID: 38467861 DOI: 10.1007/s00464-024-10743-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 01/28/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) is the standard treatment for early malignant stomach lesions. However, this procedure is technically demanding and carries a high complication risk. The level of difficulty in performing ESD is influenced by the location of the lesion. In our study, we aimed to investigate and analyze the effectiveness of robot-assisted ESD for lesions situated in challenging locations within the stomach. METHODS We developed a gastric simulator that could be used to implement various gastric ESD locations. An EndoGel (Sunarrow, Tokyo, Japan) was attached to the simulator for the dissection procedures. Robot-assisted or conventional ESD was performed at challenging or easy locations by two ESD-trainee endoscopists. RESULTS The procedure time was remarkably shorter for robotic ESD than conventional dissection at challenging locations (6.2 vs. 10.2 min, P < 0.05), mainly due to faster dissection (220.3 vs. 101.9 mm2/min, P < 0.05). The blind dissection rate was significantly lower with robotic ESD than with the conventional method (17.6 vs. 35.2%, P < 0.05) at challenging locations. CONCLUSION The procedure time was significantly shortened when robot-assisted gastric ESD procedures were performed at challenging locations. Therefore, our robotic device provides simple, effective, and safe multidirectional traction for endoscopic submucosal dissection at challenging locations, thereby reducing difficulty of the procedure.
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Affiliation(s)
- Sang Hyun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk gu, Seoul, 02841, South Korea
| | - Taebin Kwon
- Department of Mechanical Engineering, Korea University, Seoul, South Korea
| | - Hyuk Soon Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk gu, Seoul, 02841, South Korea.
- Division of Gastroenterology and Hepatology, Stanford University, Stanford, CA, USA.
| | - Chanwoo Kim
- Department of Mechanical Engineering, Korea University, Seoul, South Korea
| | - Seonghyeon Won
- Department of Mechanical Engineering, Korea University, Seoul, South Korea
| | - Han Jo Jeon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk gu, Seoul, 02841, South Korea
| | - Eun Sun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk gu, Seoul, 02841, South Korea
| | - Bora Keum
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk gu, Seoul, 02841, South Korea
| | - Yoon Tae Jeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk gu, Seoul, 02841, South Korea
| | - Joo Ha Hwang
- Division of Gastroenterology and Hepatology, Stanford University, Stanford, CA, USA
| | - Hoon Jai Chun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk gu, Seoul, 02841, South Korea
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Lee DS, Lee GH, Kim SG, Lee KL, Kim JW, Jeong JB, Jung YJ, Kang HW. Usefulness of a new polyvinyl alcohol hydrogel (PVA-H)-based simulator for endoscopic submucosal dissection training: a pilot study. Clin Endosc 2023; 56:604-612. [PMID: 37524564 PMCID: PMC10565446 DOI: 10.5946/ce.2022.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 12/27/2022] [Accepted: 01/03/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND/AIMS We developed a new endoscopic submucosal dissection (ESD) simulator and evaluated its efficacy and realism for use training endoscopists. METHODS An ESD simulator was constructed using polyvinyl alcohol hydrogel sheets and compared to a previous ESD simulator. Between March 1, 2020, and December 30, 2021, eight expert endoscopists from three different centers analyzed the procedure-related factors of the simulator. Five trainees performed gastric ESD exercises under the guidance of these experts. RESULTS Although the two ESD simulators provided overall favorable outcomes in terms of ESD-related factors, the new simulator had several benefits, including better marking of the target lesion's limits (p<0.001) and overall handling (p<0.001). Trainees tested the usefulness of the new ESD simulator. The complete resection rate improved after 3 ESD training sessions (9 procedures), and the perforation rate decreased after 4 sessions (12 procedures). CONCLUSION We have developed a new ESD simulator that can help beginners achieve a high level of technical experience before performing real-time ESD procedures in patients.
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Affiliation(s)
- Dong Seok Lee
- Department of Gastroenterology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Gyun Kim
- Department of Gastroenterology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kook Lae Lee
- Department of Gastroenterology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Won Kim
- Department of Gastroenterology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Bong Jeong
- Department of Gastroenterology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Jin Jung
- Department of Gastroenterology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hyoun Woo Kang
- Department of Gastroenterology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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Herman T, Megna B, Pallav K, Bilal M. Endoscopic mucosal resection: tips and tricks for gastrointestinal trainees. Transl Gastroenterol Hepatol 2023; 8:25. [PMID: 37601741 PMCID: PMC10432230 DOI: 10.21037/tgh-23-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/15/2023] [Indexed: 08/22/2023] Open
Abstract
Endoscopic mucosal resection (EMR) is a minimally invasive, specialized endoscopic technique that is useful in resecting superficial gastrointestinal lesions that are unable to be removed by standard polypectomy. This is typically accomplished using a submucosal injection that lifts the lesion away from the muscularis propria to allow for safe resection of the polyp, either via piecemeal or en bloc resection. Over the years, several techniques exist to perform EMR including conventional EMR or hot EMR, cold EMR and underwater EMR. Despite its established advantages and safety over conventional techniques such as surgery, the adoption of endoscopic resection (and thus the education and training of gastroenterology trainees) is lagging. The goal of this article is to offer a comprehensive review of the basic principles of colonic EMR. We review the concepts of optical diagnosis including the various polyp classification systems available to determine the polyp morphology and histology. We also discuss the technical aspects of performing colonic EMR. We also outline the common adverse events associated with EMR including bleeding, perforation, postpolypectomy syndrome, and residual or recurrent polyps, and discuss preventative measures that can be taken to mitigate adverse events. Lastly, we offer practical tips for trainees who want to undertake EMR in their clinical practice.
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Affiliation(s)
- Tessa Herman
- Department of Internal Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Bryant Megna
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN, USA
| | - Kumar Pallav
- Division of Gastroenterology & Hepatology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Mohammad Bilal
- Advanced Endoscopy, Division of Gastroenterology & Hepatology, Minneapolis Veterans Affairs Health Care System, University of Minnesota, Minneapolis, MN, USA
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Deshmukh A, Genere JR, Bazarbashi AN. Ex vivo nonbiomaterial gel-based model for endoscopic training. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2023; 8:226-228. [PMID: 37303709 PMCID: PMC10251490 DOI: 10.1016/j.vgie.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Video 1Use of artificial model for endoscopic training.
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Affiliation(s)
- Ameya Deshmukh
- Department of Internal Medicine, Saint Louis University - SOM, St. Louis, Missouri
| | - Juan Reyes Genere
- Division of Gastroenterology and Hepatology, Washington University - SOM, St. Louis, Missouri
| | - Ahmad Najdat Bazarbashi
- Division of Gastroenterology and Hepatology, Washington University - SOM, St. Louis, Missouri
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5
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Simsek C, Aihara H. Training in Endoscopic Submucosal Dissection in the United States: The Current Paradigm. Gastrointest Endosc Clin N Am 2023; 33:41-53. [PMID: 36375885 DOI: 10.1016/j.giec.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Endoscopic submucosal dissection (ESD) training in Japan is pursued through a designated master-apprentice, organ-based stepwise training model. However, applying a similar program to the United States is not a practical strategy due to the significant differences in the training system and disease prevalence. To incorporate the ESD training into the current advanced endoscopy fellowship program, the use of recently developed techniques and technologies to improve the efficiency of ESD is ideal. The ESD training program in the United States should be prevalence-based, with increased involvement of trainees depending on their objectively assessed competency levels.
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Affiliation(s)
- Cem Simsek
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hiroyuki Aihara
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Mitsui T, Yoda Y, Sunakawa H, Takayama S, Nishihara K, Inaba A, Sato D, Minamide T, Takashima K, Nakajo K, Murano T, Kadota T, Shinmura K, Ikematsu H, Yano T. Development of new gastric endoscopic submucosal dissection training model: A reproducibility evaluation study. Endosc Int Open 2022; 10:E1261-E1267. [PMID: 36118647 PMCID: PMC9473824 DOI: 10.1055/a-1845-5556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background and study aims Gastric endoscopic submucosal dissection (ESD) is a highly technical procedure mainly due to the distinctive shape of the stomach and diverse locations of lesions. We developed a new gastric ESD training model (G-Master) that could accurately recreate the location of the stomach and assessed the reproducibility of located lesions in the model. Methods The model comprises a simulated mucous membrane sheet made of konjac flour and a setting frame, which can simulate 11 locations of the stomach. We assessed the reproducibility of each location in the model by assessing the procedure speed and using a questionnaire that was distributed among experts. In the questionnaire, each location was scored on a six-point scale for similarity of locations. Results The mean score for all locations was high with > 4 points. Regarding locations, lower anterior and posterior walls had medium scores with 3 to 4 points. The procedure speed was slower in the greater curvature of the upper and middle gastric portions, where ESD is considered more difficult than the overall procedure speed. Conclusions The new gastric ESD training model appears to be highly reproducible for each gastric location and its application for training in assuming actual gastric ESD locations.
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Affiliation(s)
- Tomohiro Mitsui
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Yusuke Yoda
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan,NEXT Medical Device Innovation Center, National Cancer Center Hospital East,Division of Endoscopy, Saitama Cancer Center, Saitama, Japan
| | - Hironori Sunakawa
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | | | - Keiichiro Nishihara
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Atsushi Inaba
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Daiki Sato
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan,Division of Endoscopy, Saitama Cancer Center, Saitama, Japan
| | - Tatsunori Minamide
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Kenji Takashima
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan,NEXT Medical Device Innovation Center, National Cancer Center Hospital East
| | - Keiichiro Nakajo
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Tatsuro Murano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Tomohiro Kadota
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Kensuke Shinmura
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Hiroaki Ikematsu
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Tomonori Yano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan,NEXT Medical Device Innovation Center, National Cancer Center Hospital East
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Fujimoto A, Saito Y, Abe S, Hoteya S, Nomura K, Yasuda H, Matsuo Y, Uraoka T, Kuribayashi S, Tsuji Y, Ohki D, Maehata T, Kato M, Yahagi N. Clinical usefulness of red dichromatic imaging in hemostatic treatment during endoscopic submucosal dissection: First report from a multicenter, open-label, randomized controlled trial. Dig Endosc 2022; 34:379-390. [PMID: 34775648 DOI: 10.1111/den.14191] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 11/12/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To verify the efficacy and safety of red dichromatic imaging (RDI) in hemostatic procedures during endoscopic submucosal dissection (ESD). METHODS This is a multicenter randomized controlled trial of 404 patients who underwent ESD of the esophagus, stomach, colorectum. Patients who received hemostatic treatments by RDI during ESD were defined as the RDI group (n = 204), and those who received hemostatic treatments by white light imaging (WLI) were defined as the WLI group (n = 200). The primary endpoint was a shortening of the hemostasis time. The secondary endpoints were a reduction of the psychological stress experienced by the endoscopist during the hemostatic treatment, a shortened treatment time, and a non-inferior perforation rate, in RDI versus WLI. RESULTS The mean hemostasis time in RDI (n = 860) was not significantly shorter than that in WLI (n = 1049) (62.3 ± 108.1 vs. 56.2 ± 74.6 s; P = 0.921). The median hemostasis time was significantly longer in RDI than in WLI (36.0 [18.0-71.0] vs. 28.0 [14.0-66.0] s; P = 0.001) in a sensitivity analysis. The psychological stress was significantly lower in RDI than in WLI (1.71 ± 0.935 vs. 2.03 ± 1.038; P < 0.001). There was no significant difference in the ESD treatment time between RDI (n = 161) and WLI (n = 168) (58.0 [35.0-86.0] vs. 60.0 [38.0-88.5] min; P = 0.855). Four perforations were observed, but none of them took place during the hemostatic treatment. CONCLUSIONS Hemostatic treatment using RDI does not shorten the hemostasis time. RDI, however, is safe to use for hemostatic procedures and reduces the psychological stress experienced by endoscopists when they perform hemostatic treatment during ESD. UMIN000025134.
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Affiliation(s)
- Ai Fujimoto
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan.,Department of Gastroenterology and Hepatology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Seiichiro Abe
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Syu Hoteya
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Kosuke Nomura
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Hiroshi Yasuda
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Yasumasa Matsuo
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Toshio Uraoka
- Department of Gastroenterology and Hepatology, Gunma University, Gunma, Japan
| | - Shiko Kuribayashi
- Department of Gastroenterology and Hepatology, Gunma University, Gunma, Japan
| | | | - Daisuke Ohki
- Department of, Endoscopy and Endoscopic Surgery, The University of Tokyo, Tokyo, Japan
| | - Tadateru Maehata
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan.,Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Motohiko Kato
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Naohisa Yahagi
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
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8
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Dolan RD, Ryou M. Endoscopic simulators: training the next generation. Curr Opin Gastroenterol 2021; 37:589-595. [PMID: 34482322 DOI: 10.1097/mog.0000000000000788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
PURPOSE OF REVIEW To provide a review of current evidence evaluating endoscopic simulators as teaching platforms in gastroenterology training, with emphasis on upper gastrointestinal anatomy. RECENT FINDINGS Endoscopic simulators have leveraged mechanical, virtual reality and ex-vivo or live animal platforms to deliver training in both general and therapeutic endoscopy. Simulators have demonstrated their greatest utility in training novice endoscopists. Intermediate and expert endoscopists may additionally benefit from simulator exposure when learning advanced therapeutic techniques including large tissue resection or natural orifice transluminal endoscopic surgery. SUMMARY Simulator-based learning offers promise to complement conventional endoscopic training modalities for novice trainees. Nevertheless, additional evidence demonstrating a clear benefit is required for simulators to become an integral part of gastroenterology training. As novel advanced endoscopic therapies are developed, endoscopic simulators may assume a larger role in training prior to clinical practice.
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Affiliation(s)
- Russell D Dolan
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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9
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McCarty TR, Aihara H. Current state of education and training for endoscopic submucosal dissection: Translating strategy and success to the USA. Dig Endosc 2020; 32:851-860. [PMID: 31797470 DOI: 10.1111/den.13591] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/02/2019] [Indexed: 02/08/2023]
Abstract
Endoscopic submucosal dissection (ESD) is a rigorous and technically sophisticated method for removal of lesions within the gastrointestinal tract. Despite having advantages of en-bloc resection of lesions, regardless of size, and widespread use in Japan and Asia, ESD has not become widely adopted in the USA for a variety of reasons. Based upon Japanese education and the master-apprentice model, modification to the education system and additional techniques designed to facilitate broader adoption are required for trainees in the USA. This article will review the current state of education and training for ESD in the USA.
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Affiliation(s)
- Thomas R McCarty
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Hiroyuki Aihara
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
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10
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Lin Y, Chen M, Chen Y, Lin C, Chang C, Chen C, Chu C. Fidelity of computer‐based simulators for fellows training in Taiwan. ADVANCES IN DIGESTIVE MEDICINE 2019. [DOI: 10.1002/aid2.13105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Yang‐Sheng Lin
- Division of Gastroenterology, Department of Internal MedicineMacKay Memorial Hospital Taipei City Taiwan
- MacKay Junior College of MedicineNursing and Management Taipei City Taiwan
- Department of Medicine, MacKay Medical College New Taipei City Taiwan
- Graduate Institute of Clinical Medicine, College of MedicineTaipei Medical University Taipei City Taiwan
| | - Ming‐Jen Chen
- Division of Gastroenterology, Department of Internal MedicineMacKay Memorial Hospital Taipei City Taiwan
- MacKay Junior College of MedicineNursing and Management Taipei City Taiwan
- Department of Medicine, MacKay Medical College New Taipei City Taiwan
- Clinical Skills Training Center, Department of Medical EducationMacKay Memorial Hospital Taipei City Taiwan
| | - Yen‐Po Chen
- Division of Gastroenterology, Department of Internal MedicineMacKay Memorial Hospital Taipei City Taiwan
- MacKay Junior College of MedicineNursing and Management Taipei City Taiwan
- Department of Medicine, MacKay Medical College New Taipei City Taiwan
- Clinical Skills Training Center, Department of Medical EducationMacKay Memorial Hospital Taipei City Taiwan
| | - Ching‐Chung Lin
- Division of Gastroenterology, Department of Internal MedicineMacKay Memorial Hospital Taipei City Taiwan
- MacKay Junior College of MedicineNursing and Management Taipei City Taiwan
- Department of Medicine, MacKay Medical College New Taipei City Taiwan
- Clinical Skills Training Center, Department of Medical EducationMacKay Memorial Hospital Taipei City Taiwan
| | - Chen‐Wang Chang
- Division of Gastroenterology, Department of Internal MedicineMacKay Memorial Hospital Taipei City Taiwan
- MacKay Junior College of MedicineNursing and Management Taipei City Taiwan
- Department of Medicine, MacKay Medical College New Taipei City Taiwan
- Clinical Skills Training Center, Department of Medical EducationMacKay Memorial Hospital Taipei City Taiwan
| | - Chih‐Jen Chen
- Division of Gastroenterology, Department of Internal MedicineMacKay Memorial Hospital Taipei City Taiwan
- MacKay Junior College of MedicineNursing and Management Taipei City Taiwan
- Department of Medicine, MacKay Medical College New Taipei City Taiwan
- Clinical Skills Training Center, Department of Medical EducationMacKay Memorial Hospital Taipei City Taiwan
| | - Cheng‐Hsin Chu
- Division of Gastroenterology, Department of Internal MedicineMacKay Memorial Hospital Taipei City Taiwan
- MacKay Junior College of MedicineNursing and Management Taipei City Taiwan
- Department of Medicine, MacKay Medical College New Taipei City Taiwan
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11
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Bazarbashi AN, Thompson CC. Training and development in endoscopic full thickness resection. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2019. [DOI: 10.1016/j.tgie.2019.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Chen PH, Roth H, Galperin-Aizenberg M, Ruutiainen AT, Gefter W, Cook TS. Improving Abnormality Detection on Chest Radiography Using Game-Like Reinforcement Mechanics. Acad Radiol 2017. [PMID: 28647389 DOI: 10.1016/j.acra.2017.05.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
RATIONALE AND OBJECTIVES Despite their increasing prevalence, online textbooks, question banks, and digital references focus primarily on explicit knowledge. Implicit skills such as abnormality detection require repeated practice on clinical service and have few digital substitutes. Using mechanics traditionally deployed in video games such as clearly defined goals, rapid-fire levels, and narrow time constraints may be an effective way to teach implicit skills. MATERIALS AND METHODS We created a freely available, online module to evaluate the ability of individuals to differentiate between normal and abnormal chest radiographs by implementing mechanics, including instantaneous feedback, rapid-fire cases, and 15-second timers. Volunteer subjects completed the modules and were separated based on formal experience with chest radiography. Performance between training and testing sets were measured for each group, and a survey was administered after each session. RESULTS The module contained 74 cases and took approximately 20 minutes to complete. Thirty-two cases were normal radiographs and 56 cases were abnormal. Of the 60 volunteers recruited, 25 were "never trained" and 35 were "previously trained." "Never trained" users scored 21.9 out of 37 during training and 24.0 out of 37 during testing (59.1% vs 64.9%, P value <.001). "Previously trained" users scored 28.0 out of 37 during training and 28.3 out of 37 during testing phases (75.6% vs 76.4%, P value = .56). Survey results showed that 87% of all subjects agreed the module is an efficient way of learning, and 83% agreed the rapid-fire module is valuable for medical students. CONCLUSIONS A gamified online module may improve the abnormality detection rates of novice interpreters of chest radiography, although experienced interpreters are less likely to derive similar benefits. Users reviewed the educational module favorably.
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Affiliation(s)
- Po-Hao Chen
- Hospital of the University of Pennsylvania, Department of Radiology, 3400 Spruce St, Philadelphia, PA 19104.
| | - Howard Roth
- Cooper University Hospital, Department of Radiology, Camden, New Jersey
| | - Maya Galperin-Aizenberg
- Hospital of the University of Pennsylvania, Department of Radiology, 3400 Spruce St, Philadelphia, PA 19104
| | | | - Warren Gefter
- Hospital of the University of Pennsylvania, Department of Radiology, 3400 Spruce St, Philadelphia, PA 19104
| | - Tessa S Cook
- Hospital of the University of Pennsylvania, Department of Radiology, 3400 Spruce St, Philadelphia, PA 19104
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13
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Sato H, Mizuno KI, Sato Y, Hashimoto S, Hayashi K, Ikarashi S, Honda Y, Yokoyama J, Terai S. Development and use of a non-biomaterial model for hands-on training of endoscopic procedures. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:182. [PMID: 28616397 DOI: 10.21037/atm.2017.01.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) and peroral endoscopic myotomy (POEM) are recently developed techniques that have the potential to significantly improve clinical outcomes. However, training opportunities on these techniques remain limited. To address this issue, we developed a novel ex-vivo ESD/POEM training model. Our aim in this paper is to describe the model and provide preliminary evidence of promising feasibility to improve access to ESD/POEM training. METHODS The model was developed using polyvinyl alcohol hydrogel, which can easily be modified to reproduce the stiffness of the different intestinal layers, namely the mucosa, submucosa, and muscle layer. RESULTS A training workshop, using our ex-vivo model, was held for 28 residents. Satisfaction and feasibility in using the ex-vivo model for endoscopic training were evaluated by using a self-report questionnaire. All participants were satisfied with their training experience (100% satisfaction rate), with 27 of the 28 participants reporting that the model was feasible in replicating all components of the ESD/POEM technique (96.4% feasibility rate). CONCLUSIONS Based on this feedback, we propose that our non-biomaterial model has the feasibility to provide an effective endoscopy education tool and a satisfactory training experience.
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Affiliation(s)
- Hiroki Sato
- Division of Gastroenterology and Hepatology, Niigata University Medical and Dental Hospital, Niigata, Japan.,Division of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata, Japan
| | - Ken-Ichi Mizuno
- Division of Gastroenterology and Hepatology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Yuichi Sato
- Division of Gastroenterology and Hepatology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Satoru Hashimoto
- Division of Gastroenterology and Hepatology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Kazunao Hayashi
- Division of Gastroenterology and Hepatology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Satoshi Ikarashi
- Division of Gastroenterology and Hepatology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Yutaka Honda
- Division of Gastroenterology and Hepatology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Junji Yokoyama
- Division of Gastroenterology and Hepatology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Niigata University Medical and Dental Hospital, Niigata, Japan
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