Introduction
The training of gastroenterology residents in machine augmentd-simulated enviroment in Romania is a very limited feature and only available in the major university centers. The goal of this pilot study was to determine if a green designed simulator(Shoebox based endoscopic simulator-SBES) can mimic diagnostic endoscopy setting and thus improve endoscopy training for residents gaining dexterity and confidence.
Aims & Methods
A low-cost gastroscopy training model was created utilizing a budget of less than 10 Euro(gastroscope not included). Afterward, a training curriculum consisting of a sequence of tasks was designed to mimic standard techniques frequently utilized in gastroscopy. This curriculum was tested on the gastroenterology residents and nurses.
Development of competency in endoscopy among two gastroenterology first year residets with endoscopy naive skills was assessed during a month time while comparing it to two endoscopy naive nureses(having only visual experience of 25 years) and an endoscopy naive first year resident with gaming/instrumental background(25 years of gaming and 20 years of guitar playing skills). Baseline was assessed by performance of a consultant.
Measurement of development were rendered by supervising faculty by recording "insertion time","depth of unassisted insertion","independent procedure completion","ability to identify endoscopic landmarks" and "level of confidence".
Results
Simulator vs real life gastroscopy was assessed gaining 8/9 out of 10 points. Simulator trained residents outperformed endoscopy naive nurses by the end of the pilot study in all performance aspects(p=0.05). One however must mention that endoscopy naive nurses had a start baseline much nearer the consultant level in comparison to the residents.
Endoscopy naive resident with gaming/instrumental background held initialy a shorter "insertion time" in comparison to non gamer/instrumental counterparts.
All the assessed parameters improved gradually however the episodic assessment revealed induction reluctancy and by the end of the pilot study a steep lerning curve could be observed during thise training episodes. Confidence levels raised by the end of the study, reaching a medium level(scale 5 of 10)-consultant performace level was not reached(blinded subjects).
Conclusion
In this pilot study a month of SBES was utilized along with the GATE(gastroenterological education-training endoscopy)concept. The goal was to determine if SBES training can mimic in vivo training while enhancing competecy, dexterity and most of all self confidence. The subjective conclusion/wish of residents was to be able to continue with the simulated training. SBES training allows a wider accesability to train ex vivo and enhances faculty to be more efficient with their endoscopy practice while putting focus on sustainable care and being greener as well.
References
1 Weiguang Qiao et al, PLoS ONE, February 2014, Volume 9, Issue 2, e89224