Prolonged training on the GI Mentor II simulator with a patient-based ...

creepytreatmentΤεχνίτη Νοημοσύνη και Ρομποτική

14 Νοε 2013 (πριν από 3 χρόνια και 10 μήνες)

75 εμφανίσεις

P
ATIENT
-
BASED
A
SSESSMENT OF
P
ROLONGED
C
OLONOSCOPY
S
IMULATOR
T
RAINING


Arjun D.

Koch
, Jelle Haringsma, Erik J. Schoon, Rob
ert

A. de Man, Ernst J. Kuipers


Departments of Gastroenterology and Hepatology, Erasmus MC University Medical
Center Rotterdam, and Ca
tharina Hospital, Eindhoven, the Netherlands


Introduction

Virtual reality endoscopy simulators are increasingly used in the
training of novice endoscopists. This is the result of several developments, including
the continued further development of simulat
ors to high levels of virtual reality, the
introduction of competency models in GI training, and demands from health
authorities and the public regarding physician training in general. There are
insufficient data regarding the contribution of simulator tra
ining to the
early learning

curve of novice endoscopists. The aim of this study therefore was to assess the
performance of novice endoscopists during patient
-
based colonoscopy after intensive
and prolonged training on a
virtual reality endoscopy
simulator.

Methods

Trainees without any endoscopic experience were included in the study.
The simulator
-
training program consisted of 100 virtual
-
reality colonoscopies on the
GI Mentor II simulator (Simbionix, Israel). After 20, 60 and 100 virtual colonoscopies
,

tra
inees were assessed both simulator
-
based (SBA) and patient
-
based (PBA). At
each PBA 2 single
-
handed colonoscopies were performed with a 20
-
minute time
limit. Objective assessment consisted of the time to reach the cecum, or the
maximum distance from the an
al verge after fully straightening the colonoscope.
Subjective assessment was done by two independent expert endoscopists using tri
-
split video assessment including camera view, endoscope view, and ScopeGuide
magnetic imaging view.

Results

Ten

novices pa
rticipated in the study. All participants completed virtual
training and assessments. The mean cecal intubation time on the SBA improved from
baseline 7.08 min. to 2.08 min. at completion of the training (P=0.007). Colonic
insertion depth during PBA improv
ed from 37 to 58 and 60 cm (P=0.002). The cecum
was intubated 4 times by 3 novices, during 2nd PBA (n=1), and during the final PBA
(n=3) (P=0.11). Subjective PBA demonstrated a general increase in the efficiency of
movements, instrument handling and planne
d endoscopy. Measured on a 5 point
scale, performance significantly improved form 1.67 to 2.20 (P=0.02)

Conclusion
Virtual reality training on the GI Mentor II simulator leads to a significant
improve
ment of

performance on the simulator itself and

more i
mportantly
-

to
significant
ly

improved performances during patient
-
based colonoscopy. This study is
the first to demonstrate the rationale for intensive simulator training in the early
learning curve of
novices performing

colon
oscopy.





Simulator-based assessment
0:00:00
0:01:26
0:02:53
0:04:19
0:05:46
0:07:12
0:08:38
5
10
15
20
25
30
35
40
45
50
55
60
65
70
75
80
85
90
95
100
Number of colonoscopies
Mean time to cecal intubation

Patient-based assessment
30
35
40
45
50
55
60
65
session 1
session 2
session 3
Assessment session
Colonoscope insertion depth