Department of Surgery, University of Texas Health Science Center-San Antonio (UTHSCSA), 7703 Floyd Curl, Mail Code 7840, San Antonio, TX 78229-3900, USA.
Surg Endosc. 2011 Sep;25(9):2980-6. doi: 10.1007/s00464-011-1656-7. Epub 2011 Apr 13.
The Texas Association of Surgical Skills Laboratories (TASSL) is a nonprofit consortium of surgical skills training centers for the accredited surgery residency programs in Texas. A training and research collaborative was forged between TASSL members and Simbionix (Cleveland, OH, USA) to assess the feasibility and efficacy of a multicenter, simulation- and Web-based flexible endoscopy training curriculum using shared GI Mentor II systems.
Two GI Mentor II flexible endoscopy simulators were provided for the study, and four institutions, namely, the University of Texas Health Science Center-San Antonio (UTHSCSA), Texas A & M University (TAMU), Methodist Hospital (MHD), and Brooke Army Medical Center (BAMC), agreed to share them. One additional site, University of Texas Southwestern (UTSW), already owned a device and participated during the study period. Postgraduate years (PGYs) 1 to 4 subjects completed pre- and posttraining questionnaires and one pre- and posttraining trial of Colonoscopy Case Module 1. EndoBubble 1 and 2 tasks with predefined, expert-derived levels were used for training. Pre- and posttesting performance data were recorded on the simulator and by the Global Assessment of Gastrointestinal Endoscopic Skills (GAGES). All study materials were available through the TASSL Web site. Pre- and posttest comparisons were made by paired t-test.
The curriculum was completed successfully by 41 participants from four institutions. The mean number of trials to proficiency was 13 ± 10 for EndoBubble 1 and 23 ± 16 for EndoBubble 2. Significant improvements from pre- to posttraining were seen in cecal intubation time (229 ± 97 vs. 150 ± 57 s; p < 0.001), total time (454 ± 147 vs. 320 ± 115 s; p < 0.001), screening efficiency (85% ± 12% vs. 91% ± 5%; p < 0.002), GAGES scores (15 vs. 19; p < 0.001), subjects' endoscopy self-rating scores (1.5 ± 1.0 vs. 2.7 ± 0.6; range, 0-4; p < 0.001), and comfort level with flexible endoscopy skills (3.4 ± 3.0 vs. 7.2 ± 1.2; range, 0-8; p < 0.001).
The feasibility of sharing educational and training resources among institutions was demonstrated. Likewise, the concept of "mobile simulation" appears to be useful and effective, with three of the four institutions involved successfully in implementing the training curriculum during a fixed period. Additionally, subjects who completed the training demonstrated both subjective and objective improvements in flexible endoscopy skills.
德克萨斯州外科技能实验室协会（TASSL）是一个由德克萨斯州认证外科住院医师培训计划的外科技能培训中心组成的非营利联盟。TASSL 成员与 Simbionix（美国俄亥俄州克利夫兰）之间建立了培训和研究合作关系，以评估使用共享的 GI Mentor II 系统进行多中心、基于模拟和基于网络的灵活内窥镜培训课程的可行性和效果。
为该研究提供了两台 GI Mentor II 灵活内窥镜模拟器，四所机构，即德克萨斯大学健康科学中心-圣安东尼奥分校（UTHSCSA）、德克萨斯 A&M 大学（TAMU）、卫理公会医院（MHD）和布洛克陆军医疗中心（BAMC），同意共享它们。另外一个机构，德克萨斯大学西南医学中心（UTSW），已经拥有一台设备，并在研究期间参与了该项目。1 至 4 年级住院医师完成了培训前后的问卷调查和结肠镜检查案例模块 1 的一次培训前后试验。使用预定义的、专家推导的级别进行了 EndoBubble 1 和 2 任务的训练。在模拟器和全球胃肠内窥镜技能评估（GAGES）上记录培训前后的测试性能数据。所有研究材料均可通过 TASSL 网站获得。通过配对 t 检验进行培训前后的比较。
来自四个机构的 41 名参与者成功完成了课程。对于 EndoBubble 1，达到熟练程度的平均尝试次数为 13 ± 10；对于 EndoBubble 2，平均尝试次数为 23 ± 16。从培训前到培训后，观察到以下显著改善：盲肠插管时间（229 ± 97 秒对 150 ± 57 秒；p < 0.001）、总时间（454 ± 147 秒对 320 ± 115 秒；p < 0.001）、筛查效率（85% ± 12%对 91% ± 5%；p < 0.002）、GAGES 评分（15 对 19；p < 0.001）、受试者内镜自我评估评分（1.5 ± 1.0 对 2.7 ± 0.6；范围为 0-4；p < 0.001）和灵活内窥镜技能的舒适度评分（3.4 ± 3.0 对 7.2 ± 1.2；范围为 0-8；p < 0.001）。
成功证明了机构之间共享教育和培训资源的可行性。同样，“移动模拟”的概念似乎是有用且有效的，四个参与机构中有三个成功地在固定时间段内实施了培训课程。此外，完成培训的受试者在灵活内窥镜技能方面表现出主观和客观的改善。
