Training on an ex vivo animal model improves endoscopic skills: a randomized, single-blind study.

BACKGROUND

Animal models are used for training of different endoscopic procedures. Whether this really improves endoscopic skills remains controversial.

OBJECTIVE

To assess the effectiveness of training by using an ex vivo animal gastric model on the performance of two therapeutic procedures-hemostasis and treatment of perforation.

DESIGN

A randomized, single-blind study.

SETTING

An experimental endoscopy center in a university hospital.

PARTICIPANTS

Thirty-one gastroenterology fellows with comparable endoscopic experience.

METHODS

Participants were randomized into two groups: with (T, n = 16) and without (S, n = 15) training. All fellows continued with standard endoscopic practice. Baseline skills were assessed at enrollment. All physicians in group T underwent 2 full days of a hands-on course over a 3-month period, in addition to their standard endoscopic practice. Both groups then underwent a blinded, final evaluation. Endoscopic skills were scored from 1 (best) to 5 (poorest) by two expert, blinded tutors. Outcomes of clinical hemostatic procedures also were analyzed.

MAIN OUTCOME MEASUREMENTS

Successful hemostasis and successful perforation closure.

RESULTS

Thirty physicians completed the study. Hemostasis results (n = 15): The number of physicians who carried out a successful hemostasis procedure increased significantly in the group with training (27% vs 73%; P = .009) but did not change in the group without training (20% vs 20%). The mean scores of injection and clipping technique improved significantly only after training. The number of clips used decreased significantly only in the group with training; the time of clipping did not change significantly in either group. Perforation results (n = 15): The number of physicians with a successful and complete perforation closure increased nearly significantly in the group with training (40% vs 73%, P = .06) as opposed to the group without training (27% vs 47%; P = .27). The procedure time decreased significantly in the group with training only. In clinical practice, fellows in group T had a significantly higher success rate with respect to hemostatic procedures (83.2%, range 67-100 vs 63.6%, range 25-100; P = .0447). The majority of participants (93%) agreed that such courses should be compulsory in gastroenterological credentials.

LIMITATIONS

A retrospective analysis of clinical outcomes. Clinical outcome data were based on self-reporting of the participants.

CONCLUSION

Hands-on training by using an animal ex vivo model improves endoscopic skills in both hemostasis and perforation closure. In clinical practice, the training improves the outcome of hemostatic procedures.