Martinek Jan, Stefanova Magdalena, Suchanek Stepan, Zavada Filip, Svobodova Barbora, Strosova Alice, Zavoral Miroslav
From the Department of Hepatogastroenterology (J.M.), IKEM; and Department of Internal Medicine (M.S.), Hospital "Na Frantisku"; Department of Internal Medicine (S.S., F.Z., A.S., M.Z.), and Department of Nephrology (B.S.), 1st Faculty of Medicine, Military University Hospital (S.S., F.Z., A.S., M.Z.), and General Faculty Hospital (B.S.), Charles University in Prague, Czech Republic.
Simul Healthc. 2014 Apr;9(2):112-9. doi: 10.1097/SIH.0b013e31829be99e.
Virtual reality simulator and ex vivo animal models are used for training of both basic and advanced endoscopic techniques. The aim of this study was to assess whether hands-on training on ex vivo animal model improves endoscopic skills. Four different endoscopic techniques were practiced: endoscopic resection, endoscopic stenting, application of the over-the-scope (OVESCO) clip, and endoscopic submucosal dissection (ESD).
Except for 2 participants, all trainees participated in a 1-day course. Two remaining participants took part in 7 ESD courses. All training courses consisted of theoretical introduction and a 6-hour training on Erlangen Active Training Simulator. The endoscopic skills were assessed before and after the training session by 2 independent assessors. Each assessor evaluated the skills by using a score on a scale of 1 to 5, where 1 stands for excellent and 5 for insufficient. Each assessor also assessed whether the procedure was successfully completed. The main outcome measurement was the percentage of participants who successfully completed the procedure during the test.
For endoscopic resection, endoscopists (n = 15) improved their skills (median [10th and 90th percentiles] score before training, 3.5 [2.7-4.2]; after training 1.5 [1-2.3], P < 0.001). Seven procedures were assessed as successful before the course (47%); after the training, 13 procedures were assessed as successful (87%) (P = 0.02). For stenting, participants (n = 15) significantly improved their abilities to place both self-expandible metallic and plastic stents. For OVESCO clip (n = 10), participants (n = 10) improved their skills to prepare and apply the clip (given the score of 4.5 [3.9-5] before and 2.0 [1.2-2.8] after, P < 0.01). Before the training, only 1 clip application had been successful (10%), whereas the number rose to 9 after the course (90%). For endoscopic submucosal dissection (n = 10), eight participants of the 1-day course did not improve their competences (with scores of 4.2 [3.8-5] before and 4.0 [3.1-4.8] after, nonsignificant). Two participants who had undertaken 7 ESD courses improved their skills (with scores of 4 before and 1.6 after); given the small number of participants, this finding is statistically insignificant.
The effect of training on clinical outcome was not investigated. There was a lack of pretraining versus posttraining tests blinding.
A 1-day training course on ex vivo animal model improves general endoscopic competence on simulator in endoscopic resection, insertion of stents, and application of OVESCO clips. In contrast, 1-day course does not improve skills for ESD that requires a higher number of training courses.
虚拟现实模拟器和离体动物模型用于基础和高级内镜技术的培训。本研究的目的是评估在离体动物模型上进行的实践培训是否能提高内镜技能。我们练习了四种不同的内镜技术：内镜切除术、内镜支架置入术、套扎器（OVESCO）夹子的应用以及内镜黏膜下剥离术（ESD）。
除2名参与者外，所有学员参加了为期1天的课程。其余2名参与者参加了7次ESD课程。所有培训课程均包括理论介绍以及在埃尔朗根主动训练模拟器上进行的6小时培训。培训前后由2名独立评估者对内镜技能进行评估。每位评估者使用1至5分的评分标准对技能进行评估，其中1分代表优秀，5分代表不足。每位评估者还评估了操作是否成功完成。主要结局指标是测试期间成功完成操作的参与者百分比。
对于内镜切除术，内镜医师（n = 15）提高了他们的技能（训练前中位数[第10和第90百分位数]评分，3.5[2.7 - 4.2]；训练后1.5[1 - 2.3]，P < 0.001）。课程前有7例操作被评估为成功（47%）；训练后，有13例操作被评估为成功（87%）（P = 0.02）。对于支架置入术，参与者（n = 15）显著提高了放置自膨式金属支架和塑料支架的能力。对于OVESCO夹子（n = 10），参与者（n = 10）提高了准备和应用夹子的技能（训练前评分为4.5[3.9 - 5]，训练后为2.0[1.2 -
