Wilcox Victor, Trus Ted, Salas Nilson, Martinez Jose, Dunkin Brian J
Methodist Institute for Technology, Innovation & Education (MITIE); Department of Surgery, The Methodist Hospital, Houston, Texas.
Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
J Surg Educ. 2014 May-Jun;71(3):282-8. doi: 10.1016/j.jsurg.2013.10.004. Epub 2014 Jan 4.
The surgical training for endoscopic proficiency program is a collaborative project between Society of American Gastrointestinal and Endoscopic Surgeons and Olympus America Inc. dedicated to providing flexible endoscopy training to surgery residency programs. Currently it lacks models for proficiency-based training. This study developed 2 novel flexible endoscopy simulators, purchased a third, and established face and content validity as well as proficiency metrics for all 3.
Three simulators were tested-a foam and cardboard upper gastrointestinal tract model, a commercially available colonoscopy model (CM-15, Olympus, Japan), and an endoscopic targeting model created from the Operation Game (Hasbro). Time and errors for the performance of 12 expert surgical endoscopists on each model were used to calculate proficiency scores. Face validity and content validity were established through posttest questionnaires using a 5-point Likert scale.
Experts had a mean of 8 years of endoscopic practice (range: 1-24y). Among them, 83% teach residents or fellows using simulation. Most perform more than 50 upper endoscopies (51 to >500) and 100 colonoscopies (101 to >500) per year. The average time for completing the upper gastrointestinal tract model with correct identification of all targets was 133 ± 56 seconds. Complete navigation of the colonoscopy model averaged 325 ± 156 seconds. Proper orientation and targeting using the Operation Game model averaged 273 ± 109 seconds with 3 errors.
This study proves face and content validity for 3 physical flexible endoscopy simulators that can be used to train upper and lower endoscopy as well as instrument targeting. It also establishes expert proficiency metrics that can be used by trainees for structured rehearsal. These relatively inexpensive models will be incorporated into the surgical training for endoscopic proficiency curriculum.
内镜操作熟练程度培训的外科培训项目是美国胃肠与内镜外科医师协会和美国奥林巴斯公司之间的合作项目，致力于为外科住院医师培训项目提供灵活的内镜培训。目前，该项目缺乏基于熟练程度的培训模式。本研究开发了2种新型的灵活内镜模拟器，购买了第3种，并建立了这3种模拟器的表面效度、内容效度以及熟练程度指标。
测试了3种模拟器——一种泡沫和硬纸板制成的上消化道模型、一种市售的结肠镜检查模型（CM-15，奥林巴斯，日本）以及一种由“手术游戏”（孩之宝公司）制作的内镜靶向模型。12名外科内镜专家在每种模型上的操作时间和错误情况被用于计算熟练程度得分。通过使用5点李克特量表的测试后问卷来建立表面效度和内容效度。
专家们平均有8年的内镜操作经验（范围：1 - 24年）。其中，83%的人使用模拟培训住院医师或研究员。大多数人每年进行超过50次上消化道内镜检查（51至>500次）和100次结肠镜检查（101至>500次）。正确识别所有目标完成上消化道模型的平均时间为133±56秒。结肠镜检查模型的完整导航平均为325±156秒。使用“手术游戏”模型进行正确定向和靶向平均用时273±109秒，有3次错误。
本研究证明了3种物理灵活内镜模拟器的表面效度和内容效度，这些模拟器可用于培训上消化道和下消化道内镜检查以及器械靶向操作。它还建立了专家熟练程度指标，可供学员用于结构化演练。这些相对便宜的模型将被纳入内镜操作熟练程度培训课程的外科培训中。
