Buscaglia J M, Fakhoury J, Loyal J, Denoya P I, Kazi E, Stein S A, Scriven R, Bergamaschi R
Divisions of Gastroenterology, State University of New York, Stony Brook, New York, USA.
Divisions of Colon and Rectal Surgery, State University of New York, Stony Brook, New York, USA.
Colorectal Dis. 2015 Jun;17(6):530-5. doi: 10.1111/codi.12883.
Surgery residents are required to become proficient in colonoscopy before completing training. The aim of this study was to evaluate the responsiveness of surgery interns to simulated colonoscopy training.
Interns, defined as postgraduate year 1 residents without exposure to endoscopy, underwent training in a physical model including colonoscopy, synthetic anatomy trays with luminal tattoos and a hybrid simulator. After baseline testing and mentored training, final testing was performed using five predetermined proficiency criteria. Content-valid metrics defined by the extent of departure from clinical reality were evaluated by two blinded assessors. Responsiveness was defined as change in performance over time and assessed comparing baseline testing with nonmentored final testing.
Twelve interns (eight male, mean age 26, 80% right-handed) performed 48 colonoscopies each over 1 year. Improvement was seen in the overall procedure time (24 min 46 s vs 20 min 54 s; P = 0.03), passing the splenic flexure (20 min 33 s vs 10 min 45 s; P = 0.007), passing the hepatic flexure (23 min 31 s vs 12 min 45 s; P = 0.003), caecal intubation time (23 min 38 s vs 13 min 26 s; P = 0.008), the duration of loss of view of the lumen (75% vs 8.3%; P = 0.023), incomplete colonoscopy (100% vs 33.3%; P = 0.042), colonoscope withdrawal < 6 min (16.7% vs 8.3%; P = 0.052). Tattoo identification time (9 min 16 s vs 12 min 25 s; P = 0.50), colon looped time (2 min 12 s vs 1 min 45 s; P = 0.50) and rate of colon perforation (8.3% vs 8.3%; P = 1) remained unchanged. Interrater reliability was 1.0 for all measures.
Simulated colonoscopy training in a low-cost physical model improved the performance of surgery interns with decreased procedure time, increased rates of complete colonoscopy and appropriate scope withdrawal.
外科住院医师在完成培训前需熟练掌握结肠镜检查技术。本研究旨在评估外科实习医生对模拟结肠镜检查培训的反应能力。
将实习医生定义为未接触过内镜检查的一年级住院医师，他们在包括结肠镜检查、带有腔内纹身的合成解剖托盘和混合模拟器的物理模型中接受培训。在基线测试和带教培训后，使用五个预先确定的熟练标准进行最终测试。由两名盲法评估者评估由偏离临床实际程度定义的内容效度指标。反应能力定义为随时间的表现变化，并通过比较基线测试和无带教的最终测试进行评估。
12名实习医生（8名男性，平均年龄26岁，80%为右利手）在1年时间里每人进行了48次结肠镜检查。整体操作时间有所改善（24分46秒对20分54秒；P = 0.03），通过脾曲时间（20分33秒对10分45秒；P = 0.007），通过肝曲时间（23分31秒对12分45秒；P = 0.003），盲肠插管时间（23分38秒对13分26秒；P = 0.008），管腔视野消失持续时间（75%对8.3%；P = 0.023），不完全结肠镜检查（100%对33.3%；P = 0.042），结肠镜退出时间<6分钟（16.7%对8.3%；P = 0.052）。纹身识别时间（9分16秒对12分25秒；P = 0.50），结肠成袢时间（2分12秒对1分45秒；P = 0.50）和结肠穿孔率（8.3%对8.3%；P = 1）保持不变。所有测量指标的评估者间信度均为1.0。
在低成本物理模型中的模拟结肠镜检查培训提高了外科实习医生的操作表现，减少了操作时间，提高了全结肠镜检查率和适当的镜身退出率。
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