School of Human Movement Studies, The University of Queensland, Brisbane, Australia.
Clinical Skills Development Service, Metro North Hospital and Health Service, Brisbane, Australia.
Surg Endosc. 2017 Dec;31(12):5364-5371. doi: 10.1007/s00464-017-5617-7. Epub 2017 Jun 7.
Effective control of the colonoscope tip is one of the most fundamental components of colonoscopy skill. Mastering fine tip control can be problematic for novice trainees, yet no validated training regimes exist for developing this specific skill component in isolation. We aimed to conduct a preliminary validation of a novel training device for colonoscopic tip control, and to assess its efficacy as a training tool.
In study 1 (validation), 13 experienced colonoscopists and 16 novices used a colonoscope to accurately track 28 targets on each of four concave "training surfaces" as quickly as possible, and we compared their performance. In study 2 (pre-post-training study), another 16 novices were tested before and after a six-session training program. In both studies, the main outcome measurements were completion time (measured automatically by the device) and variability of individual performance (the SD of each individual's completion times across trials).
Compared with novices, experienced colonoscopists were faster (P < 0.0001) and their performances less variable (P < 0.0001). With training, novices became faster (P < 0.0001) and more consistent (P = 0.003), and these improvements also generalized to novel training surfaces (P's < 0.01). After training, the novices' tip control performance was indistinguishable from that of the experienced colonoscopists (P's > 0.05). The composite measures of completion time used in both studies all had acceptable to excellent internal consistency reliability (α's ranged from 0.72 to 0.93).
We found that performance measures derived from using the device to assess skill can discriminate between experienced colonoscopists and novices in terms of their ability to control and guide the colonoscope tip precisely, providing preliminary evidence to support the construct validity of the metrics. The device is also an effective training tool for this fundamental component of colonoscopy skill.
有效的控制结肠镜尖端是结肠镜技能最基本的组成部分之一。掌握精细的尖端控制对于新手学员来说可能是一个问题，但目前还没有针对这种特定技能的单独训练方案。我们旨在对一种新型结肠镜尖端控制训练设备进行初步验证，并评估其作为一种培训工具的效果。
在研究 1（验证）中，13 名经验丰富的结肠镜医师和 16 名新手使用结肠镜尽可能快地准确跟踪四个凹面“训练面”上的 28 个目标，我们比较了他们的表现。在研究 2（培训前后研究）中，另外 16 名新手在进行了六次培训课程前后接受了测试。在这两项研究中，主要的测量结果是完成时间（由设备自动测量）和个体表现的可变性（每个个体在各次试验中的完成时间的标准差）。
与新手相比，经验丰富的结肠镜医师更快（P<0.0001），表现也更稳定（P<0.0001）。经过培训，新手变得更快（P<0.0001），表现也更一致（P=0.003），这些改进也推广到了新的训练面（P<0.01）。培训后，新手的尖端控制能力与经验丰富的结肠镜医师无法区分（P>0.05）。两项研究中使用的综合完成时间测量都具有可接受的至极好的内部一致性可靠性（α 值范围为 0.72 至 0.93）。
我们发现，使用该设备评估技能的表现测量值可以根据经验丰富的结肠镜医师和新手在精确控制和引导结肠镜尖端的能力方面进行区分，为该指标的结构有效性提供了初步证据支持。该设备也是结肠镜技能这一基本组成部分的有效培训工具。
