Division of Gastroenterology, St Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Division of Gastroenterology, St Michael's Hospital, Toronto, Ontario, Canada.
Gastrointest Endosc. 2020 Nov;92(5):1070-1080.e3. doi: 10.1016/j.gie.2020.03.3754. Epub 2020 Mar 20.
Endoscopists are at risk of developing musculoskeletal injuries (MSIs), and few receive training on ergonomics. The aim of this study was to determine the impact of a simulation-based ergonomics training curriculum (ETC) on work-related MSI risk during clinical colonoscopy.
Novice endoscopists underwent a simulation-based ETC and were compared with an historical control group who received simulation-based training without ergonomics training. The ETC included a didactic lecture and video on ergonomics in colonoscopy, feedback from supervisors on ergonomics, and an ergonomics checklist to augment feedback and promote self-reflection. Participants were assessed using the rapid entire body assessment (REBA) and rapid upper limb assessment (RULA). The primary outcome was participants' REBA scores during 2 clinical colonoscopies 4 to 6 weeks after training.
In clinical colonoscopy, the ETC group had superior REBA scores (clinical procedure 1: median score, 6 vs 11; P < .001; clinical procedure 2: median score, 6 vs 10; P < .001). In a simulated colonoscopy, the ETC group did not have significantly different REBA or RULA scores between baseline, immediately after training, and 4 to 6 weeks after (REBA: median scores of 5, 5, and 5, respectively; P > .05; RULA: median scores of 6, 6, and 6, respectively; P > .05). The control group had worsening REBA and RULA scores during the study timeline (REBA: median scores of 5 at baseline, 9 immediately after training, and 9 at 4-6 weeks after training; P < .001; RULA: median scores of 6, 7, and 7, respectively; P = .04) during simulated procedures.
A simulation-based ETC is associated with reduced risk of MSI during endoscopy. Although the REBA score was improved, the intervention group was still within the medium-risk range.
内镜医生有发生肌肉骨骼损伤（MSI）的风险，且很少有人接受过有关人体工程学的培训。本研究旨在确定基于模拟的人体工程学培训课程（ETC）对临床结肠镜检查中与工作相关的 MSI 风险的影响。
新手内镜医生接受了基于模拟的 ETC，并与接受了基于模拟的培训但没有接受人体工程学培训的历史对照组进行了比较。ETC 包括关于结肠镜检查中人体工程学的讲座和视频、主管人员提供的人体工程学反馈，以及一份人体工程学检查表，以增强反馈并促进自我反思。参与者使用快速全身评估（REBA）和快速上肢评估（RULA）进行评估。主要结果是参与者在培训后 4 至 6 周内进行 2 次临床结肠镜检查时的 REBA 评分。
在临床结肠镜检查中，ETC 组的 REBA 评分更高（临床操作 1：中位数评分 6 比 11；P<0.001；临床操作 2：中位数评分 6 比 10；P<0.001）。在模拟结肠镜检查中，ETC 组在基线、培训后即刻和 4 至 6 周后的 REBA 评分没有显著差异（REBA：中位数评分分别为 5、5 和 5；P>0.05；RULA：中位数评分分别为 6、6 和 6；P>0.05）。对照组在研究期间的模拟操作中，REBA 和 RULA 评分恶化（REBA：基线中位数评分 5，培训后即刻中位数评分 9，4 至 6 周后中位数评分 9；P<0.001；RULA：中位数评分分别为 6、7 和 7；P=0.04）。
基于模拟的 ETC 与内镜检查中 MSI 风险降低有关。尽管 REBA 评分有所改善，但干预组仍处于中危范围。
