Wright Andrew P, Patel Anish H, Farida Jeremy P, Suresh Suraj, Rizk Rafat S, Prabhu Anoop
From the Division of Gastroenterology (A.P.W., A.H.P.), Loma Linda University Medical Center, Loma Linda, CA; Division of Gastroenterology (J.P.F., R.S.R., A.P.), University of Michigan Medical Center, Ann Arbor; and Division of Gastroenterology (S.S.), Henry Ford Hospital Health System, Detroit, MI.
Simul Healthc. 2022 Jun 1;17(3):198-202. doi: 10.1097/SIH.0000000000000580. Epub 2021 May 14.
Percutaneous endoscopic gastrostomy (PEG) tube placement remains a core competency of gastroenterology fellowship, although this procedure is performed infrequently. Some training programs lack sufficient procedural volume for trainees to develop confidence and competence in this procedure. We aimed to determine the impact of a simulation-based educational intervention on trainee technical skill and procedural attitudes in simulated PEG tube placement.
Gastroenterology fellows were invited to participate in the study. Baseline procedural attitudes toward PEG tube placement (self-confidence, perceived skill level, perceived level of required supervision) were assessed before simulation training using a Likert scale. Baseline technical skills were assessed by video recording-simulated PEG tube placement on a PEG tube simulator with scoring using a procedural checklist. Fellows next underwent individualized simulation training and repeated simulated PEG tube placement until greater than 90% of checklist items were achieved. Procedural attitudes were reassessed directly after the simulation. Technical skill and procedural attitudes were then reassessed 6 to 12 weeks later (delayed posttraining).
Twelve fellows completed the study. Simulation training led to significant improvement in technical skill at delayed reassessment (52.9 ± 14.3% vs. 78.0 ± 8.9% correct, P = 0.0002). Simulation training also led to significant immediate improvements in self-confidence (2.1 ± 0.7 vs. 3.1 ± 0.3, P = 0.001), perceived skill level (2.2 ± 1.0 vs. 4 ± 1.1, P < 0.001), and perceived level of required supervision (2.2 ± 0.9 vs. 3.2 ± 0.6, P = 0.003).
Simulation training led to sustained improvements in gastroenterology fellows' technical skill and procedural attitudes in PEG tube placement. Incorporation of simulation curricula in gastroenterology fellowships for this infrequently performed procedure should be considered.
经皮内镜下胃造口术（PEG）置管术仍是胃肠病学 fellowship 的一项核心技能，尽管该操作并不常见。一些培训项目缺乏足够的操作量，使学员难以在该操作中培养信心和能力。我们旨在确定基于模拟的教育干预对学员在模拟 PEG 管置管术中技术技能和操作态度的影响。
邀请胃肠病学 fellowship 学员参与研究。在模拟培训前，使用李克特量表评估学员对 PEG 管置管术的基线操作态度（自信心、感知技能水平、所需监督水平）。通过在 PEG 管模拟器上录制模拟 PEG 管置管术视频并使用操作检查表进行评分来评估基线技术技能。学员随后接受个性化模拟培训并重复模拟 PEG 管置管术，直至超过 90%的检查表项目达标。模拟结束后直接重新评估操作态度。然后在 6 至 12 周后（培训后延迟评估）再次评估技术技能和操作态度。
12 名学员完成了研究。模拟培训导致在延迟重新评估时技术技能有显著提高（正确操作率从 52.9 ± 14.3%提高到 78.0 ± 8.9%，P = 0.0002）。模拟培训还导致自信心（2.1 ± 0.7 提高到 3.1 ± 0.3，P = 0.001）、感知技能水平（2.2 ± 1.0 提高到 4 ± 1.1，P < 0.001）和所需监督水平（2.2 ± 0.9 提高到 3.2 ± 0.6，P = 0.003）立即有显著改善。
模拟培训使胃肠病学 fellowship 学员在 PEG 管置管术的技术技能和操作态度方面取得了持续的进步。对于这一不常进行的操作，应考虑将模拟课程纳入胃肠病学 fellowship 培训中。
