Mowry Christopher, Kohli Ruhail, Bhat Courtney, Truesdale Aimee, Menard-Katcher Paul, Scallon Andrew, Kriss Michael
Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Dig Dis Sci. 2023 Apr;68(4):1187-1194. doi: 10.1007/s10620-022-07665-8. Epub 2022 Aug 22.
Gastroesophageal balloon tamponade (BT) tube placement is a life-saving procedure for refractory bleeding from gastroesophageal varices performed by gastroenterologists, intensivists, internists, and emergency medicine physicians. Despite a recognized need for procedural training, no standard curriculum or assessment tools exist. Given the infrequent performance of this procedure, the development of a representative and accessible simulation model would permit hands-on training to practice and maintain proficiency with BT tube placement.
To assess BT tube placement performance before and after a novel simulation-based learning module in gastroenterology fellows and faculty.
A 16-item knowledge questionnaire and 22-item procedural skill checklist utilizing a novel 3D printed esophagus model were developed to assess participant knowledge, procedural skills, and confidence prior to our simulation-based intervention and again 8-12 weeks after. Performance metrics were compared pre- and post-intervention within groups and between participant groups.
Fifteen gastroenterology fellows (of 15 eligible; 100%) and 14 gastroenterology faculty (of 29 eligible; 48%) completed training. Fellows demonstrated improvement in knowledge (55% to 79%, p < 0.001) and procedural skill (35% to 57%, p < 0.001) following training. Baseline faculty performance did not differ from fellows' performance and post-intervention showed similar improvement in knowledge (61% to 77%, p = 0.001) and procedural skill (40% to 49%, p = 0.147). Overall satisfaction with training was high in both groups post-intervention and faculty felt more confident teaching fellows.
The presented learning module offers a unique, low stakes opportunity for learners to improve skills, gain knowledge, and build confidence in placing BT tubes using a realistic simulation model.
食管胃气囊压迫（BT）管置入术是由胃肠病学家、重症医学专家、内科医生和急诊医学医生对食管胃静脉曲张难治性出血实施的一种挽救生命的操作。尽管人们认识到需要进行操作培训，但目前尚无标准课程或评估工具。鉴于该操作的实施频率较低，开发一个具有代表性且易于使用的模拟模型将有助于进行实践培训，以练习和保持BT管置入的熟练度。
评估在胃肠病学住院医师和教员中，基于新型模拟学习模块开展前后的BT管置入操作表现。
开发了一份包含16个项目的知识问卷和一份利用新型3D打印食管模型的包含22个项目的操作技能清单，以评估参与者在基于模拟的干预之前以及干预后8至12周的知识、操作技能和信心。对干预前后组内以及参与者组间的表现指标进行比较。
15名胃肠病学住院医师（符合条件的15名全部参与；100%）和14名胃肠病学教员（符合条件的29名中的14名；48%）完成了培训。住院医师在培训后知识水平（从55%提高到79%，p<0.001）和操作技能（从35%提高到57%，p<0.001）均有改善。教员的基线表现与住院医师的表现无差异，干预后知识水平（从61%提高到77%，p=0.001）和操作技能（从40%提高到49%，p=0.147）也有类似改善。两组在干预后对培训的总体满意度都很高，教员对教授住院医师更有信心。
所呈现的学习模块为学习者提供了一个独特的、低风险的机会，使其能够利用逼真的模拟模型提高技能、获取知识并增强放置BT管的信心。
