Kanno Takeshi, Arata Yutaro, Greenwald Eric, Moayyedi Paul, Suzuki Suguo, Hatayama Yutaka, Saito Masahiro, Jin Xiaoyi, Hatta Waku, Uno Kaname, Asano Naoki, Imatani Akira, Kagaya Yutaka, Koike Tomoyuki, Masamune Atsushi
Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
R & D Division of Career Education for Medical Professionals, Medical Education Center, Jichi Medical University, Shimotsuke, Japan.
Endosc Int Open. 2024 Feb 28;12(2):E245-E252. doi: 10.1055/a-2248-5110. eCollection 2024 Feb.
Endoscopic hemostasis is a life-saving procedure for gastrointestinal bleeding; however, training for it is often performed on real patients and during urgent situations that put patients at risk. Reports of simulation-based training models for endoscopic hemostasis are scarce. Herein, we developed a novel simulator called "Medical Rising STAR-Ulcer type" to practice endoscopic hemostasis with hemoclips and coagulation graspers. This study aimed to evaluate the reproducibility of the clinical difficulty of this model and the effectiveness of simulation-based training for clipping hemostasis. This was a prospective educational study. Fifty gastroenterology residents from Japan and Canada were recruited to participate in a simulation-based training program. The primary outcome was the success rate for clipping hemostasis. We measured differences in trainee subjective assessment scores and evaluated the co-occurrence network based on comments after training. The hemostasis success rate of the trainees significantly increased after instruction (64% vs. 86%, < 0.05). The success rate for ulcers in the upper body of the stomach (59%), a high-difficulty site, was significantly lower than that for ulcers in the antrum, even after feedback and instruction. Trainee self-perceived proficiency and confidence significantly improved after simulation-based training ( < 0.05). Co-occurrence network analysis showed that trainees valued a structured learning approach, acknowledged simulator limitations, and recognized the need for continuous skill refinement. Our study demonstrates the potential of our simulation-based training model as a valuable tool for improving technical skills and confidence in trainees learning to perform endoscopic hemostasis.
内镜止血是治疗胃肠道出血的一项挽救生命的操作；然而，其培训通常在真实患者身上且在使患者处于风险的紧急情况下进行。关于基于模拟的内镜止血训练模型的报道很少。在此，我们开发了一种名为“Medical Rising STAR - 溃疡型”的新型模拟器，用于使用止血夹和凝血抓钳进行内镜止血练习。本研究旨在评估该模型临床难度的可重复性以及基于模拟的夹闭止血训练的有效性。这是一项前瞻性教育研究。招募了来自日本和加拿大的50名胃肠病学住院医师参加基于模拟的培训项目。主要结局是夹闭止血的成功率。我们测量了学员主观评估分数的差异，并根据培训后的评论评估了共现网络。培训后学员的止血成功率显著提高（64%对86%，<0.05）。即使经过反馈和指导，胃体上部溃疡（59%）这一高难度部位的成功率仍显著低于胃窦部溃疡。基于模拟的培训后，学员自我感知的熟练程度和信心显著提高（<0.05）。共现网络分析表明，学员重视结构化学习方法，认识到模拟器的局限性，并认识到持续技能提升的必要性。我们的研究证明了我们基于模拟的培训模型作为一种有价值的工具，在提高学员学习进行内镜止血的技术技能和信心方面的潜力。
