Endoscopic Skills Training: The Impact of Virtual Exercises on Simulated Colonoscopy

Abstract

<b><i>Background:</i></b> A previous study suggested that psychomotor training improves the performance on colonoscopy. Since then, newer exercises have been included in the latest generation of GI Mentor®. In order to optimize a colonoscopy training program, we aimed to determine the impact of 3 virtual exercises in simulated colonoscopy skills. <b><i>Methods:</i></b> This was a prospective and randomized study. Nineteen residents completed a pre-training questionnaire and a colonoscopy trial before randomization in a study group (<i>n</i> = 10) that performed three exercises (Endobubble I, Navigation I, and Mucosal Evaluation I) until they achieved expert level, and a control group (<i>n</i> = 9). Both groups performed 10 repetitions of a simulated colonoscopy and were assessed on a final case. Learning curves and skills transfer were assessed by four parameters: mucosal surface examined (%), time to reach the cecum (s), screening efficiency (%), and time the patient was in pain (%). We also evaluated the construct validity for the exercises. <b><i>Results:</i></b> Construct validity was confirmed for Endobubble I and verified in Navigation I (experts were faster than novices; 5 vs. 7 s, <i>p</i> = 0.040), but not for Mucosal Evaluation I. Analyzing the learning curves and performance in the 10 repetitions<b>,</b> the study group reached the cecum faster (278 vs. 356 s, <i>p</i> = 0.035) and achieved a higher screening efficiency (83% vs. 75%, <i>p</i> = 0.019). Concerning skills transfer, the control group took longer to reach the cecum (241 vs. 292 s, <i>p</i> = 0.021) and the percentage of time the patient was in pain was higher (6% vs. 9%, <i>p</i> = 0.021). General performances of the study group had smaller interquartile variations. <b><i>Conclusion:</i></b> Psychomotor training has a significant impact on the homogeneous acquisition and assimilation of colonoscopy skills. Endobubble I and Navigation I should be considered in the training programs for novices.