Zusammenfassung

BACKGROUND: Colonoscopy is essential for the diagnosis and treatment of colonic diseases. Simulation is increasingly prevalent in colonoscopy skills acquisition as it allows controlled experiential learning without risk to patients. However, objectively assessing when trainees achieve the competence required to proceed to patients remains an outstanding challenge. AIMS: To establish a novel metric using advanced motion analysis to objectively assess colonoscopy skills acquisition across multiple simulation models. METHODS: This pilot study assessed the difference between experienced (N=9) and novice endoscopists (N=20) before and after training on a low-fidelity bench-top colonoscopy simulator developed by Walsh et al. (2009) which is designed to teach basic endoscope handling skills. Experienced colonoscopists were asked to scope four different courses with two repetitions in a random sequence to define the benchmark workflow. Novice endoscopists were asked to scope the same course prior to and after completing a 1-hour practice session. Execution time in seconds, hand path length in meters and number of hand movements were recorded using electromagnetic position sensors attached to the left and right hands and forearms. RESULTS: Before practice novice endoscopists had average right hand (RH) path length, number RH movements, and total time of 6.42m, 48.7, and 153s, respectively. This was significantly higher than expert endoscopist values of 2.91m, 13.6 and 39.9s (p < 0.001 for all). Additionally, pre-practice values were significantly higher than post-practice values of 3.24m, 21.1 and 59.0s (p=0.002, p=0.003, p=0.002, respectively). Fifteen of 20 novice endoscopists reached competency after 1-hour of practice on this model; competency was defined using the second lowest performing expert’s scores. Figure 1 shows execution time of the top and bottom quartile of novice endoscopists after practice compared to the mean of experienced endoscopists. CONCLUSIONS: We are the first group to propose a novel ...