Elsevier

Gastrointestinal Endoscopy

Volume 61, Issue 2, February 2005, Pages 204-215
Gastrointestinal Endoscopy

Original Article
Training with the compactEASIE biologic endoscopy simulator significantly improves hemostatic technical skill of gastroenterology fellows: a randomized controlled comparison with clinical endoscopy training alone

https://doi.org/10.1016/S0016-5107(04)02471-XGet rights and content

Background

The Erlangen Active Simulator for Interventional Endoscopy (EASIE) was introduced in 1997 for interventional endoscopy training. compactEASIE developed in 1998 is a modified, light-weight version of the original model. Objective evidence of the benefits of training with these models is limited. A randomized controlled study, therefore, was conducted to compare the effects of intensive 7-month, hands-on training in hemostatic techniques by using the compactEASIE model (in addition to clinical endoscopic training) vs. pure clinical training in endoscopic hemostatic methods.

Methods

Thirty-seven fellows in gastroenterology in New York City area training programs were enrolled. Baseline skills were assessed on the simulator for the following techniques: manual skills, injection and electrocoagulation, hemoclip application, and variceal ligation. Twenty-eight fellows were then randomized into two comparable groups. Those randomized to Group A received purely clinical training in endoscopic hemostatic techniques at their hospitals. Those in Group B, in addition, were trained by experienced tutors in 3 full-day hemostasis workshops over 7 months. Both groups underwent a final evaluation on the compactEASIE simulator conducted by their tutors and additional evaluators who were blinded to the method of training. Initial and final evaluation scores were compared for each group and between groups. Outcomes of actual clinical hemostatic procedures performed during the study period also were analyzed.

Results

Ten of 14 fellows randomized to Group A (standard training) and 13 of 14 in Group B (intensive training) returned for the final evaluation. For Group B, scores for all techniques were significantly improved. In Group A, a significant improvement was noted for variceal ligation alone.

Conclusions

compactEASIE simulator training (3 sessions over 7 months), together with clinical endoscopic training resulted in objective improvement in the performance by fellows of all 4 endoscopic hemostatic techniques, whereas significant improvement was noted for variceal ligation alone for fellows who had standard clinical training. In clinical practice, fellows who had intensive simulator/clinical training had a significantly higher success rate and a nonsignificant reduction in the frequency of occurrence of complications.

Section snippets

Study design

Fellows in 3-year gastroenterology fellowship programs in 9 hospitals in New York City and environs were invited to participate in the project. Participants were asked to complete a questionnaire to document prior endoscopic experience in diagnostic and therapeutic procedures. At entry, all participants had already received some standard endoscopy training during their fellowship. The study design was prospective, two-armed, and randomized. The endoscopic experience of all participating fellows

Results

Thirty-seven fellows in gastroenterology (first-, second-, and third-year) from 9 New York City area training programs applied to participate in this pilot project. Of the 37 who applied, 28 who were able to commit to participation in all 3 predetermined weekend training sessions entered the trial. After the baseline assessment of skills, the 28 fellows were randomized by opening sealed envelopes into two equal groups: Group A (standard training) included 6 first-year, 4 second-year, and 4

Discussion

Optimal patient care and quality assurance relies heavily on the availability of well-trained physicians. Successful endoscopy training combines the acquisition of theoretical background knowledge with mastery and refinement of manual skills. Such practical skills typically are acquired by practicing on the patient, initially under the supervision of an experienced endoscopist. Videoendoscopy has been an important advance with respect to teaching.21 Endoscopy courses that demonstrate actual

Acknowledgments

A special thank you to all of the “blinded tutors” and the numerous “helping hands” who made this training project possible.

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    The first author (J.H) and the second author (K.M.) contributed in equal parts as principal authors to this study.

    The study is part of the medical thesis of Mr. Kai Matthes at the Friedrich-Alexander University of Erlangen, Germany.

    The results of the study were presented in part as oral presentations at Digestive Diseases Week, May 19-23, 2002, San Francisco, California (Gastrointest Endosc 2002;55:AB77; Gastrointest Endosc 2002;55:AB78); Digestive Diseases Week, May 18-21, 2003, Orlando, Florida.

    This study was supported by a research grant of the “Verein zur Foerderung der qualitaetsorientierten praktischen Weiterbildung in der Endoskopie e.V.” (Endo-Verein Erlangen), a noncommercial, nonprofit training organization of the City Court of Erlangen, Germany (Reg. No VR 1380).

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