Development and validation of metric-based-training to proficiency simulation curriculum for upper gastrointestinal endoscopy using a novel assessment checklist
Nahla Azzam1, Nehal Khamis2, Majid Almadi1, Faisal Batwa3, Fahad Alsohaibani4, Abdulrahman Aljebreen1, Ahmad Alharbi5, Yasser Alaska6, Turki Alameel7, Peter Irving8, Richard M Satava9
1 Department of Medicine, Division of Gastroenterology, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
2 Saudi Commission for Health Specialties; King Saud University Clinical Skills and Simulation Center, Riyadh, Kingdom of Saudi Arabia; Departments of Pathology and Medical Education, College of Medicine, Suez Canal University, Egypt
3 Department of Medicine, Division of Gastroenterology, King Saud bin AbdulAziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia
4 Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
5 Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia
6 King Saud University Clinical Skills and Simulation Center; Department of Emergency Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
7 Department of Medicine, King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia
8 London Digestive Health, London Hospital Medical College, London, United Kingdom
9 Department of Surgery, University of Washington Medical Center, Seattle, Washington, United States of America
Dr. Majid Almadi
Division of Gastroenterology, King Saud University Medical City, Riyadh - 12372
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
Background/Aims: This study aimed to design a structured simulation training curriculum for upper endoscopy and validate a new assessment checklist.
Materials and Methods: A proficiency-based progression stepwise curriculum was developed consisting of didactic, technical and non-technical components using a virtual reality simulator (VRS). It focused on: scope navigation, anatomical landmarks identification, mucosal inspection, retro-flexion, pathology identification, and targeting biopsy. A total of 5 experienced and 10 novice endoscopists were recruited. All participants performed each of the selected modules twice, and mean and median performance were compared between the two groups. Novices pre-set level of proficiency was set as 2 standard deviations below the mean of experts. Performance was assessed using multiple-choice questions for knowledge, while validated simulator parameters incorporated into a novel checklist; Simulation Endoscopic Skill Assessment Score (SESAS) were used for technical skills.
Results: The following VRS outcome measures have shown expert vs novice baseline discriminative ability: total procedure time, number of attempts for esophageal intubation and time in red-out. All novice trainees achieved the preset level of proficiency by the end of training. There were no statistically significant differences between experts' and trainees' rate of complications, landmarks identification and patient discomfort. SESAS checklist showed high degree of agreement with the VRS metrices (kappa = 0.83) and the previously validated direct observation of procedural skills tool (kappa = 0.90).
Conclusion: The Fundamentals of Gastrointestinal Endoscopy simulation training curriculum and its SESAS global assessment tool have been primarily validated and can serve as a valuable addition to the gastroenterology fellowship programs. Follow up study of trainee performance in workplaces is recommended for consequences validation.