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Preclinical endoscopic training using a part-task simulator: learning curve assessment and determination of threshold score for advancement to clinical endoscopy

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Abstract

Background

Preclinical simulator training has the potential to decrease endoscopic procedure time and patient discomfort. This study aims to characterize the learning curve of endoscopic novices in a part-task simulator and propose a threshold score for advancement to initial clinical cases.

Methods

Twenty novices with no prior endoscopic experience underwent repeated endoscopic simulator sessions using the part-task simulator. Simulator scores were collected; their inverse was averaged and fit to an exponential curve. The incremental improvement after each session was calculated. Plateau was defined as the session after which incremental improvement in simulator score model was less than 5%. Additionally, all participants filled out questionnaires regarding simulator experience after sessions 1, 5, 10, 15, and 20. A visual analog scale and NASA task load index were used to assess levels of comfort and demand.

Results

Twenty novices underwent 400 simulator sessions. Mean simulator scores at sessions 1, 5, 10, 15, and 20 were 78.5 ± 5.95, 176.5 ± 17.7, 275.55 ± 23.56, 347 ± 26.49, and 441.11 ± 38.14. The best fit exponential model was [time/score] = 26.1 × [session #]−0.615; r 2 = 0.99. This corresponded to an incremental improvement in score of 35% after the first session, 22% after the second, 16% after the third and so on. Incremental improvement dropped below 5% after the 12th session corresponding to the predicted score of 265. Simulator training was related to higher comfort maneuvering an endoscope and increased readiness for supervised clinical endoscopy, both plateauing between sessions 10 and 15. Mental demand, physical demand, and frustration levels decreased with increased simulator training.

Conclusion

Preclinical training using an endoscopic part-task simulator appears to increase comfort level and decrease mental and physical demand associated with endoscopy. Based on a rigorous model, we recommend that novices complete a minimum of 12 training sessions and obtain a simulator score of at least 265 to be best prepared for clinical endoscopy.

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Adapted from Hart SG, Staveland LE. Development of NASA-TLX (Task Load Index): Results of Empirical and Theoretical Research. Advances in Psychology. 1988;52:139–183

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Acknowledgements

Materials and financial support were provided by the Department of Medicine, Brigham and Women’s Hospital; Harvard Digestive Diseases Center at Harvard Medical School (DK034854); and the Center for Integration of Medicine and Innovative Technology (CIMIT).

Author contributions

P. J: Study design, data collection and analysis, drafting and revision of the manuscript; W. A: Data analysis and drafting of the manuscript; H. A: Data collection; T. Z: Data collection; C. T: Data collection; A. I: Study design and data collection; C. T: Study design and critical revision of the manuscript.

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Authors and Affiliations

  1. Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Pichamol Jirapinyo, Wasif M. Abidi, Hiroyuki Aihara & Christopher C. Thompson

  2. Harvard Medical School, Boston, MA, USA

    Pichamol Jirapinyo, Wasif M. Abidi, Hiroyuki Aihara & Christopher C. Thompson

  3. Yale University School of Medicine, New Haven, CT, USA

    Theodore Zaki, Cynthia Tsay & Avlin B. Imaeda

  4. VA Connecticut Healthcare System, West Haven, CT, USA

    Avlin B. Imaeda

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  1. Pichamol Jirapinyo
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  2. Wasif M. Abidi
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  3. Hiroyuki Aihara
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  4. Theodore Zaki
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  7. Christopher C. Thompson
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Correspondence to Christopher C. Thompson.

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Disclosures

Dr. Jirapinyo reports personal fees from Endosim during the conduct of the study. Dr. Thompson reports personal fees from Olympus and personal fees from Endosim during the conduct of the study. Aihara, Zaki, Tsay, and Imaeda report no conflict of interest.

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Jirapinyo, P., Abidi, W.M., Aihara, H. et al. Preclinical endoscopic training using a part-task simulator: learning curve assessment and determination of threshold score for advancement to clinical endoscopy. Surg Endosc 31, 4010–4015 (2017). https://doi.org/10.1007/s00464-017-5436-x

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