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Simulation-based mastery learning for endoscopy using the endoscopy training system: a strategy to improve endoscopic skills and prepare for the fundamentals of endoscopic surgery (FES) manual skills exam

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Abstract

Introduction

The fundamentals of endoscopic surgery (FES) program has considerable validity evidence for its use in measuring the knowledge, skills, and abilities required for competency in endoscopy. Beginning in 2018, the American Board of Surgery will require all candidates to have taken and passed the written and performance exams in the FES program. Recent work has shown that the current ACGME/ABS required case volume may not be enough to ensure trainees pass the FES skills exam. The aim of this study was to investigate the feasibility of a simulation-based mastery-learning curriculum delivered on a novel physical simulation platform to prepare trainees to pass the FES manual skills exam.

Methods

The newly developed endoscopy training system (ETS) was used as the training platform. Seventeen PGY 1 (10) and PGY 2 (7) general surgery residents completed a pre-training assessment consisting of all 5 FES tasks on the GI Mentor II. Subjects then trained to previously determined expert performance benchmarks on each of 5 ETS tasks. Once training benchmarks were reached for all tasks, a post-training assessment was performed with all 5 FES tasks.

Results

Two subjects were lost to follow-up and never returned for training or post-training assessment. One additional subject failed to complete any portion of the curriculum, but did return for post-training assessment. The group had minimal endoscopy experience (median 0, range 0–67) and minimal prior simulation experience. Three trainees (17.6%) achieved a passing score on the pre-training FES assessment. Training consisted of an average of 48 ± 26 repetitions on the ETS platform distributed over 5.1 ± 2 training sessions. Seventy-one percent achieved proficiency on all 5 ETS tasks. There was dramatic improvement demonstrated on the mean post-training FES assessment when compared to pre-training (74.0 ± 8 vs. 50.4 ± 16, p < 0.0001, effect size = 2.4). The number of ETS tasks trained to proficiency correlated moderately with the score on the post-training assessment (r = 0.57, p = 0.028). Fourteen (100%) subjects who trained to proficiency on at least one ETS task passed the post-training FES manual skills exam.

Conclusions

This simulation-based mastery learning curriculum using the ETS is feasible for training novices and allows for the acquisition of the technical skills required to pass the FES manual skills exam. This curriculum should be strongly considered by programs wishing to ensure that trainees are prepared for the FES exam.

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Funding

The Funding was provided by Society of American Gastrointestinal and Endoscopic Surgeons and Henry M. Jackson Foundation (Grant No. 64438).

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Authors and Affiliations

  1. Department of Surgery at the Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, and National Capital Region Simulation Consortium, 4301 Jones Bridge Road A-3020 C, Bethesda, MD, 20814, USA

    E. Matthew Ritter, Zachary A. Taylor, Kathryn R. Wolf, Brenton R. Franklin & Sarah B. Placek

  2. Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA

    James R. Korndorffer Jr.

  3. Baylor College of Medicine, Houston, TX, USA

    Aimee K. Gardner

Authors
  1. E. Matthew Ritter
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  2. Zachary A. Taylor
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  3. Kathryn R. Wolf
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  4. Brenton R. Franklin
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  5. Sarah B. Placek
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  6. James R. Korndorffer Jr.
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  7. Aimee K. Gardner
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Corresponding author

Correspondence to E. Matthew Ritter.

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Disclosures

Dr. Ritter receives research support from the Henry M. Jackson Foundation for the Advancement of Military Medicine. Dr. Gardner has ownership interest in SurgWise Consulting, LLC. Dr. Korndorffer receives honoraria from Becton Dickinson Medical. Drs. Wolf, Taylor, Franklin, and Placek have nothing to disclose.

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Ritter, E.M., Taylor, Z.A., Wolf, K.R. et al. Simulation-based mastery learning for endoscopy using the endoscopy training system: a strategy to improve endoscopic skills and prepare for the fundamentals of endoscopic surgery (FES) manual skills exam. Surg Endosc 32, 413–420 (2018). https://doi.org/10.1007/s00464-017-5697-4

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  • DOI: https://doi.org/10.1007/s00464-017-5697-4

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