Skip to main content
SpringerLink
Log in

Can a Computerized Simulator Assess Skill Level and Improvement in Performance of ERCP?

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Endoscopic retrograde cholangiography (ERCP) is a challenging procedure with considerable risk. Computerized simulators are valuable in training for flexible endoscopy, but little data exist for their use in ERCP training.

Aim

To determine a simulator’s ability to assess the level of ERCP skill and its responsiveness over time to increasing trainee experience.

Materials and Methods

In this prospective parallel-arm cohort study, six novice gastroenterology fellows and four gastroenterology faculty with expertise in ERCP completed four simulated baseline cases and the same four cases at a later date. This study took place at a surgical skills center at an academic tertiary referral center. The primary outcome was the total time to complete the ERCP procedure.

Results

For the baseline session, experts had a shorter total procedure time than novices (444.0 vs. 616.9 s; least squares mean; p = 0.026). There was no significant difference between experts and novices in the difference of total procedure time between session 1 and session 2 (−200.3 vs. −164.4; least squares mean; p = 0.402).

Conclusions

The simulator was able to differentiate experts from novices for the primary outcome of total procedure time. The simulator was not responsive to an increase in trainee experience over time.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

ERCP:

Endoscopic retrograde cholangiopancreatography

GI:

Gastrointestinal

SD:

Standard deviation

SE:

Standard error

References

  1. Andriulli A, Loperfido S, Napolitano G, et al. Incidence rates of post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol. 2007;102:1781–1788.

    Article  PubMed  Google Scholar 

  2. Baillie J, Jowell P. ERCP training in the 1990s. Time for new ideas. Gastrointest Endosc Clin N Am. 1990;1994:409–421.

    Google Scholar 

  3. Eisen GM, Baron TH, Dominitz JA, et al. Methods of granting hospital privileges to perform gastrointestinal endoscopy. Gastrointest Endosc. 2002;55:780–783.

    Article  PubMed  Google Scholar 

  4. Training the gastroenterologist of the future: the gastroenterology core curriculum. The Gastroenterology Leadership Council. Gastroenterology. 1996;110:1266–1300.

    Google Scholar 

  5. Verma D, Gostout CJ, Petersen BT, et al. Establishing a true assessment of endoscopic competence in ERCP during training and beyond: a single-operator learning curve for deep biliary cannulation in patients with native papillary anatomy. Gastrointest Endosc. 2007;65:394–400.

    Article  PubMed  Google Scholar 

  6. Kowalski T, Kanchana T, Pungpapong S. Perceptions of gastroenterology fellows regarding ERCP competency and training. Gastrointest Endosc. 2003;58:345–349.

    Article  PubMed  Google Scholar 

  7. Gerson LB, Van Dam J. Technology review: the use of simulators for training in GI endoscopy. Gastrointest Endosc. 2004;60:992–1001.

    Article  PubMed  Google Scholar 

  8. Ferlitsch A, Glauninger P, Gupper A, et al. Evaluation of a virtual endoscopy simulator for training in gastrointestinal endoscopy. Endoscopy. 2002;34:698–702.

    Article  PubMed  CAS  Google Scholar 

  9. McConnell RA, Kim S, Ahmad NA, et al. Poor discriminatory function for endoscopic skills on a computer-based simulator. Gastrointest Endosc. 2012;76:993–1002.

    Article  PubMed  Google Scholar 

  10. Bittner JGT, Mellinger JD, Imam T, et al. Face and construct validity of a computer-based virtual reality simulator for ERCP. Gastrointest Endosc. 2010;71:357–364.

    Article  PubMed  Google Scholar 

  11. Kim S, Spencer G, Makar GA, et al. Lack of a discriminatory function for endoscopy skills on a computer-based simulator. Surg Endosc. 2010;24:3008–3015.

    Article  PubMed  Google Scholar 

Download references

Author contributions

Sahakian involved in study design, data collection, and data analysis and drafted the manuscript. Laine and Aslanian involved in study design and data analysis and revised the manuscript. Jamidar, Siddiqui, and Nagar involved in study design and revised the manuscript. Duffy revised the manuscript. Ciarleglio and Deng involved in data analysis and revised the manuscript.

Author information

Authors and Affiliations

  1. Division of Gastrointestinal and Liver Diseases, University of Southern California School of Medicine, 1510 San Pablo St, Los Angeles, CA, 90033, USA

    Ara B. Sahakian

  2. Section of Digestive Diseases, Yale University School of Medicine, 333 Cedar Street-1080 LMP, New Haven, CT, 06520, USA

    Loren Laine, Priya A. Jamidar, Anil Nagar & Harry R. Aslanian

  3. Section of Digestive Diseases, V.A. Connecticut Healthcare System, 333 Cedar Street-1080 LMP, West Haven, CT, 06520, USA

    Loren Laine & Anil Nagar

  4. Section of Gastroenterology, University of Chicago, 5700 S. Maryland Ave, Chicago, IL, 60637, USA

    Uzma D. Siddiqui

  5. Department of Surgery, Yale University School of Medicine, PO Box 208062, New Haven, CT, 06510, USA

    Andrew Duffy

  6. Department of Biostatistics, Yale School of Public Health, 60 College St, Suite 209, New Haven, CT, 06510, USA

    Maria M. Ciarleglio

  7. Yale Center for Analytical Sciences, Yale School of Public Health, 300 George St, Suite 555, New Haven, CT, 06510, USA

    Yanhong Deng

Authors
  1. Ara B. Sahakian
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Loren Laine
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Priya A. Jamidar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Uzma D. Siddiqui
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrew Duffy
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maria M. Ciarleglio
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yanhong Deng
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Anil Nagar
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Harry R. Aslanian
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ara B. Sahakian.

Ethics declarations

Conflict of interest

None.

Appendices

Appendix 1

See Fig. 2.

Fig. 2
figure 2

Participant questionnaire (part 1)

Full size image

Appendix 2

See Fig. 3.

Fig. 3
figure 3

Participant questionnaire (part 2)

Full size image

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sahakian, A.B., Laine, L., Jamidar, P.A. et al. Can a Computerized Simulator Assess Skill Level and Improvement in Performance of ERCP?. Dig Dis Sci 61, 722–730 (2016). https://doi.org/10.1007/s10620-015-3939-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-015-3939-7

Keywords

Search

Navigation