Simulator training improves practical skills in therapeutic GI endoscopy: results from a randomized, blinded, controlled study.

摘要

BACKGROUND: Therapeutic endoscopic procedures are technically challenging and have higher complication rates than diagnostic procedures. Less-experienced practitioners are significantly more likely to have a complication, yet there is very limited evidence of the efficacy of training in such procedures. OBJECTIVE: To evaluate the effect of knowledge-based teaching and hands-on, simulation-based skills training in 4 therapeutic endoscopic procedures: control of nonvariceal upper GI bleeding, polypectomy, stricture dilation, and percutaneous endoscopic gastrostomy (PEG) tube insertion. DESIGN: Single-blind, randomized, controlled trial. SETTING: Nationally accredited therapeutic endoscopy course. PARTICIPANTS AND INTERVENTION: Participants were randomized into groups to assess the effect of knowledge-based teaching and into subjects or controls to assess skills-based training. All delegates had an initial knowledge and skills assessment by blinded experts. Subjects received one-half day of hands-on skills training, whereas the controls did not. All delegates were retested on their procedural skills. MAIN OUTCOME MEASUREMENTS: Knowledge was assessed by using a multiple-choice questionnaire. Practical skills were assessed using station-specific checklists and a global score. RESULTS: Twenty-eight participants were randomized. There was no significant effect of knowledge-based teaching on the participants' practical skills or initial multiple-choice questionnaire score, although there was a trend toward improvement. There was a significant improvement in the subjects compared with the controls in the performance of polypectomy, control of upper GI bleeding, and esophageal dilation. There were no significant differences for PEG tube insertion. LIMITATIONS: The 2-person nature of PEG tube insertion may have resulted in performance improvement despite a lack of training. CONCLUSION: Hands-on skills training significantly improved performance in 3 therapeutic modalities. Knowledge-based teaching alone did not have a measurable effect. These results strongly support the benefit of intensive hands-on, simulation-based courses for endoscopic skills training.