Authors: S N Buzink A D Koch J Heemskerk S M B I Botden R H M Goossens H de Ridder E J Schoon J J Jakimowicz
Publish Date: 2007/05/05
Volume: 21, Issue: 11, Pages: 1996-2003
Abstract
Achieving proficiency in flexible endoscopy requires a great amount of practice Virtual reality VR simulators could provide an effective alternative for clinical training This study aimed to gain insight into the proficiency curve for basic endoscope navigation skills with training on the GI Mentor IIFor this study 30 novice endoscopists performed four preset training sessions In each session they performed one EndoBubble task and managed multiple VR colonoscopy cases two in first session and three in subsequent sessions Virtual reality colonoscopy I3 was repeatedly performed as the last VR colonoscopy in each session The assignment for the VR colonoscopies was to visualize the cecum as quickly as possible without causing patient discomfort Five expert endoscopists also performed the training sessions Additionally the performance of the novices was compared with the performance of 20 experienced and 40 expert endoscopistsThe novices progressed significantly particularly in the time required to accomplish the tasks p 005 Friedman’s analysis of variance ANOVA p 005 Wilcoxon signed ranks The experts did not improve significantly except in the percentage of time the patient was in excessive pain For all the runs the performance of the novices differed significantly from that of both the experienced and the expert endoscopists p 005 Mann–Whitney U The performance of the novices in the latter runs differed less from those of both the experienced and the expert endoscopistsNavigation through the colon with a flexible endoscope is technically demanding like many other imagebased procedures 1 It requires a high level of both psychomotor and visual–spatial skills Consequently trainees need a great amount of handson experience to master colonoscopy skills Traditional assessment and accreditation methods are based mainly on a minimal number of supervised procedures after which average trainees are expected to have achieved a sufficient level of proficiency Although there are recommendations regarding these minimal numbers 2 3 4 5 6 the suggested minimums differ considerably 7 8 There is a growing need for more objective methods of proficiency assessment and a desire for training until a predetermined level of actual proficiency is achieved 9 10 11In addition training of basic endoscopy skills in a clinical setting is losing acceptance because of ethical and economic considerations 9 11 12 13 This makes it necessary for novice endoscopists to train in the fundamentals of colonoscopy in a skills lab settingVirtual reality VR simulators could provide an effective alternative for clinical training and for objective data supplied to educators about the proficiency of their trainees Currently VR simulators are obtaining an increasingly prominent position in medical education and they have enhanced training programs for endoscopic skills 1 14 They still are being thoroughly evaluated because their application must be proven valid before their widespread integration into education and training programs 12 15 16Most VR simulators record multiple performance parameters assumed to provide objective insight into the proficiency level of the trainee Some of the parameters provided by the simulators are calculated using multiple variables recorded by the simulator see Appendix A Currently one of the major issues concerning the application of VR simulators in training program is to determine which types of exercises are most appropriate and which combination of performance parameters best represents performance 9 10
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