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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Mar 16, 2020; 12(3): 98-110
Published online Mar 16, 2020. doi: 10.4253/wjge.v12.i3.98
Impact of a simulation-based induction programme in gastroscopy on trainee outcomes and learning curves
Keith Siau, James Hodson, Peter Neville, Jeff Turner, Amanda Beale, Susi Green, Aravinth Murugananthan, Paul Dunckley, Neil D Hawkes
Keith Siau, Paul Dunckley, Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London NW1 4LE, United Kingdom
Keith Siau, Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom
Keith Siau, James Hodson, Institute of Translational Medicine, University Hospitals Birmingham, Birmingham B15 2TH, United Kingdom
Peter Neville, Neil D Hawkes, Department of Gastroenterology, Cwm Taf Morgannwg Health Board, Llantrisant CF45 4SN, United Kingdom
Jeff Turner, Department of Gastroenterology, Cardiff and Vale University Health Board, Cardiff CF14 4XW, United Kingdom
Amanda Beale, Department of Gastroenterology, University Hospitals Bristol NHSFT, Bristol BS1 3NU, United Kingdom
Susi Green, Department of Gastroenterology, Royal Sussex County Hospital, Brighton BN2 5BE, United Kingdom
Aravinth Murugananthan, Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton W10 0QP, United Kingdom
Paul Dunckley, Department of Gastroenterology, Gloucestershire Hospitals NHSFT, Gloucester GL1 3NN, United Kingdom
Author contributions: Siau K contributed to the study design, statistical analyses, literature review, initial draft of the manuscript; Hodson J contributed to the statistical analyses, critical review of manuscript; Neville P, Turner J, Beale A, Green S, Murugananthan A contributed to the study design, conduct of study, training faculty, critical review of manuscript; Dunckley P contributed to the study design, critical review of manuscript; Hawkes ND contributed to the study conception, oversight and guarantorship.
Institutional review board statement: Study approval was granted by JAG Quality Assurance of Training working group.
Clinical trial registration statement: This was not a clinical trial, not register.
Informed consent statement: All participants provided written, informed consent for inclusion within the study.
Conflict-of-interest statement: None of the authors have any conflicts of interest to declare. Surgical Science was blinded to the results of the study.
Data sharing statement: There is no additional data available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Keith Siau, MBChB, MRCP, Doctor, Senior Research Fellow, Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, 11 St Andrew's Place, London NW1 4LE, United Kingdom. keithsiau@nhs.net
Received: October 24, 2019
Peer-review started: October 24, 2019
First decision: November 20, 2019
Revised: December 21, 2019
Accepted: February 23, 2020
Article in press: February 23, 2020
Published online: March 16, 2020
BACKGROUND
Pre-clinical simulation-based training (SBT) in endoscopy has been shown to augment trainee performance in the short-term, but longer-term data are lacking.
AIM
To assess the impact of a two-day gastroscopy induction course combining theory and SBT (Structured PRogramme of INduction and Training – SPRINT) on trainee outcomes over a 16-mo period.
METHODS
This prospective case-control study compared outcomes between novice SPRINT attendees and controls matched from a United Kingdom training database. Study outcomes comprised: (1) Unassisted D2 intubation rates; (2) Procedural discomfort scores; (3) Sedation practice; (4) Time to 200 procedures; and (5) Time to certification.
RESULTS
Total 15 cases and 24 controls were included, with mean procedure counts of 10 and 3 (P = 0.739) pre-SPRINT. Post-SPRINT, no significant differences between the groups were detected in long-term D2 intubation rates (P = 0.332) or discomfort scores (P = 0.090). However, the cases had a significantly higher rate of unsedated procedures than controls post-SPRINT (58% vs 44%, P = 0.018), which was maintained over the subsequent 200 procedures. Cases tended to perform procedures at a greater frequency than controls in the post-SPRINT period (median: 16.2 vs 13.8 per mo, P = 0.051), resulting in a significantly greater proportion of cases achieving gastroscopy certification by the end of follow up (75% vs 36%, P = 0.017).
CONCLUSION
In this pilot study, attendees of the SPRINT cohort tended to perform more procedures and achieved gastroscopy certification earlier than controls. These data support the role for wider evaluation of pre-clinical induction involving SBT.
Core tip: Simulation-based training has been shown to improve short-term trainee outcomes, but longer-term data on trainee and patient-based outcomes are lacking. A 2-d induction programme covering fundamental theory and hands-on training can improve trainee confidence and shorten the time to achieve gastroscopy certification.
