Su1571 A Randomized Trial of Endoscopic Simulator Training in First Year Gastroenterology Fellows

tablet application with an additional observer resulted in a 10.2% increase in the polyp detection rate, increasing the number of detected polyps by an average of 1.7 0.9 per procedure. Conclusions: Using the tablet software to increase the number of qualified participants is a valid approach to increasing the polyp detection rate for decreasing the incidence of colorectal cancer. The approach additionally allows for more effective medical training by enabling experienced physicians to more effectively highlight lesions and polyps using the endoscopic video. The proposed platform can be easily integrated into existing infrastructure for colonoscopy without interfering with the standard of care, and additionally be used for other types of endoscopy. Su1571 A Randomized Trial of Endoscopic Simulator Training in First Year Gastroenterology Fellows Pichamol Jirapinyo*, Vicki Bing, Nitin Kumar, Michele B. Ryan, Hiroyuki Aihara, Avlin B. Imaeda, Christopher C. Thompson Yale-New Haven Hospital, New Haven, CT; Division of Gastroenterology, Brigham & Women’s Hospital, Boston, MA Background: Training in endoscopy has traditionally relied upon clinical hands-on experience. Simulators may now allow the development of endoscopic skills in a non-clinical environment. Aim: To assess the effect of an endoscopic part-task simulator on trainees’ endoscopic performance. Methods: Simulator An endoscopic part-task training box consisting of 5 modules (snare polypectomy, retroflexion, torque, knob control and loop reduction/navigation) and a validated scoring system. Subjects: First year gastroenterology fellows from 2 academic institutions. Design: Fellows were randomized into 2 arms. The study arm practiced on the simulator for at least 45 minutes per week for the first 3 months of training, in addition to receiving traditional hands-on clinical training. The control arm received only hands-on clinical training. Outcomes: All fellows were assessed for their endoscopic skill performance using the Mayo Colonoscopy Skills Assessment Tool (MCSAT) and the simulator at month 0, 1 and 3. MCSAT scores, training box scores and the numbers of esophagoduodenoscopies (EGDs) and colonoscopies performed were collected. Statistical Analysis: Training box scores from the 2 arms were compared using a linear regression model adjusting for the numbers of EGDs and colonoscopies. Results: Ten first year gastroenterology fellows from 2 academic institutions participated in the study. Five were randomized into the study arm and 5 into the control arm. No participants had used the simulator prior to the study. Average numbers of prior EGDs and colonoscopies are shown in Table 1. There was no difference in total MCSAT hands-on skill scores between the 2 groups at month 1 (pO0.05), however, there was a trend for fellows in the simulator group taking less time (pZ0.09) to reach a farther landmark (hepatic flexure in simulator group vs. splenic flexure in control group (pZ0.22). Additionally, fellows in the study arm performed significantly better on the simulator at month 1 (Table 2; p!0.01), and showed significant improvement in training box performance from month 0 to month 1, compared to the control group (Table 2; p!0.05). At month 3, the control group eliminated this difference as reflected by similar MCSAT hands-on skill scores, time spent reaching the maximal insertion site, location of the farthest landmark reached without assistance and absolute simulator scores, compared to the simulator group (pO0.05 in all variables). Conclusion: The part-task endoscopic simulator provides a non-clinical environment for trainees to practice fundamental endoscopic maneuvers and become familiar with accessories prior to initiation of clinical cases, and during ongoing clinical training. This small sample size suggests that routine use of the simulator may improve technical endoscopic performance during the early phases of training, and larger studies are now needed. Table 1. Average numbers of esophagoduodenoscopies (EGDs) and colonoscopies (colons) performed www.giejournal.org Month 0 Month 1 Month 3 EGDs Colons EGDs Colons EGDs Colons Study arm (n [ 5) 4 4 31 21 62 38 Control arm (n [ 5) 4 1 24 20 51 25 Table 2. Average simulator scores