How Effective Can a Simulator-Based Training Course For Beginners In Endoscopy Be Made?

Study Overview
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Brief Summary
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The aim of the study is to clarify whether physicians training for gastroscopies benefit from a modified training course. The duration and type of optimized use of training simulators as part of a basic gastroscopy course can lead to a higher level of competence in patient examinations (main target parameters) than conventional use. Further goals are the comparison of the theoretical knowledge gained through the modified versus conventional course, as well as the self-assessment of the participants.

Detailed Description
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Training in interventional medicine, including surgery and endoscopy, is usually still done on the patient, under more or less qualified supervision. Previous exercises on models or simulators are still the exception and only reach around 40% of colleagues in countries with defined curricula and guidelines.The simulator-based training, however, offers a protected area in which, without risk to the patient, initial learning successes in flexible endoscopy can be achieved according to the trial and error principle. Various studies have shown that initial training on the simulator is beneficial: Physicians trained on the simulator require less support during the first examinations on the patient, less examination time, can reach and identify anatomical landmarks better and have better hand-eye coordination.If the simulator training is embedded in a structured curriculum, greater successes seem to be achieved in comparison to unstructured training. The feedback during the training is also a positive influencing factor; this should ideally take place at the end of each unit. It is also possible to use a simulator to train defined partial performances and to repeat these in the required amount. A step-by-step structure with defined intermediate goals, in the sense of mastery learning, also increases effectiveness.There is little data on the optimal duration or the saturation of the learning curve in simulator training. In one study the learning curve flattened after 60 simulated colonoscopies. Another study showed a gradual improvement up to 6 hours on the simulator. It also used threshold values for the performance score to define the optimal point in time for transition to patient-based training. The current certification for the standardization of the nationwide endoscopy training courses by the German Gastroenterological Society (DGVS), provides for 4 hours of training on the simulator, including one hour of introduction. With an also recommended maximum group size of 4 participants per simulator, this corresponds to a duration of only 1 hour of effective simulator training per trainee. There are no recommendations for structuring simulator trainings or the type of simulators used. The main aim of the present study is to find out whether it is possible to improve this situation without unrealistically extending the training and course times. Trainees will randomly attend either a conventional training or an extended simulator training. Immediately after the course, in accordance with the DGVS guidelines, an examination of the same content for both groups to inquire the theoretical knowledge is done.1-5 weeks after completion of the training course, an evaluation of the endoscopic skills of the participants takes place. It is done on the patient, under supervision, as is currently customary in everyday clinical training. After a one-day introduction through observation of routine gastroscopies, two gastroscopies are then carried out. Two endoscopists independently assess the performance based on a Video record of the examination. All endoscopists involved in supervision or assessment are blinded to the trainee's group membership..

Official Title
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How Effective Can a Simulator-Based Training Course For Beginners In Endoscopy Be Made?

Conditions
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Physicians Gastroscopy Training

Intervention / Treatment
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* Other: conventional DGVS training
* Other: extended simulator training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Trainees: licensed physicians in internal medicine, surgery or gastroenterology, no endoscopic or laparoscopic experience informed consent Patient's endoscopies: all patients > 18 years of age who are capable of being informed and have a clinical indication for esophagogastroduodenoscopy informed consent simple examination expected Exclusion Criteria: Patient's endoscopies: - difficult examination expected

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| conventional gastroscopy training course<br>physicians receive the DGVS-recommended training, consisting of a 2-day course with 1 hour of simulator training | Other: conventional DGVS training<br>* see above<br>|
| extended simulator course<br>physicians receive a two-day simulator course with a minimum of 6 hours of simulator training per trainee, structured in stages in the sense of progressive or mastery learning. The initial part of the training will be part-task training. | Other: extended simulator training<br>* see above<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Global Assessment of Gastrointestinal Endoscopic Skills (GAGES) competence score competence score | Comparison of the GAGES competence score of the video-based observations of the first two patient examinations, each assessed by two endoscopists. To be valuated: intubation of esophagus, scope navigation, ability to keep a clear endoscope field, instrumentation, quality of examination. Best score each question 5 pts, worst 1 pt. | one to five weeks after training course | 
| Non-inferiority of the new training procedure | Non-inferiority of the new training procedure in the final exams according to DGVS criteria | through study completion, approximately 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| competence assessment Direct Observation of Procedural Skills (DOPS) by Joint Advisory Group on Gastrointestinal Endoscopy (JAG) | Comparison of the JAG DOPS competence level of the video-based observations of the first two patient examinations, each assessed by two endoscopists. Assession of trainee's needed level of supervision at pre- and post procedure, insertion and withdrawal, visualisation, management of findings, and non-technical skills. Each has 4 values, best is Competent for independent practice, worst is maximal supervision | one to five weeks after training course | 
| Assessment of Competency in Endoscopy (ACE) | Comparison of the ACE competence evaluation of the video-based observations of the first two patient examinations, each assessed by two endoscopists. | one to five weeks after training course | 
| mean self-assessment by Visual Analog Scale (VAS) | VAS after the first two patient examinations. This enables an assessment of the stress level and ultimately a measurement of the cognitive load of the subject. To be evaluated on a non-scaled line from do not agree at all to totally agree. | one to five weeks after training course | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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simulator training, gastroscopy training, physicians training