Development and validation of metric-based-training to proficiency simulation curriculum for upper gastrointestinal endoscopy using a novel assessment checklist

Nahla Azzam; Nehal Khamis; Majid Almadi; Faisal Batwa; Fahad Alsohaibani; Abdulrahman Aljebreen; Ahmad Alharbi; Yasser Alaska; Turki Alameel; Peter Irving; Richard Satava

doi:10.4103/sjg.SJG_113_20

Development and validation of metric-based-training to proficiency simulation curriculum for upper gastrointestinal endoscopy using a novel assessment checklist

Nahla Azzam, Nehal Khamis, Majid Almadi^*, Faisal Batwa, Fahad Alsohaibani, Abdulrahman Aljebreen, Ahmad Alharbi, Yasser Alaska, Turki Alameel, Peter Irving, Richard Satava

^*Corresponding author for this work

Peter Gorer Department of Immunobiology

Research output: Contribution to journal › Article › peer-review

5 Citations (Scopus)

Abstract

Background/Aims: This study aimed to design a structured simulation training curriculum for upper endoscopy and validate a new assessment checklist. Materials and Methods: A proficiency-based progression stepwise curriculum was developed consisting of didactic, technical and non-technical components using a virtual reality simulator (VRS). It focused on: scope navigation, anatomical landmarks identification, mucosal inspection, retro-flexion, pathology identification, and targeting biopsy. A total of 5 experienced and 10 novice endoscopists were recruited. All participants performed each of the selected modules twice, and mean and median performance were compared between the two groups. Novices pre-set level of proficiency was set as 2 standard deviations below the mean of experts. Performance was assessed using multiple-choice questions for knowledge, while validated simulator parameters incorporated into a novel checklist; Simulation Endoscopic Skill Assessment Score (SESAS) were used for technical skills. Results: The following VRS outcome measures have shown expert vs novice baseline discriminative ability: total procedure time, number of attempts for esophageal intubation and time in red-out. All novice trainees achieved the preset level of proficiency by the end of training. There were no statistically significant differences between experts' and trainees' rate of complications, landmarks identification and patient discomfort. SESAS checklist showed high degree of agreement with the VRS metrices (kappa = 0.83) and the previously validated direct observation of procedural skills tool (kappa = 0.90). Conclusion: The Fundamentals of Gastrointestinal Endoscopy simulation training curriculum and its SESAS global assessment tool have been primarily validated and can serve as a valuable addition to the gastroenterology fellowship programs. Follow up study of trainee performance in workplaces is recommended for consequences validation.

Original language	English
Pages (from-to)	179-187
Number of pages	9
Journal	Saudi Journal of Gastroenterology
Volume	26
Issue number	4
DOIs	https://doi.org/10.4103/sjg.SJG_113_20
Publication status	Published - 1 Jul 2020

Keywords

Assessment tool
colonoscopy
curriculum
endoscopy skills
gastroenterology training
gastroscopy
metrics
simulation
training to proficiency

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10.4103/sjg.SJG_113_20

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Azzam, N., Khamis, N., Almadi, M., Batwa, F., Alsohaibani, F., Aljebreen, A., Alharbi, A., Alaska, Y., Alameel, T., Irving, P., & Satava, R. (2020). Development and validation of metric-based-training to proficiency simulation curriculum for upper gastrointestinal endoscopy using a novel assessment checklist. Saudi Journal of Gastroenterology, 26(4), 179-187. https://doi.org/10.4103/sjg.SJG_113_20

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title = "Development and validation of metric-based-training to proficiency simulation curriculum for upper gastrointestinal endoscopy using a novel assessment checklist",

abstract = "Background/Aims: This study aimed to design a structured simulation training curriculum for upper endoscopy and validate a new assessment checklist. Materials and Methods: A proficiency-based progression stepwise curriculum was developed consisting of didactic, technical and non-technical components using a virtual reality simulator (VRS). It focused on: scope navigation, anatomical landmarks identification, mucosal inspection, retro-flexion, pathology identification, and targeting biopsy. A total of 5 experienced and 10 novice endoscopists were recruited. All participants performed each of the selected modules twice, and mean and median performance were compared between the two groups. Novices pre-set level of proficiency was set as 2 standard deviations below the mean of experts. Performance was assessed using multiple-choice questions for knowledge, while validated simulator parameters incorporated into a novel checklist; Simulation Endoscopic Skill Assessment Score (SESAS) were used for technical skills. Results: The following VRS outcome measures have shown expert vs novice baseline discriminative ability: total procedure time, number of attempts for esophageal intubation and time in red-out. All novice trainees achieved the preset level of proficiency by the end of training. There were no statistically significant differences between experts' and trainees' rate of complications, landmarks identification and patient discomfort. SESAS checklist showed high degree of agreement with the VRS metrices (kappa = 0.83) and the previously validated direct observation of procedural skills tool (kappa = 0.90). Conclusion: The Fundamentals of Gastrointestinal Endoscopy simulation training curriculum and its SESAS global assessment tool have been primarily validated and can serve as a valuable addition to the gastroenterology fellowship programs. Follow up study of trainee performance in workplaces is recommended for consequences validation.",

keywords = "Assessment tool, colonoscopy, curriculum, endoscopy skills, gastroenterology training, gastroscopy, metrics, simulation, training to proficiency",

author = "Nahla Azzam and Nehal Khamis and Majid Almadi and Faisal Batwa and Fahad Alsohaibani and Abdulrahman Aljebreen and Ahmad Alharbi and Yasser Alaska and Turki Alameel and Peter Irving and Richard Satava",

year = "2020",

month = jul,

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doi = "10.4103/sjg.SJG_113_20",

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Azzam, N, Khamis, N, Almadi, M, Batwa, F, Alsohaibani, F, Aljebreen, A, Alharbi, A, Alaska, Y, Alameel, T, Irving, P & Satava, R 2020, 'Development and validation of metric-based-training to proficiency simulation curriculum for upper gastrointestinal endoscopy using a novel assessment checklist', Saudi Journal of Gastroenterology, vol. 26, no. 4, pp. 179-187. https://doi.org/10.4103/sjg.SJG_113_20

TY - JOUR

T1 - Development and validation of metric-based-training to proficiency simulation curriculum for upper gastrointestinal endoscopy using a novel assessment checklist

AU - Azzam, Nahla

AU - Khamis, Nehal

AU - Almadi, Majid

AU - Batwa, Faisal

AU - Alsohaibani, Fahad

AU - Aljebreen, Abdulrahman

AU - Alharbi, Ahmad

AU - Alaska, Yasser

AU - Alameel, Turki

AU - Irving, Peter

AU - Satava, Richard

PY - 2020/7/1

Y1 - 2020/7/1

N2 - Background/Aims: This study aimed to design a structured simulation training curriculum for upper endoscopy and validate a new assessment checklist. Materials and Methods: A proficiency-based progression stepwise curriculum was developed consisting of didactic, technical and non-technical components using a virtual reality simulator (VRS). It focused on: scope navigation, anatomical landmarks identification, mucosal inspection, retro-flexion, pathology identification, and targeting biopsy. A total of 5 experienced and 10 novice endoscopists were recruited. All participants performed each of the selected modules twice, and mean and median performance were compared between the two groups. Novices pre-set level of proficiency was set as 2 standard deviations below the mean of experts. Performance was assessed using multiple-choice questions for knowledge, while validated simulator parameters incorporated into a novel checklist; Simulation Endoscopic Skill Assessment Score (SESAS) were used for technical skills. Results: The following VRS outcome measures have shown expert vs novice baseline discriminative ability: total procedure time, number of attempts for esophageal intubation and time in red-out. All novice trainees achieved the preset level of proficiency by the end of training. There were no statistically significant differences between experts' and trainees' rate of complications, landmarks identification and patient discomfort. SESAS checklist showed high degree of agreement with the VRS metrices (kappa = 0.83) and the previously validated direct observation of procedural skills tool (kappa = 0.90). Conclusion: The Fundamentals of Gastrointestinal Endoscopy simulation training curriculum and its SESAS global assessment tool have been primarily validated and can serve as a valuable addition to the gastroenterology fellowship programs. Follow up study of trainee performance in workplaces is recommended for consequences validation.

AB - Background/Aims: This study aimed to design a structured simulation training curriculum for upper endoscopy and validate a new assessment checklist. Materials and Methods: A proficiency-based progression stepwise curriculum was developed consisting of didactic, technical and non-technical components using a virtual reality simulator (VRS). It focused on: scope navigation, anatomical landmarks identification, mucosal inspection, retro-flexion, pathology identification, and targeting biopsy. A total of 5 experienced and 10 novice endoscopists were recruited. All participants performed each of the selected modules twice, and mean and median performance were compared between the two groups. Novices pre-set level of proficiency was set as 2 standard deviations below the mean of experts. Performance was assessed using multiple-choice questions for knowledge, while validated simulator parameters incorporated into a novel checklist; Simulation Endoscopic Skill Assessment Score (SESAS) were used for technical skills. Results: The following VRS outcome measures have shown expert vs novice baseline discriminative ability: total procedure time, number of attempts for esophageal intubation and time in red-out. All novice trainees achieved the preset level of proficiency by the end of training. There were no statistically significant differences between experts' and trainees' rate of complications, landmarks identification and patient discomfort. SESAS checklist showed high degree of agreement with the VRS metrices (kappa = 0.83) and the previously validated direct observation of procedural skills tool (kappa = 0.90). Conclusion: The Fundamentals of Gastrointestinal Endoscopy simulation training curriculum and its SESAS global assessment tool have been primarily validated and can serve as a valuable addition to the gastroenterology fellowship programs. Follow up study of trainee performance in workplaces is recommended for consequences validation.

KW - Assessment tool

KW - colonoscopy

KW - curriculum

KW - endoscopy skills

KW - gastroenterology training

KW - gastroscopy

KW - metrics

KW - simulation

KW - training to proficiency

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U2 - 10.4103/sjg.SJG_113_20

DO - 10.4103/sjg.SJG_113_20

M3 - Article

C2 - 32719238

AN - SCOPUS:85089713915

SN - 1319-3767

VL - 26

SP - 179

EP - 187

JO - Saudi Journal of Gastroenterology

JF - Saudi Journal of Gastroenterology

IS - 4

ER -

Development and validation of metric-based-training to proficiency simulation curriculum for upper gastrointestinal endoscopy using a novel assessment checklist

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Keywords

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