Basic Endoscopy Training: Usefulness Of A Computer-Based Simulator.

DIEGO FREGONESE, TINO CASETTI, RENZO CESTARI, FAUSTO CHILOVI, GIANCARLO D'AMBRA, GIANFRANCO DELLE FAVE, EMILIO DI GIULIO, GIOVANNI DI MATTEO, LEONARDO FICANO

Cooperative Group for Training in Endoscopy (Endo Teaching Group) - Rome, Italy

Presented as a Poster at the DDW exhibition on May 22, 2001,
Atlanta, U.S.A

This study is supported by an unrestricted education grant by Bracco Italia.

AIM OF THE STUDY

Education in medical practice is time consuming and very expensive. An endoscopic fellowship is particularly difficult due to the invasive endoscopic procedures. To learn endoscopy adds a potential risk for the patients. Endoscopic training on simulators could theoretically reduce both the learning curvature than critical mistakes, dangerous for the patients. Endoscopic training is generally long and expensive. The introduction of sophisticated simulators as GI Mentor has made possible to evaluate a training program based on a simulator device. Our prospective study has the aim to validate the use of a computer-based simulator in the endoscopic fellowship.
Generally it starts with the simpler procedure: the upper gastrointestinal endoscopy (UGE).
Our study has evaluated the differences between two groups of fellows, one of them pre-trained on the simulator.

THE GI-Mentor: a computer-based simulator

The Simbionix simulators are based on the production of a three-dimensional geometric model. The texture of the GI tract is videotaped during a real endoscopic procedure and manipulated by a computer. The computer also stores information related to the endoscope movement during the procedure. Information about the location of the endoscope is transmitted form sensors located in the endoscope. The force feedback is based on both the motion model and the characteristics of GI tract. All these effects are finally manipulated by the computer and give a realistic effect: in real-time. The endoscopy is performed in a mannequin using a Pentax endoscope. Steering and torque of the endoscope is therefore possible and there are suction and inflation buttons as well. All these effects made the simulator endoscopic procedure similar to the reality.

PLAN OF THE STUDY

Two groups of fellows has been considered:

   1. NoSIM GROUP: Gastroenterology fellows without any previous
   experience on endoscopy. They were request to perform UGE after the
   simply observation of UGE procedures performed by an experienced
    endoscopist, as usually happen during the fellowship.

   2. SIM GROUP: Gastroenterology fellows without any previous
    experience on endoscopy. They were pre-trained for 10 hours on
    GI Mentor, before start the normal UGE learning procedure, as described
    before.

Each fellow has been requested to perform up to 20 UGEs inclusive of intubation, in a pre-definite time, with a complete exploration of the UGI tract. An experienced tutor has been always present to the procedures, recording definite steps of during the UGEs, and giving help if request and/or necessary.
Patients has been normal scheduled cases, relate to the tutor list. All the procedures have been performed in an Endoscopy Unit of a teaching hospital. Patients under 18 years were excluded, as patients with previous gastric operations. Patients need to give their agreement as routine.

GI-Mentor looks to be very helpful in the endoscopic training program. SIM Group requires less assistance and in this group fellows quickly learn to manage a complete UGE without assistance. Intubation does not improve after simulator training, as the length of the procedure. In both the groups the skipped lesions number is not surprisingly high: this data has been expected. Endoscopic movements capture all the fellows attention, and they easily miss little lesions.
Finally the difference in trainer judgement is significatively high. More data are necessary to confirm our study, but the practical use of a simulator on a training endoscopic program looks to be validate.

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