Impact of a simulation-based induction programme in gastroscopy on trainee outcomes and learning curves

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.

Impact of a national basic skills in colonoscopy course on trainee performance: An interrupted time series analysis

BACKGROUND The Joint Advisory Group on Gastrointestinal Endoscopy basic skills in colonoscopy(BSC) course was introduced in 2009 to improve colonoscopy training within the United Kingdom, but its impact on trainee performance is unknown.AIM To assess whether attendance of the BSC could improve colonoscopy performance.METHODS Trainees awarded colonoscopy certification between 2011-2016 were stratified into 3 groups according to pre-course procedure count(< 70, 70-140 and > 140).Study outcomes, comprising the unassisted caecal intubation rate(CIR) and the performance indicator of colonic intubation(PICI), were studied over the 50 procedures pre and post-course. Interrupted time series analyses were performed to detect step-change changes attributable to the course.RESULTS A total of 369 trainees with pre-course procedure counts of < 70(n = 118), 70-140(n = 121) and > 140(n = 130) were included. Over the 50 pre-course procedures,significant linear improvements in CIR were found, with average increases of 4.2,3.6 and 1.7 percentage points(pp) per 10 procedures performed in the < 70, 70-140 and > 140 groups respectively(all P < 0.001). The < 70 procedures group saw a significant step-change improvement in CIR, increasing from 46% in the last pre-course procedure, to 51% in the first procedure post-course(P = 0.005). The CIR step-change was not significant in the 70-140(68% to 71%;P = 0.239) or > 140(86% to 87%;P = 0.354) groups. For PICI, significant step-change improvements were seen in all three groups, with average increases of 5.6 pp(P < 0.001), 5.4 pp(P = 0.003) and 3.9 pp(P = 0.014) respectively.CONCLUSION Attendance of the BSC was associated with a significant step-change improvement in PICI, regardless of prior procedural experience. However, CIR data suggest that the optimal timing of course attendance appears to be at earlier stages of training(< 70 procedures).