A multicenter, simulation-based skills training collaborative using shared GI Mentor II systems: results from the Texas Association of Surgical Skills Laboratories (TASSL) flexible endoscopy curriculum.

Van Sickle, Kent R; Buck, Lauren; Willis, Ross; Mangram, Alicia; Truitt, Michael S; Shabahang, Mohsen; Thomas, Scott; Trombetta, Lee; Dunkin, Brian; Scott, Daniel

BACKGROUND The Texas Association of Surgical Skills Laboratories (TASSL) is a nonprofit consortium of surgical skills training centers for the accredited surgery residency programs in Texas. A training and research collaborative was forged between TASSL members and Simbionix (Cleveland, OH, USA) to assess the feasibility and efficacy of a multicenter, simulation- and Web-based flexible endoscopy training curriculum using shared GI Mentor II systems. METHODS Two GI Mentor II flexible endoscopy simulators were provided for the study, and four institutions, namely, the University of Texas Health Science Center-San Antonio (UTHSCSA), Texas A & M University (TAMU), Methodist Hospital (MHD), and Brooke Army Medical Center (BAMC), agreed to share them. One additional site, University of Texas Southwestern (UTSW), already owned a device and participated during the study period. Postgraduate years (PGYs) 1 to 4 subjects completed pre- and posttraining questionnaires and one pre- and posttraining trial of Colonoscopy Case Module 1. EndoBubble 1 and 2 tasks with predefined, expert-derived levels were used for training. Pre- and posttesting performance data were recorded on the simulator and by the Global Assessment of Gastrointestinal Endoscopic Skills (GAGES). All study materials were available through the TASSL Web site. Pre- and posttest comparisons were made by paired t-test. RESULTS The curriculum was completed successfully by 41 participants from four institutions. The mean number of trials to proficiency was 13 ± 10 for EndoBubble 1 and 23 ± 16 for EndoBubble 2. Significant improvements from pre- to posttraining were seen in cecal intubation time (229 ± 97 vs. 150 ± 57 s; p < 0.001), total time (454 ± 147 vs. 320 ± 115 s; p < 0.001), screening efficiency (85% ± 12% vs. 91% ± 5%; p < 0.002), GAGES scores (15 vs. 19; p < 0.001), subjects' endoscopy self-rating scores (1.5 ± 1.0 vs. 2.7 ± 0.6; range, 0-4; p < 0.001), and comfort level with flexible endoscopy skills (3.4 ± 3.0 vs. 7.2 ± 1.2; range, 0-8; p < 0.001). CONCLUSIONS The feasibility of sharing educational and training resources among institutions was demonstrated. Likewise, the concept of "mobile simulation" appears to be useful and effective, with three of the four institutions involved successfully in implementing the training curriculum during a fixed period. Additionally, subjects who completed the training demonstrated both subjective and objective improvements in flexible endoscopy skills.