Development and initial validation of an endoscopic part-task training box

Abstract

Background and study aims There is currently no objective and validated methodology available to assess the progress of endoscopy trainees or to determine when technical competence has been achieved. The aims of the current study were to develop an endoscopic part-task simulator and to assess scoring system validity. Methods Fundamental endoscopic skills were determined via kinematic analysis, literature review, and expert interviews. Simulator prototypes and scoring systems were developed to reflect these skills. Validity evidence for content, internal structure, and response process was evaluated. Results The final training box consisted of five modules (knob control, torque, retroflexion, polypectomy, and navigation and loop reduction). A total of 5 minutes were permitted per module with extra points for early completion. Content validity index (CVI)-realism was 0.88, CVI-relevance was 1.00, and CVI-representativeness was 0.88, giving a composite CVI of 0.92. Overall, 82% of participants considered the simulator to be capable of differentiating between ability levels, and 93% thought the simulator should be used to assess ability prior to performing procedures in patients. Inter-item assessment revealed correlations from 0.67 to 0.93, suggesting that tasks were sufficiently correlated to assess the same underlying construct, with each task remaining independent. Each module represented 16.0%–26.1% of the total score, suggesting that no module contributed disproportionately to the composite score. Average box scores were 272.6 and 284.4 (P=0.94) when performed sequentially, and average score for all participants with proctor 1 was 297.6 and 308.1 with proctor 2 (P=0.94), suggesting reproducibility and minimal error associated with test administration. Conclusion A part-task training box and scoring system were developed to assess fundamental endoscopic skills, and validity evidence regarding content, internal structure, and response process was demonstrated.

Proposed Experimental Model for Qualification of Endoscopic Practices

“…It is estimated that about 80 million Americans are affected by digestive diseases, and about 30 million endoscopic procedures are performed annually in the US [1,2]. In Brazil, it was estimated that the national average of endoscopies number was 600 tests / 100,000 inhabitants per year [3][4][5][6].…”

“…As demand requirement, there is an increasing number of patients undergoing bariatric surgery that is increasingly demanding that professionals know the therapeutic and endoscopic aspects of the main gastroenterological repercussions of bariatric operations [1,2,3]. As a consequence, some of the complications may arise after the completion of this surgery as the emergence of strictures, fistulas, ring migration and regained weight, conditions which until recently were resolved through a new surgical procedures [7,8].…”

“…Thus, stenoses of the gastrointestinal anastomoses are corrected through the use of balloon dilator with symptomatic improvement of patients after the [1,2] procedure.…”

“…The cases of regained weight, related to dilation of gastrojejunal anastomosis, is a therapeutic option by using argon plasma, causing a fibrotic scar and consequent reduction of the diameter of anastomosis [1,2]. Since migration of the ring in gastric bypass and stenosis , and even fistulae they can be solved by positioning the prosthesis by means of endoscopy [1,3].…”

“…Despite the common nature of the procedures, there is no standard methodology for the training of endoscopists or when a trainee met important technical competence. In addition, there is no tool that determines the qualification of front trainees to familiarize themselves with the endoscope and endoscopic equipment for clinical procedures [3,4].As demand requirement, there is an increasing number of patients undergoing bariatric surgery that is increasingly demanding that professionals know the therapeutic and endoscopic aspects of the main gastroenterological repercussions of bariatric operations [1,2,3]. As a consequence, some of the complications may arise after the completion of this surgery as the emergence of strictures, fistulas, ring migration and regained weight, conditions which until recently were resolved through a new surgical procedures [7,8].…”