The validation and application of a novel colonic polypectomy trainer. The WIMAT colonoscopy suitcase

Summary Background and Aims The WIMAT colonoscopy suitcase is an ex-vivo, porcine, polypectomy simulator. This has been developed in response to the increasing demand for polypectomy training following the introduction of the National Bowel Cancer Screening Programme. The aims of this thesis are to establish if the simulator is a valid form of polypectomy skills training and to identify if this model can be used to develop objective parameters for polypectomy assessment. Materials and Methods A series of clinical trials were systematically conducted to test the validity of the WIMAT colonoscopy suitcase. This included evaluating its content, construct and concurrent validity and conducting a skills transfer study comparing the WIMAT colonoscopy suitcase with a virtual reality simulator. Objective assessment parameters were examined by measuring the accuracy of self-assessment and using video coding software to analyse the hand movements performed during simulated polypectomy tasks. Results Content validity was demonstrated by experts who scored the model’s anatomical, mechanical and visual realism favourably across multiple parameters (p=0.05). The ratio of rotational hand movements to endoscopic tip angulation (RoTA) was significantly different when comparing novices to experts (p=<0.05). Discussion The WIMAT colonoscopy suitcase is a valid form of polypectomy skills training. The simulator can be used to address the increasing demand for training in this procedure. Further work is needed to assess the reliability of the RoTA score at different stages of the polypectomy procedure before it is used as an assessment tool

Entwicklung eines Endoskopiesimulators mit spezieller Haptik für verschiedenartige neue Trainingsmethoden

Koloskopie ist ein endoskopisches Verfahren zur Untersuchung des Colons. Da das Erlernen der Untersuchung schwierig ist und für den Patienten gefährlich sein kann, wird versucht, durch den Einsatz von Trainingsmodellen oder Computersimulatoren ein patientenunabhängiges Training zu realisieren. Die Möglichkeiten und Grenzen dieser Methoden werden in der vorliegenden Arbeit aufgezeigt und daraus neuartige Methoden zur Verbesserung des Trainings abgeleitet. Um diese neuen Trainingsmöglichkeiten zu realisieren, wurde der vorhandene Simulator "EndoSim" um eine akustische Ausgabe ergänzt. Die Haptik wurde sowohl im Umfang als auch bezüglich der Funktionalität erweitert. Dadurch entstand der erste Koloskopiesimulator, welcher eine maximale Realitätstreue durch aktives Force-Feedback auf allen bei dieser Untersuchung möglichen Freiheitsgraden bietet. Des Weiteren ist dabei erstmals ein Koloskopiesimulator mit Positionierung auf den vier Freiheitsgraden realisiert worden. Dies wurde genutzt, um dem Trainierenden neue Möglichkeiten der Hilfe anzubieten: Ein Lernender kann sich anhand von Aufnahmen führen lassen, diesen Wiedergabemodus für eigene Versuche unterbrechen und sich bei Schwierigkeiten wieder auf den empfohlenen Weg zurücksetzen lassen. Für Nutzer des Force-Feedback-Modus wurde die Möglichkeit geschaffen, sich bei Problemen einen vorausberechneten Weg sowohl optisch als auch haptisch aufzeigen zu lassen. Die neu eingeführten Methoden erweitern in Ausbildung und Assessment den Einsatzbereich von Endoskopiesimulatoren. Zusätzlich ist es durch die neue Haptik einfach möglich, weitere Anwendungen zur Verbesserung des Trainings -- wie paralleles haptisches Training oder delokalisierte Anleitung durch einen Experten -- zu realisieren

Quality assurance of training in diagnostic and therapeutic gastrointestinal endoscopy

Previous evidence has shown that standards of performance in gastrointestinal endoscopy are variable and that there are disparities in training outcomes. Many changes have been made recently to both training and assessment of endoscopy in the UK. However, no prospective methods of evaluating their outcome have been put in place. The aims of this research were to evaluate current and new training processes and assessments in order to quality assure the outcomes and improve the training process. Two audits were undertaken demonstrating improvements in colonoscopy training over 5 years within a single region and in trainee perceptions of their training nationally. Two studies were done investigating a novel computer colonoscopy simulator for assessment of colonoscopic skills, demonstrating excellent construct validity. A multi-centre randomised controlled trial evaluated the use of this simulator in novice training, which was shown to be equivalent to standard bed-side training with a high degree of skills transfer to real-life colonoscopy. Assessment tools for therapeutic endoscopic procedures were developed, validated and used to quality assure a course in therapeutic endoscopy. This course resulted in significant improvements in practical skills for three of the four therapeutic procedures following training. Web-based training and assessment modules for lesion recognition at capsule endoscopy were developed, validated and piloted. This demonstrated the effectiveness of using new training methodologies for skills improvement in this area. A training course for radiographers in virtual colonoscopy was developed and the training evaluated. This demonstrated competence in practical performance and improvements in knowledge and interpretative skill. Finally, two qualitative studies on non-technical skills in endoscopy were undertaken in order to widen the assessment domains from purely knowledge and skill. An interview study provided the basis for development of a nontechnical skills taxonomy and a video-analysis study resulted in production of a marker system for professional behaviour within gastrointestinal endoscopy