Objective Benefit of a 1-day Training Course in Endoscopic Hemostasis Using the “compactEASIE” Endoscopy Simulator

Background and Study Aims: The Erlangen Active Simulator for Interventional Endoscopy (EASIE) was introduced in 1997 as a training model for interventional endoscopy. Objective evidence of the benefits of training with this model has not previously been published. As part of two long-term projects, the benefits of a 1-day training course with the “compactEASIE” simulator were evaluated.
Materials and Methods: Fourteen American and 18 French gastroenterology fellows were enrolled. These fellows were participants in the intensive groups performing training in endoscopic hemostasis, with a total number of 28 fellows in New York and 36 in France. Gastrointestinal endoscopy faculty members in New York and France evaluated and timed the fellows in four disciplines to establish baseline skills (manual skills; injection and coagulation; Hemoclip application; and variceal ligation) with the compactEASIE simulator. The trainees were reevaluated after an intensive 1-day course (with two or three fellows and one instructor per station), also including preparation and assistance for each procedure. The assessment (overall and parts) was done by expert tutors using an ordinal scale ranging from 1 to 10 (1 = poorest, 10 = best), recording also mistakes and performance time. The compactEASIE simulator, equipped with an upper gastrointestinal organ package and an artificial blood perfusion system, was used as the training tool.
Results: A highly significant improvement (P ≤ 0.001) was observed in the performance of all endoscopic techniques. A significant reduction in performance time was also observed with three of the four endoscopic techniques. Successful hemostasis was significantly improved in two out of three techniques.
Conclusions: A 1-day training course on endoscopic hemostasis using the compactEASIE simulator is capable of improving the performance of hemostasis procedures. Long-term effects of repeated training sessions are currently subject of collaborative studies in New York and France.

References

• 1 Hochberger J, Maiss J, Magdeburg B. et al . Training simulators and education in gastrointestinal endoscopy: current status in 2001 and perspectives.  Endoscopy. 2001;  33 541-549
• 2 Hochberger J, Maiss J, Hahn E G. The use of simulators for training in GI endoscopy.  Endoscopy. 2002;  34 727-729
• 3 Hochberger J, Neumann M, Hohenberger W, Hahn E G. Neuer Endoskopie-Trainer für die therapeutische flexible Endoskopie.  Z Gastroenterol. 1997;  35 722-723
• 4 Hochberger J, Neumann M, Maiss J. et al . EASIE: Erlangen Active Simulator for Interventional Endoscopy - a new bio-simulation-model. First experiences gained in training workshops.  Gastrointest Endosc. 1998;  47 AB116
• 5 Maiss J, Hahn E G, Hochberger J. A prospective evaluation of 14 EASIE team training workshops on endoscopic hemostasis.  Endoscopy. 2000;  32 (Suppl 1) E23
• 6 American Society for  Gastrointestinal Endoscopy. Endoscopy simulators.  Gastrointest Endosc. 1999;  50 935-937
• 7 Bar-Meir S. Endoscopy simulators: the state of the art, 2000.  Gastrointest Endosc. 2000;  52 201-203
• 8 Hochberger J, Matthes K, Maiss J. et al . Training with the compactEASIE biologic endoscopy simulator significantly improves hemostatic technical skill of gastroenterology fellows: a randomized controlled comparison with clinical endoscopy training alone.  Gastrointest Endosc. 2005;  61 204-215
• 9 Hochberger J, Maiss J, Prat F. et al . Prospective evaluation of intensive hands-on training in hemostasis using the EASIE endoscopy simulator compared to standard endoscopy education - national French training project.  Gastrointest Endosc. 2003;  57 AB109 (abstract S1494)
• 10 Hochberger J, Euler K, Nägel A. et al . The compactEASIE simulator (compact Erlangen Active Simulator for Interventional Endoscopy): a prospective comparison in structured team-training courses on “endoscopic hemostasis” for doctors and nurses to the “Endo-Trainer” model.  Scand J Gastroenterol. 2004;  39 895-902
• 11 Williams C B, Saunders B P, Bladen J S. Development of colonoscopy teaching simulation.  Endoscopy. 2000;  32 901-905
• 12 Grund K E, Bräutigam D, Zindel C. et al . Interventionsfähiges Tübinger Simulationsmodell Interphant für die flexible Endoskopie.  Endosk Heute. 1998;  11 134
• 13 Bar-Meir S. A new endoscopic simulator.  Endoscopy. 2000;  32 898-900
• 14 Sedlack R E, Kolars J C. Colonoscopy curriculum development and performance-based assessment criteria on a computer-based endoscopy simulator.  Acad Med. 2002;  77 750-751
• 15 Adamsen S. Simulators and gastrointestinal endoscopy training.  Endoscopy. 2000;  32 895-897
• 16 Williams C B, Baillie J, Gillies D F. et al . Teaching gastrointestinal endoscopy by computer simulation: a prototype for colonoscopy and ERCP.  Gastrointest Endosc. 1990;  36 49-54
• 17 Aabakken L, Adamsen S, Kruse A. Performance of a colonoscopy simulator: experience from a hands-on endoscopy course.  Endoscopy. 2000;  32 911-913
• 18 Ferlitsch A, Glauninger P, Gupper A. et al . Evaluation of a virtual endoscopy simulator for training in gastrointestinal endoscopy.  Endoscopy. 2002;  34 698-702
• 19 Cohen J, Cohen S, Vora K C. et al . Randomized controlled trial of virtual reality simulator training in acquisition of competency in colonoscopy (DDW 2003).  Gastrointest Endosc. 2003;  57 AB 108 (abstract S1492)
• 20 Hochberger J, Maiss J, Naegel A. et al . Polypectomy/vital endoscopic staining/mucosectomy: a new structured team training in a close to reality endoscopy simulator (EASIE).  Endoscopy. 2000;  32 (Suppl) E23
• 21 Maiss J, Naegel A, Tex S. et al . EASIE team training ERCP: experiences with a new training concept for interventional ERCP.  Endoscopy. 2000;  32 (Suppl 1) E65
• 22 Matsumoto E D, Hamstra S J, Radomski S B. et al . A novel approach to endourological training: training at the Surgical Skills Centre.  J Urol. 2001;  166 1261-1266
• 23 Matsumoto E D, Hamstra S J, Radomski S B, Cusimano M D. The effect of bench model fidelity on endourological skills: a randomized controlled study.  J Urol. 2002;  167 1243-1247