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Efficacy of a One Day Hands-on EASIE® Endoscopy Simulator Train-The-Trainer Workshop
*S1541 Experience of Endoscopists and Radiation Exposure to Patients During ERCP Anthony Li, Danny Lee, Simon Wong, Angus Chan Aim: To investigate the relationship between experience of endoscopists and radiation exposure to patients during ERCP. Methods: Radiation dose during fluoroscopy and image acquisition, measured by dose-area product meter (DAP), was recorded prospectively for patients undergoing ERCP. The levels of endoscopists’ expertise in these procedures were divided into 3 groups: 1. Trainees only, 2. Trainers only, 3. Trainees & Trainers. Patients’ demographic data and other details of the ERCP procedures were also recorded. Results: 319 procedures were carried out over a 10-month period. Mean radiation exposure for those ERCP performed by trainees only (Gp1 n = 79) was 35.98 Gy cm2 (95% CI, 3.0151.0), trainers only (Gp2 n = 170) was 41.13 Gy cm2 (95% CI, 1.9-161.4), and trainees & trainers (Gp3 n = 70) was 55.86 Gy cm2 (95% CI, 6.3-197.4). Intergroup analysis using ANOVA showed that the p value for differences in mean radiation exposure between Gp1 and Gp2 = 0.22, between Gp2 and Gp3 < 0.001, between Gp1 and Gp3 < 0.001. Conclusion: The levels of radiation that patients were exposed to during ERCP varied widely. Patients who underwent ERCP carried out by both trainees & trainers were exposed to significantly more radiation than those procedures that were performed by either trainees or trainers alone.
minutes, and it is clear that there are unidentified variables associated with completion times in clinical practice. Aim: We studied multiple variables associated with completion time for colonoscopy by a single trained gastroenterologist in a university teaching hospital with special reference to participating trainees. Methods: 399 consecutive patients (mean age 55 years; range 17-90; 225 female), attending for routine colonoscopy were prospectively studied. Patients completed a highly structured questionnaire before the procedure and a comprehensive series of demographic, clinical and endoscopic data were collected. A standard bowel preparation was assessed using conventional guidelines. Results: Colonoscopy was incomplete in 101 cases (25%), usually as a result of poor preparation or patient discomfort. Median completion time was 25 minutes. Factors associated with a longer procedure time included participation by a trainee (median 30 v’s 18 min; p<0.001), female sex (25 v’s 22 min; p=0.04), anaemia (30 v’s 23 min; p=0.01), incomplete bowel preparation (25 v’s 19 min; p<0.001), the presence of a polyp or cancer (30 v’s 23 min; p=0.004) and performance of polypectomy (34 v’s 24 min; p=0.03). Intubation of the terminal ileum did not lead to a lengthened procedure time. The only independent variables were participation by a trainee (p<0.001), incomplete bowel preparation (p=0.05) and polypectomy (p<0.001). Conclusions: There are variables that could be modified to reduce colonoscopy procedure times in routine clinical practice. The significantly increased times related to participation by gastroenterology fellows has implications for resourcing and structure of fellowship training programs.
*S1542 Unsedated Colonoscopy Performed by Trainees Under Supervision Felix W. Leung, S. Chu, B. Nguyen, S. Aharonian, R. Chitayat, M. Feinerman, P. Gulsrud, L. Jacobs INTRODUCTION: The effectiveness of unsedated colonoscopy in the setting of a GI training program has not been described. AIM: To test the hypothesis that the time required to complete unsedated and sedated colonscopy by trainees under supervision is comparable. METHOD: Ambulatory VA patients referred for diagnostic and screening colonoscopy were offered the option of colonoscopy without sedation. The time for completing the examination (from insertion to complete withdrawal from the anus of the colonoscope) was prospectively recorded. A group of sedated patients examined over a similar time period served as controls. Trainees supervised by attending staff performed all of the colonoscopic examinations. RESULTS (Table 1): All of the unsedated patients with completed examination of the colon to the cecum indicated they were likely to accept repeat colonoscopy without sedation. The trainees perceived the completed unsedated examination to vary from easy to moderately difficult, but the incomplete unsedated procedures to be uniformly difficult. The patients reported the following reasons for choosing the unsedated option: able to return to work the same day (40%), no need to arrange for escort (83%), able to communicate during and immediately after the procedure (90%) and shorter waiting time (90%). Unsedated patients uniformly did not require intravenous medication. Nursing staff for monitoring the patient, transportation of the patient to recovery unit and recovery of the patient was unnecessary for the unsedated examination. CONCLUSION: In the hands of supervised trainees, the time required to complete the unsedated and sedated examination was comparable. The rate of incomplete colonoscopy was higher, but transient hypotension lower, when performed without than with sedation. Where nursing resources are significantly limited, unsedated colonoscopy is an option for selected patients.
*S1544 Efficacy of a One Day Hands-on EASIEÒ Endoscopy Simulator Train-The-Trainer Workshop Jonathan Cohen, Kai Matthes, Michael L. Kochman, Maurice A. Cerulli, Kinjal C. Vora, Juergen Maiss, Juergen Hochberger, New York Society for Gastrointestinal Endoscopy (NYSGE) Study Group Background: The compact-EASIEÒ (Erlanger Active Simulator for Interventional Endoscopy) has been used to conduct structured training workshops on endoscopic hemostasis for over 400 physicians and GI-assistants since 1997. Two randomized prospective trials demonstrated the efficacy of EASIEÒ hemostasis training led by tutors experienced in using this model. Expanding the benefits of this training modality depends on the ability to train a large cohort of tutors capable of achieving comparable results from these workshops. We conducted a train-the-trainer-workshop to evaluate how quickly and effectively new tutors, without simulator training pre-experience, are able to acquire hemostasis teaching skills using this model. Methods: Five tutors with at least 6 days of prior EASIEÒ teaching experience provided 6 hours of training on how to set up the model and train fellows with it to 7 endoscopists without prior EASIEÒ simulator experience . The following day, the 7 new tutors independently set up and ran a workshop for 8 GI fellows in four hemostasis techniques. Fellows’’ skill scores at the end of training were compared to their baseline skill assessments. Qualitative ratings of the new tutors were obtained from the trainees and the experienced tutors. Results: Significant improvement was achieved by the fellows in all 4 techniques. The skill acquisition using new tutors in this study was of similar magnitude to that achieved in the two prior trials using experienced tutors. Both the experienced tutors observing the session and the trainees rated highly the new tutors’’ teaching skill. Conclusion: It is feasible to conduct an effective EASIEÒ train-the-trainer course in one day. Tutors trained in this manner are able to provide a similar educational experience with objective improvement in trainee skill to teachers who have conducted many hands-on workshops. This process should facilitate more widespread access for fellows to ex-vivo animal model training.
*S1543 Trainee and Trainer: A Prospective Study of Completion Times in Patients Attending for Routine Colonoscopy in a Single University Hospital Endoscopy Service Diarmuid S. Manning, Gayle Bennett, Suzi Clarke, Richard Walsh, Hugh E. Mulcahy Introduction: There are many published data on procedure times for colonoscopy, mostly from dedicated colonoscopists within specialist units. Even so, published median completion times range from less than 7 minutes to greater than 20
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minutes, and it is clear that there are unidentified variables associated with completion times in clinical practice. Aim: We studied multiple variables associated with completion time for colonoscopy by a single trained gastroenterologist in a university teaching hospital with special reference to participating trainees. Methods: 399 consecutive patients (mean age 55 years; range 17-90; 225 female), attending for routine colonoscopy were prospectively studied. Patients completed a highly structured questionnaire before the procedure and a comprehensive series of demographic, clinical and endoscopic data were collected. A standard bowel preparation was assessed using conventional guidelines. Results: Colonoscopy was incomplete in 101 cases (25%), usually as a result of poor preparation or patient discomfort. Median completion time was 25 minutes. Factors associated with a longer procedure time included participation by a trainee (median 30 v’s 18 min; p<0.001), female sex (25 v’s 22 min; p=0.04), anaemia (30 v’s 23 min; p=0.01), incomplete bowel preparation (25 v’s 19 min; p<0.001), the presence of a polyp or cancer (30 v’s 23 min; p=0.004) and performance of polypectomy (34 v’s 24 min; p=0.03). Intubation of the terminal ileum did not lead to a lengthened procedure time. The only independent variables were participation by a trainee (p<0.001), incomplete bowel preparation (p=0.05) and polypectomy (p<0.001). Conclusions: There are variables that could be modified to reduce colonoscopy procedure times in routine clinical practice. The significantly increased times related to participation by gastroenterology fellows has implications for resourcing and structure of fellowship training programs.
*S1542 Unsedated Colonoscopy Performed by Trainees Under Supervision Felix W. Leung, S. Chu, B. Nguyen, S. Aharonian, R. Chitayat, M. Feinerman, P. Gulsrud, L. Jacobs INTRODUCTION: The effectiveness of unsedated colonoscopy in the setting of a GI training program has not been described. AIM: To test the hypothesis that the time required to complete unsedated and sedated colonscopy by trainees under supervision is comparable. METHOD: Ambulatory VA patients referred for diagnostic and screening colonoscopy were offered the option of colonoscopy without sedation. The time for completing the examination (from insertion to complete withdrawal from the anus of the colonoscope) was prospectively recorded. A group of sedated patients examined over a similar time period served as controls. Trainees supervised by attending staff performed all of the colonoscopic examinations. RESULTS (Table 1): All of the unsedated patients with completed examination of the colon to the cecum indicated they were likely to accept repeat colonoscopy without sedation. The trainees perceived the completed unsedated examination to vary from easy to moderately difficult, but the incomplete unsedated procedures to be uniformly difficult. The patients reported the following reasons for choosing the unsedated option: able to return to work the same day (40%), no need to arrange for escort (83%), able to communicate during and immediately after the procedure (90%) and shorter waiting time (90%). Unsedated patients uniformly did not require intravenous medication. Nursing staff for monitoring the patient, transportation of the patient to recovery unit and recovery of the patient was unnecessary for the unsedated examination. CONCLUSION: In the hands of supervised trainees, the time required to complete the unsedated and sedated examination was comparable. The rate of incomplete colonoscopy was higher, but transient hypotension lower, when performed without than with sedation. Where nursing resources are significantly limited, unsedated colonoscopy is an option for selected patients.
*S1544 Efficacy of a One Day Hands-on EASIEÒ Endoscopy Simulator Train-The-Trainer Workshop Jonathan Cohen, Kai Matthes, Michael L. Kochman, Maurice A. Cerulli, Kinjal C. Vora, Juergen Maiss, Juergen Hochberger, New York Society for Gastrointestinal Endoscopy (NYSGE) Study Group Background: The compact-EASIEÒ (Erlanger Active Simulator for Interventional Endoscopy) has been used to conduct structured training workshops on endoscopic hemostasis for over 400 physicians and GI-assistants since 1997. Two randomized prospective trials demonstrated the efficacy of EASIEÒ hemostasis training led by tutors experienced in using this model. Expanding the benefits of this training modality depends on the ability to train a large cohort of tutors capable of achieving comparable results from these workshops. We conducted a train-the-trainer-workshop to evaluate how quickly and effectively new tutors, without simulator training pre-experience, are able to acquire hemostasis teaching skills using this model. Methods: Five tutors with at least 6 days of prior EASIEÒ teaching experience provided 6 hours of training on how to set up the model and train fellows with it to 7 endoscopists without prior EASIEÒ simulator experience . The following day, the 7 new tutors independently set up and ran a workshop for 8 GI fellows in four hemostasis techniques. Fellows’’ skill scores at the end of training were compared to their baseline skill assessments. Qualitative ratings of the new tutors were obtained from the trainees and the experienced tutors. Results: Significant improvement was achieved by the fellows in all 4 techniques. The skill acquisition using new tutors in this study was of similar magnitude to that achieved in the two prior trials using experienced tutors. Both the experienced tutors observing the session and the trainees rated highly the new tutors’’ teaching skill. Conclusion: It is feasible to conduct an effective EASIEÒ train-the-trainer course in one day. Tutors trained in this manner are able to provide a similar educational experience with objective improvement in trainee skill to teachers who have conducted many hands-on workshops. This process should facilitate more widespread access for fellows to ex-vivo animal model training.
*S1543 Trainee and Trainer: A Prospective Study of Completion Times in Patients Attending for Routine Colonoscopy in a Single University Hospital Endoscopy Service Diarmuid S. Manning, Gayle Bennett, Suzi Clarke, Richard Walsh, Hugh E. Mulcahy Introduction: There are many published data on procedure times for colonoscopy, mostly from dedicated colonoscopists within specialist units. Even so, published median completion times range from less than 7 minutes to greater than 20
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VOLUME 59, NO. 5, 2004