Successful Training in Gastrointestinal Endoscopy. Группа авторов. Читать онлайн. Newlib. NEWLIB.NET

Автор: Группа авторов
Издательство: John Wiley & Sons Limited
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isbn: 9781119529682
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target="_blank" rel="nofollow" href="#ulink_d16c36b2-6993-52b2-894c-779f09e0f2d7">Figure 1.10 (a) Artificial tissue colonoscopy “Phantom” simulator, U. of Tübingen. (b) Combined artificial tissue “Phantom” upper GI simulator with integrated chicken heart tissue papilla for ERCP simulation.

      While this model represented a technological advance over prior static models and added many new capabilities, there remained several limitations that hindered its more widespread use in training. The main drawbacks were that the pathology remained hand‐prepared and that the models were not mass‐produced. Therefore, the “Phantoms” have not been readily available and have required the presence of the Tübingen team if the device was to be used at a training course. The trade‐off for increased realism and the ability to start practicing therapeutic manipulations were significant increases in the logistical and cost obstacles to widespread use. Furthermore, models combining the real tissue abnormalities of the Tübingen model with the more accessible ex vivo animal tissue simulators described below now exist.

      Ex vivo animal tissue simulators: Erlanger and EASIE models

Photos depict (a) Compact-EASIE porcine model hemostasis simulator. (b) Close-up view of porcine stomach with arteries sutured in attached to catheters for hook-up to tubing connecting vessels to pump.

      imageWhile the most common application of the Hochberger model has been for hemostasis training, this group has conducted a number of training courses using the EASIE model in other areas, including EMR, stricture management, vital staining, polypectomy, and ERCP [28, 30–32]. A wide range of techniques can be demonstrated, including basic biliary cannulation, plastic stent insertion, choledochoscopy, laser lithotripsy, and placement of bilateral hilar metal stents (Videos 1.3 and 1.4). EASIE training has been shown to significantly improve technical skill in endoscopic hemostasis in gastroenterology trainees as compared to clinical endoscopy training alone [33]. As detailed in multiple chapters in this book, further adaptations of the ex vivo simulator have extended the use of this modality for training in colonoscopy, balloon‐assisted small bowel endoscopy, improved simulation of bile duct and pancreatic duct manipulation, EUS with FNA, and even NOTES® [34–37].

      Just as in the Lucero et al. experience described above, training sessions using the Erlanger or EASIE models are labor intensive, with high faculty‐to‐trainee ratios. Moreover, the advance work to organize and staff workshops using this technology is extensive. Since the compact EASIE is relatively portable, its use may allow easier access to animal simulator training at local sites, but this is counterbalanced by the need to have the required expertise to prepare the animal tissues and “load” the models. For this training technique to be applied widely, many expert teachers will still need to be trained; the feasibility of 1 day “train‐the‐trainer” courses has now been demonstrated [38].

      On the other hand, like the static models before it, the EASIE model allows trainees to perform multiple repetitions of the same technique. The use of real tissue and the capability of performing advanced therapeutic procedures make this an attractive simulator for practitioners hoping to learn new techniques and for advanced fellows to practice and improve their skills, as well as to acquire new abilities [39].

      By devising a way to allow realistic simulation of diagnostic and therapeutic techniques using a model that is portable, Hochberger set in motion a rapid expansion in the use of hands‐on training for GI fellows in the United States and Europe. Workshops at courses such as the annual NYSGE course and at national and regional endoscopy meetings proliferated. Around 2000, under the leadership of Christopher Gostout, the ASGE launched a major initiative to create opportunities for ex vivo model training in a central freestanding location. This effort culminated in the creation of the Integrated Technology and Training (ITT) center of the ASGE, and the development of a standardized first year fellows’ course curriculum, integrating a day of intensive hands‐on work in the ex vivo laboratory with interactive didactic lectures. The ongoing ASGE and industry support for these courses has led to over 300 fellows each year since 2005 attending the ITT workshop in the summer of their first year of fellowship. Through this effort, ex vivo hands‐on training to some degree has become part of the standard endoscopy training for US GI fellows. Efforts to extend such opportunities for advanced endoscopy trainees and to individuals in practice have expanded considerably since the mid 2000s and are addressed in Chapters 37 and 38 of this book.

      Live animal courses

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