1.4.6 Incorporating Simulator Training into Educational Programs and Maintaining Skills in Complex Procedures
Simulator training in interventional endoscopy provides an effective opportunity for endoscopy trainees to gain considerable experience in ERCP techniques without time limitations and patient risk. In the New York study on EASIE simulator training in hemostasis, the trainees achieved significant improvement in the performance of multiple skills on the simulator after only three workshops.44 It appears that a structured educational program with access to simulator training, in addition to supervised real cases in the hospital plus DOPS evaluation, would increase the effectiveness of education in any interventional technique. The results of the real hemostasis cases performed in the New York study highlight this potential.40 The analogous French training project confirmed that more complex techniques like clipping or injection/gold-probe application need repeat training courses to acquire and to maintain competence compared to easier techniques like band ligation.39
Fig. 1.11 Outline of a prospective and randomized study of training conducted in New York City, comparing conventional clinical education in endoscopic hemostasis provided for 14 gastroenterology fellows with 14 fellows who received additional hands-on training in simulators in three 1-day workshops. After a period of 7 months, the intensive training group had significantly improved in all disciplines, while the conventional clinical group had only improved in variceal band ligation. (Adapted from Hochberger et al 2005.6)
The role of simulators in training the proper application of new devices and new techniques is not really known. However, many manufacturers have already now made specific certified training and supervision of the first clinical cases obligatory for new suturing, closure, or resective devices.
There is little doubt that the knowledge and skills gained once may decline over time. Apart from sphincterotomy volume, little is known about deterioration of skill or outcome with infrequently practiced techniques. British experience with web-based e-portfolio of trainees and independent endoscopists highlights that central monitoring of practice may play a role in the future.
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