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Development of a fundamentals of endoscopic surgery proficiency‐based skills curriculum for general surgery residents

  • Tomoko Mizota
  • Nicholas E. Anton
  • Elizabeth M. Huffman
  • Michael J. Guzman
  • Frederick Lane
  • Jennifer N. Choi
  • Dimitrios StefanidisEmail author
Article
  • 18 Downloads

Abstract

Background

Fundamentals of Endoscopic Surgery (FES) has become a board certification requirement for general surgery residents. While the FES program provides a robust didactic curriculum, an endoscopic skills curriculum is lacking for this high stakes assessment. The aims of this study were to develop a proficiency-based endoscopic skills curriculum and assess its effectiveness on success in the FES exam.

Methods

Endoscopy experts developed a multiple-choice questionnaire based on the FES online didactics. Five training cases from the GI Mentor II simulator were selected, and expert performance defined proficiency levels for each case. Participating surgery residents were required to review online didactics and achieve proficiency twice on selected simulator cases. The multiple-choice questionnaire, simulator-generated metrics of two endoscopy cases, Global Assessment of Gastrointestinal Endoscopic Skills (GAGES), NASA-Task Load Index (TLX), and the manual portion of the FES exam were used for assessment before and after training. The curriculum was implemented either alongside a clinical endoscopy rotation or independent of the rotation. Clinical endoscopic skills of participants with a dedicated rotation were assessed using GAGES.

Results

Twenty-eight general surgery residents (PGY 2–5) participated in the study, of which 25 (89%) completed the curriculum. Scores of the multiple-choice questionnaire and all simulator-generated metrics improved in the post-training assessment, with the exception of the percentage of mucosal surface examined, which was slightly decreased. Simulated and clinical GAGES scores and the NASA-TLX score improved after training. Performance scores on four of five FES exam tasks were significantly improved.

Conclusions

The proficiency-based endoscopic skills curriculum was successfully implemented both alongside the clinical endoscopy rotation and independent of the rotation. Participating residents acquired skills to pass the FES exam. This curriculum will be valuable to general surgery residency programs.

Keywords

Competency Simulation Curriculum development Mastery learning Colonoscopy 

Notes

Acknowledgements

We thank the FES committee of SAGES for their input with the study, and Drs. William W Hope, Ranjan Sudan, Raghid S Bitar, and Mark Manwaring for their contribution to the curriculum development. We acknowledge Victoria G Dodge for the editing of this manuscript.

Disclosures

This study was funded by Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) through one of their FES research grants. Drs. Mizota, Huffman, Guzman, Lane, Choi, Stefanidis, and Mr. Anton have no conflict of interest or financial ties to disclose.

Funding

This study was funded by a grant from the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES).

References

  1. 1.
    Decker MR, Dodgion CM, Kwok AC, Hu YY, Havlena JA, Jiang W, Lipsitz SR, Kent KC, Greenberg CC (2014) Specialization and the current practices of general surgeons. J Am Coll Surg 218:8–15CrossRefGoogle Scholar
  2. 2.
    Chung JI, Kim N, Um MS, Kang KP, Lee D, Na JC, Lee ES, Chung YM, Won JY, Lee KH, Nam TM, Lee JH, Choi HC, Lee SH, Park YS, Hwang JH, Kim JW, Jeong SH, Lee DH (2010) Learning curves for colonoscopy: a prospective evaluation of gastroenterology fellows at a single center. Gut Liver 4:31–35CrossRefGoogle Scholar
  3. 3.
    Gardner AK, Scott DJ, Willis RE, Van Sickle K, Truitt MS, Uecker J, Brown KM, Marks JM, Dunkin BJ (2016) Is current surgery resident and GI fellow training adequate to pass FES? Surg Endosc.  https://doi.org/10.1007/s00464-016-4979-6 Google Scholar
  4. 4.
    Barsuk JH, Cohen ER, Feinglass J, McGaghie WC, Wayne DB (2017) Residents’ procedural experience does not ensure competence: a research synthesis. J Grad Med Educ 9:201–208CrossRefGoogle Scholar
  5. 5.
    Ritter EM, Scott DJ (2007) Design of a proficiency-based skills training curriculum for the fundamentals of laparoscopic surgery. Surg Innov 14:107–112CrossRefGoogle Scholar
  6. 6.
    Scott DJ, Ritter EM, Tesfay ST, Pimentel EA, Nagji A, Fried GM (2008) Certification pass rate of 100% for fundamentals of laparoscopic surgery skills after proficiency-based training. Surg Endosc 22:1887–1893CrossRefGoogle Scholar
  7. 7.
    Stefanidis D, Acker C, Heniford BT (2008) Proficiency-based laparoscopic simulator training leads to improved operating room skill that is resistant to decay. Surg Innov 15:69–73CrossRefGoogle Scholar
  8. 8.
    Brunner WC, Korndorffer JR Jr, Sierra R, Dunne JB, Yau CL, Corsetti RL, Slakey DP, Townsend MC, Scott DJ (2005) Determining standards for laparoscopic proficiency using virtual reality. Am Surg 71:29–35Google Scholar
  9. 9.
    Vassiliou MC, Kaneva PA, Poulose BK, Dunkin BJ, Marks JM, Sadik R, Sroka G, Anvari M, Thaler K, Adrales GL, Hazey JW, Lightdale JR, Velanovich V, Swanstrom LL, Mellinger JD, Fried GM (2010) Global assessment of gastrointestinal endoscopic skills (GAGES): a valid measurement tool for technical skills in flexible endoscopy. Surg Endosc 24:1834–1841CrossRefGoogle Scholar
  10. 10.
    Hart SG, Steveland LE (1988) Human mental workload development of NASA-TLX (task load index): results of empirical and theoretical research. Adv Psychol 52:139–183CrossRefGoogle Scholar
  11. 11.
    Yurko YY, Scerbo MW, Prabhu AS, Acker CE, Stefanidis D (2010) Higher mental workload is associated with poorer laparoscopic performance as measured by the NASA-TLX tool. Simul Healthc 5:267–271CrossRefGoogle Scholar
  12. 12.
    Hinkle DE, Wiersma W, Jurs SG (2003) Applied statistics for the behavioral sciences, 5th edn. Houghton Mifflin, BostonGoogle Scholar
  13. 13.
    Gomez PP, Willis RE, Van Sickle K (2015) Evaluation of two flexible colonoscopy simulators and transfer of skills into clinical practice. J Surg Educ 72:220–227CrossRefGoogle Scholar
  14. 14.
    Stefanidis D, Scerbo MW, Sechrist C, Mostafavi A, Heniford BT (2008) Do novices display automaticity during simulator training? Am J Surg 195:210–213CrossRefGoogle Scholar
  15. 15.
    Mueller CL, Kaneva P, Fried GM, Feldman LS, Vassiliou MC (2014) Colonoscopy performance correlates with scores on the FES manual skills test. Surg Endosc 28:3081–3085CrossRefGoogle Scholar
  16. 16.
    Vassiliou MC, Dunkin BJ, Fried GM, Mellinger JD, Trus T, Kaneva P, Lyons C, Korndorffer JR Jr, Ujiki M, Velanovich V, Kochman ML, Tsuda S, Martinez J, Scott DJ, Korus G, Park A, Marks JM (2014) Fundamentals of endoscopic surgery: creation and validation of the hands-on test. Surg Endosc 28:704–711CrossRefGoogle Scholar
  17. 17.
    Fayez R, Feldman LS, Kaneva P, Fried GM (2010) Testing the construct validity of the Simbionix GI Mentor II virtual reality colonoscopy simulator metrics: module matters. Surg Endosc 24:1060–1065CrossRefGoogle Scholar
  18. 18.
    Andreatta PB, Woodrum DT, Gauger PG, Minter RM (2008) LapMentor metrics possess limited construct validity. Simul Healthc 3:16–25CrossRefGoogle Scholar
  19. 19.
    Woodrum DT, Andreatta PB, Yellamanchilli RK, Feryus L, Gauger PG, Minter RM (2006) Construct validity of the LapSim laparoscopic surgical simulator. Am J Surg 191:28–32CrossRefGoogle Scholar
  20. 20.
    Ritter EM, Taylor ZA, Wolf KR, Franklin BR, Placek SB, Korndorffer JR Jr, Gardner AK (2017) Simulation-based mastery learning for endoscopy using the endoscopy training system: a strategy to improve endoscopic skills and prepare for the fundamentals of endoscopic surgery (FES) manual skills exam. Surg Endosc.  https://doi.org/10.1007/s00464-017-5697-4 Google Scholar
  21. 21.
    Van Sickle KR, Buck L, Willis R, Mangram A, Truitt MS, Shabahang M, Thomas S, Trombetta L, Dunkin B, Scott D (2011) A multicenter, simulation-based skills training collaborative using shared GI Mentor II systems: results from the Texas association of surgical skills laboratories (TASSL) flexible endoscopy curriculum. Surg Endosc 25:2980–2986CrossRefGoogle Scholar
  22. 22.
    Arora S, Sevdalis N, Nestel D, Woloshynowych M, Darzi A, Kneebone R (2010) The impact of stress on surgical performance: a systematic review of the literature. Surgery 147:318–330CrossRefGoogle Scholar
  23. 23.
    Wetzel CM, Kneebone RL, Woloshynowych M, Nestel D, Moorthy K, Kidd J, Darzi A (2006) The effects of stress on surgical performance. Am J Surg 191:5–10CrossRefGoogle Scholar
  24. 24.
    Fundamentals of Endoscopic Surgery. http://www.fesprogram.org. 2 April 2018

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Tomoko Mizota
    • 1
  • Nicholas E. Anton
    • 1
  • Elizabeth M. Huffman
    • 1
  • Michael J. Guzman
    • 1
  • Frederick Lane
    • 1
  • Jennifer N. Choi
    • 1
  • Dimitrios Stefanidis
    • 1
    Email author
  1. 1.Department of SurgeryIndiana University School of MedicineIndianapolisUSA

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