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Surgical Endoscopy

, Volume 32, Issue 3, pp 1414–1421 | Cite as

Teaching peroral endoscopic myotomy (POEM) to surgeons in practice: an “into the fire” pre/post-test curriculum

  • Tomokazu Kishiki
  • Brittany Lapin
  • Chi Wang
  • Brandon Jonson
  • Lava Patel
  • Matthew Zapf
  • Matthew Gitelis
  • Maria A. Cassera
  • Lee L. Swanström
  • Michael B. Ujiki
Article

Abstract

Introduction

With the increasing adoption of peroral endoscopic myotomy (POEM) as a first-line therapy for achalasia as well as a growing list of other indications, it is apparent that there is a need for effective training methods for both endoscopists in training and those already in practice. We present a hands-on-focused with pre- and post-testing methodology to teach these skills.

Methods

Six POEM courses were taught by 11 experienced POEM endoscopists at two independent simulation laboratories. The training curriculum included a pre-training test, lectures and discussion, mentored hands-on instruction using live porcine and ex-plant models, and a post-training test. The scoring sheet for the pre- and post-tests assessed the POEM performance with a Likert-like scale measuring equipment setup, mucosotomy creation, endoscope navigation, visualization, myotomy, and closure. Participants were stratified by their experience with upper-GI endoscopy (Novices <100 cases vs. Experts ≥100 cases), and their data were analyzed and compared.

Results

Sixty-five participants with varying degrees of experience in upper-GI endoscopy and laparoscopic achalasia cases completed the training curriculum. Participants improved knowledge scores from 69.7 ± 17.1 (pre-test) to 87.7 ± 10.8 (post-test) (p < 0.01). POEM performance increased from 15.1 ± 5.1 to 25.0 ± 5.5 (out of 30) (p < 0.01) with the greatest gains in mucosotomy [1.7–4.4 (out of 5), p < 0.01] and equipment (3.4–4.7, p < 0.01). Novices had significantly lower pre-test scores compared with Experts in upper-GI endoscopy (overall pre-score: 11.9 ± 5.6 vs. 16.3 ± 4.6, p < 0.01). Both groups improved significantly after the course, and there were no differences in post-test scores (overall post-score: 23.9 ± 6.6 vs. 25.4 ± 5.1, p = 0.34) between Novices and Experts.

Conclusions

A multimodal curriculum with procedural practice was an effective curricular design for teaching POEM to practitioners. The curriculum was specifically helpful for training surgeons with less upper-GI endoscopy experience.

Keywords

Simulation curriculum Course design Methodology POEM Pre-test Post-test 

Notes

Compliance with ethical standards

Disclosures

Tomokazu Kishiki, Brittany Lapin, Chi Wang, Brandon Jonson, Lava Patel, Matthew Zapf, Matthew Gitelis, Maria A. Cassera, Lee L. Swanström, and Michael B. Ujiki have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Pandolfino JE, Kahrilas PJ (2013) Presentation, diagnosis, and management of achalasia. Clin Gastroenterol Hepatol 11:887–897CrossRefPubMedGoogle Scholar
  2. 2.
    Pasricha PJ, Hawari R, Ahmed I, Chen J, Cotton PB, Hawes RH, Kalloo AN, Kantrsvoy SV, Gostout CJ (2007) Submucosal endoscopic esophageal myotomy: a novel experimental approach for the treatment of achalasia. Endoscopy 39:761–764CrossRefPubMedGoogle Scholar
  3. 3.
    Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, Satodate H, Odaka N, Itoh H, kudo S (2010) Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 42:265–271CrossRefPubMedGoogle Scholar
  4. 4.
    Zendejas B, Brydes B, Hamstra SJ (2013) State of the evidence on simulation-based training for laparoscopic surgery. Ann Surg 17:212–215Google Scholar
  5. 5.
    De Win G, Van Bruwaene S, Kulkarni J, Van Calster B, Aggarwal R, Allen C, Lissens A, De Ridder D, Miserez M (2016) An evidence-based laparoscopic simulation curriculum shortens the clinical learning curve and reduces surgical adverse events. Adv Med Educ Pract 7:357–370CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Kolozsvari NO, Feldman LS, Vassiliou MC, Demyttenaere S, Hoover ML (2011) Sim one, do one, teach one: considerations in designing training curricula for surgical simulation. J Surg Educ 68:421–427CrossRefPubMedGoogle Scholar
  7. 7.
    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 24:1834–1841CrossRefPubMedGoogle Scholar
  8. 8.
    Eleftheriadis N, Inoue H, Ikeda H, Onimaru M, Yoshida A, Hosoya T, Maselli R, Kudo SE (2012) Training in preoral endoscopic myotomy (POEM) for esophageal achalasia. Ther Clin Risk Manag 8:329–342CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Tomokazu Kishiki
    • 1
    • 2
  • Brittany Lapin
    • 1
  • Chi Wang
    • 1
  • Brandon Jonson
    • 1
  • Lava Patel
    • 1
  • Matthew Zapf
    • 1
  • Matthew Gitelis
    • 1
  • Maria A. Cassera
    • 3
  • Lee L. Swanström
    • 3
    • 4
  • Michael B. Ujiki
    • 1
    • 5
  1. 1.Grainger Center for Simulation & InnovationNorthShore University HealthSystem, A Teaching Affiliate of the University of Chicago Pritzker School of MedicineEvanstonUSA
  2. 2.Department of SurgeryKyorin University School of MedicineTokyoJapan
  3. 3.The Oregon ClinicPortlandUSA
  4. 4.Institute for Image Guided SurgeryStrasbourgFrance
  5. 5.Section of Minimally Invasive Surgery, Department of SurgeryNorthShore University HealthSystemEvanstonUSA

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