Computer simulator among experts involved in screening colonoscopy.
BACKGROUND
In the era of screening colonoscopy, assessment of operator competence is warranted.


OBJECTIVE
To evaluate feasibility of a computer simulator (CS) use for assessment of competence in colonoscopy by investigating performance of expert endoscopists at CS.


METHODS
Twenty expert endoscopists involved in screening colonoscopy.


METHODS
Experts returned a questionnaire regarding personal practice (duration of activity, number of colonoscopies in the last year and assistance by a nurse) and performances (percentage of caecal intubation and polyp detection rate). One easy and one difficult colonoscopy were proposed at CS in randomized order.


RESULTS
Participation rate was 75%. Caecal intubation rate in clinical practice was more than 90% for all experts. At CS, time to caecal intubation and number of attempts for ileal intubation were significantly lower during easy versus difficult colonoscopy (P<0.01 for both items); interestingly, percentage of mucosa explored was higher (P<0.05) during the difficult simulation. Withdrawal time >/=6 min was achieved by 40 and 33% of experts during the easy and difficult simulation, respectively. Independent of simulation difficulty, time with loop was lower (P<0.05) for experts using hands-free insertion (n = 8) compared with those using nurse assistance in their clinical practice (n = 7). No correlation was found between scores at CS and performance in clinical practice.


CONCLUSIONS
Scores at CS are sensitive to the rate of technical difficulty and nurse assistance during daily practice. Withdrawal time is often shorter than required for high accuracy in polyp detection. CS could be a well-accepted tool for assessment of competence.
Cantù
Paolo
P
Postgraduate School of Gastroenterology, University of Milan, Gastrointestinal Unit 2, Fondazione IRCCS Ospedale Maggiore Policlinico, Pad. Granelli, 3rd floor, Via F. Sforza 35, Milan 20122, Italy. paolo.cantu@unimi.it
Grigolon
Ausilia
A
Caparello
Chiara
C
Bravi
Ivana
I
Tenca
Andrea
A
Elvevi
Alessandra
A
Nicita
Maria Teresa
MT
Duca
Piergiorgio
P
Conte
Dario
D
Penagini
Roberto
R
D002432:Cecum; D002983:Clinical Competence; D003113:Colonoscopy / Q000193:education / Q000592:standards*; D003198:Computer Simulation; D004502:Education, Medical, Continuing / Q000379:methods; D004521:Educational Measurement / Q000379:methods; D005240:Feasibility Studies; D006801:Humans; D007558:Italy; D008348:Manikins; D008403:Mass Screening / Q000592:standards; D008505:Medical Staff, Hospital / Q000193:education / Q000592:standards; D016544:Patient Simulation