title: 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.
abstract: BACKGROUND
  The Texas Association of Surgical Skills Laboratories (TASSL) is a nonprofit consortium of surgical skills training centers for the accredited surgery residency programs in Texas. A training and research collaborative was forged between TASSL members and Simbionix (Cleveland, OH, USA) to assess the feasibility and efficacy of a multicenter, simulation- and Web-based flexible endoscopy training curriculum using shared GI Mentor II systems.
  
  
  METHODS
  Two GI Mentor II flexible endoscopy simulators were provided for the study, and four institutions, namely, the University of Texas Health Science Center-San Antonio (UTHSCSA), Texas A & M University (TAMU), Methodist Hospital (MHD), and Brooke Army Medical Center (BAMC), agreed to share them. One additional site, University of Texas Southwestern (UTSW), already owned a device and participated during the study period. Postgraduate years (PGYs) 1 to 4 subjects completed pre- and posttraining questionnaires and one pre- and posttraining trial of Colonoscopy Case Module 1. EndoBubble 1 and 2 tasks with predefined, expert-derived levels were used for training. Pre- and posttesting performance data were recorded on the simulator and by the Global Assessment of Gastrointestinal Endoscopic Skills (GAGES). All study materials were available through the TASSL Web site. Pre- and posttest comparisons were made by paired t-test.
  
  
  RESULTS
  The curriculum was completed successfully by 41 participants from four institutions. The mean number of trials to proficiency was 13 ± 10 for EndoBubble 1 and 23 ± 16 for EndoBubble 2. Significant improvements from pre- to posttraining were seen in cecal intubation time (229 ± 97 vs. 150 ± 57 s; p < 0.001), total time (454 ± 147 vs. 320 ± 115 s; p < 0.001), screening efficiency (85% ± 12% vs. 91% ± 5%; p < 0.002), GAGES scores (15 vs. 19; p < 0.001), subjects' endoscopy self-rating scores (1.5 ± 1.0 vs. 2.7 ± 0.6; range, 0-4; p < 0.001), and comfort level with flexible endoscopy skills (3.4 ± 3.0 vs. 7.2 ± 1.2; range, 0-8; p < 0.001).
  
  
  CONCLUSIONS
  The feasibility of sharing educational and training resources among institutions was demonstrated. Likewise, the concept of "mobile simulation" appears to be useful and effective, with three of the four institutions involved successfully in implementing the training curriculum during a fixed period. Additionally, subjects who completed the training demonstrated both subjective and objective improvements in flexible endoscopy skills.
authors.affiliation: Department of Surgery, University of Texas Health Science Center-San Antonio (UTHSCSA), 7703 Floyd Curl, Mail Code 7840, San Antonio, TX 78229-3900, USA. sickle@uthscsa.edu
authors.forename: Kent R
authors.initials: KR
authors.lastname: Van Sickle
authors.forename: Lauren
authors.initials: L
authors.lastname: Buck
authors.forename: Ross
authors.initials: R
authors.lastname: Willis
authors.forename: Alicia
authors.initials: A
authors.lastname: Mangram
authors.forename: Michael S
authors.initials: MS
authors.lastname: Truitt
authors.forename: Mohsen
authors.initials: M
authors.lastname: Shabahang
authors.forename: Scott
authors.initials: S
authors.lastname: Thomas
authors.forename: Lee
authors.initials: L
authors.lastname: Trombetta
authors.forename: Brian
authors.initials: B
authors.lastname: Dunkin
authors.forename: Daniel
authors.initials: D
authors.lastname: Scott
mesh_terms: D002983:Clinical Competence; D003113:Colonoscopy / Q000193:education / Q000379:methods; D003198:Computer Simulation; D003194:Computer-Assisted Instruction / Q000295:instrumentation*; D003479:Curriculum; D004521:Educational Measurement; D016099:Endoscopy, Gastrointestinal / Q000193:education* / Q000379:methods; D005240:Feasibility Studies; D006801:Humans; D020407:Internet; D011795:Surveys and Questionnaires; D013781:Texas; D014584:User-Computer Interface