title: A proficiency-based skills training curriculum for the SAGES surgical training for endoscopic proficiency (STEP) program.
abstract: BACKGROUND
  The surgical training for endoscopic proficiency program is a collaborative project between Society of American Gastrointestinal and Endoscopic Surgeons and Olympus America Inc. dedicated to providing flexible endoscopy training to surgery residency programs. Currently it lacks models for proficiency-based training. This study developed 2 novel flexible endoscopy simulators, purchased a third, and established face and content validity as well as proficiency metrics for all 3.
  
  
  METHODS
  Three simulators were tested-a foam and cardboard upper gastrointestinal tract model, a commercially available colonoscopy model (CM-15, Olympus, Japan), and an endoscopic targeting model created from the Operation Game (Hasbro). Time and errors for the performance of 12 expert surgical endoscopists on each model were used to calculate proficiency scores. Face validity and content validity were established through posttest questionnaires using a 5-point Likert scale.
  
  
  RESULTS
  Experts had a mean of 8 years of endoscopic practice (range: 1-24y). Among them, 83% teach residents or fellows using simulation. Most perform more than 50 upper endoscopies (51 to >500) and 100 colonoscopies (101 to >500) per year. The average time for completing the upper gastrointestinal tract model with correct identification of all targets was 133 ± 56 seconds. Complete navigation of the colonoscopy model averaged 325 ± 156 seconds. Proper orientation and targeting using the Operation Game model averaged 273 ± 109 seconds with 3 errors.
  
  
  CONCLUSIONS
  This study proves face and content validity for 3 physical flexible endoscopy simulators that can be used to train upper and lower endoscopy as well as instrument targeting. It also establishes expert proficiency metrics that can be used by trainees for structured rehearsal. These relatively inexpensive models will be incorporated into the surgical training for endoscopic proficiency curriculum.
authors.affiliation: Methodist Institute for Technology, Innovation & Education (MITIE); Department of Surgery, The Methodist Hospital, Houston, Texas. Electronic address: VWilcox@houstonmethodist.org.
authors.forename: Victor
authors.initials: V
authors.lastname: Wilcox
authors.affiliation: Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: Ted
authors.initials: T
authors.lastname: Trus
authors.affiliation: Methodist Institute for Technology, Innovation & Education (MITIE); Department of Surgery, The Methodist Hospital, Houston, Texas.
authors.forename: Nilson
authors.initials: N
authors.lastname: Salas
authors.affiliation: Department of Surgery, University of Miami Health System, Miami, Florida.
authors.forename: Jose
authors.initials: J
authors.lastname: Martinez
authors.affiliation: Methodist Institute for Technology, Innovation & Education (MITIE); Department of Surgery, The Methodist Hospital, Houston, Texas.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Dunkin
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003479:Curriculum; D004724:Endoscopy / Q000193:education*; D005260:Female; D013502:General Surgery / Q000193:education; D006801:Humans; D007221:Industry; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D012955:Societies, Medical; D014481:United States
keywords: Endoscopy; Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; Proficiency; SAGES; STEP; Surgical < Technical; Training < Endoscopy