title: Simulated colonoscopy training using a low-cost physical model improves responsiveness of surgery interns.
abstract: OBJECTIVE
  Surgery residents are required to become proficient in colonoscopy before completing training. The aim of this study was to evaluate the responsiveness of surgery interns to simulated colonoscopy training.
  
  
  METHODS
  Interns, defined as postgraduate year 1 residents without exposure to endoscopy, underwent training in a physical model including colonoscopy, synthetic anatomy trays with luminal tattoos and a hybrid simulator. After baseline testing and mentored training, final testing was performed using five predetermined proficiency criteria. Content-valid metrics defined by the extent of departure from clinical reality were evaluated by two blinded assessors. Responsiveness was defined as change in performance over time and assessed comparing baseline testing with nonmentored final testing.
  
  
  RESULTS
  Twelve interns (eight male, mean age 26, 80% right-handed) performed 48 colonoscopies each over 1 year. Improvement was seen in the overall procedure time (24 min 46 s vs 20 min 54 s; P = 0.03), passing the splenic flexure (20 min 33 s vs 10 min 45 s; P = 0.007), passing the hepatic flexure (23 min 31 s vs 12 min 45 s; P = 0.003), caecal intubation time (23 min 38 s vs 13 min 26 s; P = 0.008), the duration of loss of view of the lumen (75% vs 8.3%; P = 0.023), incomplete colonoscopy (100% vs 33.3%; P = 0.042), colonoscope withdrawal < 6 min (16.7% vs 8.3%; P = 0.052). Tattoo identification time (9 min 16 s vs 12 min 25 s; P = 0.50), colon looped time (2 min 12 s vs 1 min 45 s; P = 0.50) and rate of colon perforation (8.3% vs 8.3%; P = 1) remained unchanged. Interrater reliability was 1.0 for all measures.
  
  
  CONCLUSIONS
  Simulated colonoscopy training in a low-cost physical model improved the performance of surgery interns with decreased procedure time, increased rates of complete colonoscopy and appropriate scope withdrawal.
authors.affiliation: Divisions of Gastroenterology, State University of New York, Stony Brook, New York, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Buscaglia
authors.affiliation: Divisions of Colon and Rectal Surgery, State University of New York, Stony Brook, New York, USA.
authors.forename: J
authors.initials: J
authors.lastname: Fakhoury
authors.affiliation: Divisions of Colon and Rectal Surgery, State University of New York, Stony Brook, New York, USA.
authors.forename: J
authors.initials: J
authors.lastname: Loyal
authors.affiliation: Divisions of Colon and Rectal Surgery, State University of New York, Stony Brook, New York, USA.
authors.forename: P I
authors.initials: PI
authors.lastname: Denoya
authors.affiliation: Divisions of Colon and Rectal Surgery, State University of New York, Stony Brook, New York, USA.
authors.forename: E
authors.initials: E
authors.lastname: Kazi
authors.affiliation: Divisions of Colon and Rectal Surgery, State University of New York, Stony Brook, New York, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Stein
authors.affiliation: Department of Surgery, State University of New York, Stony Brook, New York, USA.
authors.forename: R
authors.initials: R
authors.lastname: Scriven
authors.affiliation: Divisions of Colon and Rectal Surgery, State University of New York, Stony Brook, New York, USA.
authors.forename: R
authors.initials: R
authors.lastname: Bergamaschi
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003113:Colonoscopy / Q000193:education* / Q000379:methods; D003198:Computer Simulation; D004521:Educational Measurement; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008953:Models, Anatomic
keywords: Surgery; colonoscopy; residents; responsiveness; simulation; training