title: Can a Computerized Simulator Assess Skill Level and Improvement in Performance of ERCP?
abstract: BACKGROUND
  Endoscopic retrograde cholangiography (ERCP) is a challenging procedure with considerable risk. Computerized simulators are valuable in training for flexible endoscopy, but little data exist for their use in ERCP training.
  
  
  OBJECTIVE
  To determine a simulator's ability to assess the level of ERCP skill and its responsiveness over time to increasing trainee experience.
  
  
  METHODS
  In this prospective parallel-arm cohort study, six novice gastroenterology fellows and four gastroenterology faculty with expertise in ERCP completed four simulated baseline cases and the same four cases at a later date. This study took place at a surgical skills center at an academic tertiary referral center. The primary outcome was the total time to complete the ERCP procedure.
  
  
  RESULTS
  For the baseline session, experts had a shorter total procedure time than novices (444.0 vs. 616.9 s; least squares mean; p = 0.026). There was no significant difference between experts and novices in the difference of total procedure time between session 1 and session 2 (-200.3 vs. -164.4; least squares mean; p = 0.402).
  
  
  CONCLUSIONS
  The simulator was able to differentiate experts from novices for the primary outcome of total procedure time. The simulator was not responsive to an increase in trainee experience over time.
authors.affiliation: Division of Gastrointestinal and Liver Diseases, University of Southern California School of Medicine, 1510 San Pablo St, Los Angeles, CA, 90033, USA. arasahak@med.usc.edu.
authors.forename: Ara B
authors.initials: AB
authors.lastname: Sahakian
authors.affiliation: Section of Digestive Diseases, Yale University School of Medicine, 333 Cedar Street-1080 LMP, New Haven, CT, 06520, USA. loren.laine@yale.edu.|Section of Digestive Diseases, V.A. Connecticut Healthcare System, 333 Cedar Street-1080 LMP, West Haven, CT, 06520, USA. loren.laine@yale.edu.
authors.forename: Loren
authors.initials: L
authors.lastname: Laine
authors.affiliation: Section of Digestive Diseases, Yale University School of Medicine, 333 Cedar Street-1080 LMP, New Haven, CT, 06520, USA. priya.jamidar@yale.edu.
authors.forename: Priya A
authors.initials: PA
authors.lastname: Jamidar
authors.affiliation: Section of Gastroenterology, University of Chicago, 5700 S. Maryland Ave, Chicago, IL, 60637, USA. usiddiqui@bsd.uchicago.edu.
authors.forename: Uzma D
authors.initials: UD
authors.lastname: Siddiqui
authors.affiliation: Department of Surgery, Yale University School of Medicine, PO Box 208062, New Haven, CT, 06510, USA. andrew.duffy@yale.edu.
authors.forename: Andrew
authors.initials: A
authors.lastname: Duffy
authors.affiliation: Department of Biostatistics, Yale School of Public Health, 60 College St, Suite 209, New Haven, CT, 06510, USA. maria.ciarleglio@yale.edu.
authors.forename: Maria M
authors.initials: MM
authors.lastname: Ciarleglio
authors.affiliation: Yale Center for Analytical Sciences, Yale School of Public Health, 300 George St, Suite 555, New Haven, CT, 06510, USA. yanhong.deng@yale.edu.
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Deng
authors.affiliation: Section of Digestive Diseases, Yale University School of Medicine, 333 Cedar Street-1080 LMP, New Haven, CT, 06520, USA. anil.nagar@yale.edu.|Section of Digestive Diseases, V.A. Connecticut Healthcare System, 333 Cedar Street-1080 LMP, West Haven, CT, 06520, USA. anil.nagar@yale.edu.
authors.forename: Anil
authors.initials: A
authors.lastname: Nagar
authors.affiliation: Section of Digestive Diseases, Yale University School of Medicine, 333 Cedar Street-1080 LMP, New Haven, CT, 06520, USA. harry.aslanian@yale.edu.
authors.forename: Harry R
authors.initials: HR
authors.lastname: Aslanian
mesh_terms: D000328:Adult; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000592:standards*; D002983:Clinical Competence; D015331:Cohort Studies; D003198:Computer Simulation; D004521:Educational Measurement; D005180:Faculty, Medical; D005257:Fellowships and Scholarships; D005762:Gastroenterology / Q000193:education*; D006801:Humans; D008875:Middle Aged; D061646:Operative Time; D011446:Prospective Studies; D058996:Quality Improvement; D062606:Tertiary Care Centers
keywords: ERCP; ERCP simulator; ERCP training; Endoscopy quality measures; Endoscopy simulators