title: Evaluation of a novel tablet application for improvement in colonoscopy training and mentoring (with video).
abstract: OBJECTIVE
  Endoscopic training can be challenging for the trainee and preceptor. Frustration can result from ineffective communication regarding areas of interest. Our team developed a novel tablet application for real-time mirroring of the colonoscopy examination that allows preceptors to make annotations directly on the viewing monitor. The potential for improvement in team proficiency and satisfaction is unknown.
  
  
  METHODS
  The on-screen endoscopic image is mirrored to an Android tablet and permits real-time annotation directly on the in-room endoscopic image display. Preceptors can also "freeze-frame" an image and provide visual on-screen instruction (telestration). Trainees, precepted by a GI attending, were 1:1 randomized to perform colonoscopy on a training phantom using the application with traditional precepting or traditional precepting alone. Magnetized polyps (size < 5 mm) were placed in 1 of 5 preset location scenarios. Each trainee performed a total of 10 colonoscopies and completed each location scenario twice. During withdrawal, the trainee and the attending identified polyps. Outcome measures included number of polyps missed and participant satisfaction after each trial.
  
  
  RESULTS
  Fifteen trainees (6 novice and 9 GI fellows) performed a total of 150 colonoscopies where 330 polyps in total were placed. Fellows missed fewer polyps using the tablet versus traditional precepting alone (4.2% vs 12.5%; P = .04). There was no significant difference in missed polyps for novices (12.5% vs 18.8%; P = .66). Overall, fellows missed fewer polyps when compared with novices regardless of the precepting method (P = .01). The attending and all trainees reported reduced stress with improved communication using the tablet.
  
  
  CONCLUSIONS
  Fellows missed fewer polyps using the tablet when compared with traditional endoscopy precepting. All trainees reported reduced stress, quicker identification of polyps, and improved educational satisfaction using the tablet. Our application has the potential to improve trainee plus attending team lesion detection and to enhance the endoscopy training experience for both the trainee and attending preceptor.
authors.affiliation: Division of Gastroenterology, Vanderbilt University, Nashville, Tennessee, USA.
authors.forename: Cregan J
authors.initials: CJ
authors.lastname: Laborde
authors.affiliation: Department of Mechanical Engineering, Vanderbilt University, Nashville, Tennessee, USA.
authors.forename: Charreau S
authors.initials: CS
authors.lastname: Bell
authors.affiliation: Division of Gastroenterology, Vanderbilt University, Nashville, Tennessee, USA.
authors.forename: James Chris
authors.initials: JC
authors.lastname: Slaughter
authors.affiliation: Department of Mechanical Engineering, Vanderbilt University, Nashville, Tennessee, USA; School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom.
authors.forename: Pietro
authors.initials: P
authors.lastname: Valdastri
authors.affiliation: Division of Gastroenterology, Vanderbilt University, Nashville, Tennessee, USA; Department of Mechanical Engineering, Vanderbilt University, Nashville, Tennessee, USA.
authors.forename: Keith L
authors.initials: KL
authors.lastname: Obstein
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000328:Adult; D002983:Clinical Competence; D003111:Colonic Polyps / Q000601:surgery*; D003113:Colonoscopy / Q000193:education*; D015179:Colorectal Neoplasms / Q000601:surgery*; D034201:Computers, Handheld; D005257:Fellowships and Scholarships; D005260:Female; D005762:Gastroenterology / Q000193:education*; D006801:Humans; D008297:Male; D000071252:Mentoring / Q000379:methods*; D008953:Models, Anatomic; D019047:Phantoms, Imaging; D058996:Quality Improvement; D000066908:Simulation Training / Q000379:methods*; D055815:Young Adult