Score Card Endoscopy: A Multicenter Study to Evaluate Learning Curves in 1-Week Courses Using the Erlangen Endo-Trainer

Background and Study Aims: The present study was carried out in the context of current discussions concerning ways in which simulation systems can be integrated sensibly and effectively into clinical educational structures, in order to shorten the training period for assistants and reduce potential risks for the patient. In our study, a number of centers used a standardized training approach, in 1 week courses, to investigate the learning curve improvement that can be achieved with a group of beginners in upper gastroduodenal endoscopy.
Materials and Methods: The multicenter study used the Erlangen Endo-Trainer, with specially prepared biological specimens from pigs. Using this, the individual steps of diagnostic upper gastrointestinal endoscopy with biopsy can be carried out following a score-card system. After a theoretical introduction and a demonstration of the examination by an experienced endoscopist, an initial evaluation score for each participant was obtained on day 1. On the following days, the program consisted of 2 hours' training by a tutor, followed by a test run for each participant. On days 1, 2, 3, 4, and 5 the test run was directly followed by a self-assessment. In addition, on days 1, 3, and 5 the test run for each beginner was recorded on video, with each video assigned an encrypted code number. All the end of the study week, control assessments of these videos were carried out by an experienced endoscopist.
Results: Both the self-assessments and the control assessments showed significant improvements in the endoscopic parameters tested during the course (days 1 - 5; all parameters P < 0.001, Wilcoxon-test). However, it was found that the trainees tended to give themselves better marks than the marks given by experienced endoscopists.
Conclusion: During 1 week of training, using the model and following the score card, a significant improvement in the learning curve was achieved in the beginners' group for the individual steps involved in diagnostic upper gastrointestinal endoscopy. When this approach is used with trainees who are also provided with the necessary theoretical background, this type of preparation may lead to a better, lower-risk start to supervised practical endoscopic examinations in patients.

References

• 1 Classen M, Ruppin H. Practical training using a new gastrointestinal phantom.  Endoscopy. 1974;  6 127-131
• 2 Rey J F, Romañzyk T. The development of experimental models in the teaching of endoscopy: an overview.  Endoscopy. 1995;  27 101-105
• 3 Neumann M, Hochberger J, Felzmann T. et al . The Erlangen Endo-Trainer.  Endoscopy . 2001;  33 887-890
• 4 Hochberger J, Neumann M, Maiss J. et al . EASIE - Erlangen Active Simulator for Interventional Endoscopy - a new bio-simulation model - first experiences gained in training workshops.  Gastrointest Endosc. 1988;  47 (Suppl.) AB116
• 5 Grund K E, Straub T, Farin G. Integriertes Ausbildungskonzept für die diagnostische und interventionelle flexible Endoskopie.  Z Gastroenterol. 1999;  37 943
• 6 Bar-Meir S. A new endoscopic simulator.  Endoscopy. 2000;  32 898-900
• 7 Neumann M. Pilotprojekt - systematisches OP-Training nach bewertbaren Qualitätskriterien.  Mitt Dtsch Ges Chir. 1997;  4 317-320
• 8 Neumann M, Siebert T, Rausch J. et al . Scorecard endoscopy: a pilot study to assess basic skills in trainees for upper gastrointestinal endoscopy.  Langenbecks Arch Surg. 2003;  387 (9 - 10) 386-391
• 9 Neumann M, Friedl S, Meining A. et al . A score-card for diagnostic upper Gl endoscopy: evaluation of interobserver variability in examiners with various levels of experience.  Z Gastroenterol. 2002;  40 857-862
• 10 American Society for Gastrointestinal Endoscopy Standards of Training and Practice Committee. Methods of granting hospital privileges to perform gastrointestinal endoscopy.  Gastrointest Endosc. 1992;  38 765-767
• 11 Farthing M JG, Watt R P, Allan R N. et al . A national training programme for gastroenterology and hepatology.  Gut. 1966;  38 459-470
• 12 Conjoint Committee for Recognition of Training in Gastrointestinal Endoscopy .Information for supervisors: changes to endoscopic training. Sydney; The Conjoint Committee for Recognition of Training in Gastrointestinal Endoscopy 1997
• 13 Rey J F, Lambert R, and the European Society for Gastrointestinal Endoscopy Quality Assurance Committee. ESGE recommendations for quality control in gastroinestinal endoscopy: guidelines for image documentation in upper and lower Gl endoscopy.  Endoscopy. 2001;  33 901-903
• 14 American Society for Gastrointestinal Endoscopy. Principles of training in gastrointestinal endoscopy.  Gastrointest Endosc. 1999;  49 845-850
• 15 American Society for Gastrointestinal Endoscopy. Guidelines for advanced endoscopic training.  Gastrointest Endosc. 2001;  53 846-848
• 16 American Society for Gastrointestinal Endoscopy. Methods of privileging for new technology in gastrointestinal endoscopy.  Gastrointest Endosc. 1999;  50 899-900
• 17 Society of American Gastrointestinal Endoscopic Surgeons .Granting of privileges for gastrointestinal endoscopy by surgeons. Santa Monica, California; Society of American Gastrointestinal Endoscopic Surgeons 1992
• 18 Federation of Digestive Disease Societies .Guidelines for training in endoscopy. Manchester, Massachusetts; Federation of Digestive Disease Society 1981