Supplementary Material for: Endoscopic Skills Training: The Impact of Virtual Exercises on Simulated Colonoscopy

Background: A previous study suggested that psychomotor training improves the performance on colonoscopy. Since then, newer exercises have been included in the latest generation of GI Mentor®. In order to optimize a colonoscopy training program, we aimed to determine the impact of 3 virtual exercises in simulated colonoscopy skills. Methods: This was a prospective and randomized study. Nineteen residents completed a pre-training questionnaire and a colonoscopy trial before randomization in a study group (n = 10) that performed three exercises (Endobubble I, Navigation I, and Mucosal Evaluation I) until they achieved expert level, and a control group (n = 9). Both groups performed 10 repetitions of a simulated colonoscopy and were assessed on a final case. Learning curves and skills transfer were assessed by four parameters: mucosal surface examined (%), time to reach the cecum (s), screening efficiency (%), and time the patient was in pain (%). We also evaluated the construct validity for the exercises. Results: Construct validity was confirmed for Endobubble I and verified in Navigation I (experts were faster than novices; 5 vs. 7 s, p = 0.040), but not for Mucosal Evaluation I. Analyzing the learning curves and performance in the 10 repetitions, the study group reached the cecum faster (278 vs. 356 s, p = 0.035) and achieved a higher screening efficiency (83% vs. 75%, p = 0.019). Concerning skills transfer, the control group took longer to reach the cecum (241 vs. 292 s, p = 0.021) and the percentage of time the patient was in pain was higher (6% vs. 9%, p = 0.021). General performances of the study group had smaller interquartile variations. Conclusion: Psychomotor training has a significant impact on the homogeneous acquisition and assimilation of colonoscopy skills. Endobubble I and Navigation I should be considered in the training programs for novices.

背景：既往研究表明，精神运动训练可提升结肠镜检查操作水平。自此之后，新一代胃肠内镜模拟器（GI Mentor®）中加入了全新的训练练习。为优化结肠镜检查培训方案，本研究旨在探讨3项虚拟练习对模拟结肠镜操作技能的影响。
方法：本研究为前瞻性随机对照研究。19名住院医师在随机分组前完成了培训前调查问卷及结肠镜预操作试验，随后被分为两组：试验组（n=10）需完成Endobubble I、Navigation I及Mucosal Evaluation I三项练习，直至达到专家操作水平；对照组（n=9）则不进行该专项练习。两组均完成10次模拟结肠镜操作，并通过1例最终模拟病例进行技能评估。本研究通过四项参数评估学习曲线与技能迁移效果：黏膜检视覆盖率（%）、抵达盲肠所需时长（秒）、筛查效率（%）及患者疼痛时长占比（%）。同时，我们还对各项练习的结构效度进行了评估。
结果：Endobubble I与Navigation I的结构效度得到验证（专家操作速度显著快于新手：5秒 vs 7秒，p=0.040），但Mucosal Evaluation I未验证出结构效度。对10次重复操作的学习曲线及操作表现进行分析后可见，试验组抵达盲肠的速度更快（278秒 vs 356秒，p=0.035），且筛查效率更高（83% vs 75%，p=0.019）。在技能迁移效果方面，对照组抵达盲肠所需时长更长（241秒 vs 292秒，p=0.021），患者疼痛时长占比也更高（6% vs 9%，p=0.021）。试验组的整体操作表现的四分位间距更小，即操作结果更为均匀一致。
结论：精神运动训练对结肠镜检查技能的同质化掌握与内化具有显著促进作用。针对新手的结肠镜培训方案中，应纳入Endobubble I与Navigation I两项训练模块。