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

<b><i>Background:</i></b> 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. <b><i>Methods:</i></b> This was a prospective and randomized study. Nineteen residents completed a pre-training questionnaire and a colonoscopy trial before randomization in a study group (<i>n</i> = 10) that performed three exercises (Endobubble I, Navigation I, and Mucosal Evaluation I) until they achieved expert level, and a control group (<i>n</i> = 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. <b><i>Results:</i></b> Construct validity was confirmed for Endobubble I and verified in Navigation I (experts were faster than novices; 5 vs. 7 s, <i>p</i> = 0.040), but not for Mucosal Evaluation I. Analyzing the learning curves and performance in the 10 repetitions<b>,</b> the study group reached the cecum faster (278 vs. 356 s, <i>p</i> = 0.035) and achieved a higher screening efficiency (83% vs. 75%, <i>p</i> = 0.019). Concerning skills transfer, the control group took longer to reach the cecum (241 vs. 292 s, <i>p</i> = 0.021) and the percentage of time the patient was in pain was higher (6% vs. 9%, <i>p</i> = 0.021). General performances of the study group had smaller interquartile variations. <b><i>Conclusion:</i></b> 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（psychomotor training）可提升结肠镜检查（colonoscopy）操作水平。自此之后，新一代GI Mentor®模拟器中纳入了全新的训练项目。为优化结肠镜检查培训方案，本研究旨在探究3项虚拟训练项目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（prospective and randomized study）。19名住院医师在随机分组前完成了培训前调查问卷与结肠镜操作预测试，随后被随机分为两组：观察组（n = 10）完成3项训练项目（Endobubble I、Navigation I及Mucosal Evaluation I），直至操作水平达到专家级；对照组（n = 9）未进行该专项训练。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情况：黏膜检查覆盖率（%）、抵达盲肠所需时间（秒）、筛查效率（%）以及患者疼痛时长占比（%）。此外，本研究还对各项训练项目的结构效度（construct validity）进行了评估。 **结果：** Endobubble I与Navigation I的结构效度得到验证（专家操作速度快于新手：5秒 vs 7秒，p = 0.040），但Mucosal Evaluation I未验证结构效度。对10次操作的学习曲线与表现进行分析后发现，观察组抵达盲肠的时间更短（278秒 vs 356秒，p = 0.035），且筛查效率更高（83% vs 75%，p = 0.019）。关于技能迁移情况，对照组抵达盲肠的时间更长（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）。观察组的整体操作表现的四分位距波动幅度更小。 **结论：** 精神运动训练对结肠镜操作技能的同质化习得与内化具有显著影响。针对新手的结肠镜培训方案中，应纳入Endobubble I与Navigation I两项训练项目。