K. S. Oberoi1, M. T. Scott2, J. Schwartzman1, N. Maloney Patel2, M. M. Alvarez-Downing1, A. M. Merchant1, A. Kunac1 1Rutgers New Jersey Medical School,Department Of Surgery,Newark, NJ, USA 2Rutgers Robert Wood Johnson Medical School,Department Of Surgery,New Brunswick, NJ, USA
Introduction: Fundamentals of Endoscopic Surgery (FES) certification is now required for American Board of Surgery exam eligibility. Previous studies have shown that there is a correlation between clinical endoscopy experience and FES exam scores, which are based on a summation of one’s performance of 5 individual tasks on a virtual-reality simulator (VRS). These tasks are meant to test specific endoscopy skills in isolation of one another. When one performs a complete diagnostic colonoscopy, however, one must utilize all of these skills concurrently, rather than in isolation. As such, we aimed to evaluate the association between clinical endoscopy experience and performance of a complete diagnostic colonoscopy on a VRS at two large, academic surgical residency programs.
Methods: PGY2 through PGY5 residents in two large, academic general surgery programs completed an assessment on the Symbionix GI Bronch-Mentor™ VRS. This included 2 brief practice modules followed by “easy” and “difficult” diagnostic colonoscopies. The difficult colon was prone to loop formation. The simulator recorded several performance parameters. Endoscopy numbers for each resident were obtained from ACGME case logs. Correlations between endoscopy experience and performance parameters were assessed using Spearman’s correlation. Bivariate logistic regression was used to assess for an association between experience and both the ability to retroflex as well as complete the colonoscopy. A p-value of <0.05 was considered significant.
Results: The assessment was completed by 55 out of 66 total PGY2 through PGY5 residents across both institutions.
Easy colonoscopy: There was a positive correlation between upper endoscopy experience and percentage of mucosa examined (ρ=0.30; p=0.03). This correlation was not seen with lower or total endoscopy experience. There was no correlation between endoscopy experience and time to cecum, percentage of time the virtual patient was in pain, or ability to retroflex.
Difficult colonoscopy: There was a correlation between upper (ρ=0.37; p=0.02), lower (ρ=0.29; p=0.02), and total (ρ=0.38; p=0.004) endoscopy experience and time to cecum. There was no correlation between endoscopy experience and percentage of mucosa examined, withdrawal time greater than 6 minutes, ability to complete the colonoscopy, and percentage of time the virtual patient was in pain.
Conclusions: Clinical endoscopy experience may correlate with time to cecum in a colon prone to loop formation, suggesting that residents with more experience may be more facile at loop reduction. However, there is no correlation between clinical endoscopy experience and any of the other meaningful performance parameters recorded during a VRS colonoscopy and the VRS may not be a useful surrogate for testing endoscopic skills.