Mahmood, T.; Darzi, A.; Bann, S.; Datta, V.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA71
Academic Journal
Obiectives: To investigate the relationship between clinical experience and performance with regard to colonoscopic procedures performed on the HT Immersion Medical Colonoscopy Simulator. The hypothesis is that the performance of the novice, intermediate, and experienced operator is different on simulators just as on real patients. Thus validating HT Immersion Medical Colonoscopy Simulator. Method: 25 postgraduate doctors were divided into three groups according to their level of colonoscopic experience. Candidates at random performed colonoscopy on module 3 or 4 of the HT Immersion Medical Colonoscopy Simulator. Candidates in the first group called "novice", had each performed less than 10 colonoscopies and included 4 PRHOs, 5 SpRs, and 2 Consultants. This group completed 80 episodes. The second group, called "intermediate", had each performed 11-100 colonoscopies and included 5 SpRs and 2 Research fellows. This group completed 65 episodes. Members of the third group, called "experienced", had each performed more than 101 colonoscopies and included 1 SpR and 6 Consultants. This group completed 45 episodes. A result of 3600 seconds (1 h) was used to denote perforation. Results: The experienced were shown to perform better than the intermediate group, who in turn performed better than the novice. The assessment was made on multiple factors, including time taken to complete the test, percentage of the colonic mucosa visualised, incidence of colonic perforations, and path length used. The results were statistically highly significant for all these factors, p < 0.000 except in path length used. Conclusions: Operators who differ in terms of their clinical experience and technical ability also differ in their performance of simulated colonoscopy. Thus the simulator technology has been shown to be a powerful discriminator of manipulative skills in colonoscopy. The experienced perform better than the intermediate than the novice on the simulator, thus validating HT...


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