Mahmood, T.; Darzi, A.; Bann, S.; Datta, V.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA71
Academic Journal
Objectives: To investigate the learning curve for colonoscopic procedures performed on the HT Immersion Medical Colonoscopy Simulator without any feedback. The hypothesis is that no learning curve exists without a feedback. In other words, the student does not learn the simulation machine itself, instead of the colonoscopy technique that it is primarily meant to teach. Method: 22 postgraduate doctors were recruited, including 5 research fellows, 4 PRHOs, 6 SpRs and 7 consultants. Candidates were asked to perform colonoscopy on the HT Immersion Medical Colonoscopy Simulator. Modules 3 and 4 were used at random. In total, each candidate was asked to perform five consecutive virtual colonoscopies on the same module. These five episodes were collectively referred to as one trial. A time result of 3600 seconds (1 h) was used to denote perforation. No guidance or feedback was given to candidates before, during or after each procedure. Results: 23 candidates recorded five attempts or episodes each, meaning one trial each, on only one module of the colonoscopy simulator, (Total 115 episodes over 23 trials). Another 15 people recorded five attempts, meaning one trial each, on two modules of the colonoscopy simulator (Total 150 episodes over 30 trials). Therefore the total episodes recorded were 265, over 53 trials. There was no improvement in performance on the simulator from first attempt to the fifth in absence of feedback. The outcomes measured included time taken to complete the test, percentage of the mucosa visualised, depth of the instrument inserted, and the path length used. The results were statistically very significant p < 0.000 for all outcomes. Conclusions: This study has demonstrated that in absence of feedback, it is not possible to improve performance on the HT Immersion Colonoscopy Simulator. Thus there is no learning curve for the machine itself. The information from this study is vital for using the simulators in training and assessment because any...


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