A proficiency-based virtual reality endoscopy curriculum improves performance on the fundamentals of endoscopic surgery examination

Abstract

Introduction: The fundamentals of endoscopic surgery (FES) examination is a national test of knowledge and skill in flexible gastrointestinal endoscopy. The skill portion of the examination involves five tasks that assesses the following skills: scope navigation, loop reduction, mucosal inspection, retroflexion, and targeting. This project aimed to assess the efficacy of a proficiency-based virtual reality (VR) curriculum in preparing residents for the FES skills exam.

Methods: Experienced (>100 career colonoscopies) and inexperienced endoscopists (<50 career colonoscopies) were recruited to participate. Six VR modules were identified as reflecting the skills tested in the exam. All participants were asked to perform each of the selected modules twice, and median performance was compared between the two groups. Inexperienced endoscopists were subsequently randomized in matched pairs into a repetition (10 repetitions of each task) or proficiency curriculum. After completion of the respective curriculum, FES scores and pass rates were compared to national data and historical institutional control data (endoscopy-rotation training alone).

Results: Five experienced endoscopists and twenty-three inexperienced endoscopists participated. Construct valid metrics were identified for six modules and proficiency benchmarks were set at the median performance of experienced endoscopists. FES scores of inexperienced endoscopists in the proficiency group had significantly higher FES scores (530 ± 86) versus historical control (386.7 ± 92.2, p = 0.0003) and higher pass rate (proficiency: 100%, historical control 61.5%, p = 0.01).

Conclusion: Trainee engagement in a VR curriculum yields superior FES performance compared to an endoscopy rotation alone. Compared to the 2012-2016 national resident pass rate of 80, 100% of trainees in a proficiency-based curriculum passed the FES manual skills examination.

Keywords: Clinical competence; Curriculum; Fundamentals of endoscopic surgery; Graduate medical education; Proficiency; Task performance and analysis.

Conflict of interest statement

Disclosures

Drs. Hashimoto, Petrusa, Phitayakorn, Casey, and Gee have no conflicts of interest or financial ties to disclose. Mrs. Valle has no conflicts of interest or financial ties to disclose.

Figures

Figure 1

A) Phase I – Comparison of performance between experienced and inexperienced endoscopists to determine proficiency benchmarks. B) Phase II – Randomized controlled trial to compare effect of repetition versus proficiency-based curricula on FES performance.

Figure 2

Mean +/− SEM scaled scores in the FES manual skills exam across groups. * and ** denote statistical significance.

Figure 3

Mean +/− SEM of total hours spent on the VR simulator for each curriculum group. p=0.25