Introduction:. The simulation-based mastery learning (SBML) method holds promise to make endoscopy training more efficient and effective, but further study to establish of its potential advantage over the traditional apprentice method is needed. The aim of this study is to prospectively compare the outcomes of GI endoscopy trainees who were trained using SBML vs the conventional apprenticeship method for upper endoscopy diagnostic examination.
Methods: We performed a blinded stepwise comparative study. Participants in the SBML method learned using deliberate practice method. They first learned tip deflection and manipulation using a specially created task simulator and upper endoscopy using the koken EGD simulator. They deliberately practiced the deconstructed steps of the WEO standardized upper endoscopy method. Participants in the conventional apprenticeship method learned knowledge and skills through routine observation of endoscopic procedures performed by the trainers. We assessed the trainees’ endoscopic skills at baseline and 2 weeks after the training. Three different trainers, who were blinded to the intervention groups, performed the assessments using a validated EGD assessment tool. We estimated the sample size for mean difference. We defined minimum pass standard criteria as score 2 or above. Based on a previous study showing the effect size is 2.4, we calculated the sample size (p<0.05) to be 6 trainees per group. We compared the minimum pass standard of the groups. We used standard statistics and paired t-test to measure the effect size.
Results: Six trainees were enrolled in the SBML and six in the traditional group, respectively. All trainees in the SBML group passed the minimum standard as compared to Yy in the conventional group (p=0.06). All The SBML group obtained significantly higher scores in overall basic GI endoscopic skills, esophageal, stomach, and duodenal observation skills as compared to those of the conventional apprenticeship group (p<0.,05). The SBML curriculum led to three times more learning (Cohen’s d = 6.5) than the conventional method (Cohen’d = 1.8).
Conclusion: This randomized study supports the application of SBML to train upper endoscopy technique over the traditional apprentice-based method. The use of SBML training leads to a steeper learning curve as trainees learned three times more during the same period. More importantly, trainees developed uniform competency level at the end of training.

Comparison of Pre- and Post-Test Scores Between Conventional Apprenticeship vs SBML Groups

The Comparison of Scores in Esophagoduodenoscopy Skills Between Conventional Apprenticeship vs SBML groups

Ardi Findyartini

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