BACKGROUND: Implementing ergonomic principles in the endoscopy unit can mitigate the risk of endoscopy related injury. An efficient and effective training tool is needed to facilitate ergonomic endoscopy. We have developed an easy to remember sequence of steps to teach a pre-procedure ergonomic time-out using the mnemonic “MYSELF”. This study aims to evaluate the effectiveness and usability of implementing “MYSELF” in a simulated setting. METHODS: Faculty and participants of the ASGE Women Teaching Women Course were included; they provided informed consent. All participants were instructed to perform a simulated colonoscopy as per their usual practice and an ergonomic assessment was completed using the Rapid Entire Body Assessment (REBA) tool, which correlates with risk of musculoskeletal injury (Figure 1). The components of a pre-procedure ergonomic time-out (intervention) were taught using the “MYSELF” mnemonic: M=monitor, Y=upside-down Y stance, S=scope, E=elbow/ bed position, L=lower extremities, F=free movement of endoscope/ processor placement (Figure 2). Individualized feedback was given to optimize posture and positioning. A second simulated procedure was performed and a post-training assessment was completed. A brief survey assessing the usability of the mnemonic device was administered. A paired t-test was performed to compare REBA scores pre- and post- intervention. The usability of the mnemonic device was evaluated using the Systems Usability Score (SUS), a valid and reliable tool for measuring subjective perceptions of the usability of a system. A net promoter score (NPS) was calculated to assess overall enthusiasm for recommending “MYSELF” as a mnemonic device. RESULTS: Thirty-six subjects were included. The average baseline REBA score of participants was 6.1 (SD 1.7; median 6). The average REBA score after implementation of the “MYSELF” pre-procedure time-out was 3.8 (SD 0.9, median 4; p<0.001). The effect size, as measured by Cohen’s d, was d = 1.81, indicating the training (15 min) produced a large learning effect. Thirty-one subjects completed the survey. The SUS was 84 and correlated with the NPS of 63. CONCLUSION: Implementation of a pre-procedure ergonomic time-out with the “MYSELF” mnemonic device resulted in a significant decrease in risk for endoscopy related injury, from “medium risk” to “low risk”, and our training program resulted in a large learning effect. The SUS score indicated that the “MYSELF” mnemonic device was easy to use (grade=A; “excellent” usability) and was consistent with the NPS, which indicated that a significant percentage of respondents are likely to recommend the mnemonic device to colleagues. Longitudinal studies are needed to evaluate the impact of “MYSELF” on the incidence of endoscopy related injury.

Figure 1. Rapid Entire Body Assessment (REBA) score and associated level of musculoskeletal (MSD) risk

FIGURE 2. Pre-procedure ergonomic time-out: MYSELF

Tiffany Nguyen-Vu

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