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      The efficacy of training insertion skill on a physical model colonoscopy simulator

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          Abstract

          Background and study aims: Prior research supports the validity of performance measures derived from the use of a physical model colonoscopy simulator – the Kyoto Kagaku Colonoscope Training Model (Kyoto Kagaku Co. Ltd., Kyoto, Japan) – for assessing insertion skill. However, its use as a training tool has received little research attention. We assessed the efficacy of a brief structured program to develop basic colonoscope insertion skill through unsupervised practice on the model.

          Participants and methods: This was a training study with pretesting and post-testing. Thirty-two colonoscopy novices completed an 11-hour training regime in which they practiced cases on the model in a colonoscopy simulation research laboratory. They also attempted a series of test cases before and after training. For each outcome measure (completion rates, time to cecum and peak force applied to the model), we compared trainees’ post-test performance with the untrained novices and experienced colonoscopists from a previously-reported validation study.

          Results: Compared with untrained novices, trained novices had higher completion rates and shorter times to cecum overall ( Ps < .001), but were out-performed by the experienced colono-scopists on these metrics ( Ps < .001). Nevertheless, their performance was generally closer to that of the experienced group. Overall, trained novices did not differ from either experience-level comparison group in the peak forces they applied ( P > .05). We also present the results broken down by case.

          Conclusions: The program can be used to teach trainees basic insertion skill in a more or less self-directed way. Individuals who have completed the program (or similar training on the model) are better prepared to progress to supervised live cases.

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          Most cited references 25

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          A power primer.

           Jacob Cohen (1992)
          One possible reason for the continued neglect of statistical power analysis in research in the behavioral sciences is the inaccessibility of or difficulty with the standard material. A convenient, although not comprehensive, presentation of required sample sizes is provided here. Effect-size indexes and conventional values for these are given for operationally defined small, medium, and large effects. The sample sizes necessary for .80 power to detect effects at these levels are tabled for eight standard statistical tests: (a) the difference between independent means, (b) the significance of a product-moment correlation, (c) the difference between independent rs, (d) the sign test, (e) the difference between independent proportions, (f) chi-square tests for goodness of fit and contingency tables, (g) one-way analysis of variance, and (h) the significance of a multiple or multiple partial correlation.
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            Teaching surgical skills--changes in the wind.

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              A systematic review of skills transfer after surgical simulation training.

              To determine whether skills acquired by simulation-based training transfer to the operative setting. The fundamental assumption of simulation-based training is that skills acquired in simulated settings are directly transferable to the operating room, yet little evidence has focused on correlating simulated performance with actual surgical performance. A systematic search strategy was used to retrieve relevant studies. Inclusion of articles was determined using a predetermined protocol, independent assessment by 2 reviewers, and a final consensus decision. Only studies that reported on the use of simulation-based training for surgical skills training, and the transferability of these skills to the operative setting, were included. Ten randomized controlled trials and 1 nonrandomized comparative study were included in this review. In most cases, simulation-based training was in addition to normal training programs. Only 1 study compared simulation-based training with patient-based training. For laparoscopic cholecystectomy and colonoscopy/sigmoidoscopy, participants who received simulation-based training before undergoing patient-based assessment performed better than their counterparts who did not receive previous simulation training, but improvement was not demonstrated for all measured parameters. Skills acquired by simulation-based training seem to be transferable to the operative setting. The studies included in this review were of variable quality and did not use comparable simulation-based training methodologies, which limited the strength of the conclusions. More studies are required to strengthen the evidence base and to provide the evidence needed to determine the extent to which simulation should become a part of surgical training programs.
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                Author and article information

                Journal
                Endosc Int Open
                Endosc Int Open
                10.1055/s-00025476
                Endoscopy International Open
                © Georg Thieme Verlag KG (Stuttgart · New York )
                2364-3722
                2196-9736
                December 2016
                30 September 2016
                : 4
                : 12
                : E1252-E1260
                Affiliations
                [1 ]School of Human Movement Studies, The University of Queensland, St Lucia, Brisbane, Australia
                [2 ]School of Psychology, The University of Queensland, St Lucia, Brisbane, Australia
                [3 ]Clinical Skills Development Service, Metro North Hospital and Health Service, Herston, Brisbane, Australia
                [4 ]School of Medicine, The University of Queensland, Herston, Brisbane, Australia
                Author notes
                Corresponding author Andrew Hill, PhD Clinical Skills Development Service, Metro North Hospital and Health Service School of Psychology The University of Queensland St Lucia QLD 4072Australia+61-7-3646 6500+61-7-3646 6501 Andrew.Hill@ 123456health.qld.gov.au a.hill@ 123456psy.uq.edu.au
                Article
                10.1055/s-0042-114773
                5161130
                © Thieme Medical Publishers
                Categories
                Original article

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