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      Kinematic analysis of wrist motion during simulated colonoscopy in first-year gastroenterology fellows

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          Abstract

          Background and study aims: Gastroenterology trainees acquire skill and proficiency in performing colonoscopies at different rates. The cause for heterogeneous competency among the trainees is unclear. Kinematic analysis of the wrist joint while performing colonoscopy can objectively assess the variation in wrist motion. Our objective was to test the hypothesis that the time spent by the trainees in extreme ranges of wrist motion will decrease as the trainees advance through the fellowship year.

          Subjects and methods: Five first-year gastroenterology fellows were prospectively studied at four intervals while performing simulated colonoscopies. The setting was an endoscopy simulation laboratory at a tertiary care center. Kinematic assessment of wrist motion was done using a magnetic position/orientation tracker held in place by a custom-made arm sleeve and hand glove. The main outcome measure was time spent performing each of four ranges of wrist motion (mid, center, extreme, and out) for each wrist degree of freedom (pronation/supination, flexion/extension, and adduction/abduction).

          Results: There were no statistically significant differences in the time spent for wrist movements across the three degrees of freedom throughout the study period. However, fellows spent significantly less time in extreme range (1.47 ± 0.34 min vs. 2.44 ± 0.34 min, P = 0.004) and center range (1.02 ± 0.34 min vs 1.9 ± 0.34 min, P = 0.01) at the end of the study compared to the baseline evaluation. The study was limited by the small number of subjects and performance of colonoscopies on a simulator rather than live patients.

          Conclusions: Gastroenterology trainees alter the time spent at the extreme range of wrist motion as they advance through training. Endoscopy training during the first 10 months of fellowship may have beneficial effects on learning ergonomically correct motion patterns.

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          Most cited references 15

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          Objective evaluation of endoscopy skills during training.

          To evaluate the number of supervised gastrointestinal endoscopic procedures required to achieve initial competency using a simple objective grading system. Prospective, cross-sectional study. A gastroenterology and surgical training program at a large, university-affiliated county hospital. Seven gastroenterology fellows and five fourth-year surgery residents. Trainees were graded postprocedure using a microcomputer program. Grading criteria for esophagogastroduodenoscopy included entering the esophagus (esophageal intubation), traversing the pylorus into the duodenum, and recognizing whether the upper gastrointestinal tract was abnormal. Criteria for colonoscopy were traversing the splenic flexure, intubating the cecum, and recognizing whether the colon was abnormal. When presented with a case mix representative of practice, esophageal intubation did not reach 90% until more than 100 procedures had been done. Cecal intubation remained at only 84% after 100 procedures. More than 100 supervised upper gastrointestinal endoscopies or colonoscopies are necessary to achieve technical competence in gastrointestinal endoscopy.
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            Validation of orthopaedic bench models for trauma surgery.

            The aim of this study was to validate the use of three models of fracture fixation in the assessment of technical skills. We recruited 21 subjects (six experts, seven intermediates, and eight novices) to perform three procedures: application of a dynamic compression plate on a cadaver porcine model, insertion of an unreamed tibial intramedullary nail, and application of a forearm external fixator, both on synthetic bone models. The primary outcome measures were the Objective Structural Assessment of technical skills global rating scale on video recordings of the procedures which were scored by two independent expert observers, and the hand movements of the surgeons which were analysed using the Imperial College Surgical Assessment Device. The video scores were significantly different for the three groups in all three procedures (p 0.6). A total of 85% (18 of 21) of the subjects found the dynamic compression model and 57% (12 of 21) found all the models acceptable tools of assessment. This study has validated a low-cost, high-fidelity porcine dynamic compression plate model using video rating scores for skills assessment and movement analysis. It has also demonstrated that Synbone models for the application of and intramedullary nail and an external fixator are less sensitive and should be improved for further assessment of surgical skills in trauma. The availability of valid objective tools of assessment of surgical skills allows further studies into improving methods of training.
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              Level of fellowship training increases adenoma detection rates.

              The adenoma detection rate (ADR) is critical to the success of colonoscopy for colorectal cancer screening. The effects of involving gastroenterology fellows in screening colonoscopies are uncertain. We assessed the effects of gastroenterology fellow participation on ADR and whether outcomes vary with year of fellowship training. We performed a retrospective review of all average-risk screening colonoscopies performed from April 2005-April 2007 at the University of Colorado Hospital. A gastroenterology attending physician alone performed 2895 colonoscopies; 699 were performed by a gastroenterology fellow supervised by an attending physician. Statistical analyses of polyp, adenoma, and advanced adenoma (or cancer) detection were performed by using logistic regression. The ADR was significantly higher (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.10-1.59) among colonoscopies that included a gastroenterology fellow compared with those performed by only a gastroenterology attending physician. Similarly, the polyp detection rate was higher (OR, 1.28; 95% CI, 1.08-1.52) among colonoscopies involving a gastroenterology fellow. There was no difference in the detection of advanced adenomas or cancers (OR, 1.05; 95% CI, 0.77-1.44) among colonoscopies involving a gastroenterology fellow. The ADR differed greatly by year of training. Compared with colonoscopies performed by an attending gastroenterologist alone, the ADR increased with each year of training: OR, 0.89 (95% CI, 0.66-1.22) for first-year fellows; OR, 1.31 (95% CI, 0.89-1.93) for second-year fellows; and OR, 1.70 (95% CI, 1.33-2.17) for third-year fellows. Involvement of fellows in screening colonoscopies increases the ADR, primarily because of the increased ADR in procedures involving third-year gastroenterology fellows. Copyright (c) 2010 AGA Institute. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Endosc Int Open
                Endosc Int Open
                10.1055/s-0034-1377934
                Endoscopy International Open
                © Georg Thieme Verlag KG (Stuttgart · New York )
                2364-3722
                2196-9736
                December 2015
                05 November 2015
                : 3
                : 6
                : E621-E626
                Affiliations
                [1 ]Division of Gastroenterology, Mayo Clinic Arizona
                [2 ]Division of Health Sciences and Research, Mayo Clinic Arizona
                [3 ]School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona
                Author notes
                Corresponding Author: Kevin C Ruff MD Division of Gastroenterology 13400 East Shea BoulevardScottsdale, AZ 85259480-301-6990480-301-6737 ruff.kevin@ 123456mayo.edu
                Article
                10.1055/s-0034-1393061
                4683126
                © Thieme Medical Publishers
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