Coached practice using ERCP mechanical simulator improves trainees' ERCP performance: A randomized controlled trial

Wei Chih Liao, Joseph Leung, Hsiu Po Wang, Wen Hsinug Chang, Cheng Hsin Chu, Jaw Town Lin, Roberte Wilson, Brians Lim, Felixw Leung

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background and study aims: Preliminary data suggested that simulation practice using an endoscopic retrograde cholangiopancreatography (ERCP) mechanical simulator (EMS) improved trainees' skill. The aims of the current study were to confirm the impact of coached EMS practice at the beginning of ERCP training and to investigate whether subsequent uncoached EMS practice provides additional benefit. Methods: Trainees entering ERCP training in 2008 (n = 8) and 2009 (n = 8) at two referral medical centers were randomized to receive a coached EMS practice either with (2009) or without (2008) subsequent uncoached practices or only routine training (controls). The outcome measures were successful deep biliary cannulation by the trainee and overall performance score as rated by blinded trainers, during the subsequent 3 months of clinical practice. Results: Trainees undergoing single and multiple EMS practices were more likely than controls to achieve successful biliary cannulation (single: adjusted odds ratio [aOR] 2.89, 95 % confidence interval [CI] 2.21 - 3.80 [P < 0.001]; multiple: 3.09, 95 %CI 1.13 - 8.46 [P = 0.028]) and to have superior overall performance scores (aOR 3.29, 95 %CI 1.37 - 7.91 [P = 0.008] and 6.92, 95 %CI 3.77 - 12.69 [P < 0.001], respectively). The benefit of single and multiple EMS practices on overall performance score remained significant after adjustment for success or failure of deep biliary cannulation (aOR 2.98, 95 %CI 1.38 - 6.43 [P = 0.005] and 6.09, 95 %CI 2.40 - 15.45 [P < 0.001], respectively). The benefits of single vs. multiple EMS practices were not statistically different. Conclusions: Coached simulation using EMS improved novice trainees' success of biliary cannulation and overall ERCP performance. Additional uncoached practices did not appear to provide further benefit. Trainees should undergo a coached EMS practice at the beginning of ERCP training.

Original languageEnglish (US)
Pages (from-to)799-805
Number of pages7
JournalEndoscopy
Volume45
Issue number10
DOIs
StatePublished - 2013

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Endoscopic Retrograde Cholangiopancreatography
Randomized Controlled Trials
Confidence Intervals
Catheterization
Odds Ratio
Mentoring
Referral and Consultation

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Coached practice using ERCP mechanical simulator improves trainees' ERCP performance : A randomized controlled trial. / Liao, Wei Chih; Leung, Joseph; Wang, Hsiu Po; Chang, Wen Hsinug; Chu, Cheng Hsin; Lin, Jaw Town; Wilson, Roberte; Lim, Brians; Leung, Felixw.

In: Endoscopy, Vol. 45, No. 10, 2013, p. 799-805.

Research output: Contribution to journalArticle

Liao, WC, Leung, J, Wang, HP, Chang, WH, Chu, CH, Lin, JT, Wilson, R, Lim, B & Leung, F 2013, 'Coached practice using ERCP mechanical simulator improves trainees' ERCP performance: A randomized controlled trial', Endoscopy, vol. 45, no. 10, pp. 799-805. https://doi.org/10.1055/s-0033-1344224
Liao, Wei Chih ; Leung, Joseph ; Wang, Hsiu Po ; Chang, Wen Hsinug ; Chu, Cheng Hsin ; Lin, Jaw Town ; Wilson, Roberte ; Lim, Brians ; Leung, Felixw. / Coached practice using ERCP mechanical simulator improves trainees' ERCP performance : A randomized controlled trial. In: Endoscopy. 2013 ; Vol. 45, No. 10. pp. 799-805.
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title = "Coached practice using ERCP mechanical simulator improves trainees' ERCP performance: A randomized controlled trial",
abstract = "Background and study aims: Preliminary data suggested that simulation practice using an endoscopic retrograde cholangiopancreatography (ERCP) mechanical simulator (EMS) improved trainees' skill. The aims of the current study were to confirm the impact of coached EMS practice at the beginning of ERCP training and to investigate whether subsequent uncoached EMS practice provides additional benefit. Methods: Trainees entering ERCP training in 2008 (n = 8) and 2009 (n = 8) at two referral medical centers were randomized to receive a coached EMS practice either with (2009) or without (2008) subsequent uncoached practices or only routine training (controls). The outcome measures were successful deep biliary cannulation by the trainee and overall performance score as rated by blinded trainers, during the subsequent 3 months of clinical practice. Results: Trainees undergoing single and multiple EMS practices were more likely than controls to achieve successful biliary cannulation (single: adjusted odds ratio [aOR] 2.89, 95 {\%} confidence interval [CI] 2.21 - 3.80 [P < 0.001]; multiple: 3.09, 95 {\%}CI 1.13 - 8.46 [P = 0.028]) and to have superior overall performance scores (aOR 3.29, 95 {\%}CI 1.37 - 7.91 [P = 0.008] and 6.92, 95 {\%}CI 3.77 - 12.69 [P < 0.001], respectively). The benefit of single and multiple EMS practices on overall performance score remained significant after adjustment for success or failure of deep biliary cannulation (aOR 2.98, 95 {\%}CI 1.38 - 6.43 [P = 0.005] and 6.09, 95 {\%}CI 2.40 - 15.45 [P < 0.001], respectively). The benefits of single vs. multiple EMS practices were not statistically different. Conclusions: Coached simulation using EMS improved novice trainees' success of biliary cannulation and overall ERCP performance. Additional uncoached practices did not appear to provide further benefit. Trainees should undergo a coached EMS practice at the beginning of ERCP training.",
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T1 - Coached practice using ERCP mechanical simulator improves trainees' ERCP performance

T2 - A randomized controlled trial

AU - Liao, Wei Chih

AU - Leung, Joseph

AU - Wang, Hsiu Po

AU - Chang, Wen Hsinug

AU - Chu, Cheng Hsin

AU - Lin, Jaw Town

AU - Wilson, Roberte

AU - Lim, Brians

AU - Leung, Felixw

PY - 2013

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N2 - Background and study aims: Preliminary data suggested that simulation practice using an endoscopic retrograde cholangiopancreatography (ERCP) mechanical simulator (EMS) improved trainees' skill. The aims of the current study were to confirm the impact of coached EMS practice at the beginning of ERCP training and to investigate whether subsequent uncoached EMS practice provides additional benefit. Methods: Trainees entering ERCP training in 2008 (n = 8) and 2009 (n = 8) at two referral medical centers were randomized to receive a coached EMS practice either with (2009) or without (2008) subsequent uncoached practices or only routine training (controls). The outcome measures were successful deep biliary cannulation by the trainee and overall performance score as rated by blinded trainers, during the subsequent 3 months of clinical practice. Results: Trainees undergoing single and multiple EMS practices were more likely than controls to achieve successful biliary cannulation (single: adjusted odds ratio [aOR] 2.89, 95 % confidence interval [CI] 2.21 - 3.80 [P < 0.001]; multiple: 3.09, 95 %CI 1.13 - 8.46 [P = 0.028]) and to have superior overall performance scores (aOR 3.29, 95 %CI 1.37 - 7.91 [P = 0.008] and 6.92, 95 %CI 3.77 - 12.69 [P < 0.001], respectively). The benefit of single and multiple EMS practices on overall performance score remained significant after adjustment for success or failure of deep biliary cannulation (aOR 2.98, 95 %CI 1.38 - 6.43 [P = 0.005] and 6.09, 95 %CI 2.40 - 15.45 [P < 0.001], respectively). The benefits of single vs. multiple EMS practices were not statistically different. Conclusions: Coached simulation using EMS improved novice trainees' success of biliary cannulation and overall ERCP performance. Additional uncoached practices did not appear to provide further benefit. Trainees should undergo a coached EMS practice at the beginning of ERCP training.

AB - Background and study aims: Preliminary data suggested that simulation practice using an endoscopic retrograde cholangiopancreatography (ERCP) mechanical simulator (EMS) improved trainees' skill. The aims of the current study were to confirm the impact of coached EMS practice at the beginning of ERCP training and to investigate whether subsequent uncoached EMS practice provides additional benefit. Methods: Trainees entering ERCP training in 2008 (n = 8) and 2009 (n = 8) at two referral medical centers were randomized to receive a coached EMS practice either with (2009) or without (2008) subsequent uncoached practices or only routine training (controls). The outcome measures were successful deep biliary cannulation by the trainee and overall performance score as rated by blinded trainers, during the subsequent 3 months of clinical practice. Results: Trainees undergoing single and multiple EMS practices were more likely than controls to achieve successful biliary cannulation (single: adjusted odds ratio [aOR] 2.89, 95 % confidence interval [CI] 2.21 - 3.80 [P < 0.001]; multiple: 3.09, 95 %CI 1.13 - 8.46 [P = 0.028]) and to have superior overall performance scores (aOR 3.29, 95 %CI 1.37 - 7.91 [P = 0.008] and 6.92, 95 %CI 3.77 - 12.69 [P < 0.001], respectively). The benefit of single and multiple EMS practices on overall performance score remained significant after adjustment for success or failure of deep biliary cannulation (aOR 2.98, 95 %CI 1.38 - 6.43 [P = 0.005] and 6.09, 95 %CI 2.40 - 15.45 [P < 0.001], respectively). The benefits of single vs. multiple EMS practices were not statistically different. Conclusions: Coached simulation using EMS improved novice trainees' success of biliary cannulation and overall ERCP performance. Additional uncoached practices did not appear to provide further benefit. Trainees should undergo a coached EMS practice at the beginning of ERCP training.

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