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Published VersionCC BY V4.0, Open Access
Journal article
Assessing colonoscopic inspection skill using a virtual withdrawal simulation: a preliminary validation of performance metrics
BMC Medical Education, Vol.17, pp.1-10
2017
PMCID: PMC5508767
PMID: 28701200
Abstract
The effectiveness of colonoscopy for diagnosing and preventing colon cancer is largely dependent on the ability of endoscopists to fully inspect the colonic mucosa, which they achieve primarily through skilled manipulation of the colonoscope during withdrawal. Performance assessment during live procedures is problematic. However, a virtual withdrawal simulation can help identify and parameterise actions linked to successful inspection, and offer standardised assessments for trainees.
Eleven experienced endoscopists and 18 endoscopy novices (medical students) completed a mucosal inspection task during three simulated colonoscopic withdrawals. The two groups were compared on 10 performance metrics to preliminarily assess the validity of these measures to describe inspection quality. Four metrics were related to aspects of polyp detection: percentage of polyp markers found; number of polyp markers found per minute; percentage of the mucosal surface illuminated by the colonoscope (≥0.5 s); and percentage of polyp markers illuminated (≥2.5 s) but not identified. A further six metrics described the movement of the colonoscope: withdrawal time; linear distance travelled by the colonoscope tip; total distance travelled by the colonoscope tip; and distance travelled by the colonoscope tip due to movement of the up/down angulation control, movement of the left/right angulation control, and axial shaft rotation.
Statistically significant experienced-novice differences were found for 8 of the 10 performance metrics (p's < .005). Compared with novices, experienced endoscopists inspected more of the mucosa and detected more polyp markers, at a faster rate. Despite completing the withdrawals more quickly than the novices, the experienced endoscopists also moved the colonoscope more in terms of linear distance travelled and overall tip movement, with greater use of both the up/down angulation control and axial shaft rotation. However, the groups did not differ in the number of polyp markers visible on the monitor but not identified, or movement of the left/right angulation control. All metrics that yielded significant group differences had adequate to excellent internal consistency reliability (α = .79 to .90).
These systematic differences confirm the potential of the simulated withdrawal task for evaluating inspection skills and strategies. It may be useful for training, and assessment of trainee competence.
Details
- Title
- Assessing colonoscopic inspection skill using a virtual withdrawal simulation: a preliminary validation of performance metrics
- Authors
- Christine M Zupanc (Author) - The University of QueenslandGuy M Wallis (Author) - The University of QueenslandAndrew Hill (Author) - The University of QueenslandRobin Burgess-Limerick (Author) - The University of QueenslandStephan Riek (Author) - The University of QueenslandAnnaliese M Plooy (Author) - The University of QueenslandMark S Horswill (Author) - The University of QueenslandMarcus O Watson (Author) - The University of QueenslandHans de Visser (Author) - Commonwealth Scientific and Industrial Research OrganisationDavid Conlan (Author) - Commonwealth Scientific and Industrial Research OrganisationDavid G Hewett (Author) - The University of Queensland
- Publication details
- BMC Medical Education, Vol.17, pp.1-10
- Publisher
- BioMed Central Ltd.
- Date published
- 2017
- DOI
- 10.1186/s12909-017-0948-6
- ISSN
- 1472-6920
- PMID
- 28701200; PMC5508767
- Copyright note
- This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
- Organisation Unit
- Graduate Research School; University of the Sunshine Coast, Queensland
- Language
- English
- Record Identifier
- 99472607302621
- Output Type
- Journal article
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