Non‐technical skills curriculum incorporating simulation‐based training improves performance in colonoscopy among novice endoscopists: Randomized controlled trial

Abstract

Background and Aims Non‐technical skills (NTS), involving cognitive, social and interpersonal skills that complement technical skills, are important for the completion of safe and efficient procedures. We investigated the impact of a simulation‐based curriculum with dedicated NTS training on novice endoscopists’ performance of clinical colonoscopies. Methods A single‐blinded randomized controlled trial was conducted at a single center. Novice endoscopists were randomized to a control curriculum or a NTS curriculum. The control curriculum involved a didactic session, virtual reality (VR) simulator colonoscopy training, and integrated scenario practice using a VR simulator, a standardized patient, and endoscopy nurse. Feedback and training were provided by experienced endoscopists. The NTS curriculum group received similar training that included a small‐group session on NTS, feedback targeting NTS, and access to a self‐reflective NTS checklist. The primary outcome was performance during two clinical colonoscopies, assessed using the Joint Advisory Group Direct Observation of Procedural Skills (JAG DOPS) tool. Results Thirty‐nine participants completed the study. The NTS group (n = 21) had superior clinical performance during their first (P < 0.001) and second clinical colonoscopies (P < .0.001), compared to the control group (n = 18). The NTS group performed significantly better on the VR simulator (P < 0.05) and in the integrated scenario (P < 0.05). Conclusion Our findings demonstrate that dedicated NTS training led to improved performance of clinical colonoscopies among novices.

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“…First, emphasis should shift toward maximizing gains from evidence-based, hands-off training interventions. For beginners, simulation-based training can be used to develop technical 25,26 and nontechnical skills 27 and to accelerate time to achievement of competence. 28 Although simulation training requires performance feedback to be optimally effective, 29 self-assessment with benchmark videos and computerized feedback are viable alternatives.…”

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“…The course covers a colonoscopy curriculum ranging from sedation, lesion recognition, optimal positions and troubleshooting techniques. During hands-on sessions, trainees are subjected to rigorous performance review of technical aspects, e.g ., scope handling, loop avoidance and resolution, to non-technical skills[ 21 ], e.g ., situational awareness, which can impact on progress and patient comfort. Tailored high-performance feedback, based on the DOPS formative assessment tool[ 22 ], is provided for each trainee and backed by future goal setting to encourage practice changes within their usual training environment.…”

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“…Para esta pandemia es importante mejorar ambos tipos de habilidades. Dentro de las habilidades no técnicas encontramos el liderazgo, el trabajo en equipo, la comunicación efectiva, la conciencia situacional y la toma de decisiones (18) , los cuales son factores importantes en la atención médica, su optimización puede reducir el error del sistema y fallas en la coordinación de los equipos de atención (19)(20)(21)(22) . Una reciente revisión sistemática de incidentes críticos en unidades de cuidados intensivos encontró que las fallas en dominios no técnicos contribuyeron a una gran proporción de errores médicos (20) , por lo tanto, las mejoras en estas habilidades pueden traer beneficios al sistema de atención.…”