Objective Evaluation of Competence in Flexible Sigmoidoscopy

Abstract

Purpose: Determination of competence in endoscopy is important in any endoscopy training program. While objective assessments have been attempted they have not been standardized. A program to train registered nurses (RNs) to perform flexible sigmoidoscopy (FS) has been developed in Ontario, Canada in order to create increased endoscopy capacity to screen for colorectal cancer. Objectives: To develop a standardized method to determine technical competence based on a simulator experience. Methods: Simulator training was undertaken before the RNs performed procedures on patients. Checklists and global assessments to assess performance on the simulator were developed incorporating simulator-generated parameters and technical characteristics used in the surgical literature. Checklists included measurement of procedure duration, insertion depth, percent mucosa visualized, and percent of time in red-out. Results: Six RN trainees each performed 10 FSs using the simulator over two days. The simulator provided 18 different endoscopic scenarios divided by an expert endoscopist into categories for degree of technical difficulty (easy, average, and difficult). Figure 1 shows that the time to perform procedures decreased with trainee experience for the average and technically difficult scenarios. There was no distinction seen for the technically easy procedures. Other trends for improved mucosal visualization, depth of endoscope insertion, and time spent in red-out have also been detected. (Data not shown.)FigureConclusions: These observations indicate that objective evaluations of endoscopic competence are possible on simulator experience, although they need to be validated. These tools may predict skill transfer to patients and this will be assessed as the students gain experience performing FS on patients. [figure1]