Can a Computerized Simulator Assess Skill Level and Improvement in Performance of ERCP?

Abstract

Background

Endoscopic retrograde cholangiography (ERCP) is a challenging procedure with considerable risk. Computerized simulators are valuable in training for flexible endoscopy, but little data exist for their use in ERCP training.

Aim

To determine a simulator's ability to assess the level of ERCP skill and its responsiveness over time to increasing trainee experience.

Materials and Methods

In this prospective parallel-arm cohort study, six novice gastroenterology fellows and four gastroenterology faculty with expertise in ERCP completed four simulated baseline cases and the same four cases at a later date. This study took place at a surgical skills center at an academic tertiary referral center. The primary outcome was the total time to complete the ERCP procedure.

Results

For the baseline session, experts had a shorter total procedure time than novices (444.0 vs. 616.9 s; least squares mean; p = 0.026). There was no significant difference between experts and novices in the difference of total procedure time between session 1 and session 2 (−200.3 vs. −164.4; least squares mean; p = 0.402).

Conclusions

The simulator was able to differentiate experts from novices for the primary outcome of total procedure time. The simulator was not responsive to an increase in trainee experience over time.

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