Teaching Peroral Endoscopic Pyloromyotomy (POP) To Practicing Endoscopists: An "Into The Fire" Approach To Simulation
*Harry J Wong, *Bailey Su, *Mikhail Attaar, *Kristine Kuchta, Michael B Ujiki
NorthShore University HealthSystem, Evanston, IL
Peroral endoscopic pyloromyotomy (POP), also known as gastric per-oral endoscopic myotomy (G-POEM), is a novel minimally invasive procedure that has shown great promise in the treatment of refractory gastroparesis. However, the technical demand of this procedure has limited the widespread adoption and utilization, demonstrating the need for an effective training program. We present a simulation-based curriculum using an "into the fire" approach with hands-on pre- and post-tests to teach this procedure.
Six one-day POP courses were taught by an expert endoscopist between 2018-2019. The curriculum is composed of a series of pre-training tests, lectures, mentored hands-on instruction, and post-training tests, using ex-vivo and live porcine models. Both pre- and post-testing included a confidence survey and a knowledge-based written test. Additionally, an evaluation form designed specifically for the POP procedure was used to evaluate technical performance of the procedure including equipment setup, access, navigation/orientation, visualization/stabilization, myotomy, and closure. Participants scores were analyzed and compared using paired t-tests. Post-course surveys were sent within one year of participants' completion of the course.
Twenty-eight practicing physicians (20 general surgeons, 7 thoracic surgeons, and 1 gastroenterologist) completed the one-day simulation curriculum. After completion of the curriculum, participants had improved confidence scores from 10.5±5.2 (pre-test) to 19.4±3.6 (post-test) (p<0.001). Knowledge-based written test scores also improved from 6.8±1.6 to 8.0±1.1 (p<0.001). Most importantly, hands-on performance of the POP procedure improved from 23.6±3.4 to 29.3±1.4 (out of 30) (p<0.001) with significant improvement in all components of the hands-on skills. The greatest improvement was in creating the myotomy (3.1±1.4 to 4.9±0.3, p<0.001) and the least improvement was in equipment setup (4.6±0.7 to 5.0±0.0, p=0.031). Post-course surveys showed that 92% of participants had performed or were planning to perform the POP procedure within the next year.
Our simulation curriculum using the "into the fire" approach to teach POP is effective in improving practitioner knowledge, confidence, and technical skills. The hands-on pre-tests allow participants to construct a framework for the new procedure prior to didactic content and identify possible deficiencies which lead to more focused and efficient learning during formal instructions.
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