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Teaching Endoscopic Management Of Gastrointestinal Hemorrhage Using A Modular Simulation Curriculum
*Vanessa Nichole VanDruff, *Harry Wong, *Julia R Amundson, *Hoover Wu, *Michelle Campbell, *Kristine Kuchta, Herbert M Hedberg, Michael B Ujiki
NorthShore University HealthSystem, Evanston, IL

ObjectiveAs flexible endoscopy is increasingly adopted as a minimally invasive approach to surgical challenges, an efficient curriculum is needed to effectively train surgeons in therapeutic endoscopy. We developed a simulation-based approach to teaching endoscopic management of gastrointestinal (GI) hemorrhage as part of a modular curriculum for practicing physicians, complete with task performance pre- and post-testing.
MethodsTwo sessions of our advanced flexible endoscopy course were taught by two expert gastrointestinal surgeons specialized in advanced endoscopy. Ex-vivo porcine models were used to simulate active GI hemorrhage scenarios commonly encountered in clinical practice. These models allowed for hands-on endoscopic treatment of simulated active gastric hemorrhage. The module is further composed of didactics and mentored practice sessions, followed by post-course assessments. Pre- and post-course tests and surveys were used to evaluated knowledge, confidence, and performance of participants, and analyzed using the paired t-test.
ResultsSixteen practicing surgeons participated in the course, of whom 62% of participants had completed over 200 upper endoscopies, and 43.8% were certified in Fundamentals of Endoscopic Surgery. After course completion, overall knowledge-based assessments improved from 3.41.9 to 5.82.0 (p<0.001). Although participants with glove sizes >7.0 and >2 years in practice had higher pre-test evaluator scores (p=0.0449 and p=0.0195), all participants demonstrated overall improvement in endoscopic management of hemorrhage, with post-course evaluator score increases from 20.91.6 to 23.62.0 (p=0.001), and specific improvements in identification of target bleeding (p=0.015), endoscopic clip setup (p<0.001), and clip deployment (p=0.002). Surveys also demonstrated increased confidence in competency after curriculum completion, 11.63.4 to 23.05.5 (p<0.001).
ConclusionsThe simulated approach to teaching endoscopic management of GI bleeding provides an effective education model to improve knowledge, confidence, and performance. To facilitate training efficiency, our methodology emphasizes hands-on simulation-based pre-testing to expose physician-specific gaps in knowledge and experience and focus mentored practice sessions for a tailored educational experience.


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