INTRODUCTION: Virtual reality simulator and ex vivo animal models are used for training of both basic and advanced endoscopic techniques. The aim of this study was to assess whether hands-on training on ex vivo animal model improves endoscopic skills. Four different endoscopic techniques were practiced: endoscopic resection, endoscopic stenting, application of the over-the-scope (OVESCO) clip, and endoscopic submucosal dissection (ESD). METHODS: Except for 2 participants, all trainees participated in a 1-day course. Two remaining participants took part in 7 ESD courses. All training courses consisted of theoretical introduction and a 6-hour training on Erlangen Active Training Simulator. The endoscopic skills were assessed before and after the training session by 2 independent assessors. Each assessor evaluated the skills by using a score on a scale of 1 to 5, where 1 stands for excellent and 5 for insufficient. Each assessor also assessed whether the procedure was successfully completed. The main outcome measurement was the percentage of participants who successfully completed the procedure during the test. RESULTS: For endoscopic resection, endoscopists (n = 15) improved their skills (median [10th and 90th percentiles] score before training, 3.5 [2.7-4.2]; after training 1.5 [1-2.3], P < 0.001). Seven procedures were assessed as successful before the course (47%); after the training, 13 procedures were assessed as successful (87%) (P = 0.02). For stenting, participants (n = 15) significantly improved their abilities to place both self-expandible metallic and plastic stents. For OVESCO clip (n = 10), participants (n = 10) improved their skills to prepare and apply the clip (given the score of 4.5 [3.9-5] before and 2.0 [1.2-2.8] after, P < 0.01). Before the training, only 1 clip application had been successful (10%), whereas the number rose to 9 after the course (90%). For endoscopic submucosal dissection (n = 10), eight participants of the 1-day course did not improve their competences (with scores of 4.2 [3.8-5] before and 4.0 [3.1-4.8] after, nonsignificant). Two participants who had undertaken 7 ESD courses improved their skills (with scores of 4 before and 1.6 after); given the small number of participants, this finding is statistically insignificant. LIMITATION: The effect of training on clinical outcome was not investigated. There was a lack of pretraining versus posttraining tests blinding. CONCLUSIONS: A 1-day training course on ex vivo animal model improves general endoscopic competence on simulator in endoscopic resection, insertion of stents, and application of OVESCO clips. In contrast, 1-day course does not improve skills for ESD that requires a higher number of training courses.

• MeSH
• dospělí MeSH
• endoskopie výchova   MeSH
• gastroenterologie výchova   MeSH
• klinické kompetence MeSH
• lidé středního věku MeSH
• lidé MeSH
• modely u zvířat MeSH
• počítačová simulace MeSH
• studium lékařství specializační postgraduální metody   MeSH
• uživatelské rozhraní počítače MeSH
• zvířata MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Animal models are used for training of different endoscopic procedures. Whether this really improves endoscopic skills remains controversial. OBJECTIVE: To assess the effectiveness of training by using an ex vivo animal gastric model on the performance of two therapeutic procedures-hemostasis and treatment of perforation. DESIGN: A randomized, single-blind study. SETTING: An experimental endoscopy center in a university hospital. PARTICIPANTS: Thirty-one gastroenterology fellows with comparable endoscopic experience. METHODS: Participants were randomized into two groups: with (T, n = 16) and without (S, n = 15) training. All fellows continued with standard endoscopic practice. Baseline skills were assessed at enrollment. All physicians in group T underwent 2 full days of a hands-on course over a 3-month period, in addition to their standard endoscopic practice. Both groups then underwent a blinded, final evaluation. Endoscopic skills were scored from 1 (best) to 5 (poorest) by two expert, blinded tutors. Outcomes of clinical hemostatic procedures also were analyzed. MAIN OUTCOME MEASUREMENTS: Successful hemostasis and successful perforation closure. RESULTS: Thirty physicians completed the study. Hemostasis results (n = 15): The number of physicians who carried out a successful hemostasis procedure increased significantly in the group with training (27% vs 73%; P = .009) but did not change in the group without training (20% vs 20%). The mean scores of injection and clipping technique improved significantly only after training. The number of clips used decreased significantly only in the group with training; the time of clipping did not change significantly in either group. Perforation results (n = 15): The number of physicians with a successful and complete perforation closure increased nearly significantly in the group with training (40% vs 73%, P = .06) as opposed to the group without training (27% vs 47%; P = .27). The procedure time decreased significantly in the group with training only. In clinical practice, fellows in group T had a significantly higher success rate with respect to hemostatic procedures (83.2%, range 67-100 vs 63.6%, range 25-100; P = .0447). The majority of participants (93%) agreed that such courses should be compulsory in gastroenterological credentials. LIMITATIONS: A retrospective analysis of clinical outcomes. Clinical outcome data were based on self-reporting of the participants. CONCLUSION: Hands-on training by using an animal ex vivo model improves endoscopic skills in both hemostasis and perforation closure. In clinical practice, the training improves the outcome of hemostatic procedures.

• MeSH
• dospělí MeSH
• gastroenterologie výchova   MeSH
• gastrointestinální endoskopie výchova   MeSH
• hemostáza endoskopická výchova   MeSH
• jednoduchá slepá metoda MeSH
• klinické kompetence MeSH
• lidé MeSH
• modely u zvířat MeSH
• perforace střeva terapie   MeSH
• prasata MeSH
• studium lékařství specializační postgraduální metody   MeSH
• zvířata MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH