Simulation-Based Training of Non-Technical Skills in Colonoscopy: Protocol for a Randomized Controlled Trial

Background Non-technical skills (NTS), such as communication and professionalism, contribute to the safe and effective completion of procedures. NTS training has previously been shown to improve surgical performance. Moreover, increases in NTS have been associated with improved clinical endoscopic performance. Despite this evidence, NTS training has not been tested as an intervention in endoscopy. Objective The aim of this study is to evaluate the effectiveness of a simulation-based training (SBT) curriculum of NTS on novice endoscopists’ performance of clinical colonoscopy. Methods Novice endoscopists were randomized to 2 groups. The control group received 4 hours of interactive didactic sessions on colonoscopy theory and 6 hours of SBT. Hours 5 and 6 of the SBT were integrated scenarios, wherein participants interacted with a standardized patient and nurse, while performing a colonoscopy on the virtual reality (VR) simulator. The NTS (intervention) group received the same teaching sessions but the last hour was focused on NTS teaching. The NTS group also reviewed a checklist of tasks relevant to NTS concepts prior to each integrated scenario case and was provided with dedicated feedback on their NTS performance during the integrated scenario practice. All participants were assessed at baseline, immediately after training, and 4 to 6 weeks post-training. The primary outcome measure is colonoscopy-specific performance in the clinical setting. Results In total, 42 novice endoscopists completed the study. Data collection and analysis is ongoing. We anticipate completion of all assessments by August 2017. Data analysis, manuscript writing, and subsequent submission for publication is expected to be completed by December 2017. Conclusions Results from this study may inform the implementation of NTS training into postgraduate gastrointestinal curricula. NTS curricula may improve attitudes towards patient safety and self-reflection among trainees. Moreover, enhanced NTS may lead to superior clinical performance and outcomes in colonoscopy. Trial Registration Clinicaltrial.gov NCT02877420; https://www.clinicaltrials.gov/ct2/show/NCT02877420 (Archived by WebCite at http://www.webcitation.org/6rw94ubXX NCT02877420)


Question 13 (1 point)
A 50 year old patient presents for a screening colonoscopy to your open access endoscopy unit. They have completed a 4L bowel preparation. Upon taking a history, you discover that they had a colonoscopy 2 years ago to work up anorectal bleeding but you don't have the results. What is the appropriate course of action? Mark only one oval.
A. Complete a screening colonoscopy because the indication of colorectal cancer screening is different than anorectal bleeding.
B. Another screening colonoscopy is not needed; send patient home.
C. Make concerted effort to track down report of prior colonoscopy and if not obtained, then proceed with screening colonoscopy.
D. Make concerted effort to track down report of prior colonoscopy and if not obtained, then explain to patient that they can choose to defer procedure until report is obtained and reviewed E. Your endoscopic skills exceed that of the previous endoscopist and the procedure must be repeated.

Question 14 (1 point)
A unilingual Azerbaijani woman comes in for a gastroscopy to work up epigastric pain. She is unable to understand the consent process, which of the following is most correct? Mark only one oval.
A. Do a physical examination; if she has abdominal discomfort, continue with gastroscopy.
B. Ask the patient's daughter to translate the consent form.
C. Reschedule the gastroscopy and ask her to bring a translator.
D. Reschedule the gastroscopy and arrange for a translator to accompany her.
E. Obtain consent from daughter and proceed with procedure 26. Question 15 (1 point) You are completing a screening colonoscopy and discover a 12 mm pedunculated polyp in the transverse colon. The endoscopy nurse suggests the use of a 10 mm snare and no electrocautery, but you believe a 15 mm snare with electrocautery would be more appropriate. What do you do? Mark only one oval.
A. Take the nurse's suggestion since he/she is more experienced than yourself.
B. Use a 15 mm snare and ignore the nurse.
C. Ask the nurse for the rationale for the smaller snare and the absence of cautery and verbalize your decision to proceed with the 15 mm snare with cautery. D. Discuss with the nurse why you wish to proceed with the larger snare and electrocautery before proceeding with the polypectomy. E. Call in a colleague to assist in the decision making.

Question 16 (1 point)
You are completing a polypectomy of a 2 cm Paris IIa (flat) polyp in the cecum of a 65 year old male. After the polypectomy you notice a perforation in the cecum. You aim to close the defect with endoclips, start antibiotics, and arrange imaging and possible surgery. Which of the following would not be appropriate? Mark only one oval.
A. Start the plan above for the management of the patient's complication, as soon as possible.
B. Inform family members of the procedure's complications before proceeding with the above plan.
C. Ensure airway, breathing and circulation are intact above all else. D. Call for extra assistance into the room as soon as possible.
E. Stay calm as you manage the situation.

Question 17 (1 point)
You perform a screening colonoscopy on an anemic 50 year old male who complains of weight loss, altered bowel habits and blood in his stool. You identify the patient is suffering from colorectal cancer. Which one of the following would not be appropriate in explaining the results of the colonoscopy to the patient? Mark only one oval.

TEAMSTEPPS TEAMWORK ATTITUDES QUESTIONNAIRE
With respect to how each question applies to interactions with a team in ENDOSCOPY, please respond to the questions below by placing a checkmark in the box that corresponds to your level of agreement from Strongly Disagree to Strongly Agree. We realize that the questions may be a little vague but please select only one response for each question. Thanks for your participation.